nose triggers Flashcards
can be caused by:
Viral URI (MC)
Allergic rhinitis
NG tube
dental infections
acute bacterial sinusitis
what sinus is affected w pain on the vertex of the head
sphenoid
pain with palpation just below medial portion of eyebrows is likely which sinus
frontal
unilateral face pressure and tenderness with pain referred to incisor or canine teeth
maxillary sinus pain
tx with augmentin is seen in which diagnoses
- acute bacterial rhinosinusitis
- chronic sinusitis
- epistaxis to prophylactically tx toxic shock
tx w augmentin.
if anaphylaxis to PCN use doxy, levo, moxi or azithro
acute bacterial rhinosinusitis
tx with augmentin, if non-severe PCN allergy use cinda + cefixime or cefpodoxime.
acute bacterial rhinosinusitis
intranasal corticosteroids
acute bacterial rhinosinusitis
chronic sinusitis
mod-severe allergic rhinitis
black eschar on middle turbinate
invasive fungal sinusitis
CN V and VII involvement in severe cases
invasive fungal sinusitis
long standing unilateral symptoms, non-specific mucosal changes on CT with opacification of a single sinus
Mycetoma (chronic fungal sinusitis)
biopsy from nasal endoscopy and CT to determine extent of disease
Chronic fungal sinusitis
treated with IC amphotericin B then after 3-6 months switch to itraconazole
chronic fungal sinusitis
risk factors include hx of nasal polyposis, asthma, and sinus surgeries
allergic fungal sinusitis
also caused by:
high levels of IgE in body
fungus allergy
endoscopic sinus surgery to remove debris followed by 3 months of systemic steroids
allergic fungal sinusitis
causes inflammation of the blood vessels
wegener’s ganulomatosis
symptoms include joint aches, blood in urine, cough, fever, hearing loss and sinus pain
Wegener’s granulomatosis
saddle-nose deformity
wegener’s granulomatosis
purulent bloody discharge, nasal crusting, smell disturbances, sinus pain
wegener’s granulomatosis d/t blood flow reduced to nose
diagnostics include PFT, CT sinus, CXR, rheumatology workup and a biopsy
wegener’s granulomatosis
treated with steroids and immunosuppressants
wegener’s granulomatosis
cobblestoning of pharynx
allergic rhinitis
nasal mucosa that is pale, bluish hue and boggy d/t venous engorgement
allergic rhinitis
what could increase obstructive symptoms in allergic rhinitis
nasal polyps
nasal secretion biopsy
serum IgE level
Allergic rhinitis diagnostics
also allergy skin testing
Nasal secretion will show EOSINOPHILS
which testing requires refrainment form antihistamines
skin allergy test
NOT teh IgE one!
when are antihistamines preferred
2ng gen antihistamines used in mild intermittent allergic rhinitis
nasal irrigation
intranasal steroids
augmentin
chronic sinusitis
2nd gen antihistamines
all end in dine or zine
Cetirizine (Zyrtec)
Loratadine (Claritin)
Fexofenadine (Allegra)
Desloratadine (Clarinex)
Levocetirizine (Xyzal)
nasal antihistamines
azelastine
olopatadine
avoid in narrow angle glaucoma, CVD, CAD, HTN hypothyroidism and urinary retention
sudafed
has risks of rebound vasodilation and rhinitis medicamentosa
phenylephrine/oxymetazoline
Insomnia, tremor, tachycardia, HTN are all common side effects of what
decongestants (sudafed or phenylephrine/oxymetazoline)
combo drugs for allergic rhinitis
claritin D and allegra D
antihistamine + sudafed
Neuropsychiatric changes such as dreams, insomnia, anxiety, depression, suicidal thinking
montelukast SE
what are the leukotriene antagonists
leukotrienes, montelukast,
what is the anticholinergic used in allergic rhinitis
ipratropium bromide
usually combined with intranasal steroids
CI in CVD, uncontrolled asthma, BB use
allergy shots.
only for severe allergic rhinitis
what is the MOA of the allergy shots
slowly introduce small amounts of allergins into the tissues and over the course of 3-5 years desensitize the patient to allergens
bilateral nose bleed
posterior epistaxis
kiesselbacks plexus
MC area of anterior epistaxis
silver nitrate or lidocaine + epi
anterior epistaxis.
can also use nasal packing or cocaine
narcotic analgesics
posterior epistaxis
ligation of nasal arterial supply
posterior epistaxis
augmentin, clinda and keflex used for…
ABX prophylaxis in nasal packing for toxic shock syndrome
Pale, edematous, mucosally covered masses.
nasal polyps
indicative of cystic fibrosis when found in children
nasal polyps
topical nasal steroids 1-3 months followed by oral steroids. if no change surgery is indicated
nasal polyps
presents with persisten unilateral epistaxis and foul smelling, copious rhinorrhea
nasal foreign body
