Nose & Sinus

Question 1

channel that links frontal sinus, anterior ethmoid air cells, & maxillary sinus to middle meatus, allowing airflow & mucociliary drainage

Answer 1

Ostiomeatal complex

Question 2

clear rhinorrhea, hyposmia, & nasal congestion with malaise, HA, & Cough ; erythematous engorged nasal mucosa

Answer 2

ACute Viral Rhinosinusitis (common cold

Question 3

complication of acute viral rhinosinusitis

Answer 3

ETD
OM w/ effusion
acute bacterial sinusitis

Question 4

Tx of Acute Viral Rinosinusitis

Answer 4

Zinc 75mg lozenges
nasal irrigation
Decongestants
pseudoephedtine 30-60 mg q 4-6 hrs /120mg BID
Oxymetazoline & phenylephrine nasal spray effective D/C after 3 days

Question 5

purulent nasal discharge w/ facial pain/pressure over sinuses, nasal obstruction, acute onset, cough, malaise, fever, HA

Answer 5

Acute Bacterial Rhinosinusitis (ABRS)

Question 6

predisposing facters to ABRS

Answer 6

URI, allergies, mechanical obstruction (deviated septum)

Question 7

bugs associated w/ ABRS

Answer 7

Community aquired- S. pneumoniae, H. influenzae

Hospital aquired- P. aeruginosa, S. aureus

Question 8

Presentation of ABRS

Answer 8

Facial pain/pressure

Fever

Question 9

3 things to ID ABRS vs AVRS

Answer 9

1. persists 10+ day w/o improvement
2. sever Sx’s w/fever >102F & purulent discharge facial pain 3-4days
3. worsening Sx after initial improvement (double -sickening)

Question 10

Classifications of ABRS

Answer 10

acute < 4 weeks
subacute 4-12 weeks
chronic > 12 weeks
Recurrent >/= 4 episodes in a year

Question 11

Most common paranasal sinusitis

Answer 11

Acute Maxillary sinusitis

Question 12

Sx of Acute Maxillary Sinusitis

Answer 12

Unilat facial fullness/pressure over cheek

referred tooth pain (from dental infection)

remove tooth/drainage of periapical abcess resolve infection

Question 13

localized pain/pressure over high lateral wall of nose between eyes may radiate to orbit is what kind of sinusitis?

Answer 13

Acute Ethmoid Sinusitis

also may be accompanied w/acute maxillary dinusitis Sx’s

Question 14

Pt complains of HA “in middle of head” points to vertex, what sinusitis

Answer 14

Acute sphenoid sinusitis

seen w/ pansinusitis

Question 15

pain tenderness of forehead elicited by palpation of orbital roof below medial end of eyebrow is what type of sinusitis

Answer 15

Acute Frontal Sinusitis

Question 16

Hospital Pt w/unknown source of fever & NG tube present

Answer 16

Hospital associated Sinusitis

Question 17

imaging considered for Tx failures w/ Acute Rhinosinusitis?

Answer 17

CT imaging of choice

Question 18

Tx for ABRS

Answer 18

1. NSAIDS/Tylenol
2. Irrigation
3. Seudaphed 30-120mg (240mg/day)
4. Topical Decongestants (oxymetazoline) no longer than 3 days
5. Intranasal corticosteroids (mometasone 200mcg BID x 21 dsys)
6. ABX? controversial

Question 19

ABX Tx for ABRS

Answer 19

1st line Amoxicillin-clavulanate (augmentin)

PCN allergy Doxy or Clinda + cephalosporin (Cefixime)

Question 20

ABX Tx in ABRS if

Answer 20

1. signs & Sx’s persist > 10 days
2. Severe Sx’s
3. Sx’s worsen after period of improvement

Question 21

Orbital cellulitis / abcess complication presents as ? after ABRS

Answer 21

Change in ocular exam
pain w/EOM
proptosis
gaze restriction
orbit pain

Question 22

Tx of Orbital Cellulitis / abcess cpmplication of ABRS

Answer 22

CT
IV ABX + surgery
STAT Ophthalmology consult

Question 23

Tender swelling of forehead may be a (1) complication of ABRS requiring (2) Tx

Answer 23

1. osteomyelitis

2. Prolonged IV ABX + removal of necrotic bone

Question 24

if suspected intracranial spread of ABRS what imaging should be obtained

Answer 24

MRI (Danger Triangle)

Question 25

When to refere ABRS

Answer 25

1. failure to resolve after adequate ABX 2. Nasal endoscopy & CT when Sx's longer than 4-12 wks 3. suspect extension of disease out of sinus cavity 4. facial swelling 5. proptosis 6. immunocompromised

Question 26

Nasal vestibulitis

Answer 26

inflammation/infection of nasal vestibule from folliculitis manipulation/hair trimming MCC S. aureus

Question 27

Tx of Nasal Vestibulitis

Answer 27

Dicloxacillin 250mg po QID x 7-10 w/ mupirocin topical TID I&D furuncle if present

Question 28

Pt's w/ invasive fungal sinusitis usually are

Answer 28

immunocompromised

Question 29

Sx's w/ invasive Fungal Sinusitis are

Answer 29

usually similar to ABRS though facial pain typically more severe

Question 30

Diagnosis of Rhinocerebral Mucormycosis require

Answer 30

nasal biopsy - silver stain (branching nonseptate hyphae) & necrosis w/ vascular occlusion

Question 31

Tx of invasive fungal sinusitis

Answer 31

Ampho B DOC Surgery - wide debridement medical surgical emergency

Question 32

clear rhinorrhea, sneezing, tearing, eye irritation, & pruritus indicate,

Answer 32

Allergic Rhinitis

Question 33

Physical findings of Allergic rhinitis

Answer 33

1. "Allergic Shiners" 2. conjunctival erythema 3. excessive tearing 4. Pale/violaceous Terbinates 5. Nasal polyps (yellowish) 6. Rhinorrhea/ turbinate hypertrophy 7. constant wiping nose 8. Coble stoning posterior oropharynx

Question 34

Tx of allergic rhinitis

Answer 34

DOC* Intranasal Corticosteroids (relief may take 2 weeks)

Question 35

Subjective diminished smell/taste; no nasal obstruction, w/ odjective decreased in olfaction

Answer 35

Olfactory dysfunction

Question 36

Location of majority of epistaxis

Answer 36

anterior - kiesselbach's plexus

Question 37

epistaxis w/ posterior bleeds is associated w/? & are more severe b/c?

Answer 37

artherosclerosis & HTN bigger arterial supply - woodruff's plexus

Question 38

Tx of anterior nose bleeds?

Answer 38

Direct pressure x 15 min examine & spray phenylephrine / oxymetazoline w/ 15min direct pressure repeat + anesthetic (cocaine) & cautery still bleeding nasal packing

Question 39

Pale yellow edematous mucosally covered mass associated w/ allergic rhinitis

Answer 39

Nasal polyps

Question 40

Nasal polyps + asthma & aspirin =

Answer 40

severe episode of bronchospasm

Question 41

nasal polyps found in child must r/o?

Answer 41

Cystic Fibrosis

Question 42

Tx of nasal polyps

Answer 42

1st 1-3 months topical nasal corticosteroids prednisone 6-day tapered 30mg day 1 - 5mg on day 6 if large /resistant to Tx surgical removal