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EENT > Nose and Paranasal Sinuses > Flashcards

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

A

maxillary

21
Q

MC precursor for Acute Bacterial Rhinosinusitis

A

viral URI

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
Q

Often accompanies Maxillary
Pain or pressure on high lateral wall of nose, often referred to orbits
where is the sinus pain?

A

Ethmoid

26
Q

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?

A

Sphenoid

27
Q

Pain and tenderness on forehead: pain elicited by palpation of orbital roof just below medial end of eyebrow
where is the sinus pain?

A

frontal

28
Q

pain around cheek or upper teeth
where is the sinus pain

A

maxillary

29
Q

pain between eyes or retro orbital
where is the sinus

A

ethmoid

30
Q

pain above eyebrow
where is the sinus pain

A

frontal

31
Q

pain in upper half of face or retro orbital with radiation to occiput
where is the sinus pain

A

sphenoid

32
Q

s/s of Acute Bacterial Rhinosinusitis

A

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
Q

criteria diagnosis for Acute Bacterial Rhinosinusitis

A
  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
Q

diagnosing Acute Bacterial Rhinosinusitis

A
  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
Q

type of rhinosinusitis complication of critically ill patient

A

Nosocomial Sinusitis
S. aureus
P. aeruginosa
Anaerobes
Serratia
Klebsiella
Enterobacter species

36
Q

clinical findings of nosocomial sinusitis

A

Often critically ill
Suspect if risk factors and fever

37
Q

how to confirm nosocomial sinusitis

A

CT scan

38
Q

tx for ARBS

A
  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
Q

what is not recommended for abx tx for ARBS due to high rates of resistance to S. pneumo

A

Macrolides
Bactrim
2nd and 3rd gen Cephalosporins

40
Q

abx for ARBS if PCN allergic: anaphylaxis

A

Doxycycline
Levofloxacin (Levaquin)
Moxifloxacin (Avelox)
Azithromycin (Zithromax)

41
Q

abx for ARBS if PCN allergy but can tolerate Cephalosporins

A

Clindamycin PLUS 3rd generation Cephalosporin
- Cefixime (Suprax)
- Cefpodoxime (Vantin)

42
Q

management for ARBS

A

abx for 7 - 10 days
Intranasal corticosteroids
NSAIDS for pain
Nasal saline lavage

43
Q

complications with ARBS

A
  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
Q

Invasive, life-threatening, opportunistic infection of sinuses, nasal passages, oral cavity, and brain caused by saprophytic fungi
MC in Immunocompromised patients

A

Invasive Fungal Sinusitis
Includes:
Rhinocerebral mucormycosis (molds)
Other invasive fungal infections - Aspergillus

45
Q
  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
A

Invasive Fungal Sinusitis
can involve:
Nasopharyngeal ulcerations
CN V and VII involvement - more advanced
Bony erosions

46
Q

how to diagnose invasive fungal sinusitis

A

Nasal endoscopy with biopsy

47
Q

tx for invasive fungal sinusitis

A
  1. Surgical debridement
  2. IV Amphotericin B
    - switch to oral Itraconazole for 3-6 m after improvement
48
Q

MC pathogen to cause ARBS

A
  1. strep pneumo
  2. h. flu
49
Q

what pathogen is MC in dental infection with ARBS

A

anaerobes

EENT (11 decks)

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