Nose and Paranasal Sinuses Flashcards
On average, how many URI’s do preschool aged children have per year?
5-7 episodes
On average, how many URI’s do adults have per year?
2-3 episodes
Do adults typically have a fever in the setting of URI?
No, fever is uncommon in adults
What is the diagnosis work-up for URI’s?
Clinical diagnosis
What are some common physical exam findings of a URI?
Conjunctival injection, nasal mucosal swelling, pharyngeal erythema, exudates, cobbelstoning
What are risk factors for increased URI severity?
Comorbidities
Immunodeficiency
Malnutrition
Smoking
What is the most common forms of rhinitis?
Allergic rhinitis
Vasomotor rhinitis
Rhinitis medicamentosa
What kind of immune response causes allergic rhinitis?
IgE response
What type of cough maybe present in allergic rhinitis?
Dry cough
What will be the nasal physical exam findings in allergic rhinitis?
Pale, boggy or bluish nasal mucosa (venous engorgement)
“Allergic Salute” in kids
What is the role for intranasal corticosteroids when treating allergic rhinitis?
Shrink nasal polyps and mucosa
In elderly, what nerve sensitivity causes vasomotor rhinitis?
Vidian nerve
What is the treatment for vasomotor rhinitis?
Avoid irritant
What is the cause of green boogers?
Breakdown of WBC, does not indicate bacterial infection
What is the most common etiology of acute sinusitis?
Viral infection
The typical duration of a viral cause of acute sinusitis is 7-10 days, beyond 10 and symptoms worsening is indicative of what type of infection?
Bacterial
How do you differentiate a viral acute sinusitis from bacterial?
Viral - rhinorrhea may be discolored and will last 7-10 days in duration
Bacterial - Purulent discharge and duration longer than 10 days or high fever
What are the most common pathogens of bacterial acute sinusitis?
S. pneumoniae
H. influenza
M. catarrhalis
S. pyogenes
S. aureus
What is the treatment for bacterial acute sinusitis?
Amoxicillin-clavulanate (Augmentum) for 10-14 days (longer time to penetrate sinuses)
If PCN allergy: Doxy
What duration of symptoms define chronic sinusitis?
> 12 weeks
What are the symptoms of chronic sinusitis?
Persistent rhinorrhea
Productive cough
foul breath
Low grade fever
Malaise
Headache
Facial/dental apin
What is the imaging modality of choice in working up complicated acute bacterial sinusitis?
CT scan with contrast
What is the most common cause of nasal obstruction in children?
Adenoid Hypertrophy
What are symptoms of adenoid hypertrophy?
Mouth breathing
Mucopurulent discharge
Snoring
Sleep apnea
What are clinical manifestations of “adenoid facies?”
Open mouth
Flattening and elongation of midface
Retraction of upper lip
Narrowing of hard palate resulting in crowding of teeth
What is the treatment of adenoid hypertrophy?
Adenoidectomy
What is the most common tumor of the nasal cavity?
Nasal polyps (benign)
What is the treatment for nasal polyps?
Steroids (oral, topical, or injections)
Avoid ASA
Surgical excision for larger polyps
Test and treat for allergies
Why are we concerned when button batteries are shoved in the nasal cavity?
Will result in septal perforation in about 4 hours
Approximately 90% of nasal bleeds are
anterior
Most nasal bleeds are anterior and the most common anterior location for bleeds are in what structure area?
Klesselbach’s plexus
To stop epitaxis (anterior nose bleed) how long should direct pressure be supplied for?
15 minutes
What topical medications maybe used to help stop nasal bleeding?
Oxymetazoline (Afrin)
Boyette’s solution (4% lidocaine, phenylephrine, NS)
What is the treatment for posterior nasal bleeds?
Tamponade posterior bleeding (usually done by ENT)
What is the most common cause of facial pain?
Trigeminal neuralgia
Where is pain most often in trigeminal neuralgia?
Involves V2 and/or V3 subdivisions of trigeminal nerve
