Nose/Sinus

Question 1

URI facts. Incubation

Answer 1

most often acute illness. Preschool episodes: 5-7
Adults: 2-3. Rhinovirus
Incubation: Day 2-3, duration 7 days

Question 2

Common cold. Dx, complications, Tx

Answer 2

Nasal musocal edema, congestion, pharyngeal erythema, clear lungs, conjunctivel injection.
Dx: H&P,
complication: viral, bacterial sinusitis, COPD, acute asthma, AOM, ETD
Tx: supportive care, pt edu, Zinc, hypertonic nasal saline irrigation, nasal decongestant spray, Antitussive (codeine)
Analgesics (NSAID)

Question 3

Acute Rhinosinusitis Epi, Etiology, risk factors, PE, Red flags, Dx

Answer 3

1/8 people, more women, 45-74.
Eti: rhinovirus, influenze, parainflueza, rarely bacterial.
Risk factors: Old age, smoker, air travel, swimming, Asthma, allergies, dental disease.
PE: Nasal congestion/obstrustion, purulent nasal discharge, facial pain, teeth pressure.
Red flag: Fever, Diplopia, blindness, EOM, proptosis, opthalmoplegia, mental status, periorbital edema, cranial nerve palsies. Stiff neck.
Dx: clinical, ABRS, CT

Question 4

Acute Rhinosinusitis bacterial, Tx

Answer 4

Persistent symptoms 10+ days w/o improvement. Fever, purulent discharge, facial pain 3+ days, VURI 5+ days worsening.
Tx: Days 1-9, supportive care, Amoxicillin-clavul (augmentin) (500/125 PO BID)

Question 5

Acute Rhinosinusitis PCN allergic

Answer 5

doxy, 3rd gen cephalosporin. Dont give Macrolides, Bactrim

Question 6

Acute Rhinosinusitis that leads to hospitalization & referral.

Answer 6

Severe infection, hospital, anatomical onstruction, 1st & 2nd line drugs dont work, chronic rhinosinusitis, recurrent. allergies

Question 7

Acute Rhinosinusitis complication

Answer 7

preseptal (periorbital) or orbital cellulitis, Meningitis, Osteomyelitis, cranial abscess

Question 8

Chronic Rhinosinusitis causes.

Answer 8

Allergic rhinitis, environmental irritants, defective mucociliary clearance, recurrant VURIs.

Question 9

Chronic Rhinosinusitis PE, Tx,

Answer 9

purulent mucus in ethmoid region/middle meatus. mucopurulent, facial pain, pressure, loss smell, polyps
Tx: Nasal irrigation, intranasal glucocorticoids, antileukotrienes

Question 10

Allergic Rhinits, etiology, Epi, Risk factors, PE

Answer 10

10-30% of US, increasing prevelance. Fx, Male, 1st born, early use of antibiotics, maternal smoke, IgE over 100 IU/mL.
Etiology: B-cell, T-cell
PE: allergic shiners, allergic salute, membranes bluish color, TM retraction. pharynx cobblestoning (hyperplastic lymphatoid tissue).

Question 11

allergic rhinitis atopic triad

Answer 11

allergy rhinitis, excema, asthma

Question 12

Allergic rhinitis classification

Answer 12

intermittent <4, Persistent >4, seasonal, perennial

Persistent: Cant work, school, leisure.

Question 13

Allergic Rhinitis Tx

Answer 13

Tx: Glucocordicosteriod, antihistamines, Mast cell stabilizer, leukotriene receptor antagonist, nasal decongestant, patient ed = avoid allergies, saline irrigation.

Question 14

Nonallergic rhinitis Etiology, trigger, Dx, PE, Tx

Answer 14

Etiology: Abnormal nose innervation, nasal eosinophilia
Triggers: temp changes, eating, alcohol.
Dx: Diagnosis of exclusion
PE: nasal congestion, postnasal drainage, boggy. Tx: glucocorticoids, antihistamine

Question 15

Epistaxis types

Answer 15

Anterior = non-emergency
Posterior = emergency, internal carotid (sphenopalatine art)

Question 16

Epistaxis etiology, Hx, PE, Dx, if surgery is needed what do you need to do?

Answer 16

Trauma, dryness, neoplasm, drugs, alcohol, blood disorders, Atherosclerotic disease.
Hx: find causes, PE: vitals, airways, vasoconstrictors
Dx: PT/INR hematocrit = crossmatch.

Question 17

Epistaxis Tx, pt edu

Answer 17

Tx: Contraleral packing if severe. conservative measures, cold compression at bridge, cautery (silver nitrate), nasal packing
Pt edu: avoid vigorous exercise, spicy food, nasal trauma. toxic shock syndrome

Question 18

Nasal polyps etiology, PE, Tx

Answer 18

Etiology: unclear, allergic rhinitis, asthma, avoid aspirin. ID Samter triad (Nasal polyp + asthma = no aspirin)
PE: nasal obstruction, anosmia (loss of smell), rhinorrhea, post nasal drip. Cystic fibrosis
Tx: cortocosteroids, surgery

Question 19

Samter Triad

Answer 19

immunologic salicylate sensitivity = bronchospasm mostly kids due to Aspirin Allergy.

Question 20

Malignant neoplasms, etiology, Risk factors, PE, Dx, Tx

Answer 20

Squamous cell carcinoma & adenocarcinoma.
Risk factors: tobacco smoke, wood dust, HPV
PE: obstruction and epistaxis, face swell, seizure, nodal masses.
Tx: head/neck surgeon, neurosurgeon, radiation oncology.

Question 21

Chronic Rhinosinusitis Ddx

Answer 21

Trigeminal neuralgia, nonallergic rhinitis, headaches

Question 22

Allergic Rhinitis associations

Answer 22

allergic conjuctivitis, sinusitis, Asthma, Atopic dermatitis, ETD, Serous and acute Otitis Media

Question 23

Allergic rhinitis testing

Answer 23

Dx: clinical, Prick test - wheels, Serum IgE