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Senoir 21-2 > Nose ! > Flashcards

Nose ! Flashcards

1
Q

What is the osteometal complex

A

channel that links the frontal sinus, anterior ethmoid air cells and maxillary sinus to the middle meatus, allowing airflow and mucociliary drainage.

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2
Q

A pt presents with CLEAR rhinorrhea
Nasal congestion, and sore throat

Think

A

Acute vital sinusitis

AKA COMMON COLD

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3
Q

What are the agents of the common cold

A

Adeno and rhinovirus

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4
Q

What is the treatment for acute viral sinusitis

A

NO ABX!

```
Treat the congestion
Pseudoephedrine
Saline rinse
Or Nasal sprays : Oxymetazoline
x 3 days
~~~

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5
Q

A pt presents with PURULENT nasal d/c
Congestion
Fever, and a perception of a foul odor.

+/- dental pain

Think

A

Acute BAC sinusitis

2/2 Strep Pneumoa, H. Flu, M. Cat
Or STAPH aureus

Most likely after a VIRAL URI

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6
Q

Prolonged NG tunes can lead to…

A

Acute bacterial sininusitis

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7
Q

What is the imaging appraoch for a acute Bac sinusitis

A

Typically NOT needed

However can get a CT if hospital acquired or is refractory to tx with comorbidites

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8
Q

What is the tx approach to a BAC. Sinusitis

A

Treat pain 1st with NSAIDS

Then decongest with INS or decongestants

ABX; if no resolution in 10 days, or immuno comp pts

—augmentin x 7 days (500/125 mg)

If Severe, comorbuid or older than 65
-Augmentin (2000/125) x 7-10 days

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9
Q

In pts with allergies to PCN

What is the ABX that can be used in sinusitis

A

DOXY or Clindamycin + cephalosporin

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10
Q

A pt with proptosis, gaze restriction and orbital pain
Following a Acute Bac Sinusits

Think

A

Orbital Cellulitus

IMMEEDIATELY order a CT

Treat with IV ABX with referal to ENT

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11
Q

Osteomyelitis is most common where…

A

Frontal Sinuses

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12
Q

What is the Tx approach to Osteomyelitys of the facial sinus

A

ABX, surgical removal of necrotic bone and cosmetic reconstruction

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13
Q

What is the common pathogen of nose picking infections

A

S. Aurues

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14
Q

What is a furuncle

A

Pus-filled bump under the skin arising from hair follicles

Seen in nose picking s. Aureus infections

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15
Q

What is the Tx for nose picking s. Aurues infection

A

Aka nasal vestibulitis

Tx: dicloxacillin x7-10 days
+/- Rifampin if recurrent
(Last 4 days of tx)

+/- mupirocin

I&D and furuncle

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16
Q

What is the major complication of sinus infections

A

Retrograde spread of infection

Valveless veins->Cavernous sinus->intracranial structures

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17
Q

What is the most common nosocomial infection of the nose

A

S. Aureus

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18
Q

What is the tx approach to s. Aureus nose infection

A

Mupirocin + chlorhexadine x 5 days

19
Q

What is the classic sign of fungal sinusitis

A

Black eschar on the middle turbinate

20
Q

What is the testing DX for fungal sinusits

A

Nasal BX with silver stains

21
Q

What must you do to tx a pt with fungal sinusitis

A

MEDICAL EMERGENCY!

Referal to ENT

Start IV voriconazole
(Amphotericin B is less toxic)

WIDE surgical debridemnt

22
Q

What is the tx approach to allergic rhinitis

A

Send pt for blood testing -RAST or skin testing

Then allergy avoidance 
Pharmacotherapy 
-INS :Fluticasone, mometasone, beclamethasone etc. 
-Mainstay of treatment
-Especially for congestion

Can use antihistamines
-Azelastine/ Olopatadine

Can add on montelukast or Cromolyn

23
Q

What pts have the highest risk of anaphylaxis in allergic rhinitis

A

Poorly controlled asthma pts

24
Q

What is vasomotor rhinitis and who does it mostly effect

A

Common in the elderly

Triggered by air temp, odor or light

Vivian nerve sensitivity

Tx with Ipatropium Bromide

25
Q

What is it called when you overuse Afrin (Oxymetazoline)

A

Rhinitis medicamentosa

Tx: stop Rx use
Start INS or Anticholinergic

26
Q

What is the most common cause of olfactory dysfunction

A

Blockage from polyps or septal deformities

27
Q

What are the two sites of bleeding in Epistxsis

A

Anterior- Kesselbach’s plexus (MC)

Posterior- Woodruff’s plexus (worse)

28
Q

What is the tx approach to anterior epistaxis

A

Direct pressure x 15 min

Then topical decongestant

  • phynelephrine
  • Oxymetazoline

Attempt to locate bleed
-may use topical cocaine or Oxymetazoline +lido

Cauterize if visible
Or pack with iodofrom gauze

29
Q

What is the tx approach to a posterior epistaxis

A

Refer to ENT for posterior packing

Emergency setting- double balloon pack

  • Admit
  • Opioids for comfort

Surgery- when packing fails

30
Q

When treating epistaxis what ABX should be used while packing is in place

A

Antistaph antibiotics while packing in place (min 5 days)

Cephalexin, clindamycin

31
Q

If a nose bleed lasts longer than 15 minutes

What should you do

A

Send Pt to the ER

32
Q

What is the most common bone fx in the body

A

Nasal pyramid

33
Q

What must you r/o in a nasal fx

A

Ensure no infraorbital rim step-off

Zygomatic complex fracture

34
Q

Post nasal truama a pt presents with widening of the nasal sepultura

Think

A

Infection if s. Aureus and septal hematoma

Tx: I&D
PACK!
ABX- Cephalexin or Clindamycin while packing is in place

35
Q

What is the tx approach to nasal polyps

A

INS 1st line

Short course of prednisone

Surgery when large or recurrent

36
Q

Nasal polyps + asthma =

A

AVOID ASPRIN!

37
Q

Nasal polyps in childern =

A

Eval for cystic fibrosis

38
Q

You see a cauliflower like growth on the middle meatus of the nose

Think

A

Inverted papilloma 2/2 HPV infection

39
Q

What is the most common cancer of the nose

A

SCC

40
Q

What are the key sings of nasal cancer

A

Pain and recurrent hemorrhage

41
Q

Unilateral serous otitis media, with proptosis, and ill fitting dentures

Think

A

Malignancy of the nose

42
Q

A pt presents with blood stained crusts in the nose with friable mucosa

Think

A

Granulomatosis with polyangitis

43
Q

A pt presents with engorged tubinates, and small white granulomas, and NONCASEATING granulomas

Think

A

Sarcoidosis

Senoir 21-2 (77 decks)

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