617 The nose

Question 1

Allergic Rhinitis

Answer 1

allergic inflammation from breathing dust, pollen, dander or insec venom

Question 2

Allergic rhinitis

Answer 2

itchy, runny nose, clear nasal drainage, nasal congestion, sneezing, itchy, watery eyes, HA, sore throat, no fever

Question 3

Allergic Rhinitis

Answer 3

PE: boggy nasal membranes, with clear discharge, greyish and watery. clear post nasal drip, NO cervical endopathy, Cobblestoning in the back of the throat
TX: avoid the irritant, saline nasal spray
(safe in preg) Antihistamines
1st generation-bendryl (sedating)
2nd generation -Chlorpheneramine (safe in preg) Intranasal corticosteroids are more effective but they take a few days to work, so start with antihistamine. May cause nose blleds, HTN, burning and stinging. Careful if over 60 yrs of age.

Question 4

For dander prevention

Answer 4

Keep dog out as much as possible. never let in the bedroom, wash pet bedding once per week, ventilate home

Question 5

Decongestants

Answer 5

Should not really use in pregnancy and only for three days anyway.

Question 6

epitaxis

Answer 6

bleeding that occurs from broken capillaries. Mostly in FRONT of the nasal septum in the Kiesselbach plexis;

Question 7

epitaxis

Answer 7

HX: allergies, medications, snoring, HA’s, fever, recent illness, foreign object, HTN, trauma

Question 8

epitaxis-trauma is biggest cause

Answer 8

Sit upright, tilt forward pinch nose for 15 minutes. Avoid vigorous exercise,
Packing the nose may be required and a C&S in case MRSA

Question 9

Sinusitis

Answer 9

Inflammation of paranasal sinuses. Virul, bacterial, fungal
HX: facial pain, HA, teeth pain, fever, cough, increased pressure above below or behind eyes, Hx of smoking, second hand smoke, environmental exposures

Question 10

Acute sinusitis 2-3 weeks
sub-acute 4-12 weeks
Chronic 13-20 weeks

Answer 10

fever and purulent discharge, persistant for >10 days
PE: eyes, nose, ears, mouth/throat, frontal, maxillary and ethmoidal sinuses, neck, CV, resp.
TX: Most resolve without treatment. use saline drops, decongestant, corticosteroid nasal spray.
Amoxicillin 500mg TID 10-14 days
or Bactrim-DS 1 tab BID/10 days
Analgesics, NSAIDS for pain