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Foundations II (Jess) > Nose and Sinus > Flashcards

Nose and Sinus Flashcards

1
Q

Most frequent acute illness in the U.S.?

A

URI

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2
Q

How often do children/adults get URIs?

A

Preschool children: 5-7 x per year

Adults: 2-3 x per year

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3
Q

Most common cause of common cold

A

Rhinovirus (30-50%)

Coronavirus (10-15%)
Influenza virus (5-15%)
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4
Q

Who are risk factors for the common cold?

Who is at risk for more severe complications?

A

daycare
at home parents
psychological stress
poor sleep

more severe:
chronic dz
immunodeficiency
malnutrition
cigarette smoking
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5
Q

Explain the normal course of the common cold and duration. (incubation, what symptoms normally present when?)

A

incubation: 2-3 days

Day 1 of sx: sore throat
day 2-3: nasal congestion, rhinitis
day 4-5: cough

duration: 3-10 days

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6
Q

Common sx with common cold

A 
rhinitis
nasal congestion
sore throat
cough
sneezing
malaise
\+/- fever
\+/- conjunctivitis
watery eyes
HA- mild
myalgias- mild
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7
Q

PE findings in common cold

A
  • nasal mucosal edema
  • nasal congestion
  • pharyngeal erythema
  • +/- adenopathy
  • clear lungs
  • +/- conjunctival injection
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8
Q

How do you dx common cold?

A

H&P!- aka clinical diagnosis

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9
Q

Tx of common cold

A

Supportive care

  • zinc, >75 mg
  • hypertonic nasal saline irrigation
  • nasal decongestant sprays
  • oral decongestants
  • intranasal ipratropium bromide (atrovent)
  • intranasal cromoly sodium
  • antitussives: dextromethorphan; codeine
  • expectorants: guaifenesin
  • analgesics: NSAIDS, acetaminophen

Pt education

  • expected duration
  • discuss abx
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10
Q

when should you use abx in common cold?

A

Only when you think pt will have complications like secondary bacterial infection

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11
Q

Acute Rhinosinusitis:
how many get it yearly?
men vs women?
age?

A

1 in 7-8 yearly
women> men
45-74 yo

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12
Q

Common cause of acute rhinosinisitis

A

Viral: rhinovirus, influenza, parainfluenza

bacterial- 0.5-2%

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13
Q

risk factors for Acute Rhinosinisitis

A
  • older age
  • smoking
  • air travel
  • changes in atmospheric pressure
  • swimming
  • asthma
  • allergies
  • dental dz
  • immunodeficiency
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14
Q

explain the process of acute rhinosinisitis

A

normal sterile environment

decreased drainage of thick secretions

mucosal edema and sinus inflammation

obstruction of sinus ostia

entrapment of bacteria- leading to infection

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15
Q

Most important sx of acute rhinosinisitis

A
  • nasal congestion/obstruction
  • purulent nasal discharge
  • facial pain or pressure
others (not highlighted):
tooth discomfort
fever
fatigue
cough
ear pressure
HA
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16
Q

Clinical signs of acute rhinosinisitis

A
  • erythema or edema of cheekbone or periorbital
  • cheek tenderness
  • percussion tenderness of upper teeth
  • purulent dischage in nose or pharynx
  • sinus pain w/ percussion
  • opacity of sinuses w/ transillumination
  • diffuse nasal mucosal edema, turbinate hypertrophy
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17
Q

What are some red flags to watch for in acute rhinosinusitis?

A
  • Fever > 102 w/ severe HA
  • Abnormal vision (diplopia, blindness)
  • change in mental status
  • periorbital edema
  • cranial nerve palsies
18
Q

How do you diagnose Acute rhinosinusitis?
If suspected complicated ABRS?
Recurrent resistent sinusitis?

A

clinically!

ABRS: CT w/ contrast

recurrent: Non contrast CT

19
Q

Indications of bacterial rhinosinusitis

A
  • lasting 10 or more days w/o improvement
  • fever > 102, purulent nasal discharge, facial pain
  • onset of worsening sx after initially improving (double-worsneing)
20
Q

from days 1-9, how do you treat acute Rhinosinusitis?

A

Supportive care

  • analgesics
  • saline irrigation
  • oral decongestants
  • intranasal glucocorticoids
21
Q

If bacterial acute Rhinosinusitis, how do you treat? How long?
w/ Penicillin allergy?

A

Amoxicillin-clavulanate (aka Augmentin) 500-875 mg BID; 5-7 days

-If penicillin allergy: doxycycline

22
Q

What do you NOT treat bacterial acute Rhinosinusitis with?

probs don’t need to know

A

macrolides
trimethoprim-sulfamethoxazole
cephalosporins

23
Q

Potential complications of acute Rhinosinusitis

A

periorbital/orbital cellulitis
meningitis
osteomyelitis of sinus bone
intracranial abscess

24
Q

How long does a pt need to have sx before saying it is chronic rhinosinusitis?

A

more than 12 weeks

25
Q

Possible sx that might indicate a pt has chronic rhinosinusitis

A
  • anterior/posterior nasal mucopurulent drainage
  • nasal obstruction/congestion
  • facial pain/pressure
  • reduction of smell
  • purulent mucus or edema in the middle meatus
  • polyps in nasal cavity
  • radiographic imaging showing mucosal thickening
26
Q

How do you treat chronic rhinosinusitis?

A
  • nasal irrigation
  • intranasal glucocorticoids
  • topical antimicrobials
  • oral antimicrobials
27
Q

Name some risk factors for allergic rhinitis?

how common is it?

A
  • fam hx
  • male
  • birth during pollen season
  • first born
  • early use of abx

affects 10-30% of the population and is increasing!

28
Q

How do you classify what kind of allergic rhinitis a pt has?

A
  • Intermediate: <4 days/week of less than 4 weeks
  • perisistant: >4 days/weel or more than 4 weeks
Mild: none of mod-severe criteria met
Mod-severe: 1 or more-
-sleep disturbance
-impaired work
-impaired daily activities
-troublesome sx
29
Q

What are some sx the pt might complain of if they have allergic rhinitis?

A 
sneezing
rhinorrhea
nasal congestion
cough
postnasal drip
irritability
fatigue
eye itching
30
Q

Physical exam findings that indication allergic rhinitis?

A
  • “allergic shiners”
  • “allergic salute”
  • pale bluish or pallor nasal mucosa
  • clear rhinorrhea
  • hyperplastic lymohoid tissue in posterior phargyn “cobblestoning”
  • TM retraction or serous fluff behind TM
31
Q

What is the most common allergy skin test?

A

Prick skin test

32
Q

What are some treatments options for allergic rhinitis?

A
  • Glucocorticoid nasal spray
  • Oral antihistamines
  • Nasal spray antihistamines
  • Mast cell stabilizer (ex= going to a person’s house w/ a cat)
33
Q

What are some possible triggers of nonallergic rhinitis?

A
  • temp changes
  • eating (ex= spicy food)
  • exposure to odors
  • alcohol use
34
Q

What differences in sx would you see in nonallergic rhinitis vs allergic rhinitis?

A

Would not see sneezing/itchiness as in allergic rhinitis

Nasal turbinates would be boggy, edematous, and more erythematous
In allergic rhinitis they are bluish

35
Q

Most common location for epistaxis? Most common causes?

A

Anterior! 95%

-Nasal trauma (aka nose picking)

36
Q

What are treatments of epistaxis?

A

1st- Conservative:

  • occlusion
  • lean forward to prevent swallowing of blood
  • cold compress to nasal bridge

2nd- Cautery
-silver nitrate or electrical

3rd- Nasal packing

  • nasal tampon
  • gauze packing
  • nasal baloon
37
Q

What is a bigger deal, anterior or posterior epistaxis bleed?
What is likely to be done?

A

Posterior!

Emergency, likely admit

38
Q

What are conditions a/w nasal polys?

If a child has nasal polyps, what do you think about?

A

allergic rhinitis, asthma, cystic fibrosis

children- think about cystic fibrosis

39
Q

What is Samter’s triad?

A

Nasal polyps + asthma = avoid aspirin!

immunologic salicylate sensitivity causes severe episode of bronchospasm

40
Q

How do you treat nasal polyps?

A
  • topical intranasal corticosteroids

- surgical excision

41
Q

What are the 2 possible malignant neoplasms of the nose/sinuses?

Risk factors of malignant neoplasms

A

squamous cell carcinoma
adenocarcinoma

tobacco smoke
HPV

Foundations II (Jess) (8 decks)

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