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IPAP Senior ENT > Nose & Sinus > Flashcards

Nose & Sinus Flashcards

1
Q

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

A

Ostiomeatal complex

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2
Q

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

A

ACute Viral Rhinosinusitis (common cold

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3
Q

complication of acute viral rhinosinusitis

A

ETD
OM w/ effusion
acute bacterial sinusitis

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4
Q

Tx of Acute Viral Rinosinusitis

A

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

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5
Q

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

A

Acute Bacterial Rhinosinusitis (ABRS)

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6
Q

predisposing facters to ABRS

A

URI, allergies, mechanical obstruction (deviated septum)

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7
Q

bugs associated w/ ABRS

A

Community aquired- S. pneumoniae, H. influenzae

Hospital aquired- P. aeruginosa, S. aureus

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8
Q

Presentation of ABRS

A

Facial pain/pressure

Fever

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9
Q

3 things to ID ABRS vs AVRS

A
  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)
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10
Q

Classifications of ABRS

A

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

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11
Q

Most common paranasal sinusitis

A

Acute Maxillary sinusitis

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12
Q

Sx of Acute Maxillary Sinusitis

A

Unilat facial fullness/pressure over cheek

referred tooth pain (from dental infection)

remove tooth/drainage of periapical abcess resolve infection

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13
Q

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

A

Acute Ethmoid Sinusitis

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

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14
Q

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

A

Acute sphenoid sinusitis

seen w/ pansinusitis

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15
Q

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

A

Acute Frontal Sinusitis

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16
Q

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

A

Hospital associated Sinusitis

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17
Q

imaging considered for Tx failures w/ Acute Rhinosinusitis?

A

CT imaging of choice

18
Q

Tx for ABRS

A
  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
19
Q

ABX Tx for ABRS

A

1st line Amoxicillin-clavulanate (augmentin)

PCN allergy Doxy or Clinda + cephalosporin (Cefixime)

20
Q

ABX Tx in ABRS if

A
  1. signs & Sx’s persist > 10 days
  2. Severe Sx’s
  3. Sx’s worsen after period of improvement
21
Q

Orbital cellulitis / abcess complication presents as ? after ABRS

A 
Change in ocular exam
pain w/EOM
proptosis
gaze restriction
orbit pain
22
Q

Tx of Orbital Cellulitis / abcess cpmplication of ABRS

A

CT
IV ABX + surgery
STAT Ophthalmology consult

23
Q

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

A
  1. osteomyelitis

2. Prolonged IV ABX + removal of necrotic bone

24
Q

if suspected intracranial spread of ABRS what imaging should be obtained

A

MRI (Danger Triangle)

25
Q

When to refere ABRS

A
  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
26
Q

Nasal vestibulitis

A

inflammation/infection of nasal vestibule from folliculitis

manipulation/hair trimming

MCC S. aureus

27
Q

Tx of Nasal Vestibulitis

A

Dicloxacillin 250mg po QID x 7-10 w/ mupirocin topical TID

I&D furuncle if present

28
Q

Pt’s w/ invasive fungal sinusitis usually are

A

immunocompromised

29
Q

Sx’s w/ invasive Fungal Sinusitis are

A

usually similar to ABRS though facial pain typically more severe

30
Q

Diagnosis of Rhinocerebral Mucormycosis require

A

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

31
Q

Tx of invasive fungal sinusitis

A

Ampho B DOC
Surgery - wide debridement

medical surgical emergency

32
Q

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

A

Allergic Rhinitis

33
Q

Physical findings of Allergic rhinitis

A
  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
34
Q

Tx of allergic rhinitis

A

DOC* Intranasal Corticosteroids (relief may take 2 weeks)

35
Q

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

A

Olfactory dysfunction

36
Q

Location of majority of epistaxis

A

anterior - kiesselbach’s plexus

37
Q

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

A

artherosclerosis & HTN

bigger arterial supply - woodruff’s plexus

38
Q

Tx of anterior nose bleeds?

A

Direct pressure x 15 min

examine & spray phenylephrine / oxymetazoline w/ 15min direct pressure

repeat + anesthetic (cocaine) & cautery

still bleeding nasal packing

39
Q

Pale yellow edematous mucosally covered mass associated w/ allergic rhinitis

A

Nasal polyps

40
Q

Nasal polyps + asthma & aspirin =

A

severe episode of bronchospasm

41
Q

nasal polyps found in child must r/o?

A

Cystic Fibrosis

42
Q

Tx of nasal polyps

A

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

IPAP Senior ENT (7 decks)

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