Nose/Throat Flashcards
Rhinosinusitis
inflammation of one or more of the 5 paired paranasal sinuses
acute - Sxs < 4 weeks
subacute - Sxs 4-12 weeks
Chronic - Sxs > 12 weeks
Acute Rhinosinusitis
“common cold”
maxillary sinuses most common site, ethmoidal, sphenoidal, frontal
maxillary -> pain and tenderness over cheeks, could be referred to teeth
ethmoid -> retroorbital pain
frontal -> pain and tenderness over lower forehead
Sxs: rhinorrhea and nasal congestion
If viral Sxs improve w/n 7-10 days
Virus - rhinovirus and influenza
Tx: self limited
If bacterial Sxs DO NOT improve w/n 10 days
Bacterial Sxs: nasal congestion, purulent nasal discharge, facial pain (increases when pt bends forward), fever, fatigue
“double sickening” (URI Sxs w/ initial improvement followed by increasing nasal Sxs)
Bacteria - Strep pneumoniae, H influenzae
Dx: positive culture on sinus aspiration
Tx: decongestants, ABX (amoxicillin and trimethoprim/sulfamethoxazole)
Chronic Sinusitis
Sxs: nasal congestion, purulent discharge
Pain, HA, fever absent
Sxs present 2-3 months
Staph aureus, Enterobacteriaceae, and anaerobic orgranisms
Tx: sinus irrigation or surgical drainage
Rhinosinusitis complications
osteomyelitis, orbital cellulitis, cavernous sinus thrombosis
Rhinosinusitis X-ray
mucosal thickening, sinus opacification, air fluid levels
Rhinosinusitis Referral when….
S&S: high fever, rigors, lid edema, diplopia, pupillary abnormalities, ptosis, palsies of EOM
appears toxic
Sxs extend to orbit/bone/brain/cavernous sinus
Tx failed
anatomic abnormalities
Epistaxis
Etiology: trauma, ulceration, bleeding disorder (Osler-Weber-Rendu), inflammatory and neoplastic conditions (Wegener’s granulomatosis, midline granuloma, nasal malignancy)
Most common initial presentation of hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)
nosebleed
Where is the nosebleed coming from?
Anterior: U/L, continuous, moderate bleeding from anterior septum (Kiesselbach’s plexus)
recurrent lasting few minutes to 1/2 hour
Tx: sit up, lean forward, cotton soaked in vasoconstricing nose drops (phenylephrine or oxymetazoline) placed in vestibule of nose for 10-15 minutes
Posterior: intermittent, very brisk arterial bleeding w/ blood flowing posteriorly into pharynx
Dx: BP, Hct, pulse
Tx: sit up, lean forward, spraying nose w/ topical anesthetic and vasoconstricting
after bleeding controlled -> nasal packing or surgery (cautery)
most common site of epistaxis in pts taking anti platelet agents?
anterior epistaxis
Allergic Rhinitis
S&S: nasal congestion, sneezing, profuse watery discharge, itching of nose/throat/eyes, postnasal drip, tearing, conjunctival injection, nasal mucosa pale and edematous
Dx: IgE elevated
Tx: avoid allergen, antihistamine, sympathomimetics, corticosteroids, immunotherapy
Vasomotor Rhinitis
abnormal autoimmune response and vascular dilation of submucosal vessels
S&S: nasal stuffiness or rhinorrhea occurring w/ emotional upset and sexual arousal
sneezing ABSENT
Tx: humidifier, cessation of nasal sprays, antihistamine
Rhinitis Medicamentosa
overuse of topical nasal decongestants
after 3 days of use response to decongestant is blunted (tachyphylaxis)
cessation results in rebound nasal congestion
Cocaine abuse also causes nasal congestion and discharge leads to ischemic mucosal injury, atrophy, telltale sepal perforation
Midline granuloma (polymorphic reticulosis)
ulcerative destruction of upper respiratory tract
S&S: nasal stuffiness, crusting, granulations
Wegener’s granulomatosis
immune mediated dz
S&S: nasal obstruction, rhinorrhea, chronic sinusitis
necrotizing granulomatous lesions and vasculitis found in upper and lower airways
sarcoidosis
B/L nasal obstruction
Hypothyroidism and pregnancy could lead to…
nasal congestion
turbinates pale and edematous
Mechanical obstruction
U/L congestion, discharge, recurrent episodes of sinusitis
neoplasm - blood tinged discharge
Polyps - move freely, prefunculated and contender, appear as soft pale grey smooth structures
Nasal Congestion and discharge refer when…
to remove polyps, foreign bodies, suspect neoplasm, necrotizing inflammatory condition, deviated septum
Tx isn’t working
Pharyngitis (sore throat)
group A beta-hemolytic strep, Strep pyogenes
acute onset
difficulty swallowing, erythema, exudate, cervical adenopathy, fever > 100
Dx: throat culture gold standard
Tx: ABX IM benzathine PCN or PO phenoxymethyl PCN
if allergic to PCN -> PO erythromycin
GABS complications
peritonsillar cellulitis (tonsils edematous and inflamed)
grayish white exudate
peritonsillar abscess
retropharyngeal and parapharyngeal space infections
scarlet fever
acute rheumatic fever
acute glomerulonephritis
Epstein-Barr virus
causes mononucelosis
S&S: malaise, HA, fatigue followed by fever, sore throat, cervical lymphadenopathy, enlarged tonsils and erythema
Thrush
sore throat w/ white cheesy exudate
scarlet fever
sore throat w/ “sandpaper” erythematous rash in groin and axillae
