Disorders Of Nose + Paranasal Sinuses

Question 1

Acute sinusitis :

Diseases

Answer 1

• Acute viral/BACTERIAL rhinosinusitis
• Nasal Vestibulitis / S. Aureus nasal colonization
• Invasive fungal sinusitis

Question 2

Acute Bacterial Rhinosinusitis:

Path

Answer 2

• Ostemeatal complex obstruction (sinus pore)

* Impaired mucocilliary clearance

Question 3

Acute Bacterial Rhinosinusitis:

Top 4 bugs

Answer 3

S. PNEUMONIA
H. INFLUENZA
M. Catarrhalis
S. Aureus

also anaerobe, strep, fungus

Question 4

Acute Bacterial Rhinosinusitis:

Etiology

Answer 4

Specific to community

Question 5

Acute Bacterial Rhinosinusitis:

Presentation

Answer 5

Purulent discharge
Facial pain/pressure
Nasal obstruction
Acute s/s onset
Min 10 days

W/ cough, malaise, fever, headache

Question 6

Dx Sinusitis:

Answer 6

2 major S/S
Or
1 major 2 minor S/S

Question 7

Acute Bacterial Rhinosinusitis:

Tx

Answer 7

NSAID
Oral/nasal decongestants
    (Pseudoeph/ oxymetazoline)
Intranasal corticosteroids 5 days
Systemic oral ABX (amoxi, TM-SLF)

Question 8

Sinusitis

Acute vs. Chronic

Answer 8

Acute - <4 weeks

Chronic - >12 weeks

Question 9

Chronic sinusitis

DX

Answer 9

>12 weeks
Objective (PE) evidence - mucosal inflammation
\+ 
2/4 signs:
*Nasal mucupurulent drainage
*Nasal obstruction/cong
*Facial pain/pressure
*Smell loss (kids - cough)

Question 10

Chronic Sinusitis :

Etiology

Answer 10

Children + adults

Question 11

Chronic sinusitis:

Tx

Answer 11

No cure

• Intranasal saline
• Topical/systemic steroid
• ABX (topical/syst) - Amoxi-clav or clinda (allergy)
• Antileukotriene (Montelukast)
• Surgery - AFRS
• refer - refractory

Question 12

Allergic rhinitis:

Etiology

Answer 12

1/6 - 1/2 americans

Question 13

Allergic Rhinitis :

Path

Answer 13

Exposure airborne allergen
Immune response
Cells - proinflammatory mediators

Question 14

Allergic rhinitis

Cause - early spring

Answer 14

Tree pollens

Question 15

Allergic rhinitis :

Spring/summer

Answer 15

Grass pollens

Question 16

Late summer

Answer 16

Weed pollens

Question 17

Allergic rhinitis

Cause - Throughout year

Answer 17

Fungi

Household allergens

Question 18

Allergic rhinitis :

Cause - occupational

Answer 18

Seed dusts, woods, furs, latex, flour, psyllium …

Question 19

allergic rhinitis:

Present

Answer 19

Clear rhinorrhea
Sneezing
Tearing, eye inflame
Pruritis
Ass S/S : cough, bronchospasm, eczematous dermatitis
PE: PALE TURBINATES

Question 20

Allergic Rhinitis:

Tx

Answer 20

AVOID ALLERGEN
Intranasal steroid
Antihistimine
Antileukotrenes
Ipatroprium
Immunotherapy

Question 21

Epistaxis:

Etiology

Answer 21

Before age 10

From age 45-65

Question 22

Epistaxis:

Path

Answer 22

Trauma
Dryness
FB
Rhinitis
Intranasal steroid
Bleeding disorder

Question 23

Epistaxis :

Hx - remember

Answer 23

Attempts at control
Prior episodes
Trauma/surgery
Meds/ herbs
Bleeding problems

Question 24

Epistaxis:

Dx

Answer 24

IF uncertain about etiology or prolonged:
CBC
Crossmatch/type

Question 25

Epistaxis:

Tx - initial tamponade

Answer 25

Lean forward
Blow nose
Spray decongestant
Pinch 15 mins

Question 26

Epistaxis:

Tx - further treatment

Answer 26

Topical 4% cocaine
Gelatin/collagen sponge
Cautery
Fibrin glue
Nasal packing

Question 27

Epistaxis:

Nasal tampon

Answer 27

ENT w/in 24-48 hrs

ABX

Question 28

Nose FB :

etiology

Answer 28

Children 2-4 y/o

Noticed by caregiver

Question 29

FB Nose:

Presentation

Answer 29

Unilateral nasal discharge
Halitosis
Epistaxis
Septal perf
Ingestion/Aspiration of FB

Question 30

FB Nose:

FB location

Answer 30

Nasal floor/inferior turb

Anterior superior middle turb

Question 31

FB Nose:

Tx

Answer 31

5 mins before, topical anesthetic/vasoconstrictor
Positive pressure
Balloon
Forceps 
Suction

Question 32

Nasal polyps :

Etiology

Answer 32

Allergic rhinitis patient

Question 33

Nasal Polyps:

Tx

Answer 33

Intranasal corticosteroid 1-3 months
Oral corticosteroids 6 day
Surgery

Question 34

Nasal trauma, PE see septum perf….

Answer 34

EMERGENCY