Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ClinMed NOSE > Nose > Flashcards

Nose Flashcards

1
Q

What are the different types of Rhinorrhea?

A

Allergic rhinitis
non-allergic rhinitis
Vasomotor rhinitis
Acute and chronic rhinosinusitis (sinusitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is allergic rhinitis?

A

Clear rhinorrhea, sneezing, tearing eye irritation
Associated symptoms: cough, bronchospasm, eczematous dermatitis
Environmental allergen exposure with the presence of allergen specific IgE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How common in allergic rhinitis?

A

14-40% prevalence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the seasonal allergies for rhinitis?

A

Most common: shrub and tree pollens
Spring: flowering shrub and tree pollens
Summer: flowering plants and grasses
Fall:ragweed and molds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Symptoms of allergic rhinitis?

A 
History of atopy
sneezing
watery eyes
seasonal predilection
prolonged symptoms
congestion and pale mucosa with clear discharge (d/c)
Afebrile
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What facial features are associated with allergic rhinitis?

A

Allergic shiners
Allergic salute (crease over nose)
Pale boggy turbinates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What tests are used to diagnose allergic rhinitis?

A 
CBC
Nasal smear for eosinophils
ELISA
RAST
skin prick test (affected by antihistamine or steroid use)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the components of a differential for allergic rhinitis?

A

Nonallergic rhinitis w/ eosinophilia syndrome (NARES)
Vasomotor rhinitis
Chronic sinusitis
Nasal polyps or tumor
FB
medications-rebound effect from topical nasal decongestants
septal/anatomic obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Treatment for allergic rhinitis?

A 
Avoidance
1rst line: nasal steriods (nasonex/flonase)
2nd line: antihistamines 
oral or intranasal decongestants  
Leukotriene receptor antagonist (singulair)
Intranasal antihistamines (omnaris)
cromolyn sodium
"Allergy shots"
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the side effects of nasal steroids?

A

Epistaxis
perforated septum
taste perversion
oral candidiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is Non-Allergic Rhinitis?

A

a common condition characterized by the chronic presence of one or more of the following: nasal congestion, rhinorrhea, postnasal drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is NAR distinguished from AR?

A

onset is at a later age
absence of nasal and ocular itching and prominent sneezing
nasal congestion and postnasal drainage are prominent symptoms
symptoms are perennial (year round)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the typical triggers for NAR?

A 
Irritant odors and strong fragrances 
tobacco smoke 
diesel and car exhaust
cleaning products
newsprint
changes in temperature
alcoholic beverages
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is vasomotor rhinitis?

A

intermittent symptoms of congestion and or watery rhinorrhea and exaggerated reaction to nonspecific irritants such as air pollution, temp changes, exposure to cold or dry air

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What id gustatory rhinitis?

A

Episodic condition with prominent watery rhinorrhea
triggered by hot or spicy foods
cased by the vagal-mediated reflex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is Rhinitis Medicamentosa?

A

occurs when there is use of intranasal decongestants for greater than 5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do you treat RM?

A 
strop/wean
intranasal steroids
PO steroids
nasal saline
antihistamines
decongestants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

causes of vasomotor rhinorrhea?

A 
Fumes
odors
temp
atmospheric changes 
smoke 
other irritants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the drugs involved in drug-induced rhinitis?

A 
ACE inhibitors
reserpine
guanethidine 
phentolamine
methyldopa
beta-blockers
chlorpromazine
gabapentin
penicillamine
ASA 
NSAIDS 
cocaine
Exogenous estrogens
OCP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is mixed rhinitis?

A

a combination of allergic and NAR

most common form of rhinitis, affecting ~ 45%of the population

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is occupational rhinitis?

A

Airborne allergens or irritants in patients workplace
symptoms are more prominent at work and improve on days off
underlying mechanisms may be allergic or irritant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are common examples occupational irritants?

A

proteins from urine or fur of lab animals
food proteins
enzymatic proteins in detergent manufacturers
organic dusts in wood workers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is CSF rhinorrhea?

A

Straw colored leakage of CSF
may cause one or more nasal symptoms
usually results in unilateral or bilateral clear nasal discharge without signs and symptoms of mucosal inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what can CSF rhinorrea result from?

A

skull or nasal fractures
intracranial surgery
inferior extension of sella turscia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are the postural reflexes?

A

increased congestion with supine position and increased congestion in the lower nasal passage when lying on one side
normal nasal cycle in the vertical position produces alternating congestion in the nostrils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what is crutch reflex?

A

increased congestion with pressure in the ipsilateral axilla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Hot and cold cutaneous temp reflexes

A

sneezing upon sudden exposure of the skin to dramatic temp extremes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Visible and infrared light reflexes

A

sneezing upon sudden exposure to bright light

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Bronchonasal reflex

A

brochoconstriction in response to nasal stimulation (such as with cold air)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Ovulatory rhinitis

A

increased nasal congestion in the periovulatory period of the menstrual cycle in women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the definition of acute sinusitis?

A

symptomatic inflammation of 1 or more paranasal sinuses resulting from impaired drainage and retained secretions
< 4 weeks duration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

how long subacute sinusitis?

A

symptomatic for 4-12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How long is chronic sinusitis?

A

symptomatic for > 12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is Rhinosinusitis?

A

the term given to rhinitis and sinusitis because they usually coexist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

how many annual cases of sinusitis are there each year?

A

31 million with an annual cost of 5.8 billion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what us the 5th leading reason for prescribing antibiotics?

A

acute bacterial rhinosinusitis

about 0.2-2% episodes of viral rhinosinusitis have bacterial superinfection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

When is incidence of sinusitis the highest?

A

early fall through early spring because it is related to viral URI (adults have 2-3 URIs per year- 90% accompanied by rhinosinusitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what is pathophysiology of sinusitis?

A

inflammation and edema of the sinus mucosa
obstruction of the sinus ostia
impaired mucociliary clearance
secretions that are no cleared become hospitable to bacterial growth
inflammatory response damages mucosal surfaces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what viruses cause sinusitis?

A 
Rhinovirus
Influenza A and B
parainfluenza virus
respiratory syncytail
adeno/corona/enteroviruses
40
Q

What cases bacterial sinusitis?

A

S. pnemoniae
H. Influenzae
M catarrhalis
More likely if symptoms are worse after 5-7 days or > 10 days
complicates 0.2-2% of viral cases
often over diagnosed (leads ton increased antibiotic resistance)

41
Q

when is fungal sinusitis seen?

A 
in immunocompromised ( uncontrolled DM, neutropenia, or use of corticosteroids)  
As a nosocomial infection
42
Q

Symptoms of bacterial sinusitis?

A 
worsening symptoms 5-7 days after initial improvement
persistent symptoms more than 10 days
persistent purulent nasal discharge  
unilateral upper tooth or facial pain
unilateral maxillary sinus tenderness
fever
43
Q

what are the risk factors for sinusitis?

A 
viral URI
Allergic rhinitis
Asthma
smoking
dental infections and procedures
tonsillar and adenoid hypertrophy
Turbinate hypertrophy
nasal polyps
deviated septum
cleft palate 
HIV
Cystic fibrosis
*no genetic factor
44
Q

What are the PE findings for sinusitis?

A 
Fever
Edema and erythema of nasal mucosa
Purulent discharge
tenderness to palpation over sinus
Transilllumination of the sinuses (only helpful for unilateral sinusitis)
45
Q

What are some pediatric considerations for sinusitis?

A

Sinus are not fully developed until age 20
maxillary and ethmoid sinuses present at birth
children are at risk for developing sinusitis
diagnosis can be harder because symptoms are more subtle

46
Q

What are symptoms of sinusitis that need urgent attention?

A

Visual disturbances-Diplopia
Periorbital swelling or erythema
altered mental status

47
Q

Are diagnostic tests used for sinusitis?

A

NO

imaging techniques do not distinguish bacterial from viral

48
Q

why would a coronal CT be used?

A

for recurrent infection or if medical treatment is not working

49
Q

How are most cases of rhinosinusitis resolved?

A

supportive care by treating the pain and nasal symptoms

antibiotics are used only when symptoms last more that 10 or get worse in 5-7 days

50
Q

What medications are first line for sinusitis?

A

Decongestants
Analgesics
Antibiotics

51
Q

What are the first line antibiotics for sinusitis?

A

Amoxicillin: adults 80-90 mg/kg/d
Trimethoprim-sulfamethoxazole (BACTRIM)
Doxycycline 100 mg (adults only because it yellows children’s teeth)

52
Q

What are the general treatments for sinusitis?

A 
Hydration
steam inhalation (20-30 min)
Saline irrigation
sleep with head of bed elevated
avoid smoke, fumes, caffeine, alcohol 
Analgesics
NSAIDS
53
Q

What are follow up recommendations for sinusitis?

A

return if there is no improvement in 72 hours or symptoms continue for more than 10 with antibiotics
no follow up is symptoms resolve

54
Q

What is the prognosis for sinusitis?

A

alleviation of symptoms in 72 hours and complete resolution within 10-14 days

55
Q

What is nasal vestibulitis?

A

inflammation of nasal vestibule which may be from folliculitis of hairs lining the orifice

56
Q

what is the leading nosocomial pathogen in the world?

A

Staph aureus

30% have of individual have no vestibulitis symptoms and are carriers

57
Q

What is the tx for vestibulitis?

A

Antibiotics that cover S. aureus (dicloxacillin 250 mg PO QID 7-10 D)
Topical mupirocin or bacitracin BID or TID

58
Q

what is invasive fungal sinusitis?

A

it is similar to acute bacterial rhinosinusit but with more sever facial pain
clear nasal drainage
*black eschar on middle turbinate

59
Q

How is IFS spread?

A

spreads through the vascular system
very rare
lethal if not detected early

60
Q

What are contributing factors for IFS?

A

DM
L-T corticosteroid use
end stage renal disease

61
Q

what are the features of epistaxis?

A

very common
most case are <10 or 45-65
most cases are uncomplicated

62
Q

what is the source of anterior epistaxis?

A

Kiesselbach’s plexus

63
Q

What is the source of posterior epistaxis?

A

Posterolateral branches of the sphenopalatine artery
may also be from carotid artery
can result in significant hemorrhage

64
Q

Causes of anterior epistaxis?

A

MC: manual mucus extraction via the digitus secunduc (digital trauma)
low moisture in the air
Mucosal hyperemia (allergic or viral)
FB when there is blood and purulent discharge
chronic excoriation leading to small septal perforation from internasal drug use
facial trauma

65
Q

what are the causes of anterior and posterior epistaxis?

A 
Anticoagulated patients ( on coumadin)
familial blood dyscrasias ( VwF disorder)
 nasal neoplasm
Alcohol
Long standing HTN
66
Q

How should epistaxis be evaluated?

A

Main focus is airway assessment and cardio stability
predisposing conditions
Timing, frequency, and severity
Presence of chronic medical conditions that could cause more blood loss or that could be related to dyspnea, CP, lightheadedness

67
Q

what is the initial course of treatment for epistaxis?

A
  1. tamponade
  2. Pt blows nose to remove clots
  3. PA sprays nose with Afrin or cocaine
  4. patinet pinches nose againt septum for 5-10 minutes
68
Q

What is the tx for anterior epistaxis?

A

Cautery:chemical via silver nitrate sticks or electrical

use topical lidocaine

69
Q

What is the tx for posterior epistaxis?

A

Nasal packing via nasal tampon made of merocel
Nasal ballon catheter (rapid rhino encased in carboxymethylated cellulose mesh)
Gauze packing via ribbon gauze

70
Q

what is a nasal obstruction?

A

something causing the sensation of insufficient airflow through the nose
divided into mucosal and structural causes

71
Q

How do you diagnose NO in a PE?

A

Via an external examination: look at external nasal contour for body or cartilaginous deformities
look for evidence of nasal trauma
cervical lymphadenopathy upon palpation
also do an otoscopic exam

72
Q

what can contribute to nasal obstruction in older patients?

A

deterioration or hypertrophy of the cartilage in the nasal tip

73
Q

How do you treat a nasal obstruction?

A

it depends on the cause but usually alligator forceps or nasal sprays

74
Q

What are nasal polyps?

A

sac-like growth of inflamed tissue lining the nose or sinuses

75
Q

what are the risk factors for nasal polyps?

A 
ASA sensitivity
Asthma
chronic sinus infections
cystic fibrosis
Allergic rhinitis
76
Q

What are the symptoms of nasal polyps?

A

Mouth breathing
Nose blockage
decreased sense of smell (hypoosmia)
rhinorrhea

77
Q

How do you diagnose nasal polyps?

A

they are visible upon exam as well as on CT scans

78
Q

what is the treatment of nasal polyps?

A

Glucocorticosteriods
1. nasal steroid sprays-fluticisone, budesnide, mometasone
2. oral- only for severe cases
Tx of the underlying allergies
daily lavage with saline
surgery is usually temporary tx because they usually come back because they are allergy driven

79
Q

what are the congenital anomalies of the nose?

A

Congenital nasal mass

  1. epidermal inclusion mass
  2. glioma
  3. meningocele or meningomyelocele
80
Q

what is the common cause to septal deviation?

A

Impact trauma

81
Q

what are the symptoms of septal deviation?

A 
sinusitis
sleep apnea 
sneezing
facial pain
epistaxis
difficulty breathing
hypoosmia
82
Q

What is the tx for a deviated septum?

A

no tx if mild
Antihistamines, nasal steroids, and decongestants help
if severe- septoplasty

83
Q

what are juvenile nasopharyngeal adenomas (JNA)?

A

benign locally aggressive vascular tumor that grown in the posterior nasal cavity
Tends to bleed
Occurs in the nasopharynx of prepubertal and adolescent male

84
Q

Who does JNA affect?

A

Males 7-19 years old

there is a hormonal theory

85
Q

What is JNA also know as?

A

juvenile nasopharyngeal angiofibrima or nasopharyngeal fibroma

86
Q

How does JNA present?

A

one sided nasal obstruction with recurrent bleeding

87
Q

symptoms of JNA?

A

Frequent epistaxis
Nasal obstruction and rhinorrhea
conductive hearing loss from eustation tube disfunction
Diplopia (due to erosion into cranial cavity and pressure on optic chiasma)
Rare: anosmia, recurrent otitis media and eye pain

88
Q

How is JNA diagnosed?

A

PE- smooth submucosal mass in posterior nasal cavity ( this is very hard to see, PA has to be looking/ have a suspicion of it)
CT scan

89
Q

what is the third most common fracture?

A

Nasal bone fracture
34%- from fights
28%- from accidents
23% from sports

90
Q

How to diagnose a NBF?

A

Look for asymmetry upon xray
Nasal patency
Epistaxis
*refer to ENR w/i 3-5 days unless more cute referral is needed

91
Q

TX for nasal bone fracture?

A

Manual realignment

septoplasty if there is septal deviation

92
Q

How does malignant nasopharyngeal and paranasal sinus tumors present?

A 
Hx of chronic sinus congestion 
recurrent nasal obstruction
Nasal discharge
intermittent epistaxis 
unilateral symptoms
93
Q

what are the symptoms of advanced lesions?

A

It depends on where the tumor has spread:

  1. widening of the bride of the nose
  2. Frontal headaches
  3. proptosis (eyes pushing out), diplopia or palpable orbital mass
94
Q

what doeswidening of the bride of the nose indicate?

A

the lesion is invading the olfactory region

95
Q

What do frontal headaches indicate?

A

extension through the cribriform plate or into the ethmoid sinuses

96
Q

what doproptosis, diplopia or palpable orbital mass indicate?

A

Invasion of the medial orbit

ClinMed NOSE (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions