Nasal, Paranasal and Sinus Disorders

Question 1

Define: Rhinitis

Answer 1

nasal hyperfunction and tissue inflammation. There is allergic and nonallergic

Question 2

What is rhinorrhea?

Answer 2

tissue transudate

Question 3

What is the most common cause of chronic rhinitis? What about acute?

Answer 3

allergies. infection.

Question 4

Acute viral rhinitis: most common virus

Answer 4

rhinovirus

Question 5

When does viral rhinitis usually occur?

Answer 5

winter

Question 6

What are the four stages of Acute Viral Rhinits

Answer 6

Prodromal (lasts hours): unusually clear nose
Catarrahal (hours to day): watery, nasal discharge. sneezing, fever.
Mucous Phase: most mucopurlent stage
Resolution: symptoms usually regress in 10 days

Question 7

What are some complications of acute viral rhinitis?

Answer 7

otitis media and sinusitis

Question 8

Patient presents to clinic complaining of a mild fever and runny nose. You determine that it is an acute viral rhinits…what is the treatment

Answer 8

supportive, oral fluids, and pain meds, irrigation of nose, decongestants
nasal irrigation: improves sx and reduces need for NSAID’s
- oral decongestants (ex pseudoephedrine) can provide temp relief of rhinorrhea and nasal obstruction
- nasal sprays (ex oxymetazole or phenylephrine) can be rapidly effective but can only be used for a few days
- WARNING! can lead to rebound congestion AND rhinitis medicamentosa if withdrawn after prolonged use - addictive in nature

Question 9

Patient presents with rhinorrhea, itchy watery eyes, sneezing and cough. They have a history of atopy. Patient says this happens frequently with certain exposures. What is the cause of this?

Answer 9

Allergic rhinitis, it is a TYPE I hyerpsensitivity. Exposure with IgE. Common antigens include: pollens, mold, dust.

Fixed: each time exposure occurs.
Cyclic: based on frequency

Question 10

Patient presents with rhinorrhea, itchy watery eyes, sneezing and cough. They have a history of atopy. Patient says this happens frequently with certain exposures.What do you expect their nasal mucosa to appear like?

Answer 10

pale and boggy, swollen inferior turbinates, large amounts of CLEAR secretion. can have an allergic shiner under their eye.

Question 11

Patient presents with rhinorrhea, itchy watery eyes, sneezing and cough. They have a history of atopy. Patient says this happens frequently with certain exposures. What ways can you diagnose this? how do you treat?

Answer 11

hx, pe, skin testing.

casual: avoidance, desenstitization
symptomatic: antihistamines (loratadine, certirizine), steroids, decongestants

Question 12

A patient with acute viral rhinitis, their nasal mucoa appears..

Answer 12

erythematous, edema, watery discharge

Question 13

patient with EXCESSIVE rhinorrhea bilaterally, especially in response to cold or hot air, intense smells.

Answer 13

vasomotor rhinitis, this is caused due to the vidian nerve. excessive parasymp stimulation.

Question 14

patient with EXCESSIVE rhinorrhea bilaterally, especially in response to cold or hot air, intense smells. treatment:

Answer 14

anticholinergic. surgery if very bad–> directed at inferior turbinate

Question 15

patient with EXCESSIVE rhinorrhea bilaterally, especially in response to cold or hot air, intense smells. appearance of turbinates

Answer 15

extremely RED AND HEMORRHAGIC

Question 16

acute sinusitis: what is the general rule?

Answer 16

rhinitus precedes sinustitis

Question 17

Patient presents with facial congestion and fullness, nasal blockage, nasal discharge that is yellow/green, decreased smell, and facial pain or pressure. They also have a FEVER. They say they had a cold for about 15 days.

Answer 17

You know this must be acute sinusitis because rhinitis should only last 10 or less, and they have facial pain, discharge, and a worsening of symptoms.

Question 18

Patient presents with facial congestion and fullness, nasal blockage, nasal discharge that is yellow/green, decreased smell, and facial pain or pressure. They also have a FEVER. They say they had a cold for about 15 days. what organisms cause this?

Answer 18

s. pneumo, H. flu, M. cat

Question 19

Patient presents with facial congestion and fullness, nasal blockage, nasal discharge that is yellow/green, decreased smell, and facial pain or pressure. They also have a FEVER. They say they had a cold for about 15 days. what is the pathology?

Answer 19

decreased movement of the mucociliary in the sinuses enoucrages bacteria to grow. This is most common in the middle turbinate.

Question 20

Acute sinusitis treatment:

Answer 20

Medication / Surgery:

• intranasal CCS for first 5 days of sx (reduces facial pain and congestion)
• NSAID’s for inflammation
• oral or nasal decongestants for sinus sx (ex. Pseudoephedrine)
• 80% of pts. Recover w/o Ab’s, use sparingly
  
  • 1st Line: penicillin, amoxicillin (7 - 10 days)
  • Alt for penicillin allergies: macrolide therapy or tetracycline

Question 21

At what point to acute sinustis become chronic?

Answer 21

when symptoms persist for 12 weeks. symptoms look similar to acute EXCEPT that sometimes there is a fever, sometimes there isnt..the discharge is paler. You can sometimes do a CT to confirm.

Question 22

What is Sampter’s triad?

Answer 22

polyps, asthma, and aspirin senstivity

Question 23

How do you diagnose nasal polyps?

Answer 23

rhinoscopy, CT scan

Question 24

What is treatment for nasal polyps?

Answer 24

General: Presense of polyps in children possibly sugg. cystic fibrosis
Medications / Surgical: Nasal Poly-topical intranasal corticosteroids for 1-3 mos for sm. polyps; If polyps are massive then remove surgically; Inverted Papilloma- because SCC-complete excision and removal (medical maxillectomy)-recurrence rates are high, make sure to follow up
Complications: Pts with nasal polyps and asthma, avoid aspirin, could cause bronchospasm (triad asthma-Samter triad)-immunologic salicylate sensitivity;

Question 25

sinusitis usually presents uni or bi?

Answer 25

uni