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13 ENT > Nasal Obstruction 2 > Flashcards

Nasal Obstruction 2 Flashcards

1
Q

primaru causes of ars

A

rhinovirus, adenovirus, influenza

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2
Q

symptomatology of ars

A

sudden onset of two or more symptoms:

  • nasal blockage, obstruction, congestion
  • nasal discharge (ant/post)
  • +/- facial pain or pressure
  • +/- reduction or loss of smell

for <12 wks, with symptom free intervals if recurrent

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3
Q

what is the common cold or acute viral rs

A

duration of symptoms less than 10 days

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4
Q

what is acute post-viral rhinosinusitis

A
  • increased or worsening of symptoms after 5 days
  • persistent symptoms after 10 days
  • with less than 12 wks duration
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5
Q

what is acute bacterial rs

A

at least 3:

  • discolored discharge with unilateral predominance and purulent secretion
  • severe local pain
  • fever >38c
  • elevated esr/crp
  • double sickening
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6
Q

predisposing factors for abrs

A
  • dental procedures
  • iatrogenic causes
  • immunodeficiency
  • mechanical obstruction
  • mucosal edema
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7
Q

respiratory viruses linking with receptors on nasal epithelium

A

icam1, tl3, rig-i, nlrp3, tlr7

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8
Q

if there are immune defense function defects you have __

A

prolonged course resulting to post-viral rhinosinusitis

secondary bacterial infection leads to acute bacterial rhinosinusitis

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9
Q

t/f some viruses like rsv can cause direct epithelial damage

A

true

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10
Q

epithelial dysfunction from inflammatory cascade

A

cilia loss
altered ciliary function
increased mucus production
barrier breakdown

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11
Q

t/f xray and ct is recommended on the first contact for ars

A

false

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12
Q

treatment for common cold

A
  • analgesics, nasal saline irrigation, decongestants, selected herbal compounds

if failed after 10 days, add topical steroids

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13
Q

treatment for moderate (post viral) ars

A
  • if symptoms persist after 10 d or increasing after 5 d
  • tx: topical (intranasal) steroids for 7-14 d
  • if no effect, refer
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14
Q

treatment for severe ars (+bacterial)

A
  • if symptoms persist after 10 d or increasing after 5 d AND discolored discharge, fever, severe local pain, elevated crp/esr, double sickening
  • tx: topical steroids and antibiotics
  • no effect = refer
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15
Q

indications for immediate referral

A
  • periorbital edema/ erythema
  • displaced globe
  • double vision
  • ophthalmoplegia
  • reduced vision acuity
  • severe uni/bilateral frontal headache
  • frontal swelling
  • sx meningitis / neuro sx
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16
Q

empiric antibiotics for abrs

A

coamoxiclav 625 mg q8h or 1g q12h
amoxicillin 500 mg q8h or 1g q12h

allergic: doxycycline, levofloxacin, moxifloxacin

7-10 d

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17
Q

watchful waiting indicated for

A

temp less/= 38 C
no extra sinus complications
assurance of good follow up

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18
Q

indications for intranasal cs and topical nasal saline irrigation

A

cs: symptomatic relief
irrigation: to improve ciliary beat activity and mucociliary clearance

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19
Q

second line antibiotics

A
  • for px with no response, or worsening symptoms after 5-7 d of first line
  • sus amr

coamoxiclav 2g q12h, doxycyline, levofloxacin, moxifloxacin

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20
Q

definition of chronic rhinosinusitis

A
  • > /= 12 wks for sinonasal symptoms
  • endoscopic signs: nasal polyps, mucopurulent from middle, edema or obsturction in middle
  • ct changes
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21
Q

predisposing factors to chronic rhinosinusitis

A
  • allergy
  • asthma
  • nsaid exacerbated respiratory disease
  • immune deficiencies
  • microbiology
  • fungal infection
  • ciliary impairment
  • smoking
  • pollution
  • osa, ms, obesity
22
Q

how do nasid cause respiratory disease

A
  • uninhibited 5 lipooxygenase resulting to increase leukotriene levels
  • causes smooth muscle constriction resulting to airflow obstruction
  • asthma + bronchiole constriction = bad
23
Q

most common immunodeficiencies

A

common variable immunodeficiency

24
Q

viruses that commonly cause exacerbations

A

coronavirus

parainfluenza

25
Q

how do biofilms exacerbate disase

A
  • adhere to surface, form mature biofilm, release more planktonic cells
  • targets of macrolides: disrupts biofilm
26
Q

what are superantigens

A
  • stimulate all cells and can release chemokines = massive cytokine release
27
Q

what is a fungal ball

A
  • develops in immunocompetent individuals
  • mucosa develops foreign body reaction
  • tx: surgical removal
28
Q

what is allergic fungal rhinosinusitis

A
  • immune hypersensitivity
  • florid ige response
  • tx: surgery and long term intranasal cs
29
Q

what is invasive fungal rs

A
  • immunosuppressed

- tx: surgery and iv amphotericin b

30
Q

t/f local exogenous factors can negatively modulate the ciliary dynamic response to stimuli

A

true, affects mucus blanket or ciliary beat

31
Q

host, environment, and pathology facots in crs

A

environmental: local microbial community
host: mucosal inflammation and mucociliary dysfunction
disease: failure of mechanical and innate immune protection, activation of proinflammatory responses

32
Q

mediators for type 1

A

defense against viruses

ilc, th1 cell, inf-gamma, tnf-alpha

33
Q

mediators for type 2

A

ilc2, th2 cell, il4, il5, il13

il5 = eosinophils

34
Q

what is type 2 crs

A
  • defense against parasitic and allergic rxs
  • crs with nasal polyps (caucasian)
  • more ige and eosinophils
35
Q

mediators for type 3

A

ilc3, th17, il17, il22

36
Q

what is type 3 crs

A
  • defense against bacteria and fungi
  • crs with nasal polyps (asian)
  • more non-eosinophilic (plasma cells, lymphocytes, neutrophils)
37
Q

filipinos are more type __

A

3

38
Q

localized vs diffuse crs

A

localized: unilateral, lower airway not involved, anatomically discrete sinus cavity
diffuse: bilateral, affects lower and upper airways, not limited by functional sinonasal units or spaces

39
Q

examples of primary crs

A

localized, type 2: allergic fungal rhinosinusitis
localized, non-type 2: isolated sinusitis

diffuse type 2: crswnp, afrs, central compartment allergic disease
diffuse non type 2: non-eosinophilic crs

40
Q

examples of isolated sinusitis

A

isolated maxillary sinusitis

frontal, sphenoid

41
Q

what is central compartment allergic disease

A
  • sinuses not that opacified or involved in ct, but secretions are concentrated in central compartment, sinuses not involved
42
Q

examples of secondary crs

A

localized local: odontogenic, fungal ball, tumor

diffuse mechanical: primary ciliary dyskinesia
diffuse inflammatory: granulomatosis with polyangitis, eosinophilic gpa
diffuse immunity: selective immunodeficiency

43
Q

first line for chronic rs

A

intranasal corticosteroids

  • improve symptoms, decrease polyp size, prevent recurrent, improve nasal airflow and olfaction
  • fluticasone, mometasone
44
Q

proper spraying technique

A
  • shake bottle
  • look down and lean forward
  • use right hand for left nostril
  • squirt once or twice in different directions
  • DO NOT SNIFF HARD
45
Q

recommendation for topical nasal saline irrigation

A
  • for symptom relief

- improves ciliary beat activity and mucociliary clearance

46
Q

recommendation for short term oral steroids

A
  • rapid transient symptom improvement and decrease in polyp size
  • only adjunct
47
Q

recommendation for long term low dose macrolides

A
  • if poor response to incs

- moderate symptom improvement and decrease in polyp size

48
Q

recommendation for short term doxycycline

A
  • only adjunct
  • if suspected staph superantigens
  • moderate effects
49
Q

recommendation for leukotriene receptor antagonists

A

if with concomitant allergic rhinitis, asthma, and aspirin-exacerbated respi disease

50
Q

indications for endoscopic sinus surgery

A
  • if unresponsive to medical treatment

- temporary relief of ostiomeatal complex blockage so steroids can penetrate

13 ENT (18 decks)

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