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DOOS2-FINAL > NoseThroat > Flashcards

NoseThroat Flashcards

1
Q

How do you define acute, subacute, and chronic rhinosinusitits?

A

Shorter than 4 weeks (acute)
4-12 weeks (subacute)
Longer than 12 weeks (chronic)

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2
Q

Recurrent sinusitis is when you have ____ or more recurrent episodes annually

A

4

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3
Q

What is the osteomeatal complex?

A

Functional unit and is the most common site of origin of sinus inflammation

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4
Q

Rhinosinusitis affects which sinuses for adults?

A

Maxillary or Frontal Sinuses

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5
Q

Rhinosinusitis affects which sinuses for children?

A

Ethmoid sinuses

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6
Q

Most common antecedent event of rhinosinusitis

A

Allergic rhinitis

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7
Q

Most common pathogens for rhinosinusitis

A

S. pneumo, H. influenza, Moraxella catarrhalis

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8
Q

Complications of rhinosinusitis

A

Osteomyelitis, orbital cellulitis, cavernous sinus thrombophlebitis, intracranial suppuration

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9
Q

When should you consider bacterial sinusitis?

A

Consider if >7days of maxillary pain or tenderness in maxillary area/teeth- especially unilateral, purulent nasal secretion… or worsening of s/s after initial improvement

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10
Q

Treatment of rhinosinusitis

A

Saline nasal spray, sinus irrigation, decongestants (limited duration if delivered nasally- rebound congestion if prolonged), nasal steroids, prednisone taper, antihistamines if allergic or surgical intervention

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11
Q

True or false: most cases of acute rhinosinusitis resolve without an RX

A

TRUE

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12
Q

When would you Rx antibiotics for acute rhinosinusitis

A

Moderate-severe symptoms

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13
Q

What organisms would you want to cover for Rx of acute rhinosinusistis

A

S. penumo or H. influenza

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14
Q

What would you Rx for ARS and for how long?

A

Amoxicillin 500 mg TID x 10-14 days

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15
Q

What would you Rx for someone with PCN allergy for ARS?

A

TMP/SMZ

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16
Q

How would you treat MRSA associated ARS?

A

TMP/SMZ

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17
Q

What would you Rx for pseudomonas associated ARS

A

Ciprofloxacin

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18
Q

What is the primary therapy for bacterial sinusitis?

A

Antibiotics

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19
Q

Recurrent acute rhinosinusitis is defined as _________

A

Failed Rx with 2 courses of antibiotics, history of more than 4 per year

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20
Q

What should signify an emergency admit

A

High fever, rigors, lid edema, diplopia, pupillary abnormality, ptosis, EOM palsies

21
Q

What do you need to differentiate in a nose bleed

A

Anterior vs posterior nose bleed

22
Q

Unilateral, continuous, “moderate”, lasting minutes to ½ hour. Generally venous, but can be arterial. Associated with what?

A

Anterior nose bleed, associated with Kiesselbach’s plexus

23
Q

Often bilateral, down into oropharynx. Brisk arterial bleed, spontaneous more common in older; after facial trauma

A

Posterior bleed

24
Q

Treatment of anterior nose bleed

A

1:1000 epi, phenylephrine or oxymetazoline on cotton ball

25
Q

Most common cause of chronic or recurrent nasal congestion

A

Allergic rhinitis

26
Q

What drugs can cause drug induced rhinitis

A

ACE inhibitors, reserpine, phentolamine, methyldopa, prazosin, besta blockers, chlorpramazine

27
Q

First line treatment to reduce itching, sneezing or rhinorrhea

A

Antihistamines (second generation should be considered before first generation)

28
Q

What should you caution with decongestants?

A

Caution with arrhythmias, angina pectoris, some with HTN and hyperthyroidism; topical for short term

29
Q

What is the most effective class of medication in controlling symptoms of allergic rhinitis

A

Nasal corticosteroids

30
Q

Intranasal cromolyn is most effective with _____ or ______

A

Exercise or gustatory related rhinitis.

31
Q

Ipatropium bromide is a ____________, and is used with the treatment of _________

A

Intranasal anticholinergic, rhinitis

32
Q

Prodrome is associated with what form of infectious pharyngitits? What other symptoms will you see with this?

A

Epstein-Barr. Exudate, palatal petechiae, splenomegaly, tender hepatomegaly

33
Q

What test would you run for Epstein-Barr?

A

Monospot for IgM or IgG to E-B virus

34
Q

HSV infectious pharyngitis presents with what?

A

Shallow ulcers on palate

35
Q

How does Coxsackie virus present?

A

Tonsillar pillar/soft palate vesicles/ulcers

36
Q

Pathogens associated with bacterial pharyngitis

A

GABHS, Spirochetes, Yersinia, Gonorrhea, corynebacterium exudate

37
Q

Vincent’s Angina and necrotic tonsillar ulcers are associated with what?

A

Primary, Secondary syphilis

38
Q

What disease is associated with adherent whitish blue pharyngeal exudate

A

Corynebacterium diptheriae

39
Q

Why do we treat GABHS pharyngitis?

A

Prevention of acute rheumatic fever, peritonsillar/retropharyngeal abscess

40
Q

What are the centor criteria? What is it used to determine? How many are needed?

A 
Tonsillar exudate
Tender anterior cervical LAD
History of fever
Absence of cough
Used to decrease unneeded abx use. If 3 of 4 are present, ~75% sensitivity and specificity compared to throat culture
41
Q

Someone with in infection in the ____________ might present with tooth pain

A

Maxillary sinus

42
Q

Presenting signs of acute sinusitis (harrison’s info starts here)

A

Sinus pain or pressure localizing to involved sinus. Can be worse when patient bends over or is supine

43
Q

What are the life threatening complications of sinusitis?

A

Meningitis, epidural abscess and cerebral abscess

44
Q

Biggest distinguishing factor for determining viral vs bacterial sinusitis

A

Viral= 10 days- persistent symptoms accompanied by 3 cardinal signs (purulent nasal discharge, nasal obstruction, and facial pain)

45
Q

True or false- CT is recommended for acute sinusitis

A

False- CT is not recommended on acute, recommended for persistent, recurrent or chronic sinusitis (of which CT is the radiographic study of choice)

46
Q

What is the preferred initial treatment in patients with mild-moderate symptoms of short duration?

A

Aimed at symptom relief • Decongestants
• Nasal saline lavage
• Nasal glococorticoids (in patients with Hx of chronic sinusitis or allergies)

47
Q

When should you Rx abx for acute rhinosinusitis? And what should you initial Rx be?

A

In patients with moderate symptoms (nasal congestion/cough) for >10d or for severe Sx (unilateral/focal facial swelling or tooth pain) for any duration • Amoxicillin 500 mg PO tid or
• Amox/clavulaunate 500/125 mg PO tid or
• Amox/clavulaunate 875/125 mg PO bid

48
Q

What predisposes people to malignant otitis externa

A

DM. Usually secondary to P aeurginosa infection in the soft tissue surrounding the external auditory canal. Usually begins with pain and discharge, and may rapidly progress to osteomyelitis and meningitis.

DOOS2-FINAL (8 decks)

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