MDT Nose Rhinitis/Sinusits

Question 1

Patient has some of theses issues what would you suspect?
(a) Clear rhinorrhea, nasal pruritus, and sneezing
(b) Turbinates mucosa of the turbinates is usually pale or violaceous (venous engorgement)
(c) Nasal polyps (boggy masses of hypertrophic mucosa) are associated with long-standing allergic rhinitis.

Eyes- Irritation, pruritus, conjunctival erythema, and excessive tearing

Associated symptoms
Cough, bronchospasm, wheezing and eczematous dermatitis

Answer 1

Rhinitis

Question 2

DDx for rhinitis

Answer 2

(1) Viral rhinitis
(2) Sinusitis
(3) Influenza
(4) Mononucleosis

Question 3

True.False
You need to run labs for Rhinitis

Answer 3

FALSE

Question 4

Treatment for Rhinitis

Answer 4

-Topical intranasal corticosteroids (Flonase or Nasonex) for 1–3 months (also shrinks nasal mucosa and nasal polyps)
-Antihistamines (immediate, but temporary relief)

Adjunctive Treatment Measures
-Montelukast (Singulair)
-Cromolyn (Gastrocrom) - Mast cell stabilizer

Nasal saline irrigations

Referral to an allergist (subcutaneous and sublingual immunotherapy)

Question 5

True/False
Patients should be reminded that there may be a delay in onset of relief of two or more weeks

Answer 5

True

Question 6

Complications of Rhinitis

Answer 6

(1) Nasal polyps
(2) Sinusitis
(3) Eustachian tube dysfunction

Question 7

_______ is an inflammation of the mucous membrane of one or more paranasal sinuses.

Answer 7

Sinusitis

Question 8

The typical pathogens of bacterial rhinosinusitis are

Answer 8

S pneumoniae
other streptococci
H Influenzae

less commonly S aureus and Moraxella Catarrhalis

Question 9

PT has these issues what would you suspect?
(1) Purulent yellow-green nasal discharge or expectoration.
(2) Facial pain or pressure over the affected sinus or sinuses.
(3) Nasal obstruction.
4) Acute onset of symptoms (between 1 and 4 weeks’ duration).
(5) Associated cough, malaise, fever, and headache.

Answer 9

Sinusitis

Question 10

True/False
Diagnosis for sinusitis can usually be made on clinical grounds alone.

Answer 10

Treu

Question 11

What supportive therapy would you give for sinusitis

Answer 11

NSAIDS for pain
Oral or nasal decongestants
Intranasal corticosteroids

Question 12

When are antibiotics indicated for Sinusitis

Answer 12

Fever, pain, purulent discharge
Symptomatic for > 10 days

Question 13

What is the empiric treatment for bacterial sinusitis ?

Answer 13

Amoxicillin-Clavulanate (500 mg/125 mg orally three times daily or 875 mg/125 mg orally twice daily for 5-7 days).

Question 14

What is the antibiotic treatment for Severe sinusitis?

Answer 14

High-dose AmoxicillinClavulanate (2000 mg/125 mg extended-release orally twice daily for 7-10 days).

Question 15

What antibiotic can you give for sinusitis if they have a PCN allergy or hepatic impairment?

Answer 15

Doxycycline (100 mg orally twice daily or 200 mg orally once daily for 5- 7 days).

Question 16

When would you refer your sinusitis pt and to where

Answer 16

Failure to resolve after antibiotics
ENT

Question 17

When would you admit a sinusitis PT?

Answer 17

Facial cellulitis, vision change, gaze abnormality, abscess, mental status changes

Question 18

What are some complications of Sinusitis?

Answer 18

(1) Orbital cellulitis and abscess
(2) Osteomyelitis
(3) Cavernous sinus thrombosis
(4) Intracranial extension