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Clin Med I - ENT > Disorders of the Nose > Flashcards

Disorders of the Nose Flashcards

1
Q

Definition of allergic rhinitis

A
  • inflammation of the mucous membranes of the nose, eyes, eustachian tubes, middle ear, sinuses and pharynx
  • triggered by IgE mediated response
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2
Q

Complications of allergic rhinitis

A
  • Otitis media
  • ETD
  • Sinusitis (acute and chronic)
  • impairment in quality of life
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3
Q

What is early response

A

With allergen re-exposure, the specific protein binds to the IgE on the mast cells resulting in an immediate and delayed release of inflammatory mediators (histamines) which lead to symptoms of AR

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4
Q

What is late response

A

4-10 hours after allergen exposure, you have a second release of inflammatory mediators (eosinophils), continued inflammation with persistent symptoms

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5
Q

Symptoms of allergic rhinitis

A
  • rhinorrhea
  • sneezing
  • itching
  • post nasal drip/sore throat
  • nasal congestion/obstruction
  • increased lacrimation/red eyes
  • eye swelling
  • fatigue/drowsiness
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6
Q

What is allergic salute?

A

transverse crease across the nasal bridge d/t upward rubbing of the nose

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7
Q

PE of nose in AR

A

Allergic salute
Nasal mucosa is pale and boggy
thin, watery nasal secretions

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8
Q

What are allergic shiners

A

dark, swollen, infraorbital tissue secondary to vasodilation and/pr congestion

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9
Q

PE of eyes in AR

A

conjunctiva injected and edematous with clear drainage

allergic shiners

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10
Q

PE of ears in AR

A

TM retraction, air fluid levels or bubbles

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11
Q

PE of throat in AR

A

Pharynx is generally unremarkable

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12
Q

DDX of allergic rhinitis

A

Nonallergic rhinitis syndromes

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13
Q

What are some diagnostic tests for allergic rhinitis

A
  • Blood (supportive but not sensitive or specific)
    i. e. Eosinophils in CBC, IgE elevation
  • Nasal smears (eosinophils)
  • Skin testing (immediate hypersensitivity)
  • RAST (radioallergosorbent test)
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14
Q

Allergic rhinitis treatment

A
  • Avoidance of allergens/prevention
  • pharmacologic treatment
  • immunotherapy
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15
Q

Examples of pharmacotherapy treatment for AR

A
  • Intranasal steroids
  • antihistamines
  • leukotriene antagonist
  • mast cell stabilizer- Cromolyn
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16
Q

What are nasal polyps

A

-Pale, edematous, mucosally covered masses

Benign

17
Q

Etiology of nasal polyps

A

Unknown but thought to be from chronic inflammation

18
Q

What is acute sinusitis

A
  • sinusitis of
19
Q

Diagnostic criteria for acute sinusitis

A

Moderate symptoms for > 10 days

20
Q

Cause of sinusitis

A

S. pneumonia

21
Q

Viral sinusitis

A

more common than bacterial (rhinovirus, parainfluenza virus, influenza virus)

22
Q

Bacterial sinusitis

A

Complicates only .2-2% of viral infections

  • S. pneumonia and H. Influenza make up 50-60%
  • Moraxella catarrhalis more common in children
23
Q

Pathophysiology of acute sinusitis

A
  • initiated by viral upper respiratory infection
  • mucosal edema, decreased mucus transport and obstruction of ostiomeatal complex which leads to secretions not moving
  • stagnant secretions and limited function of the nose promotes bacterial or viral overgrowth
24
Q

Acute sinusitis complications

A
  • orbital cellulitis
  • osteomyelitis of facial bones
  • subcutaneous abscesses
  • CNS complications
  • Potts puffy tumor
25
Q

What is Potts puffy tumor?

A

Rare, life threatening

extension of frontal sinus infection resulting in frontal bone osteomyelitis and subperiosteal abscess

26
Q

Signs/symptoms of acute sinusitis

A
  • Purulent nasal discharge
  • facial pain/pressure/fullness
  • nasal obstruction
  • fever
  • halitosis (bad breath)
  • dental pain
27
Q

HPI acute sinusitis

A
  • What are their symptoms and duration of symptoms
  • symptomatic OTC treatment
  • Ask about risk factors
  • others at home or work sick
  • prior nasal/sinus history
  • trauma
28
Q

Physical examination finding of acute sinusitis

A
  • Fever
  • purulent nasal discharge/post nasal drip
  • nasal obstruction
  • palpable sinus tenderness (over sinuses/upper teeth)
  • swelling, erythema or edema over cheekbone or periorbital area
  • transilluminate sinuses
  • signs of extra sinus involvement
29
Q

Distinguishing acute bacterial from viral sinusitis

A
  • signs/symptoms lasting greater than 10 days without evidence of clinical improvement
  • worsening after initial improvement
  • severe symptoms with fever over 102 and purulent nasal discharge over 3-4 consecutive days
30
Q

Diagnostic testing for acute sinusitis

A
  • typically no imaging/further diagnostic test indicated

- sinus aspiration and culture is GOLD STANDARD for acute bacterial sinusitis

31
Q

Symptomatic treatment of acute sinusitis

A
  • analgesics and antipyretics
  • fluids
  • intranasal corticosteroids
  • decongestants
  • mucolytics
  • intranasal saline irrigation (netipot)
32
Q

What is the drug therapy for acute sinusitis?

A

Amoxicillin

-if allergic then bactrim

Clin Med I - ENT (13 decks)

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