Nose

Question 1

Inflammation of the area near the osteomeatal complex. Often follows URI, can be viral or bacterial (same bacteria that cause AOM). Risks = cigarette smoke, exposure to secondary smoke, history of trauma, foreign body.

Answer 1

Acute sinusitis

Question 2

Sxs: Purulent nasal discharge, facial pain and pressure, nasal obstruction, congestion, fever.

PE: Sinuses tender to palpation. Decreased light transmission with transillumination over sinuses.

Answer 2

Acute sinusitis

Question 3

Complications of acute sinusitis

Answer 3

Orbital cellulitis, osteomyelitis, cavernous sinus thrombosis.

Question 4

How do diagnose acute sinusitis

Answer 4

Bx is usually clinically diagnosed.
X-ray can be used but is not recommended but can be useful in certain cases
CT or MRI

Question 5

NSAIDS, saline washes, steam and oral/nasal decongestants, intranasal corticosteroids

If no improvement in 10-14 days or worsening of fever, pain, swelling use antimicrobial therapy

Answer 5

Treatment acute sinusitis

Question 6

Amox = DOC; use Amox-Clav if no improvement
Macrolides, TMP-SMX, doxycycline if PCN allergic
Quinolones = treatment failure/recent Abx use

Answer 6

Treatment acute sinusitis

Question 7

Negative air pressure in sinus cavities; chronic or acute.

PE: Obstruction or chronic pain in sinuses. Get imaging to R/O mass, mucocele if warranted.

Answer 7

Barosinusitis

Question 8

Nasal decongestant spray short term & steroid spray

Referral

Complications: Can decrease O2 sats if completely blocked

Answer 8

Barosinusitis treatment

Question 9

Secondary to common cold, mild to moderate congestion (less than allergic) clear rhinnorhea

Answer 9

Viral rhinitis

Question 10

Nasal saline, symptomatic, caution with oral decongestants

Mostly self-limiting

Answer 10

Viral rhinitis

Question 11

Symptoms confused with those of a common cold. Signs may include allergic shiners (bluish discoloration below the eyes); rhinorrhea; itchy or watery eyes; sneezing; nasal congestion; dry cough; pale, boggy, or bluish mucosa. Children may develop allergic salute from ruling nose

D/C is clear and watery

Answer 11

Allergic rhinitis

Question 12

Avoid known allergens and use antihistamines, cromolyn sodium, nasal or systemic corticosteroids, nasal saline drops or washes and immunotherapy

Answer 12

Allergic rhinitis treatment

Question 13

Increased secretion of mucus from nasal mucosa. Can come from changes in temp/humidity, odors, alcohol, or neurovascular imbalance. Bogginess of nasal mucosa associated with a complaint of stuffiness and rinorrhea

Symptoms are labile and clear quickly.

Answer 13

Vasomotor rhinitis

Question 14

Avoid irritant

Answer 14

Tx vasomotor rhinitis

Question 15

Overzealous use of decongestant drops or sprays with oxymetazoline or phenylephrine. Severe congestion and pain, discharge minimal

Answer 15

Medicamentosa rhinitis

Question 16

Discontinue irritant. May be quite uncomfortable for patient; use of topical corticosteroids is warranted through the withdrawal period.

Answer 16

Medicamentosa rhinitis

Question 17

Ethmoid sinusitis causing rhinosinusitis

S. pneumoniae, H. influenzae, M. cattarhalis

Risk = smoker –> longer treatment course
Purulent discharge, can culture

Answer 17

Bacterial rhinitis

Question 18

If goes on for more than 7 days treat like otitis media; AMOX

Answer 18

Bacterial rhinitis treatment

Question 19

Pale, boggy masses on nasal mucosa; sometimes w/ allergic rhinitis

C/O chronic congestion and decreased sense of smell

Answer 19

Nasal polyps

Question 20

3 month use topical nasal corticosteroid; oral steroid can also help reduce size

Surgical removal necessary if therapy is unsuccessful

Answer 20

Nasal polyp treatment

Question 21

Most commonly occurs in Kiesselback plexus; unilateral anterior bleeding. Posterior bleeding less frequent (Woodruff plexus) and is associated w/ hypertension and atherosclerosis.

Risk = nasal trauma, dry nasal mucosa, hypertension, cocaine use, alcohol use

Answer 21

Epistaxis

Question 22

Direct pressure to area. Have pt sit and lean forward to lessen swallowing of blood. Compress nares 15 min.

Identify site of bleeding if goes on for more than 15 min.

Topical cocaine can be used as anesthetic and vasoconstrictor. Can use topical decongestants and topical anesthetics as well. Can cauterize if source is visible. Anterior packing also option.

Answer 22

Epistaxis treatment