Module 3 chronic nasal congestion, epistaxis

Question 1

Chronic rhinosinusitis (CRS)

Answer 1

related to nasal cavity and paranasal sinus inflammation

Question 2

CRS dx requirements

Answer 2

s/s x 12 weeks
2 or more of the following:
- dec. sense of smell
- facial pain
- nasal congestions
- mucopurulent drainage

Question 3

Dx of CRS provider requirement

Answer 3

• Confirmation of edema or mucous discharge in anterior ethmoid region or middle meatus
• Nasal cavity or middle meatus polyps
• Radiographic documentation of paranasal sinus inflammation

Question 4

3 variants of CRS

Answer 4

CRS with nasal polyposis
CRS without nasal polyposis
allergic fungal rhinosinusitis

Question 5

nasal congestion primarily the result of

Answer 5

vascular changes
chronic inflammation in the nasal mucosa
- immunologic
- infectious
- environmental

Question 6

CRS associated factors

Answer 6

CF
allergy
asthma
aspirin sensitivy
genetic factors
immunodeficiency
infection
pregnancy

Question 7

allergic fungal rhinosinusitis characterized by

Answer 7

polyps
- type 1 sensitivity to fungi
eosinophilic mucin

Question 8

s/s of CRS

Answer 8

cough
dental pain
facial discomfort
fatigue
fever
halitosis
headache
nasal blockage or discharge
dec. smell

Question 9

s/s of CRS can be associated with

Answer 9

asthma
allergic rhinitis
tonsillar hypertrophy
recurrent otitis media

Question 10

CRS physical exam

Answer 10

• asymmetry or deformity of the nasal structure
• nasal mucous membranes inspected
  – erythema
  – palor
  – atrophy
  – edema
  – crusting
  – discharge

Question 11

Chronic nasal congestion turbinates

Answer 11

erythematous mucosa

Question 12

allergic rhinitis turbinates

Answer 12

pale bluish hue or pallor in mucosa

Question 13

Abnormalities of nasal mucous membranes

Answer 13

polyps
erosions
septal deviations
perforation

Question 14

nasal polyp concern for malignancy

Answer 14

unilateral
bleeding

Question 15

Confirmation of CRS via

Answer 15

nasal endoscopy
possible surgery
or sinus CT scan

Question 16

pharmacological management of CRS

Answer 16

saline irrigations/intranasal corticosteroids

Question 17

allergic fungal rhinosinusitis pharmacologic management

Answer 17

treated surgically and with steroids

Question 18

complications of CRS

Answer 18

ulcerations
infections
septal perforation
diminished QOL

Question 19

ages most commonly assoc. with epistaxis

Answer 19

< 10
> 40

Question 20

more prone to epistaxis

Answer 20

fragile mucous membranes
nasal trauma
rhinitis
drying on nasal mucosa
septum deviation
alcohol use
chemical irritants (cocaine)
coagulation disorders
hematologic cancers
anticoagulation meds
herbal supplements

Question 21

Kiesselbach plexus

Answer 21

vascular plexus on the anterior nasal septum
- 90-95% of nosebleeds occur here

Question 22

anterior nosebleed presentation

Answer 22

unilateral
continuous moderate bleeding

Question 23

posterior nosebleed presentation

Answer 23

bilaterally
severe bleeding
difficult to treat
bleeding into the pharynx

Question 24

health hx regarding epistaxis

Answer 24

frequency
duration
trauma
nasal obstruction
prior tx

Question 25

Using pressure to stop epistaxis

Answer 25

sit up straight
tilt head forward
firm continuous pressure for 15 minutes

Question 26

nasal packing for epistaxis

Answer 26

once in place leave for 24-48 hours
- pack both sides if bleeding continues
observe pt for 30 minutes for posterior bleeding

Question 27

pharmacologic tx of epistaxis

Answer 27

vasoconstrictors
cautery: sliver nitrate or electrocautery
consultation : ED for posterior epistaxis
surgery: arterial ligation or vascular embolization

Question 28

complications of epistaxis

Answer 28

resp. function compromise
hypotensive or anemic with severe bleeding
Related to Tx:
- necrosis
- abscess formation
- septal perforation
- sinus infection
- toxic shock syndrom
- vagal response with posterior packing