Nose and Sinuses Flashcards
How would you perform a physical exam for Nose/Sinus
Nose– nasal immuminator/otoscope
Neuro– CN 1 test
Sinus– palpate/percuss for tenderness
Anomsia
- what if it is unilateral with visual problems?
- what if it is bilateral with nasal problems?
loss of sense of smell
- consider CN 1 abnormality if unilateral with visual problems
- consider local problem if bilateral/nasal, also consider neuro condition liek Alzheimers
Epistaxis
- Anterior vs Posterior
nosebleed.
- Anterior: Klesselbach plexus, children, risks= winter, URI irritation, allergy, truma
-Posterior: Woodruffs plexus, older, harder to control. risks=HTN, liver dz, cocaine, blood thinner
Rhinitis
inflammation of mucus membrane of nose with stuffy, obstructed, runny nose
Acute rhinitis: ssxs and PE
Bilateral
rhinovirus, self-limiting. watery, profuse discharge, clear/yellow/green, malaise
PE: erythematous (red), swollen mucosa, low fever
Allergic rhinitis
- what is it? ssxs
- Allergic salute
- Allerfix shiners
PE
Labs
Bilateral
chronic, reccurent, very common
Ag trigger IgE on mast cells –> histmaine released == seasonal allergies
itchy nose, eyes, sneezy, bad breath
Salute= crease onnose from wiping shiners= blush discolor under eye
PE: red mucosa, pale if chronic, enlarged adenoids
Lab: eosinophilia may be present if stain on discharge, on CBC
Atrophic Rhinitis: what is it, ssxs, PE
Bilateral
nasal mucosa atrophied to stratified squamous epithelium. unknown etiology, bacteria common
ssxs: anomsia, epistaxis, congestion, smell
PE: dry/shiny membrne, tissue atrophy, yellow/green crusts that bleed when removed
Vasomotor Rhinitis
ssxs
pe
labs
bilateral
nonallergic, noninfectios. causedby PSNS dominance –> vasodilation and edema
ssxs like allergic + rinorrhea
triggered by emotions, cold air, smoke
PE: swollen nferior nasal turbinates, darkeend mucosa
labs: allergy trsts neg, nasal smear neg
cocaine use
ssxs, pe
bilateral
ssxs constant running nose, watery discharge, congested
PE chemical burns, septal perforation
trauma
unilateral
ominous sign for skull fracture if trauma involved, may be CS fluid. check with benedicts– should be clear!
coanal atresia
unilateral
congenital defect in septal development
test infant- becomes distressed if block unaffected nares
foreign
unilateral
discharge, malodorous
neoplasm
unilateral
bloody dscharge, may not be painful
Polyps
- what are they?
- epidemiology?
- ssxs?
- treatment?
soft, pedunculated lesions. emenate from nalsal mucosa/ paranasal sinuses
linked to chronic inflammation, ANS dysfunction, genetic predisposition, chronic infection, allergy predisposition
4: 1 MALE, >40
ssxs: no symptoms to nasal obstruction, postnasal drainage, dull HA, snoring, rinorrhea, epitaxis, hyposomia
surgically removed- return if the cause is not managed.
nasal septum problems- deviation from trauma
perforation vs abscess
perforation: from chronic infx, crusting, nasal surgery, TB, syphyilis, cocaine ue
abscess: rare, very dangerous
