NoseThroat-Table 1 Flashcards
How do you define acute, subacute, and chronic rhinosinusitits?
Shorter than 4 weeks (acute)
4-12 weeks (subacute)
Longer than 12 weeks (chronic)
Recurrent sinusitis is when you have ____ or more recurrent episodes annually
4
What is the osteomeatal complex?
Functional unit and is the most common site of origin of sinus inflammation
Rhinosinusitis affects which sinuses for adults?
Maxillary or Frontal Sinuses
Rhinosinusitis affects which sinuses for children?
Ethmoid sinuses
Most common antecedent event of rhinosinusitis
Allergic rhinitis
Most common pathogens for rhinosinusitis
S. pneumo, H. influenza, Moraxella catarrhalis
Complications of rhinosinusitis
Osteomyelitis, orbital cellulitis, cavernous sinus thrombophlebitis, intracranial suppuration
When should you consider bacterial sinusitis?
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
Treatment of rhinosinusitis
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
True or false: most cases of acute rhinosinusitis resolve without an RX
TRUE
When would you Rx antibiotics for acute rhinosinusitis
Moderate-severe symptoms
What organisms would you want to cover for Rx of acute rhinosinusistis
S. penumo or H. influenza
What would you Rx for ARS and for how long?
Amoxicillin 500 mg TID x 10-14 days
What would you Rx for someone with PCN allergy for ARS?
TMP/SMZ
How would you treat MRSA associated ARS?
TMP/SMZ
What would you Rx for pseudomonas associated ARS
Ciprofloxacin
What is the primary therapy for bacterial sinusitis?
Antibiotics
Recurrent acute rhinosinusitis is defined as _________
Failed Rx with 2 courses of antibiotics, history of more than 4 per year
What should signify an emergency admit
High fever, rigors, lid edema, diplopia, pupillary abnormality, ptosis, EOM palsies
What do you need to differentiate in a nose bleed
Anterior vs posterior nose bleed
Unilateral, continuous, “moderate”, lasting minutes to ½ hour. Generally venous, but can be arterial. Associated with what?
Anterior nose bleed, associated with Kiesselbach’s plexus
Often bilateral, down into oropharynx. Brisk arterial bleed, spontaneous more common in older; after facial trauma
Posterior bleed
Treatment of anterior nose bleed
1:1000 epi, phenylephrine or oxymetazoline on cotton ball
Most common cause of chronic or recurrent nasal congestion
Allergic rhinitis
What drugs can cause drug induced rhinitis
ACE inhibitors, reserpine, phentolamine, methyldopa, prazosin, besta blockers, chlorpramazine
First line treatment to reduce itching, sneezing or rhinorrhea
Antihistamines (second generation should be considered before first generation)
What should you caution with decongestants?
Caution with arrhythmias, angina pectoris, some with HTN and hyperthyroidism; topical for short term
What is the most effective class of medication in controlling symptoms of allergic rhinitis
Nasal corticosteroids
Intranasal cromolyn is most effective with _____ or ______
Exercise or gustatory related rhinitis.
Ipatropium bromide is a ____________, and is used with the treatment of _________
Intranasal anticholinergic, rhinitis
Prodrome is associated with what form of infectious pharyngitits? What other symptoms will you see with this?
Epstein-Barr. Exudate, palatal petechiae, splenomegaly, tender hepatomegaly
What test would you run for Epstein-Barr?
Monospot for IgM or IgG to E-B virus
HSV infectious pharyngitis presents with what?
Shallow ulcers on palate
How does Coxsackie virus present?
Tonsillar pillar/soft palate vesicles/ulcers
Pathogens associated with bacterial pharyngitis
GABHS, Spirochetes, Yersinia, Gonorrhea, corynebacterium exudate
Vincent’s Angina and necrotic tonsillar ulcers are associated with what?
Primary, Secondary syphilis
What disease is associated with adherent whitish blue pharyngeal exudate
Corynebacterium diptheriae
Why do we treat GABHS pharyngitis?
Prevention of acute rheumatic fever, peritonsillar/retropharyngeal abscess
What are the centor criteria? What is it used to determine? How many are needed?
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
Someone with in infection in the ____________ might present with tooth pain
Maxillary sinus
Presenting signs of acute sinusitis (harrison’s info starts here)
Sinus pain or pressure localizing to involved sinus. Can be worse when patient bends over or is supine
What are the life threatening complications of sinusitis?
Meningitis, epidural abscess and cerebral abscess
Biggest distinguishing factor for determining viral vs bacterial sinusitis
Viral= 10 days- persistent symptoms accompanied by 3 cardinal signs (purulent nasal discharge, nasal obstruction, and facial pain)
True or false- CT is recommended for acute sinusitis
False- CT is not recommended on acute, recommended for persistent, recurrent or chronic sinusitis (of which CT is the radiographic study of choice)
What is the preferred initial treatment in patients with mild-moderate symptoms of short duration?
Aimed at symptom relief • Decongestants
• Nasal saline lavage
• Nasal glococorticoids (in patients with Hx of chronic sinusitis or allergies)
When should you Rx abx for acute rhinosinusitis? And what should you initial Rx be?
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
What predisposes people to malignant otitis externa
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.
