HEENT nose Flashcards
Rhinitis consist of one or more of the following:
congestion
rhinorrhea
sneezing
pruritus
rhinitis differential Dx consist of
infectious
vasomotor
obstructive
drug induced
hormonal
allergic
history for viral URI (common cold)
nasal congestion, rhinorrhea, malaise, sore throat, +- fever, 5-7 day
PE for viral URI (common cold)
nasal mucosal edema, clear rhinorrhea, pharugneal injection/ cobblestoning
T/F: you give zpaks and antibiotics for viral URI
Flase
how do you treat symptoms for common cold (viral URI) if you can not give antibiotics or zpaks?
decongestants
nasal saline
antihistamine
tylenol for fever
nonsterodial anti-inflammatory drugs (ibuprofen)
intranasal corticosteriod
wheezing + = beta agonists (albuterol)
drug induced rhinitis is called …
rhinitis medicamentosa
what causes rhinitis medicamentosa
intranasal decongestants (afrin: oxymetazoline)/ cocaine
NSAIDS/ Aspirin
ACE1
phosphodiesterase 5 selective inhibitors
alpha receptor antagonists
condition where there is abnormal autonomic responsiveness and vascular dilatation of submucosal vessels is called ….
vasomotor rhinitis
vasomotor rhinitis, which is more common in elderly people, happens during …
profuse eating - gustatory
drug use- cocaine
smoking
hot/ spicy food
nasal obstruction, which can cause rhinitis, can happen due to 5 things
(describe what symptoms show)
neoplasm - unilateral bloody discharge. no response to antibiotic
FB - unilateral obstruction, smelly, purulent discharge
deviated septum - snoring, nasal blockage, history of nasal fracture
nasal polyp: pearly, nontender, mobile, gray saclike growth, + inflamed nasal mucosa
samter’s triad: asthma, aspirin intolerance, and nasal polyp (aspirin blocks prostaglandins and leukrotrene production)
treatment for nasal obstruction
oral/nasal steriods
leukotriene inhibitors
surgery
aspirin desensitization
rhinitis gravidarum treatment
deliver the baby since it ends 2 weeks post partum
1 and 2nd generation antihistamines
rhinocort B
saline
patients with CSF rhinorrhea will complain of
headache and sweet taste
CSF rhinorrhea can result from … and cause…
trauma to head, nasal surgery, spontaneously
headache and meningitis
how to test for CSF rhinorrhea
place CSF on a filter paper = halo ring will appear
beta-2-transferrin test (hard to collect)
allergic rhinitis happens when you have _______ predisposition and ____________ reaction
genetic
gell and combs type 1 hypersensitivity reaction
during allergic rhinitis, there is sensitized mast cells that bind to IgE molecules. the mast cell degranulates and releases …… , …….. , ……
histamine
leukotrienes
kinins
allergic rhinitis comorbities
asthma
otitis media
sinusitis
atopic dermatitis
allergic conjunctivities
associated symptoms with allergic rhinitis
sneezing, itchy/watery eyes, congestion, rhinorrhea
for allergic rhinitis, ask pt about their ……/….. patterns
temporal and environmental patterns and how the symtoms
allergic r. has similiar symptoms to ….. rhinitis
viral
on PE, you noticed the patient is sneezing, nasal congestion, without fever, allergic lashes, and with dennie’s lines (muellers mm spasm), and shiners (venous stasis, and hemosiderin deposits) the pt has ….
allergic rhinitis
long, silky eyelashes
dennie’s line
inferior turbinate hypertrophy
deviated septum
shiners
pale nasal mucosa and nasal polyp
posterior pharyngeal cobble stoning
is….
allergic rhinitis
for allergic rhinitis, you will do the following tests
RAST - measure Ige antibodies and total serum Ige level . low sensitivity, high specificity . serum sample
Skin test (gold standard)
*skin prick,
*patch test
*intradermal
*intradilutional testing (IDT)
allergy treatment will be …
steroids (oral/nasal) - first line
antihistamine (oral/nasal)
expectorant/decongestants
leukotriene inhibitor (singulair- montelukast)
mast cell stabilizers (cromolyn)
saline
xolair (omalizumab) - allergic asthma/ chronic urticaria
immunotherapy works by …
increasing Ig4 so it can block antigen from binding to IgE molecule
decreases antigen specific Ige
allergy immunotherapy has both …. and …. treatments
subcutaneous - well studied, 90% rate for inhalants/ risk anaphylaxis
sublingual - not fda approved. - ragweed and grass available: dust mite pending - no risk for shock
type of nose bleed that comes from arterial, and is more profuse and harder to control, can comprise airway, seen in the back of throat, and comes from the internal maxillary artery (IMA)
posterior
type of epistaxis that 90 % comes from kiesselbach plexus, little ones area, inferior turbinate
anterior
for epistaxis, acute management, you should
control hypertension
see medication history
amount of blood, how long to control
check back of throat
labs: cbc, prothrombin/partial thrombolastin time, platelets
ENT follow up
treatment for minor anterior epistaxis is
spray otc afrin into side of blood
soak cotton in afrin and put into anterior cavity
apply pressure by pressing the cartilage
respray every 5 mins until done
treatment for minor but recurrent anterior epistaxis
anesthetize septal area with 2% lidocaine
apply silver nitrate to bleeding vessels
do not over apply = septal perforation
avoid bilateral septal cautery
when do you put nasal pack in the anterior cavity for epistaxis?
when bleeding does not stop
why would you give a pt who has a nasal pack due to nose bleed antibiotic ?
to prevent sinnuitis and infection
most often cause of posterior epistaxis is
hypertension
pts with posterior epistaxis can die from this because it does 3 harmful things and they are
airway comprise
uncontrolled bleeding
aspiration
this type of nosebleed may require IMA embolization, arterial ligation (sphenopalatine, ethmoid)
how many times should people with nose bleeds use nasal saline spray
every 2 hrs when awake
before and after bedtime
unilateral obstruction, malodorous, mucopurulent nasal drainage is
FB
it is a FB until proven otherwise
explain what sinusitis is and the etiology of it
inflammation of the sinuses (air filled cavity in skull) – > blockage of sinus ostia (drainage) –> mucus retention, hypoxia, decreased mucociliary clearance, and bacterial growth
can be caused by viral, bacterial, fungal, noninfectious (allergies)
what bacterial can cause sinusities
strep. pneumonia, H. Influenza, M. catarrhalis
atypical - mycoplasma, pseudomonas
resistant bacteria
which fungal causes sinusitis, on which pt, and which symptoms
aspergillus
immunocompromised pts
foul smelling, nasal discharge
differential diagnosis for sinusitis
TMJ pain
dental infection
viral rhinitis - common cold
allergic rhinitis
trigeminal neuralgia
sinus neoplasm
headache syndrome
migraine
sinus migraines
sinus neoplasm will show which symptoms
vision changes
unilateral nasal obstruction
unilateral epistaxis
CN deficits
acute siniuites will have
persistent symptoms for more than 7-10
nasal congestion
post nasal drip
sinus pressure
purulent nasal discharge - thick green/ yellow mucus
chronic sinuities will have
acute symptoms
chronic headache, cough, halitosis, decrease smell, ear pressure
for sinuities, the face will have and the ears will have
possible localized tenderness - face
normal TM - ears
for sinuities, the nose will have and the lungs will have
mucosal edema, inferior turbinate hypertropy, mucosale erythema, mucopus - nose
clear sounds - lungs
for sinuities, the neck will have and the pharynx will show
+/- cervical adenopathy - neck
thick postnasal drip, posterior pharygenal cobblestoning - pharynx
acute sinusities symptoms is less than … and chronic is more than
4 weeks = acute
more than 3 months = chronic
which test is best to see sinus ?
CT scan = can see sinuses, nasal cavity, air, fluid level, ostia
which types of pts with sinusitis do you give antibiotics to?
Sx not improving after 7 days/ getting worse
fever > 101
immunocompromised
comorbidities, age, health =factor
what is the initial antibiotics for ACUTE sinusitis?
augmentin (amoxicillin/ clavulanic acid
if the pt is allergic to PCN and you can not give augmentin to treat their ACUTE sinusitis, what do you give instead
doxycycline or clindamycin
…. scan sinusities if it is not improving or recurrent
CT
which nasal steroid do you give for pts with sinusities
flonase
which oral steriod do you give for pts with sinusities
prednisone
should you give antihistamine for sinusities
no
if sinusities is not fixed, the pt can end up having this eye problem
orbital cellulitis
