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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
Allergic Rhinitis Clues (4 things)
- 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
26
Allergic Rhinitis Treatment
- 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
27
What is the 1st line medical treatment for nasal symptoms
Intranasal corticosteroid sprays
28
Rinsing nasal passages with ______ has been shown to improve rhinitis sx. Recommend ___xday
Hypertonic saltine (3-5%) 3x daily
29
Intranasal corticosteroid sprays can (3 things). Available OTC options (3 things) Dosing?
- 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
Nasal saline irrigation and intranasal corticosteroid sprays are most effective after what amount of time
2 or more weeks
31
2nd & 3rd generation oral antihistamines (OTC): non-drowsy (4 medicines)
- loratadine (Claritin) - cetirizine (Zyrtec) - levocetirizine (Xyzal) - fexofenadine (Allegra)
32
First-generation oral antihistamine (OTC): | drowsiness common
- diphenhydramine (Benadryl)
33
With non-allergic rhinitis, the patient is (more/less) likely to report itching, sneaking or eye symptoms
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
Viral URI (upper respiratory infection) symptoms
Nasal symptoms PLUS - malaise - fatigue - +/- low grade fever - sore throat - cough
35
``` Viral URI (common cold) Symptoms revolve in _____, average duration is _____ ```
2-10 days 1 week (self-limited)
36
Conservative home care for viral URI (common cold) (2 things)
- Adequate hydration and rest | - Zinc lozenges at onset to reduce duration
37
Viral URI treatment to relief symptoms (4 things)
- nasal saline irrigation - humidified air - mucolytics - decongestants
38
2 mucolytics
- Guaifenesin (Mucinex) OTC | - N-Acetyl Cysteine supplement
39
Decongestants for viral URI
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
When suggesting an intranasal decongestant sprays, patients should limit use to ___ to avoid ____
``` 2-3 days Rhinitis medicamentosa (rebound nasal congestion) ```
41
Air filled cavities lined with ciliated mucosa are contiguous with nasal mucosa
Paranasal Sinuses
42
Normal sinus drainage (steps 1-4)
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
How do you Palpate Frontal and Maxillary Sinuses
- 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
Additional exam techniques for frontal and maxillary sinuses
- tap on upper molars | - sinus transillumination
45
Edematous mucosa causes obstruction of _____ resulting in ______ pressure/pain
Mucous drainage | Sinus cavity
46
Which sinus are most commonly affected
Maxillary and ethmoid
47
How do you tap on upper molars?
- Use tongue depressor to tap upper teeth and ask if any pain 93% specific for maxillary sinusitis if pai
48
Normal and abnormal Sinus Transillumination
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
What does PODS stand for
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
If you suspect infection, main goal = differentiate between these 2
Viral and bacterial
51
Acute rhinosinusitis duration ____ Rhinitis only more common when ____
7-28 days <7 days
52
Overlap exists between viral and bacterial acute RS so why is it relevant to differentiate?
Different management plans
53
How do you differentiate between viral and bacterial acute RS?
Based on symptom duration and severity
54
Signs of acute VIRAL rhinosinusitis
- 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
Which is self-limited, viral or bacterial acute RS
Viral
56
Acute Viral Rhinosinusitis Treatment: Conservative Care (4 things)
- Adequate hydration - Nasal saline irrigation - Avoid cigarette smoke - Analgesics Or watchful waiting
57
Acute Viral Rhinosinusitis Treatment: manual therapies (5 things)
- Manipulation - Sinus percussion - Lymphatic drainage AND/OR - Mucolytics - Intranasal inhaled corticosteroids
58
Acute Bacterial Rhinosinusitis Caused by __________ drainage with secondary bacterial infection
Obstructed sinus
59
Main pathogens of acute bacterial RS?
Strep pneumoniae, H influenza, Staph aureus and Moraxella catarrhalis (same bacteria that cause acute otitis media)
60
Symptoms of acute bacterial RS?
- Purulent nasal drainage accompanied by more | nasal obstruction, facial pain-pressure- fullness, and/or decreased smell lasting for
61
Acute Bacterial Rhinosinusitis Symptoms suggestive of increased severity:
- accompanied by fever >/= 102 F - severe facial or tooth pain - purple to nasal discharge
62
With acute bacterial RS, pain is often (unilateral/bilateral)
Unilateral
63
Is Imaging needed for acute bacterial RS?
No imaging needed if uncomplicated (symptoms confined to nose and sinuses) – Not cost effective, not recommended
64
Would you refer a person with cute bacterial RS to a PCP or urgent care?
Yes, for possible antibiotics
65
Differential diagnoses for “sinusitis headache”
SCM trigger points & TMJ
66
_____ acute RS is self limited and can be treated conservatively. BUT If
Viral | Bacterial infection AND REFER TO MEDICAL DOCTOR FOR POSSIBLE ORAL ANTIBIOTIC TREATMENT

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