nose & paranasal sinuses Flashcards
How long can viral particles remain viable on skin
2 hours
What is the most common cause of URIs
Rhinovirus
What is another name for influenza
Syncytial virus
How many episodes of the common cold will preschool kids have
5-7
2-3 for adults
What is the best way to diagnose URI
clinically
What are common findings with URI
conjunctival injection
nasal mucosa swelling
pharyngeal erythema
exudates & cobblestoning
how long do URI symptoms typically last
5-10 days
*can be up to 14
How long are people infectious with URI
as long as symptoms are present
What are the most common forms of rhinitis
allergic
vasomotor
rhinos medicamentosa
What is generally the cause of allergic rhinitis
Climate changing resulting in an increased amounts of pollen
what type of pollen is present in the spring
flowers and trees
What type of pollen is present in summer
flowers and grass
What type of pollen is present in fall
ragweed and mold
What type of immune response is allergic rhinitis
IgE
What are signs and symptoms of allergic rhinitis
nasal itching
watery rhinorrhea
sneezing
dry cough
itchy/watery eyes
What is seen on physical exam with allergic rhinitis
nasal polyps
allergic salute in kids
pale/boggy/bluish nasal mucosa
What is vasomotor rhinitis
increased secretion from nasal mucosa precipitated by temp or humidity, odors, alcohol, neuromuscular imbalance
What is senile rhinitis
clear rhinorrhea from increased sensitivity of the vidian nerve
What is rhinitis medicamentosa
rebound congestion from overuse of nasal decongestants
What is acute sinusitis / rhino sinusitis (ARS)
Inflammation in nasal cavity and para-nasal sinuses
What is the most common etiology of ARS
Viral infections
what are the risk factors of ARS
Older age
recent URI
chronic rhinitis
cigarette smoking
allergies
What is the main difference between viral and bacterial sinusitis
Bacterial will have purulent discharge and duration >10days and worsening
How do you treat bacterial sinusitis
amoxicillin- clavulanate (Augmentin) for 10-14 days
*If PCN allergy = doxy or levaquin
When do you use abx with bacterial sinusitis
when s/sx have lasted >10days or if symptoms are severe / complicated
What duration of time does sinusitis have to last to be considered chronic
> 12weeks
What are symptoms of chronic sinusitis
persistent rhinorrhea
productive cough
foul breath
facial/dental pain
What are s/sx of complications with bacterial sinusitis
indications spread beyond paranasal sinuses to CNS, orbit, or surrounding tissue
*urgen referral to otolaryngologist
high persistent fever >102
vision changes
cranial nerve palsies
AMS
What is the imaging of choice when there are complications with acute bacterial sinusitis
CT
What are common pathogens for chronic sinusitis
s. aureus
S. pneumo
Anaerobes
Fungus
*mostly mixed flora
What are some nasal mucosal disorders
turbinate hypertrophy
rhinosinusitis
rhinitis
nasal polyposis
What are some nasal structural disorders
turbinal hypertrophy
septal disorders
adenoid hypertrophy
foreign body
tumors
What are some inflammatory nasal mucosal obstructions
rhinosinusitits
rhinitis
polyps
sarcoidosis
wegeners
What are some infectious nasal mucosal obstructions
HIV
Syphilis
TB
What types of medications can cause mucosal nasal obstruction
thyroid meds
BP meds
anti-depressants
NSAIDs
PDE-5 inhibitors
benzodiazepines
How do you treat a deviated septum
nasal endoscopy
surgery
implants
What is the most common cause of nasal obstruction in children
adenoid hypertrophy
What are symptoms of nasal hypertrophy
mouth breathing
mucopurulent discharge
snoring
sleep apnea
What can cause adenoid hypertrophy
Chronic inflammation
allergies
chronic sinus symptoms
What is long term damage that can occur with adenoid hypertrophy
adenoid facies
*prolonged mouth breathing due to adenoid hypertrophy affects facial and dental growth/development
How do you diagnose adenoid hypertrophy
clinical suspicion
endoscopic visualization
How do you treat adenoid hypertrophy
adenoidectomy
What is the most common tumor of the nasal cavity
nasal polyp
What will be seen on physical exam with nasal polyps
nasal obstruction
pale mucosa
fleshy mass with superficial vessels
Where are foreign bodies of the nose located
floor of nasal passage just under the inferior turbinantes
or
superiorly in nasal cavity just in front of middle turbinate
What is the risk with a button battery being up the nose
septal perforation within 4 hours
How can you remove foreign bodies from the nose
Fogarty catheter
Katz extractor
forceps
irrigation
what is a Keisselbach plexus
most common location for anterior epistaxis
Where do most nose bleeds occur
anterior
What is the source of posterior nose bleeds
posterolateral branches of sphenopalantine artery
What are the most common causes of nose bleeds
nose picking
dryness
allergic / viral rhinitis
foreign body
cocaine
blunt trauma
How do you treat anterior nose bleeds
clear clots
topical meds
+/- TXA
direct pressure for 15 min
cauterize
nasal packing
After cautery of the nose, what are you not allowed to do
blow nose or sneeze
how do you treat a posterior nose bleeds
tamponade the bleed
-Foley catheter
-Brighton
-simpson balloon
-arterial ligation
-embolization
What is the most common cause of facial pain
trigeminal neuralgia
What are some causes of facial pain
trigeminal neuralgia
trigeminal neuropathy
cluster-tic syndrome
glossopharyngeal neuralgia
What is trigeminal neuralgia
Paroxysmal attack of intense, sharp, superficial, stabbing pain in distribution of one or more branches of trigeminal nerve
Where is pain the highest with trigeminal neuralgia
at or near onset and describes as electric, shock-like, or stabbing
What is the treatment of choice for trigeminal neuralgia
carbamazepine
