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PANCE 2.0 > EENT #7 (Nose/Sinus) > Flashcards

EENT #7 (Nose/Sinus) Flashcards

1
Q

With rhino sinusitis, what is considered acute, what is considered subacute, and what is considered chronic.

A

Acute: 1-4 weeks
Subacute: 4-12 weeks
Chronic: > 12 weeks

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2
Q

Although most cases of acute rhino sinusitis are viral in nature (rhinovirus, influenza, and parainfluenza), what are some bacterial causes of this condition?

A

A….SMH

Strep Pneumo (MC)
Moraxella Catarrhalis
H. Influenzae
GABHS

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3
Q

Risk factors for acute rhinosinusitis

A
  • Most common in setting of a viral URI
  • Dental infections
  • Smoking
  • Allergies
  • Cystic Fibrosis
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4
Q

Symptoms of acute rhinosinusitis

A
  • Facial pain or pressure worse with bending down and leaning forward
  • Headache
  • Malaise
  • Purulent nasal discharge
  • Fever
  • Nasal congestion
  • Worsening symptoms after a period of improvement
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5
Q

Although imaging is not necessary if it is a classic presentation and uncomplicated case of acute rhinosinusitis, what imaging CAN be done and is the diagnostic of choice.

A

CT scan: imaging of choice

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6
Q

Sinus radiographs are usually not needed, but if ordered, what view is the best for acute rhinosinusitis?

A

Water’s view

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7
Q

However, what diagnostic gives a definitive diagnosis for acute rhinosinusitis?

A

Biopsy or aspirate

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8
Q

Management for acute rhinosinusitis

A

-Symptomatic management: decongestants (promote sinus drainage), analgesics, antihistamines, intranasal glucocorticoids, naval lavage

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9
Q

When are antibiotics indicated in a patient with acute rhinosinusitis?

A

If symptoms present for 10-14 days and worsening

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10
Q

What ABX is considered in a patient with acute rhinosinusitis if needed?

A

Amoxicillin-Clavulanic Acid

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11
Q

However, second line ABX for acute rhinosinusitis is

A

Doxycycline

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12
Q

What is chronic sinusitis defined as?

A

Inflammation of the nasal cavity and paranasal sinuses for at least 12 consecutive weeks

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13
Q

MC bacterial cause of chronic sinusitis

A

S. Aureus

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14
Q

What is the MC fungal cause of chronic sinusitis

A

Aspergillus

-Mucormycosis is the 2nd MCC

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15
Q

What diagnostic should be done for chronic sinusitis?

A

Biopsy or histology (allows for identification of organism and then determining the management)

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16
Q

What is important to remember about Mucormycosis (Zygomycosis)?

A

-Fungus rapidly dissects the nasal canals and eye into the brain. High mortality.

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17
Q

What are some common etiologies of mucormycosis?

A
  • Mucor
  • Rhizopus
  • Absidia
  • Cunninghamella
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18
Q

What is the biggest risk factor with mucormycosis?

A

Seen in diabetes mellitus (especially DKA) and immunocompromised states (post-transplant, chemotherapy, HIV)

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19
Q

Symptoms of mucormycosis

A

Rhino-orbital-cerebral infections: sinusitis that progresses to orbit and brain involvement
-Swelling, necrosis, black eschar on the palate, nasal mucosa, or face

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20
Q

What is the diagnostic of choice for mucormycosis and what do you see?

A

Biopsy: non-septate broad hyphae with irregular right-angle (90 degree) branching

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21
Q

Management for mucormycosis

A
  • IV Amphotericin B + surgical debridement of necrotic areas

- Other options: Posaconazole or Isavuconazole

22
Q

MCC of nasal polyps

A

Allergic rhinitis

23
Q

Nasal polyps may also be seen with what condition?

A

Cystic Fibrosis

24
Q

Symptoms of a nasal polyp

A

-Obstruction or anosmia (decreased smell)

25
Q

What is seen on direct visualization of a nasal polyp?

A

-Pale boggy mass on nasal mucosa

26
Q

What is the initial treatment of choice for a nasal polyp?

A
  • Intranasal glucocorticoids

- Surgical removal may be needed if large and medical therapy unsuccessful

27
Q

What is the MC type of rhinitis?

A

Allergic

28
Q

Allergic rhinitis is ______

A

IgE mediated mast cell histamine release due to allergens (mold, pollen, dust, etc.)

29
Q

What is seen on physical exam of a patient with allergic rhinitis?

A
  • Pale or violaceous boggy turbinates, nasal polyps with cobblestone mucosa of the conjunctiva
  • Allergic shiner: purple discoloration around the eyes or nasal bridge from constant rubbing
30
Q

Other symptoms of rhinitis

A
  • Sneezing
  • Nasal congestion
  • Clear, watery rhinorrhea
  • Bluish discoloration around eyes in allergic
31
Q

What is the MCC of infectious rhinitis?

A

-Rhinovirus

32
Q

What is seen on physical exam of a patient with infectious (rhinovirus) rhinitis?

A

-Erythematous turbinates

33
Q

What is the treatment if the rhinitis is allergic?

A
  • Intranasal corticosteroids (Flonase, Nasacort)
  • Avoid environmental exposure
  • Antihistamines, mast cell stabilizers, short term decongestants
34
Q

What is the MOST EFFECTIVE medication for allergic rhinitis?

A

Intranasal glucocorticoids (Mometasone, Fluticasone)

35
Q

Intranasal decongestants, if used > 3-5 days, may cause ______

A

rhinitis medicamentosa (rebound congestion)

36
Q

What are some examples of intranasal decongestants?

A
  • Oxymetazoline
  • Phenylephrine
  • Naphazoline
37
Q

A nasal foreign body classically presents as

A

epistaxis associated with a mucopurulent discharge, foul odor, and nasal obstruction (mouth breathing)

38
Q

What is the management of a nasal foreign body (2 techniques).

A

Removal via positive pressure or instrument

  • Positive pressure: patient blow his nose while occluding the good nostril
  • Oral positive pressure: parent blows into mouth of patient while occluding good nostril
39
Q

MC site of anterior epistaxis

A

Kesselbach Venous plexus

40
Q

Anterior epistaxis is MC associated with _________ such as (give a bunch of examples)

A

Nasal trauma

-Nose picking, blowing nose forcefully, low humidity, hot environments, rhinitis, alcohol, cocaine use, anti platelet meds, foreign body

41
Q

The MC site of a posterior epistaxis

A

Sphenopalatine artery branches and Woodruff’s plexus

42
Q

Risk factors for posterior epistaxis

A

Hypertension, older patients, nasal neoplasms

43
Q

How do you manage a posterior epistaxis?

A
  • Balloon catheters are the MC initial management
  • Foley catheter
  • Cotton packing
44
Q

How do you manage an anterior epistaxis?

A
  • Direct pressure (first line therapy): 5-15 minutes, leaning forward
  • Adjunct medications: topical vasoconstrictors (Oxymetazoline, lidocaine with epinephrine)
  • Cauterization: electrocautery or silver nitrate if above measures not working
  • Nasal packing: if above doesn’t work or severe bleeding
45
Q

What are some post-treatment care guidelines you should recommend for the patient if they have epistaxis?

A
  • Avoid exercise for a few days
  • Avoid spicy foods
  • Bacitracin
  • Petroleum gauze
  • Humidifiers
46
Q

MCC of pharyngitis/tonsillitis

A

Viral: Adenovirus, Rhinovirus, Enterovirus, EBV, Influenza A and B, HZV

47
Q

However, the MC bacterial cause of pharyngitis is

A

Group A Strep (S. Pyogenes)

48
Q

Symptoms of pharyngitis

A
  • Sore throat
  • Pain with swallowing
  • Cough, hoarseness, coryza, conjunctivitis, and diarrhea (Viral cause)
49
Q

Although pharyngitis is usually a clinical diagnosis, what can be done to rule out bacterial cause if suspected?

A

Rapid strep or throat culture

50
Q

Treatment for pharyngitis

A

-Symptomatic is mainstay: fluids, warm saline gargles, topical anesthetics, lozenges, NSAIDs

PANCE 2.0 (62 decks)

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