Nose MDT Flashcards
Main source of posterior nosebleed
Sphenopalatine artery
Symptoms and physical exam:
Acute, unilateral bleed from the anterior nasal cavity (most common)
High blood pressures
Epistaxis
Labs/studies for:
Epistaxis
Coagulation tests:
- PT
- aPtt
- TT
Treatment for:
Epistaxis
Direct pressure by compression of the nares continuously for 15 minutes
Short acting decongestants (phenylephrine)
Treatment for:
Inaccessible epistaxis
Packing
Anti-staph antibiotics (reduce toxic shock syndrome from packing)
-Cephalexin or Clindamycin
Benign nasal tumors arising from the mucosa of the nasal passages including the paranasal sinuses. Pale, most commonly semitransparent, edematous, mucosally covered masses commonly seen in patients with allergic rhinitis.
May result in chronic nasal obstruction and a diminished sense of smell
Nasal polyps
Plays a triggering role in nasal polyps
Infectious agents causing desquamation of the mucous membrane
Strongly associated with nasal polyps
Food allergies
In 20% to 50% of patients with polyps
Asthma
In 8-26% of patients with polyps
Aspirin intolerance
Occurs in 50% of patients with polyps
Alcohol intolerance
Labs/studies for:
Nasal polyps
CT of the nose and paranasal sinuses (evaluate extent of lesion)
Treatment for:
Nasal polyps
Corticosteroids:
Topical (fluticasone nasal for 1-3 months)
Oral (prednisone for 6 days)
Treatment for:
Recurrent polyposis (infections)
Remove polyps from the sinuses
Most frequently fractured bone in the body
Nasal pyramid (frontal bone, frontal process of maxilla, and perpendicular plate of the ethmoid bone)
Labs/studies:
Nasal trauma
Radiologic
Facial bone CT to exclude orbitals
Treatment for:
Nasal trauma
Acetaminophen
Nasal packing for epistaxis
Extreme nasal displacement: Emergency consult to ENT
Seasonal allergic rhinitis - usually caused by airborne allergens such as pollen
Hay fever
Perennial allergic rhinitis is usually caused by:
Dust mites
Animal dander
Mold
Immunoglobulin E mediated inflammatory response in the nasal mucosa that occurs after sensitization with a specific allergen
Allergic rhinitis
Symptoms and physical exam:
- Nose: Clear rhinorrhea, nasal pruritus, and sneezing, pale turbinates, nasal polyps
- Eye: Irritation, pruritus, conjunctival erythema, and excessive tearing
- Cough, bronchospasm, wheezing, dermatitis
- Allergen exposure
Rhinitis
Treatment for:
Rhinitis
Topical intranasal corticosteroids (flonase or nasonex) for 1-3 months
Antihistamines
Adjunctive treatments:
- Leukotriene Inhibitors (montelukast)
- Mass cell stabilizer (cromolyn)
- Intranasal anticholinergic agents (ipratropium bromide)
Follow up and patient education for:
Rhinitis
May be a delay in onset of relief of two or more weeks
Inflammation of mucous membrane of one or more paranasal sinuses. May be caused by microbial infection, allergic reactions, polyps, or severely deviated septum
Inflammation or an obstruction blocks drainage of mucus into the nasal cavity, fluid pressure builds up in the paranasal sinuses
Sinusitis
Typical pathogens of bacterial rhinosinusitis are:
Strep pneumoniae
Streptococci H influenzae
Less common:
-Staph aureus and Moraxella Catarrhalis
Symptoms and physical exam:
- Purulent yellow-green nasal discharge or expectoration
- Facial pain or pressure over the affected sinuses
- Nasal obstruction
- Acute onset of symptoms (1-4 weeks duration)
- Associated cough, malaise, fever, and headache
Sinusitis
Labs/studies for:
Sinusitis
Imaging (when difficult to evaluate)
Endoscopic or transantral cultures (complicated causes)
Treatment for:
Sinusitis
NSAIDS for pain
Oral or nasal decongestants (or both)
Intranasal corticosteroids
Antibiotics (fever, pain, purulent discharge sx for >10 days)
Antibiotic treatment for:
Severe sinusitis
High dose Amoxicillin/Clavulanate 2g/125mg
PCN allergy: Doxycycline
