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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
What is seen on direct visualization of a nasal polyp?
-Pale boggy mass on nasal mucosa
26
What is the initial treatment of choice for a nasal polyp?
- Intranasal glucocorticoids | - Surgical removal may be needed if large and medical therapy unsuccessful
27
What is the MC type of rhinitis?
Allergic
28
Allergic rhinitis is ______
IgE mediated mast cell histamine release due to allergens (mold, pollen, dust, etc.)
29
What is seen on physical exam of a patient with allergic rhinitis?
- 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
Other symptoms of rhinitis
- Sneezing - Nasal congestion - Clear, watery rhinorrhea - Bluish discoloration around eyes in allergic
31
What is the MCC of infectious rhinitis?
-Rhinovirus
32
What is seen on physical exam of a patient with infectious (rhinovirus) rhinitis?
-Erythematous turbinates
33
What is the treatment if the rhinitis is allergic?
- Intranasal corticosteroids (Flonase, Nasacort) - Avoid environmental exposure - Antihistamines, mast cell stabilizers, short term decongestants
34
What is the MOST EFFECTIVE medication for allergic rhinitis?
Intranasal glucocorticoids (Mometasone, Fluticasone)
35
Intranasal decongestants, if used > 3-5 days, may cause ______
rhinitis medicamentosa (rebound congestion)
36
What are some examples of intranasal decongestants?
- Oxymetazoline - Phenylephrine - Naphazoline
37
A nasal foreign body classically presents as
epistaxis associated with a mucopurulent discharge, foul odor, and nasal obstruction (mouth breathing)
38
What is the management of a nasal foreign body (2 techniques).
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
MC site of anterior epistaxis
Kesselbach Venous plexus
40
Anterior epistaxis is MC associated with _________ such as (give a bunch of examples)
Nasal trauma -Nose picking, blowing nose forcefully, low humidity, hot environments, rhinitis, alcohol, cocaine use, anti platelet meds, foreign body
41
The MC site of a posterior epistaxis
Sphenopalatine artery branches and Woodruff's plexus
42
Risk factors for posterior epistaxis
Hypertension, older patients, nasal neoplasms
43
How do you manage a posterior epistaxis?
- Balloon catheters are the MC initial management - Foley catheter - Cotton packing
44
How do you manage an anterior epistaxis?
- 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
What are some post-treatment care guidelines you should recommend for the patient if they have epistaxis?
- Avoid exercise for a few days - Avoid spicy foods - Bacitracin - Petroleum gauze - Humidifiers
46
MCC of pharyngitis/tonsillitis
Viral: Adenovirus, Rhinovirus, Enterovirus, EBV, Influenza A and B, HZV
47
However, the MC bacterial cause of pharyngitis is
Group A Strep (S. Pyogenes)
48
Symptoms of pharyngitis
- Sore throat - Pain with swallowing - Cough, hoarseness, coryza, conjunctivitis, and diarrhea (Viral cause)
49
Although pharyngitis is usually a clinical diagnosis, what can be done to rule out bacterial cause if suspected?
Rapid strep or throat culture
50
Treatment for pharyngitis
-Symptomatic is mainstay: fluids, warm saline gargles, topical anesthetics, lozenges, NSAIDs

PANCE 2.0 (62 decks)

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