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Nose and Paranasal Sinuses Flashcards

1
Q

Rhinorrhea

A

runny nose

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2
Q

Symptoms of a “cold”; describes the inflammation of the mucous membranes lining the nasal cavity, usually with nasal discharge

A

Coryza

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3
Q

Symptomatic disorder of the nose characterized by itching, nasal discharge, sneezing, and nasal airway obstruction

A

Rhinitis

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4
Q

Symptomatic inflammation of the nasal cavity and paranasal sinuses

A

Rhinosinusitis

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5
Q

Induction of rhinitis symptoms after allergen exposure by an IgE-mediated immune reaction; accompanied by inflammation of the nasal mucosa and nasal airway hyperreactivity

A

Allergic Rhinitis

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6
Q

Most frequent acute illness in the US and industrialized world

A

Upper Respiratory Tract Infection (URI)

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7
Q

transmission of URI

A
  1. Hand contact
    - Cold-inducing viruses may remain viable on human skin for up to 2 hrs
  2. Droplet transmission
    - coughing or sneezing
  3. Contaminated fomites
    - can survive on surfaces for several hrs
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8
Q

URI lasts for how long in kids?

A

10 - 14 days-up to 3 weeks

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9
Q

Period of infectivity URI

A

Peak viral shedding occurs on the 2nd and 3rd day of illness
Low levels of viral shedding may persist for up to 2 weeks

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10
Q

risk factors for URI

A
  1. Exposure to children in daycare settings
  2. Psychological stress
  3. Less sleep and preexisting sleep disturbances
  4. Moderate physical exercise decreases the risk
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11
Q

Risk Factors for increased severity of URI symptoms

A
  1. Underlying chronic diseases
  2. Congenital immunodeficiency disorders
  3. Malnutrition
  4. Cigarette smoking
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12
Q

MC sx of URI

A

MC:
1. Rhinitis
2. Nasal congestion
3. Runny nose

other:
1. Sneezing
2. Sore or scratchy throat
3. Cough
4. Malaise
5. HA
6. Fever - less common in adults
7. Conjunctivitis

Symptoms due to immune response to infection
Usually develop in the first day after inoculation

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13
Q

on PE you see:
Nasal mucosal swelling
Nasal discharge or congestion
Pharyngeal erythema
Conjunctival injection
Lung examination is clear
TMs may have fluid but no sign of infection
what could it be?

A

URI

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14
Q

complications with URI

A

Secondary bacterial infections
- Rhinosinusitis
- OM
- Pneumonia

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15
Q

tx for URI

A

supportive only
1. NSAIDS/Acetaminophen
2. Fluids
3. Nasal saline irrigation
4. Oral decongestants
5. Nasal decongestants - limited to a few days

NO ANTIBIOTICS

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16
Q

tx for URI

A

supportive only
1. NSAIDS/Acetaminophen
2. Fluids
3. Nasal saline irrigation
4. Oral decongestants
5. Nasal decongestants - limited to a few days

NO ANTIBIOTICS

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17
Q

Which sinuses are present at birth?

A

Maxillary and Ethmoid

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18
Q

which sinuses develop after age 2

A

Sphenoid
start develop during first two years of life, completing full growth and size at age 12

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19
Q

Which sinuses develop after age 12?

A

Frontal
full completion not until adolescence

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20
Q

MC sinus for Acute Bacterial Rhinosinusitis

21
Q

MC precursor for Acute Bacterial Rhinosinusitis

22
Q

causes of acute bacterial rhinosinusitis

A
  1. viral URI - MC
  2. Allergic Rhinitis
    - Ostial obstruction by mucosal edema or polyps
  3. NG tube - risk factor for nosocomial sinusitis
  4. Dental infections - maxillary sinus
  5. Mucous abnormality - Cystic Fibrosis
  6. Chemical irritants
  7. Foreign bodies
  8. Tumors
  9. Granulomatous diseases - Wegener’s granulomatosis
23
Q

pathophys of Acute Bacterial Sinusitis

A
  1. Impaired mucociliary clearance
  2. Inflammation of the nasal mucosa
  3. Obstruction of the ostiomeatal complex (aka sinus pore)
    - Edematous mucosa causes obstruction of the complex = accumulation of mucus in the sinus cavity that gets secondarily infected by bacteria
24
Q

Largest sinus with single drainage pathway that is easily obstructed
Unilateral facial fullness, pressure, tenderness over cheek,
Referred pain to upper incisor and or canine teeth
where is the sinus pain?

A

Maxillary (MC)

25
Often accompanies Maxillary Pain or pressure on high lateral wall of nose, often referred to orbits where is the sinus pain?
Ethmoid
26
Associated with “pansinusitis” which is infection of all sinus cavities on one side Points to pain on vertex of head where is the sinus pain?
Sphenoid
27
Pain and tenderness on forehead: pain elicited by palpation of orbital roof just below medial end of eyebrow where is the sinus pain?
frontal
28
pain around cheek or upper teeth where is the sinus pain
maxillary
29
pain between eyes or retro orbital where is the sinus
ethmoid
30
pain above eyebrow where is the sinus pain
frontal
31
pain in upper half of face or retro orbital with radiation to occiput where is the sinus pain
sphenoid
32
s/s of Acute Bacterial Rhinosinusitis
Nasal congestion and obstruction Purulent nasal discharge Tooth pain Facial pain or pressure, worse with bending over Fever Fatigue Cough Hyposmia or anosmia Ear pressure or fullness Headache Halitosis
33
criteria diagnosis for Acute Bacterial Rhinosinusitis
1. s/s lasting +10 days not improving 2. Onset of severe s/s of high fever and purulent nasal discharge or facial pain for 3 - 4 d 3. s/s viral URI that slowly improve but then worsen after 5 - 6 d
34
diagnosing Acute Bacterial Rhinosinusitis
1. Clinical 2. Sinus radiography - Not for routine cases 3. CT scan - Study of choice; not routinely done 4. Nasal culture - blind swab or nasal secretions - Not reliable and not useful - recovery of bacteria from paranasal sinus --- Sinus aspiration - invasive and not always available
35
type of rhinosinusitis complication of critically ill patient
Nosocomial Sinusitis S. aureus P. aeruginosa Anaerobes Serratia Klebsiella Enterobacter species
36
clinical findings of nosocomial sinusitis
Often critically ill Suspect if risk factors and fever
37
how to confirm nosocomial sinusitis
CT scan
38
tx for ARBS
1. Observation for 7-10 d for uncomplicated, immune competent, reliable f/u 2. NSAIDS, nasal saline sprays and intranasal decongestants have shown to help sx - Oxymetazoline 1-2 sprays q6-8h for 3 days (Afrin) --- Watch for rebound congestion (rhinitis medicamentosa) - Intranasal steroids (Flonase) 3. abx if NO risk factors - Augmentin --- Clavulanate - coverage for H. flu and M. cat --- Evidence stronger in children for adding Clavulanate 4. Antibiotics IF risk factors - augmentin - high dose
39
what is not recommended for abx tx for ARBS due to high rates of resistance to S. pneumo
Macrolides Bactrim 2nd and 3rd gen Cephalosporins
40
abx for ARBS if PCN allergic: anaphylaxis
Doxycycline Levofloxacin (Levaquin) Moxifloxacin (Avelox) Azithromycin (Zithromax)
41
abx for ARBS if PCN allergy but can tolerate Cephalosporins
Clindamycin PLUS 3rd generation Cephalosporin - Cefixime (Suprax) - Cefpodoxime (Vantin)
42
management for ARBS
abx for 7 - 10 days Intranasal corticosteroids NSAIDS for pain Nasal saline lavage
43
complications with ARBS
1. Orbital cellulitis and abscess - ethmoid - CT scan or MRI - Drainage of abscess - IV antibiotics - Vanc + Ceftriaxone 2. Frontal subperiosteal abscess - Pott's Puffy Tumor - frontal bone osteomyelitis - Tender, doughy swelling over forehead - Drainage of abscess and frontal sinus - IV antibiotics 6 wks - cx sensitive 3. Intracranial complications - Epidural abscess, subdural empyema, meningitis, dural-vein thrombophlebitis - frontal or sphenoid - Cavernous sinus thrombophlebitis - blood clot within cavernous sinus (base of brain) --- Drains deoxygenated blood from brain back to heart
44
Invasive, life-threatening, opportunistic infection of sinuses, nasal passages, oral cavity, and brain caused by saprophytic fungi MC in Immunocompromised patients
Invasive Fungal Sinusitis Includes: Rhinocerebral mucormycosis (molds) Other invasive fungal infections - Aspergillus
45
1. severe facial pain 2. Nasal drainage clear / straw colored 3. Black eschar on middle turbinate 4. Spreads to orbits and cavernous sinus - Orbital swelling and cellulitis - Proptosis, ptosis, decreased EOM - Retro orbital or periorbital pain
Invasive Fungal Sinusitis can involve: Nasopharyngeal ulcerations CN V and VII involvement - more advanced Bony erosions
46
how to diagnose invasive fungal sinusitis
Nasal endoscopy with biopsy
47
tx for invasive fungal sinusitis
1. Surgical debridement 2. IV Amphotericin B - switch to oral Itraconazole for 3-6 m after improvement
48
MC pathogen to cause ARBS
1. strep pneumo 2. h. flu
49
what pathogen is MC in dental infection with ARBS
anaerobes

EENT (11 decks)

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