Nose/Sinus Disorders Flashcards
1
Q
Epistaxis
A
- MC anterior (Kiesselbach plexus), posterior (Woodruff’s plexus/sphenopalatine artery)
- eti: trauma, inf, allergy, atrophic rhinits, coagulopathy, tmor, arteriosclerosis (old)
- s/s: anterior: unilateral, posterior: profuse, sensation of draining down post pharynx
- mgmt: anterior: compress x 10-15 min, +/- vasoconstrictive agents, cautery (silver nitrate/electrical), packing = last resort bc of comp risk (do for posterior +/ embolization, ligation)
2
Q
Nasal polyps
A
- eti: MC rxn to bact inf in kids, allergies, chronic sinusitis
- s/s: stuffiness/pressure/fullness in face, trouble smelling
- mgmt: steroid nasal spray (x 3 mos or PO x 6 day taper), saline rinses, ref for surg (may recur)
3
Q
Allergic rhinitis
A
- not typically < 6 mos old
- Samter’s triad: ASA sensitivity + nasal polyps + asthma (can lead to sev pansinusitis)
- s/s: pruritus, clear rhinorrhea, congestion, PND, allergic shiners & salute, Dennie’s lines
- ddx: rhinitis medicamentosa (Afrin, vasoconstriction)
- mgmt: allergen avoid, saline spray/rinse, PO deconget, nasal steroid, cetirizine ok for infants > 6 mos, leukotriene inhib (montelukast), allergist ref
4
Q
Sinusitis
A
- acute (< 4 wks), subacute, chronic (> 3 mos)
- MC viral
- Bact secondary to prior URI (S pneumo, H flu more cmn, M cat, S aureus poss - same as AOM), fungal if immunocomp’d
- no correlation between reported sinus HA and CT rpt
- peds: unusual as sinuses not fully formed, may have bad breath, abrupt onset
- mgmt: 80% improve w/o any abx w/in 2 wks, abx after 10-14 days (amox, septra, doxy = 1st, augmentin/levo if sev or recent abx use), supportive, afrin short-term
- send to ED if facial cellulitis, proptosis, vision change, AMS
- comps: orbital cellulitis/abscess, osteomyelitis (Pott’s puffy tumor), intracranial extension, cavernous sinus thrombosis - get MR (CT sens, not spec)
5
Q
FB
A
- s/s: unilater, purulent, foul-smelling d/c, black or epistaxis if battery (emergent!)
- wu: SR if unable to visualize
- mgmt: urgent ENT ref for button batteries, magnets attached across septum, penetrating/impacted FB, or posterior FB
- occulsive: nose blowing or mouth-to-mouth via parent
- non-occlusive: instrumentation
