Conditions of the Nose and Pananasal sinuses

Question 1

how long do viral particles remain viable on skin

Answer 1

up to 2 hours

Question 2

how are URI viruses tranmitted

Answer 2

hand contact
droplet (sneezing or coughing)
close contact with infected person

Question 3

what are the common URI virus families

Answer 3

Rhinovirus
coronavirus
adenovirus
parainfluenza
enteroviruses
respiratory synctytial virus(also influenza)

Question 4

what is the incubation period for URI

Answer 4

24-48 hours - can be up to 8 days after exposure

Question 5

how are URI’s treated

Answer 5

self limited - usually lasts 5-10 days - can be up to 14 days
symptomatic with OTC medications: analgesics, decongestants, antitussives,etc

Question 6

what is rhinitis

Answer 6

inflammation of the nasal mucosa

Question 7

what are the common forms of rhinitis

Answer 7

allergic
vasomotor
rhinitis medicamentosa

Question 8

What are the treatments for allergic rhinitis

Answer 8

antihistamines
corticosteroids (intranasal)
intranasal anticholinergic
cromolyn
antileukotriene
immunotherapy

Question 9

What is vasomotor rhinitis

Answer 9

increased secretion from nasal mucosa precipitated by temp or humidity, odors, light, alcohol or neurovascular imbalance
in elderly, increased sensitivity of the vidian nerve, common cause of clear rhinorrhea
tx: avoid irritant

Question 10

What is rhinitis medicamentosa

Answer 10

rebound congestion from overuse of nasal decongestant
tx: discontinue nasal decongestant (afrin)

Question 11

What is acute sinusitis/rhinosinusitis (ARS)

Answer 11

inflammation in nasal cavity and para-nasal sinuses
most commonly - viral infection

Question 12

what are risk factors for ARS

Answer 12

older age
recent URI
chronic rhinitis
cigarette smoking
allergies

Question 13

what is the treatment for acute bacterial sinutisits

Answer 13

amoxicillin-clavulanate 875mg/125mg for 10-14 days

Question 14

what are the most common bacterial pathogens for actue bacterial sinusitis

Answer 14

S. pneumoniae, H. influenzae, M. catarrhalis, S. pyogenes, s. aureus

Question 15

what is chronic sinusitis

Answer 15

single infection lasting > 12 weeks
what are the symptoms of chronic sinusistis

Question 16

what are the symptoms of chronic sinusitis

Answer 16

persistent rhinorrhea, productive cough, foul breath, low grade fever, malaise, headache, facial or dental pain

Question 17

what are the most likely chronic sinusitis bacteria

Answer 17

S. aureus, s. pneumo, and anaerobes, fungus; mixed is most likely

Question 18

what is complicated acute bacterial sinutisis

Answer 18

URGENT referral to otolaryngologist for evaluation and diagnosis
high persistent fever > 102F
periorbital edema, inflammation or erythema
CN palsies
abdominal extra-ocular movements
severe headache, AMS or meningeal sings

Question 19

What are the different types of nasal obstructions

Answer 19

mucosal disorders
structural disorders

Question 20

what are the causes of mucosal nasal obstructions

Answer 20

inflammatory
infectious
medications

Question 21

What is turbinate hypertrophy

Answer 21

inflammation of turbinates resulting in increased congestion and drainage
URI, allergic rhinitis, vasomotor rhinitis, drugs

Question 22

what is the treatment of turbinate hypertrophy

Answer 22

treat underlying etiology - surgery is last resort

Question 23

what can cause deviated septums

Answer 23

trauma
CT diseases
drugs - cocaine
post-surgical changes

Question 24

how do we treat deviated septum

Answer 24

nasal endoscopy
surgery
implants

Question 25

what is adenoid hypertrophy

Answer 25

chronic inflammation, allegies, chronic sinus symptoms
most common cause of nasal obstruction in a child

Question 26

what is adenoid facies

Answer 26

open mouth
flattening and elongation of the midface
retraction of upper lip
narrowing of hard palate resulting in crowding of maxillary teeth

Question 27

what is the most common tumor of the nasal cavity

Answer 27

nasal polyps

Question 28

what are the treatments of nasal polyps

Answer 28

steroids (oral, topical or intra-polyp injections), avoid ASA, surgical excision or larger polyps, test or treat for allergies

Question 29

where are FB often found within the nose

Answer 29

floor of nasal passage just under inferior turbinate
or
superiorly in nasal cavity just in front of middle turbinate

Question 30

what are treatment options for nasal FB

Answer 30

fogarty catheter
katz extractor
forcepts (if you can visualize the object)
irrigation?

Question 31

what is epistaxis

Answer 31

bloody nose
most common causes: nose picking, dryness, allergic or viral rhinitis, FB, chronic intranasal drug use, blunt trama

Question 32

what are the most common types of nasal bleeds

Answer 32

anterior bleed at Kiesselbachs plexus

Question 33

what is the treatment of anterior nose bleeds

Answer 33

clear clots
topical medications (oxymetazoline drops, boyette’s solution)
can add topical tranexamic acid (TXA)
direct pressure ~15 minutes
cauterize, nasal packing as needed

Question 34

Wha tis the treatment of posterior nose bleeds

Answer 34

balloon catheters: tamponade posterior bleeding
-foley catheter, brighton balloons, simpsons balloons
arterial ligation
angiographic embolization

Question 35

What is trigeminal neuralgia

Answer 35

rare condition W>M
paroxysmal attacks of usually intense, sharp, superficial or stabbing pain in distribution of one or more branches of fifth cranial (trigeminal) nerve
usually lasts from one to several second but may occur repetitively