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Head And Neck > Final - Nose And Sinus > Flashcards

Final - Nose And Sinus Flashcards

1
Q

The nasal vestibule is lines with _____ and everything past it is lined with _____

A
  • skin with hair

- mucosa

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2
Q

Nasal mucosa functions

A

Warm, humidify, filter inhaled air

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3
Q

Bony structures surrounded by soft tissue in the nose

A

3 turbinates = inferior, middle, superior

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4
Q

Nasal spaces

A

3 meatuses: inferior, middle, superior

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5
Q

A procedure based on rapid dilation of the nasal meatuses

A

Nasal specific treatment

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6
Q

What should you avoid in a nasal examination

A

The nasal septum - VERY sensitive

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7
Q

on a normal ear inspection you would fin….

Normal nasal color = ____
Normal swelling = _____
Normal discharge = ______
Normal septum = _____

A
  • pinkish
  • none (open passageway)
  • minimal or clear
  • no deviation
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8
Q

Deviated nasal septum is due to ______

May cause____

A

Congenital or trauma

one-sided nasal congestion

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9
Q

Epistaxis

A

Nasal bleeding

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10
Q

T/F epistaxis in the posterior nasal structures are likely to bleed out the nose

A

F - likely to bleed into the throat

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11
Q

causes of epistaxis (most common and least common)

A

most common (benign) - Localized trauma (nose-picking), inflammation, dry mucosa

Less common - tumor, coagulation disorder

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12
Q

What is another name for nasal discharge

A

Exudate

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13
Q

Normal nasal discharge

A

Clear (serous), not too watery or too thick, not too much

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14
Q

Purulent to nasal discharge

A

Plus-like, thick, colored, cloudy (suggests infection)

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15
Q

Eythematous, swollen turbinates, increased serous or pure lent nasal discharge describes ____

A

Inflamed nasal cavity

Inflamed nasal mucosa = Rhinitis (aka coryza)

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16
Q

What is a rhinorrhea

A

Runny nose

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17
Q

Symptoms of a post-natal drip

A
  • Frequent throat-clearing, chronic cough
  • cobblestoning of the oropharynx

*mucus accumulates at & drips down he back of the throat

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18
Q

Symptoms of nasal congestion

A
  • fluid becomes thickened, decreased dripping

* turbinates become swollen further blocking drainage

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19
Q

Nasal symptoms

How many do you have to have to be considered rhinitis?

A

Rhinorrhea, post-nasal drip, congestion, sometimes sneezing, itchy nose

*1 or more nasal symptoms = rhinitis

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20
Q

Causes of rhinitis

A
  • allergies
    – non-allergic rhinitis (environmental irritants)
    – viral upper respiratory infection (URI)
    – bacterial infection
    – medications (aspirin, oral contraceptives)
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21
Q

What does an allergic rhinitis look like? (3 things, 1 possible)

A
  • Violet-bluish colored
  • pale, boggy
  • turbinate swelling
  • possibly violaceous, pale, or erythematous mucosa
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22
Q

Pale, saclike protrusions of hypertrophied mucosa

A

Nasal polyps

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23
Q

With nasal polyps, _____ swelling leads to loss of elastance of involved tissues. This is most often associated with _____

A

Chronic swelling

Chronic allergies but also chronic rhinosinusitis

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24
Q

Inflammation of both the nasal cavity and

paranasal sinuses

A

Rhinosinusitis

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25
Q

Allergic Rhinitis Clues (4 things)

A
  • Nasal Itchiness, clear runny nose and/or
    congestion, sneezing; sometimes cough too
  • Symptoms occur with exposure to specific environmental triggers
    (cats, dust, etc.) or seasonally with high pollen counts
  • Pale or violaceous nasal mucosa; swollen turbinates, increased clear nasal discharge, w/ or w/out nasal polyps

May also have allergic conjunctivitis: bilateral itchy, watery eyes

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26
Q

Allergic Rhinitis Treatment

A
  • Counsel patient to avoid exposure to identified
    allergens (maybe referral to allergist for testing)
  • Nasal saline irrigation
  • Intranasal corticosteroid sprays (1st line medical treatment for nasal symptoms)
  • Oral antihistamines
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27
Q

What is the 1st line medical treatment for nasal symptoms

A

Intranasal corticosteroid sprays

28
Q

Rinsing nasal passages with ______ has been shown to improve rhinitis sx. Recommend ___xday

A

Hypertonic saltine (3-5%)

3x daily

29
Q

Intranasal corticosteroid sprays can (3 things).

Available OTC options (3 things)

Dosing?

A
  • decrease nasal mucosa swelling
  • help shrink nasal polyps
  • lead to improved nasal airway drainage
  • budesonide (Rhinocort)
  • triamcinolone (Nasacort)
  • fluticasone propionate (Flonase)

1-2 sprays per nostril daily

30
Q

Nasal saline irrigation and intranasal corticosteroid sprays are most effective after what amount of time

A

2 or more weeks

31
Q

2nd & 3rd generation oral antihistamines (OTC): non-drowsy (4 medicines)

A
  • loratadine (Claritin)
  • cetirizine (Zyrtec)
  • levocetirizine (Xyzal)
  • fexofenadine (Allegra)
32
Q

First-generation oral antihistamine (OTC):

drowsiness common

A
  • diphenhydramine (Benadryl)
33
Q

With non-allergic rhinitis, the patient is (more/less) likely to report itching, sneaking or eye symptoms

A

Less

  • Generally considered idiopathic or a diagnosis of exclusion
  • not due to infection, allergies, medications, etc.
  • patients rarely identify specific triggers
  • often have year round symptoms
34
Q

Viral URI (upper respiratory infection) symptoms

A

Nasal symptoms PLUS

  • malaise
  • fatigue
  • +/- low grade fever
  • sore throat
  • cough
35
Q 
Viral URI (common cold)
 Symptoms revolve in \_\_\_\_\_, average duration is \_\_\_\_\_
A

2-10 days

1 week (self-limited)

36
Q

Conservative home care for viral URI (common cold) (2 things)

A
  • Adequate hydration and rest

- Zinc lozenges at onset to reduce duration

37
Q

Viral URI treatment to relief symptoms (4 things)

A
  • nasal saline irrigation
  • humidified air
  • mucolytics
  • decongestants
38
Q

2 mucolytics

A
  • Guaifenesin (Mucinex) OTC

- N-Acetyl Cysteine supplement

39
Q

Decongestants for viral URI

A

Oral
– refer to PCP for Rx pseudoephedrine (Sudafed)
– OTC phenylephrine

Intranasal decongestant sprays (Maybe, very short term)
– OTC oxymetazoline 0.05% (Afrin)
***LIMIT USE TO 2-3 DAYS MAX to avoid rhinitis medicamentosa (rebound nasal congestion)

40
Q

When suggesting an intranasal decongestant sprays, patients should limit use to ___ to avoid ____

A 
2-3 days
Rhinitis medicamentosa (rebound nasal congestion)
41
Q

Air filled cavities lined with ciliated mucosa are contiguous with nasal mucosa

A

Paranasal Sinuses

42
Q

Normal sinus drainage (steps 1-4)

A

Steps 1,2: Ciliary action in the sinus cavities moves secreted mucus towards and through the ostium

Steps 3,4: Mucus from ostiomeatal complex (confluence of maxillary, ethmoid, and frontal sinuses) normally drains into the middle meatus and out

43
Q

How do you Palpate Frontal and Maxillary Sinuses

A
  • Apply thumb pressure, pressing up, into the
    frontal and maxillary sinuses
  • Note if any pain response
  • If palpation is painful, sinuses may not be draining > suggests rhinosinusitis (RS)
44
Q

Additional exam techniques for frontal and maxillary sinuses

A
  • tap on upper molars

- sinus transillumination

45
Q

Edematous mucosa causes obstruction of _____ resulting in ______ pressure/pain

A

Mucous drainage

Sinus cavity

46
Q

Which sinus are most commonly affected

A

Maxillary and ethmoid

47
Q

How do you tap on upper molars?

A
  • Use tongue depressor to tap upper teeth and ask if any pain

93% specific for maxillary sinusitis if
pai

48
Q

Normal and abnormal Sinus Transillumination

A

normal: Red glow visible

Abnormal: absence of glow
– suggests thickened mucosa/increased secretions of
rhinosinusitis BUT not very sensitive or specific ~25% may have congenital absence of frontal sinuses

49
Q

What does PODS stand for

A

1) facial Pain-Pressure-fullness AND/OR
2) nasal congestion Obstruction AND/OR
3) nasal Drainage/Discharge AND/OR 4) reduced sense of Smell

50
Q

If you suspect infection, main goal = differentiate between these 2

A

Viral and bacterial

51
Q

Acute rhinosinusitis duration ____

Rhinitis only more common when ____

A

7-28 days

<7 days

52
Q

Overlap exists between viral and bacterial acute RS so why is it relevant to differentiate?

A

Different management plans

53
Q

How do you differentiate between viral and bacterial acute RS?

A

Based on symptom duration and severity

54
Q

Signs of acute VIRAL rhinosinusitis

A
  • mild to moderate symptoms for 4-10 days
  • may last up to 14 days with symptoms gradually improving during this time
  • self limited: do NOT refer to medical doctor for antibiotics
  • Often starts with URI sx: sneezing, general malaise, throat discomfort, cough, mild fever, etc. PLUS serous (watery) or mucousy rhinorrhea and/or nasal congestion AND
  • typical sinus symptoms: sinus pain/pressure and/or hyposmia for ~ 1 week
55
Q

Which is self-limited, viral or bacterial acute RS

A

Viral

56
Q

Acute Viral Rhinosinusitis Treatment: Conservative Care (4 things)

A
  • Adequate hydration
  • Nasal saline irrigation
  • Avoid cigarette smoke
  • Analgesics

Or watchful waiting

57
Q

Acute Viral Rhinosinusitis Treatment: manual therapies (5 things)

A
  • Manipulation
  • Sinus percussion
  • Lymphatic drainage
    AND/OR
  • Mucolytics
  • Intranasal inhaled corticosteroids
58
Q

Acute Bacterial Rhinosinusitis Caused by __________ drainage with
secondary bacterial infection

A

Obstructed sinus

59
Q

Main pathogens of acute bacterial RS?

A

Strep pneumoniae, H influenza, Staph aureus and Moraxella catarrhalis

(same bacteria that cause acute otitis media)

60
Q

Symptoms of acute bacterial RS?

A
  • Purulent nasal drainage accompanied by more

nasal obstruction, facial pain-pressure- fullness, and/or decreased smell lasting for

61
Q

Acute Bacterial Rhinosinusitis Symptoms suggestive of increased
severity:

A
  • accompanied by fever >/= 102 F
  • severe facial or tooth pain
  • purple to nasal discharge
62
Q

With acute bacterial RS, pain is often (unilateral/bilateral)

A

Unilateral

63
Q

Is Imaging needed for acute bacterial RS?

A

No imaging needed if uncomplicated
(symptoms confined to nose and sinuses)
– Not cost effective, not recommended

64
Q

Would you refer a person with cute bacterial RS to a PCP or urgent care?

A

Yes, for possible antibiotics

65
Q

Differential diagnoses for “sinusitis headache”

A

SCM trigger points & TMJ

66
Q

_____ acute RS is self limited and can be treated conservatively. BUT If

A

Viral

Bacterial infection AND REFER TO MEDICAL DOCTOR FOR POSSIBLE ORAL ANTIBIOTIC TREATMENT

Head And Neck (18 decks)

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