ENT VI Flashcards

1
Q

Symptoms present with rhinitis

A
  • sneezing
  • rhinorrhea
  • nasal congestion
  • nasal itching
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2
Q

Most common forms of rhinitis

A
  • allergic rhinitis
  • nonallergic rhinitis
  • rhinitis due to structural nasal problems
  • rhinitis of pregnancy
  • occupation rhinitis
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3
Q

Classification of allergic rhinitis

A
  • intermittent
  • seasonal
  • persistent/perennial
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4
Q

What helps to distinguish allergic rhinitis from other forms of rhinitis

A

nasal itching

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5
Q

Physical exam in pts with allergic rhinitis

A
  • nasal mucosa edematous and pale
  • allergic shiners
  • nasal crease from rubbing nose
  • pale or bluish boggy mucosa
  • clear mucous
  • polyps
  • septal issues
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6
Q

Treatment for allergic rhinitis

A
  • environmental control and allergen avoidance
  • oral anhistamines
  • leukotriene receptor antagonist
  • mast cell stabilizers
  • immunotherapy
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7
Q

Leukotriene receptor antagonists are best for what kind of rhinitis

A

allergic

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8
Q

What does nasal mucosa look like in non allergic rhinitis

A

normal

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9
Q

What does nasal mucosa look like in acute rhinosinusitis or rhinitis medicamentosa

A

beefy red

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10
Q

How is nonallergic rhinitis distinguished from allergic rhinitis

A
  • onset at later age
  • absence of nasal and ocular itching
  • nasal congestion and postnasal drainage are prominent
  • symptoms are perennial
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11
Q

Types of nonallergic rhinitis

A
  • vasomotor rhinitis
  • mixed rhinitis (most common)
  • gustatory rhinitis
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12
Q

Classifications of rhinosinusitis

A
  • acute, less than 4 weeks (bacterial or viral)
  • subactue, 4 to 12 weeks
  • chronic, more than 12 weeks
  • recurrent, 4 or more episodes a year
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13
Q

Most common cause of acute rhinosinusitis

A

VIRAL INFECTION

  • rhinovirus
  • influenza
  • parainfluenza
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14
Q

Clinical presentation of acute rhinosinusitis

A
  • nasal congestion
  • purulent nasal discharge
  • fever/fatigue
  • cough
  • ear pressure
  • facial pain/pressure worse with bending forward
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15
Q

Exam finding with acute rhinosinusitis

A

rhinoscopy

  • diffuse mucosal edema
  • narrowing of middle meatus
  • inferior turbinate hypertrophy
  • polyps or septal deviation
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16
Q

When to do a CT scan with acute rhinosinusitis

A

complication or involvement of the orbital, intracranial or soft tissue

17
Q

How do you treat acute rhinosinusitis

A

resolves in 10 days to treat symptomatically

18
Q

Most common pathogens for acute bacterial rhinosinusitis

A

s. pneumoniae

h. influenzae

19
Q

Treatment for bacterial rhinosinusitis

A
if sx last longer than 10 days
-amoxicillin
AUGMENTIN
-doxy if PCN allergy
-levo if failed augmentin
20
Q

Most common causes of fungal rhinosinusitis

A
  • mucor
  • rhizopus
  • aspergillus
  • absidia
  • basidiobolus
21
Q

Pts at risk for fungal rhinosinusitis

A
  • immunocompromised
  • diabetic
  • heme malignancies
  • chemo induced neutropenia
  • organ transplant
22
Q

What differentiates bacterial rhinosinusitis from others

A
  • facial numbness if cranial nerves involved

- necrotic tissue in nares/oropharynx

23
Q

Treatment for fungal rhinosinusitis

A
  • surgical eval for biopsy and debridement
  • amphotericin B
  • voriconazol
24
Q

Risk factors for chronic rhinosinusitis

A
  • allergic rhinitis

- asthma

25
4 symptoms that must be present for diagnosis of chronic rhinosinusitis
- anterior/posterior mucopurulent drainage - nasal obstruction - facial pain, pressure, fullness - hyposmia
26
3 subtypes of rhinosinnusitis
- CRS with nasal polyposis - CRS without nasal polyposis - allergic fungal rhinosinusitis
27
Samter's triad
asthma, CRS with nasal polys, aspirin
28
Presentation of allergic fungal rhinosinusitis
- sx similar to CRS with NP - usually nasal polyps are present - semi solid nasal crusts or rubbery globs of dark colored mucus
29
What is the first choice in imagine for chronic rhinosinusitis
sinus CT scan - mucosal thickening - obstruction of ostimeatal complex - sinus opacification
30
Treatment of CRS with NP
- oral glucocorticoids to shrink polyps - nasal gluccorticoids to follow - add leukotriene inhibitor for maintenance therapy
31
Treatment of CRS without NP
- oral glucocorticoids - abx - nasal glucorticoids - 2nd gen antihistamine - leukotriene inhibitor
32
Treatment of allergic fungal rhinosinusitis
- surgery | - prolong course of oral glucocorticoids
33
Most common spot of anterior nosebleeds
Kiesselbach's plexus
34
Most common source of posterior nosebleeds
sphenopalatine artery
35
Common casue of posterior nosebleeds
- carotid artery aneurysm | - nasal neoplasm
36
Treatment for anterior nosebleed
- compression - short acting topical nasal decongestant - topical cocaine - cauterize bleeding site
37
Treatment for posterior nosebleed
- topical sympathimimetics | - double balloon packs
38
What do you have to do if using a rhino rocket
provide abx coverage
39
What two things need to be removed immediatly if lodged in the nose
button batteries and disc magnets