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Foundations- Nose and Sinus > Nose and Sinus > Flashcards

Nose and Sinus Flashcards

1
Q

What is the most frequent acute illness in the US?

A

URI

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2
Q

How many URI episodes do preschool children have per. year?

A

5-7

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3
Q

How many URI episodes do adults have per. year?

A

2-3

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4
Q

What virus is the most common cause for the common cold?

A

Rhinovirus

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5
Q

Transmission of the common cold

A
  1. Respiratory droplets

2. Direct contact

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6
Q

Incubation period of the common cold

A

2-3 days

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7
Q

Typical duration of the common cold

A

3-10 days

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8
Q

Day 1 sx’s of the common cold

A

Sore throat

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9
Q

Day 2-3 sx’s of the common cold

A

Nose sx’s, congestion, drainage

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10
Q

Day 4-5 sx’s of the common cold

A

Cough

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11
Q

Why should you to discontinue Nasal Decongestant Spray (Afrin) after 3 days?

A

To avoid rebound congestion

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12
Q

Why do you want to use antihistamines (Diphenhydramine) with a decongestant with a common cold?

A

to avoid drying out

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13
Q

What is the most common cause of acute rhinosinusitis?

A

Viral: Rhinovirus, influenza, parainfluenza

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14
Q

What are some ref flags with acute rhinosinusitis?

A
  1. Fever >102 with severe HA
  2. Abnormal vision, EOM, proptosis, papilledema
  3. AMS
  4. CN palsies
  5. Meningeal signs
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15
Q

When would a CT with contrast be indicated for acute rhinosinusitis?

A

Suspected complicated acute bacterial rhinosinusitis (ABRS)

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16
Q

What imaging study would you order for recurrent or treatment resistant sinusitis?

A

Noncontrast CT

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17
Q

Features of bacterial cause

A
  1. Persistent signs or sx’s lasting 10 or more days
  2. Onset with severe sx’s lasting @ least 3 consecutive days @ beginning of illness
  3. “Double-worsening”
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18
Q

Acute rhinosinusitis treatment days 1-9?

A

Supportive care

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19
Q

Acute rhinosinusitis abx treatment?

A

Amoxicillin-clavulanate (Augmentin) x5-7 days

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20
Q

When would you give a high dose (2 g PO BID) of Amoxicillin-clavulanate for the treatment of Acute rhinosinusitis?

A
  1. > 65 y/o
  2. Recent hospitalization
  3. Antibiotic tx in past month
  4. Immunocompromised
  5. S. pneumo penicillin resistance > 10%
21
Q

What abx are NOT recommended in the treatment of Acute rhinosinusitis?

A
  1. Macrolides
  2. Trimethoprim-sulfamethoxazole (Bactrim)
  3. 2nd or 3rd generation cephalosporins
22
Q

Indications for referral for urgent endoscopy or surgical biopsy in acute rhinosinusitis?

A
  1. Fungal sinusitis or granulomatous disease is suspected
  2. Failure to respond to 1st and 2nd line antimicrobial tx
    + other obvious reasons listed
23
Q

Complicated of acute rhinosinusitis?

A
  1. Periorbital or orbital cellulitis
  2. Meningitis
  3. Osteomyelitis of sinus bone
  4. Intracranial abscess
24
Q

What is the number one risk factor for chronic rhinosinusitis?

A

Allergic rhinitis

25
Q

chronic rhinosinusitis Ddx?

A
  1. Trigeminal neuralgia
  2. Migraines, HA’s
  3. Recurrent, acute rhinosinusitis
  4. Allergic rhinitis
26
Q

Chronic rhinosinusitis supportive care treatments

A
  1. Nasal irrigation
  2. intranasal glucocorticoids
  3. Topical/oral antimicrobials
  4. Oral glucocorticoids
  5. Antileukotriene agents
27
Q

Surgical Treatment in chronic rhinosinusitis if the patient can’t manage the sx’s

A

Endoscopic sinus surgery

28
Q

Risk factors for allergic rhinitis?

A
  1. Early use of abx
  2. First born
  3. Male sex
  4. Birth during pollen season
  5. Presence of allergen-specific IgE
29
Q

Intermittent allergic rhinitis classification

A

< 4 days/week OR < 4 weeks

30
Q

Persistent allergic rhinitis classification

A

> 4 days/week AND >4 weeks

31
Q

Moderate-severe allergic rhinitis

A
  1. Sleep disturbance
  2. Impaired school/work performance
  3. Impaired daily activities, leisure, and/or sport activities
  4. Troublesome sx’s
32
Q

Perennial allergic rhinitis

A

Year round sx’s

33
Q

Allergic Rhinitis physical exam findings

A
  1. “Allergic Shiners”
  2. “Allergic salute”
  3. “Cobblestoning”- hyperplastic lymphoid tissue in pos. pharynx
  4. Pale, bluish nasal mucosa
  5. Clear rhinorrhea
  6. TM retractions or serous fluid behind TM
34
Q

What is the most common allergy skin test?

A

Prick skin test

-Given serum with allergen, trigger mast cels if sensitivity there

35
Q

What is the most sensitive skin test?

A

Intradermal skin test

36
Q

What do you want to remember to do with allergy skin testing?

A

Discontinue medications as they may interfere with testing/results

37
Q

What is the benefit of a serum IgE for specific allergens?

A
  • DONT have to stop meds

- Geographic panel

38
Q

Allergic Rhinitis medication options

A
  1. Glucocorticoid + antihistamine nasal spray
  2. Oral Antihistamines-2nd or 3rd generation (Claritin, Allegra, Zyrtec)
  3. Nasal decongestant sprays
  4. Mast cell stabilizer
39
Q

Nonallergic/Vasomotor Rhinitis etiology

A
  • Abnormal autonomic regulation of innervation of nose

- Nasal eosinophilia without allergen sensitivity

40
Q

Nonallergic/Vasomotor Rhinitis triggers

A
  1. Temperature changes-Humidity
  2. Eating-Hot or spicy
  3. Exposure to odors/chemicals
  4. Alcohol use
41
Q

What is the first line treatment of nonallergic/vasomotor rhinitis?

A

Topical intranasal glucocorticoids

42
Q

What is the most common cause of Epistaxis?

A

Nasal trauma-Nose picking

43
Q

If someone is having a severe bleed, what lab would you order?

A

Hematocrit: Type and crossmatch

44
Q

Conservative treatment for epistaxis

A

Occlusion, continuous x 10-15 minutes

45
Q

Samter triad

A

Nasal Polyps +Asthma= Avoid Aspirin

-Immunologic salicylate sensitivity causes severe episode of bronchospasm

46
Q

Nasal polyps treatment

A

Topical intranasal corticosteroids

47
Q

Malignant neoplasms

A

Squamous cell carcinoma

Adenocarcinoma

48
Q

Presentation of malignant neoplasms

A

Obstruction + Epistaxis

Foundations- Nose and Sinus (1 decks)

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