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General Medicine & Family Medicine > ENT_Nasal Cogestion > Flashcards

ENT_Nasal Cogestion Flashcards

1
Q

What is the most common cause of chronic rhinitis and nasal congestion?

A

Allergic rhinitis

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2
Q

What is the most common cause of acute rhinitis and nasal congestion (and also happens to be the leading cause of work and school absenteeism)?

A

The common cold

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3
Q

Causes of Rhinitis

A
  • Other upper respiratory infections (influenza, rhinosinusitis)
  • allergic rhinitis
  • idiopathic rhinitis (ie, vasomotor rhinitis, autonomic hyperresponsiveness)
  • atrophic rhinitis
  • rhinitis medicamentosum from drug withdrawal (eg, cocaine, OTC decongestant nasal sprays)
  • nasal foreign bodies
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4
Q

What is rhinosinusitis (aka “sinusitis”)?

A

Inflammation of one or more of the paranasal sinuses

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5
Q

How does rhinosinusitis develop?

A
  • Nasal passage edema (usually due to infection) causes obstruction of the sinus ostia
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6
Q

Common cold vs Influenza

A
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7
Q

Common cold vs Sinusitus

A
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8
Q

Sinusitis vs Allergic rhinitis

A
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9
Q

What kind of pathogen is the most common cause of the common cold and how is it most commonly transmitted?

A

Viruses (eg, rhinovirus, coronavirus) transmitted by hand-to-hand contact

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10
Q

How long do colds last?

A

A few days to a few weeks (this is important to tell patients)

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11
Q

What are the potential complications of a cold?

A
  • Sinusitis
  • otitis media
  • lower respiratory tract infection
  • exacerbation of asthma/chronic obstructive pulmonary disease (COPD)
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12
Q

What are some nonpharmacologic ways to help relieve cold symptoms?

A
  • Rest
  • high fluid intake
  • saline drops
  • humidifier
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13
Q

What over-the-counter medications can be used for symptomatic relief of cold symptoms?

A
  • Acetaminophen or ibuprofen for fever and headache
  • pseudoephedrine for congestion and rhinorrhea
  • dextromethorphan/guaifenesin for cough
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14
Q

Of the three genera of influenza viruses (A, B, and C) which is the most virulent and has been the cause of all pandemics, including the 1918 Spanish Flu Pandemic and the 2009 H1N1 Flu Pandemic?

A

Influenza A

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15
Q

What are the main prevention strategies for flu?

A
  • good hygiene( effective hand washing)
  • flu vaccination (IM/ nasal)
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16
Q

What are the pharmacologic treatments for the flu and within what timeframe from the onset of symptoms should they be administered?

A
  • Oseltamivir(oral)
  • Zanamivir (inhaled)
  • initiated within 48 hours of the onset of symptoms
  • treatments may be used in patients who have been ill > 48 hours, If they have severe disease requiring hospitalization.
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17
Q

What are the major complications of flu?

A
  • pneumonia (sometimes requiring supplemental oxygen or mechanical ventilation)
    • primary influenza pneumonia
    • S aureus pneumonia
  • cardio pulmonary insufficiency
  • Shock –> organ failure
  • myocarditis
  • rhabdomyolysis
  • neurologic impairment or disease (altered mental status)
  • encephalitis
  • exacerbation of chronic conditions.
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18
Q

Named for sinus cavities.

A
  • ethmoid
  • maxillary
  • frontal
  • sphenoid
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19
Q

Which sinus cavities is present at birth?

A
  • ethmoid
  • maxillary
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20
Q

which sinus cavity begins development at age2 yrs but only apparent by x-ray at 5 years?

A

Sphenoid

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21
Q

Which sinus cavity is the last to develop?

A
  • frontal (develops from age 4-20 years)
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22
Q

Why is the order of sinus development important?

A
  • In children most infections involve the ethmoid and maxillary sinuses
  • frontal and sphenoid infections usually begin to appear in adolescence.
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23
Q

Children with sinusitis, often complain of headache and facial pain.
True or False?

A
  • False. Remember the location of earlier developing sinuses
    • ethmoid and maxillary
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24
Q

during what season does the incidence of sinusitis peak?

A

Winter

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25
Q

Under what circumstances does fungal sinusitis develop?

A
  • immunocompromised patient
  • look for mucormycosis in diabetics.
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26
Q

What findings may help distinguish bacterial sinusitis from a viral one?

A
  • bacterial sinusitis is more likely to present with at least one of the following
    • fever unilateral sinus pain
    • maxillary tooth pain
    • Persistence of symptoms for greater than seven to 10 days.
    • Double sickening (a biphasic illness)
27
Q

What isthe “double sickening” phenomenon?

A
  • biphasic illness = patient begins to improve from an upper respiratory tract infection but then acquire secondary bacterial acute sinusitis.
28
Q

What is the duration of acute versus subacute versus chronic sinusitis?

A
  • acute sinusitis is usually greater than 3 days, but less than 4 weeks
  • subacute = 4 to 12 weeks
  • Chronic > 12 weeks.
29
Q

What are the usual bacterial causes of acute sinusitis versus chronic sinusitis?

A
  • Acute:
    • Streptococcus pneumoniae
    • Haemophilus Influenza
    • Moraxella catarrhalis
    • Staphylococcus aureus
  • Chronic
    • anaerobic bacteria.
30
Q

What kind of pathogens are the usual causes of sinusitis when you to result from spreading dental infection?

A
  • Microaerophilic or anaerobic bacteria.
31
Q

Most cases of sinusitis will spontaneously resolve without antibiotics within two weeks. True or False?

A

true.

32
Q

under what circumstances should you consider the use of antibiotics to treat sinusitis?

A
  • antibiotic use recommendation for sinusitis ever changing.
  • However, in general, patients who have sinusitis, that is likely bacterial and those without symptom improvement for more than 7 to 14 days may benefit from antibiotics (sometimes risk of drug side effects is greater than benefits )
33
Q

Under what circumstances should you consider intravenous IV antibiotics to treat sinusitis?

A
  • Patients who have very severe symptoms or signs of complications (eg facial erythema, orbital manifestations).
34
Q

What is the initial treatment of acute sinusitis?

A
  • non pharmacologic treatment
    • saline nasal sprays
    • humidifier
  • Nasal symptom relief (efficacy is controversial pain relief)
    • decongestant
    • nasal steroids
    • antihistamines
  • Pain relief- Eg paracetamol, Ibuprofen
35
Q

what antibiotics used to treat bacterial sinusitis?

A
  • high dose amoxicillin amoxicillin + Clavulanate.
  • Cephalosporins
  • Macrolides

(Follow local antibiotic guidelines)

36
Q

What systemic disease may predispose a patient to recurrent or persistent sinusitis?

A
  • cystic fibrosis
  • Kartagener syndrome.
  • Rare vasculitides e.g. Wegener’s Granulomatosis Churg-Strauss syndrome.
  • Immune Deficiency including diabetes,
37
Q

what circumstances dictate an ENT consultation (for possible surgery) for the pain treatment of sinusitis?

A
  • patients with more than three attacks in one year.
  • Chronic sinusitis
  • unresponsiveness to antibiotics
  • anatomic abnormalities amenable to surgery
38
Q

Are imaging studies, helpful in the initial evaluation of sinusitis?

A
  • No (except in certain or recurring cases)
39
Q

Under what circumstances is a CT scan indicated?

A
  • to establish a diagnosis of chronic sinusitis
  • workup a preoperative patient
  • obtain more information when medical management has failed.
40
Q

What are the potential complications of sinusitis?

A
  • Mucocele or mucopyoceles
  • Preseptal or orbital cellulitis
  • orbital or brain abscess
  • cavernous or sagittal sinus thrombosis
  • meningitis
  • encephalitis
  • subdural empyema
  • osteomyelitis.

Note, a patient to exhibit ocular or neuro signs or symptoms should be evaluated and treated promptly.

41
Q

In what sinus do mucoceles most frequently occur?

A

frontal sinus.

42
Q

How does the patient mucocele in the frontal sinus present?

A
  • displaced eye
  • diplopia.
43
Q

Orbital complications from sinusitis are most likely to happen when the infection is in what sinus cavity?

A

Ethmoid sinus

44
Q

What are the signs of cavernous sinus thrombosis?

A
  • Bilateral ophthalmoplegia
  • conjunctival swelling
  • retinal engorgement
  • fever
45
Q

What allergens typically cause seasonal allergies?

A
  • Pollens and mold spores
46
Q

What allergens typically cause perennial allergens?

A
  • Dust mites
  • mold spores
  • cockroach feces
  • pet dander
47
Q

What is the primary “treatment” of allergic rhinitis?

A

Avoidance of allergens

48
Q

Oral antihistamines usually help reduce what symptoms associated with allergic rhinitis?

A
  • Sneezing
  • rhinorrhea
49
Q

Are antihistamines effective in relieving nasal congestion?

A

No. Generally, decongestants are needed in addition to antihistamines in order to relieve congestion.

50
Q

What are some available second-generation antihistamines?

A
  • Loratadine
  • desloratadine
  • fexofenadine
  • cetirizine
51
Q

What are the main differences between first- and second-generation antihistamines?

A
  • Second-generation antihistamines are less likely to cause anticholinergic side effects (eg, drowsiness),
  • some come in an antihistamine-decongestant combination
  • they are not necessarily more effective, but are more expensive and sometimes require a prescription.
52
Q

What types of nasal sprays are available for the treatment of allergic rhinitis?

A
  • steroid nasal sprays (beclomethasone, flunisolide, fluticasone propionate, fluticasone furoate, mometasone, triamcinolone, budesonide)
  • antihistamine spray (azelastine)
  • mast cell stabilizer (cromolyn sodium)
  • anticholinergic agents (eg, ipratropium bromide)
53
Q

Which type of nasal spray relieves rhinorrhea but does not relieve nasal congestion or sneezing?

A

Anticholinergic spray

54
Q

Which of the steroid nasal sprays is effective in relieving allergic eye symptoms in addition to nasal symptoms?

A
  • Fluticasone furoate
55
Q

All nasal sprays are more effective when used consistently, not simply in response to symptoms when they arise; however, which type of nasal spray never works once allergy symptoms are already present and must always be used prior to allergen exposure?

A

Mast cell stabilizer

56
Q

Which nasal sprays are approved for children less than 6 years old?

A
  • Azelastine (5 years)
  • mometasone (2 years)
  • fluticasone furoate (2 years)
  • fluticasone propionate (4 years)
57
Q

What techniques should patients employ when administering nasal sprays?

A
  • First blow nose to remove mucus from nasal passages
  • shake bottle before removing the cap
  • sniff gently while spraying with tip of bottle pointing to outer part of nostril.
58
Q

Which patients should undergo allergen skin testing?

A
  • Patients with moderate to severe symptoms or perennial allergies
  • patients who have failed medical treatment
  • patients who need guidance for appropriate avoidance measures or immunotherapy
59
Q

Which medications should be withheld before allergen skin testing?

A
  • Methylxanthines
  • beta-blockers
  • antihistamines
60
Q

What does radioallergosorbent (RAST) testing measure?

A

Allergen-specific IgE levels

61
Q

What is immunotherapy (also known as desensitization)?

A

Patient receives weekly injections with gradually increasing doses of antigens and over time the IgE response diminishes.

62
Q

What class of antihypertensives should be avoided during immunotherapy?

A

Beta-blockers

63
Q

How long should immunotherapy be administered to avoid recurrence of symptoms?

A

3-5 years

64
Q
A

General Medicine & Family Medicine (150 decks)

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