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7MO SEMESTRE > otorrino 2do parcial > Flashcards

otorrino 2do parcial Flashcards

1
Q

INICIO DE MANAGEMENT OF ADENOTONSILLAR DISEAS

A

:)

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2
Q

Both the tonsils and adenoids are part of the _____ a circular structure of lymphoid tissue located in the nasopharynx and the oropharynx

A

Waldeyer ring

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3
Q

largest component of the Waldeyer ring

A

palatine tonsils

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4
Q

The glossopharyngeal nerve lies deep to the superior pharyngeal constrictor and supplies sensation to the tonsil through the tonsillar branch, true or false

A

true

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5
Q

Acute pharyngotonsillitis may be caused by viral infection (most common) or bacterial infection. It is often difficult to distinguish between the 2 etiologies based on clinical exam. Patients with acute pharyngotonsillitis present with:

A

fever, malaise, odynophagia, dysphagia, foul breath, and tender lymphadenitis

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6
Q

Tonsillar enlargement due to infection may also manifest as airway obstruction with symptoms including

A

mouth breathing, snoring, or sleep­disordered breathing. On physical exam tonsillar enlargement, erythema, and exudates may be present

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7
Q

Approximately 70% to 85% of cases of acute pharyngotonsillitis have a ___ etiology

A

viral

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8
Q

Common viral pathogens include:

A

adenovirus,
rhinovirus,
coronavirus,
Epstein­Barr virus (EBV), cytomegalovirus (CMV), Coxsackievirus
, herpes simplex virus, human immunodeficiency virus (HIV)
, and influenza virus

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9
Q

Associated signs and symptoms may help determine the specific virus responsible, for example:

A
  1. conjunctival involvement is associated with adenovirus
  2. he presence of herpangina—or ulcerative vesicles over the tonsils—may be due to Coxsackievirus or herpes virus
  3. profuse lymphadenopathy is typically seen with EBV, CMV, or HIV
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10
Q

Treatment for most viral infections is generally supportive, including:

A

hydration, antipyretics, and pain relievers as needed—and management does not require further testing

tx in asymptomatic, px should drink water, antihistamine for posterior mucus discharge,
NSAIDs

antifludes: Amantadina/Clorfenamina/Paracetamol

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11
Q

EBV belongs to the herpes family of viruses and causes acute pharyngitis as a part of infectious mononucleosis. EBV is transmitted orally and manifests as:

A

high fever, generalized malaise, lymphadenopathy, hepatosplenomegaly, and pharyngitis.
The tonsils are often severely enlarged, sometimes to the point of compromising the airway, and are covered with an extensive grayish­white exudate.

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12
Q

distinguishing feature of EBV in clinical exam:

A

lymphoid hypertrophy, especially with involvement of the posterior nodes

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13
Q

Influenza presents with

A

sore throat, fever, and cough, similar to other viral illnesses.

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14
Q

most common cause of acute bacterial pharyngotonsillitis in children:

A

Group A beta­hemolytic streptococcus (GABHS)

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15
Q

“Strep throat” is a very common disease among adolescents and children. Symptoms include:

A

fever, sore throat, cervical lymphadenopathy, dysphagia, and odynophagia

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16
Q

Group A beta­hemolytic streptococcus physical examination typically reveals:

A

tonsillar and pharyngeal erythema with purulent exudate

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17
Q

standard method for establishing the diagnosis of group A streptococcus pharyngitis in children

A

Throat culture with a blood agar plate (BAP)

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18
Q

The definitive test for GABHS infection measures:

A

serum titers of antistreptolysin O (ASO)

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19
Q

standard of care to prevent the development of rheumatic fever in patients with GABHS

A

Early diagnosis and appropriate antimicrobial treatment

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20
Q

treatment regimen of choice for GABHS

A

10­day course of penicillin V.
Amoxicillin is commonly substituted for penicillin

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21
Q

Complications of GABHS infection:

NONSUPPURATIVE COMPLICATIONS

A

Scarlet fever occurs secondary to endotoxin production by bacteria during acute streptococcal pharyngotonsillitis.

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22
Q

clinical presentation of Scarlet fever

A

erythematous rash, fever, lymphadenopathy, dysphagia, and erythematous tonsils and pharynx covered with a yellow membranous film. The tongue may become red with desquamation of the papillae, often described as “strawberry tongue.”

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23
Q

Acute rheumatic fever is a complication that can develop 1 to 4 weeks after an episode of pharyngotonsillitis caused by GABHS. Rheumatic fever results from cross­reactive antibodies that are produced in reaction to the streptococcal infection that subsequently affect heart muscle, leading to:

A

endocarditis, myocarditis, or pericarditis. Once heart tissue damage occurs, little can be done to reverse the process.

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24
Q

Complications of GABHS infection:

SUPPURATIVE COMPLICATIONS

A

peritonsillar abscess, parapharyngeal abscess, retropharyngeal abscess, and cervical lymphadenitis or abscess

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25
Q

Peritonsillar abscess (orms as a result of the spread of infection from the superior pole of the tonsil into the potential space between the tonsillar capsule and the pharyngeal muscle bed. Common pathogens include aerobes such as GABHS, Staphylococcus aureus, and Haemophilus influenzae, and anaerobes) usually occur unilaterally and patients present with:

A

severe pain, odynophagia, muffled voice (or “hot potato” voice), and dysphagia

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26
Q

Needle aspiration and incision and drainage should be performed to treat the abscess. In patients with recurrent tonsillitis and recurrent peritonsillar abscesses, a _____ is often recommended.

A

tonsillectomy

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27
Q

Infection from the tonsil or from a peritonsillar abscess can spread through the superior constrictor muscle into a potential space between the superior constrictor muscle and the deep cervical fascia, forming a:

A

parapharyngeal space abscess

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28
Q

parapharyngeal space abscess

Patients often present with:

A

trismus and decreased neck range of motion secondary to inflammation of the adjacent pterygoid and paraspinal muscles. If not treated, the abscess can spread down the carotid sheath and into the mediastinum.

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29
Q

A retropharyngeal abscess may result from spread of a peritonsillar abscess or from infection of the lymph nodes in the retropharyngeal space. It is more common in children and symptoms usually include:

A

fever, dysphagia, muffled speech, noisy breathing, neck stiffness, and cervical lymphadenopathy.

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30
Q

Pharyngotonsillitis can lead to lymphadenitis, the enlargement and infection of the corresponding draining lymph nodes. Patients present with:

A

enlarged, warm, erythematous, tender lymph nodes that can progress to suppuration and abscess formation and may require surgical drainage.

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31
Q

Non–group A streptococci have never been shown to cause acute rheumatic fever, true or false:

A

true

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32
Q

Pharyngeal diphtheria, which is caused by

A

Corynebacterium diphtheria, is now extremely rare due to the widespread use of childhood immunization

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33
Q

Pharyngeal diphtheria

In addition to the usual symptoms of acute pharyngitis, this disease is characterized by the presence of:

A

a grayish, firmly adherent pseudomembrane that covers the tonsils and may extend to the nares, uvula, soft palate, and pharynx.

Removal of the pseudomembrane reveals bleeding of the underlying surface.

The disease can spread to the larynx and tracheobronchial tree, potentially compromising the airway.

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34
Q

Exotoxins produced by C. diphtheriae may produce cardiac toxicity and neurotoxicity. The diagnosis is confirmed by:

A

ulturing the pseudomembrane in Loeffler’s or tellurite selective medium.

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35
Q

Treatment for infection by C. diphtheriae:

A

diphtheria antitoxin and penicillin or erythromycin.

Treatment should be started immediately, even before confirmation with a culture

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36
Q

atients with exposure to sexually transmitted diseases can develop tonsillar infections with:

A

Neisseria gonorrhoeae or Treponema pallidum

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37
Q

Gonococcal infections may present as:

A

exudative pharyngitis

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38
Q

Primary oral syphilis manifests as:

A

painless chancre on the lips, buccal mucosa, or oropharynx.

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39
Q

Patients with secondary syphilis may present with

A

bilateral tonsillar hypertrophy and painful oropharyngeal and tonsillar ulcers

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40
Q

Oropharyngeal candidiasis, or “thrush,” is caused by overgrowth of Candida albicans and often presents in patients with a history of:

A

mmunosuppression, radiation, or altered microflora following long­term broad­spectrum antibiotic use

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41
Q

Oropharyngeal candidiasis

Physical examination:

A

white cottage cheese­like plaques over the pharyngeal mucosa, which bleed if removed with a tongue depressor

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42
Q

Oropharyngeal candidiasis

Clinical diagnosis may be confirmed with

A

potassium hydroxide staining revealing fungal hyphae

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43
Q

Treatment of oropharyngeal candidiasis:

A

Initial therapy usually consists of oral hygiene and topical treatment. Some of the available agents include oral nystatin preparations, amphotericin lozenges, and clotrimazole troches.

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44
Q

The most common bacteria isolated in recurrent tonsillitis are

A

Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae

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45
Q

Current recommendations suggest tonsillectomy for patients with

A

6 to 7 episodes of acute tonsillitis in 1 year, 5 episodes per year for 2 consecutive years, or 3 episodes per year for 3 consecutive years.

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46
Q

Tonsilloliths are microbial biofilms that form within tonsillar crypts and are associated with halitosis and chronic cryptic tonsillitis. Patients may present

A

foreign body sensation in the throat and expressible, hard white masses on their tonsils.

Complete or intracapsular tonsillectomy is a treatment option for chronic cryptic tonsillitis in adults.

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47
Q

Paradise criteria for tonsillectomy

A

PREGUNTA DE EXAMEN!!

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48
Q

Chronic tonsillitis is diagnosed when a sore throat is present for at least __ months and is associated with:

A

3 months

onsillar inflammation, halitosis, and persistent tender cervical adenopathy

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49
Q

A polymicrobial population—including _________—is responsible for most cases of chronic tonsillitis

A

Staphylococcus aureus, Haemophilus influenza, and Bacteroides species

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50
Q

treatment for chronic tonsillitis

A

Antibiotics effective against anaerobes and beta­lactamase producing organisms, such as clindamycin or amoxicillin clavulanate, can be used for treatment.

***In patients with chronic tonsillitis unresponsive to appropriate antimicrobial therapy, tonsillectomy is indicated.

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51
Q

3 big indications for tonsillectomy

A

● Infections (paradise criteria)

● Obstructive (p ej adenoid hypertrophy)

● Neoplasia
Indications for tonsillectomy
○ Never take a biopsy of the tonsils

*Centro criteria para saber si es viral o bacteriano

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52
Q

Hypertrophy of lymphoid tissue can occur in response to colonization with normal flora, exposure to pathogenic microorganisms, or as a reaction to environmental factors. Adenoid hypertrophy usually presents as:

A

nasal obstruction, rhinorrhea, and hyponasal speech. Tonsillar enlargement can cause snoring, dysphagia, and either a hypernasal or muffled voice

*Lateral neck soft tissue radiography can be helpful in evaluating hypertrophic adenoids.

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53
Q

Chronic adenotonsillar hypertrophy is commonly associated with

A

sleep­disordered breathing in children, with symptoms ranging from upper airway obstruction to obstructive sleep apnea syndrome (OSAS). Upper airway obstruction can manifest as loud snoring, chronic mouth breathing, and secondary enuresis.

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54
Q

A history of witnessed apneic episodes, hypersomnolence or hyperactivity, frequent nighttime awakenings, poor school performance, and a general failure to thrive are common manifestations of _____ in children

A

obstructive sleep apnea syndrome (OSAS)

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55
Q

A tonsil grading system is often used to describe tonsillar size

A

Tonsil grades.
( A ) Grade 0 tonsils.
( B ) Grade I tonsils.
( C ) Grade II tonsils.
( D ) Grade III tonsils.
( E ) Grade IV tonsils.

ESTUDIAR FOTO

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56
Q

Symptomatic asymmetric tonsillar hypertrophy is a physical finding that should raise concern for possible:

A

tonsillar neoplasm

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57
Q

The likelihood of a malignant process is increased when tonsillar asymmetry is associated with:

A

rapid enlargement, constitutional symptoms, atypical tonsillar appearance, ipsilateral cervical lymphadenopathy, or a history of previous malignant growths.

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58
Q

tonsillar lymphoma should be considered when unilateral tonsillar enlargement is present in an:

A

immunocompromised child or when acute asymmetric tonsillitis is unresponsive to medical therapy.

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59
Q

Management when asymmetry is accompanied by a suspicious clinical course or history:

A

tonsillectomy should be performed to provide tissue for biopsy

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60
Q

most common primary tonsillar neoplasms:

A

Lymphoma and squamous cell carcinoma (SCC)

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61
Q

Benign tumors of the tonsil are rare and include:

A

lipomas, fibromas, and schwannomas

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62
Q

indications for tonsillectomy and adenoidectomy

A

estudiar del libro

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63
Q

one of the important complications of tonsillectomy:

A

Bleeding

There must be a good hemostasis/cauterization

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64
Q

Herpangina

Coxsackie → (hand, teeth and mouth), frequent in children

Characteristics

A
  • Ulcers on the soft palate it’s an effect from the fever
  • 5-7 days
  • red with circles gray
    Everytime we have ulcers we have to think in a viral infection (bacterial not usually causes ulcers)
    Do NOT give aciclovir
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65
Q

tx for herpangina

A

Antivirals may be used
● Amantadina → Avirol
● Chlorpheniramine
● Paracetamol

66
Q

When is acyclovir prescribed?

A

● Herpes
● CMV
● Varicella

67
Q

Tx for herpes

A

Tx is acyclovir is a treatment for herpes caused ulcers → (800 mg every 6 hours for 7-10 days),
Pregabalin (Neuropathic pain due to the virus nerve location), Benzamide (Vantal, is a Topical anesthetic, anti inflammatory antiseptico)

68
Q

Infectious mononucleosis

A

● IgG and IgM antibodies can help determine the presence of the disease
● The kiss disease” → High virulence
● PCR may be performed, antibodies and antigens can also be used to identify the infection.
● Ask for a complete blood count → Look for the elevation of white blood cells, specifically
lymphocytes
● Do NOT give antibiotics (like amoxicillin with ac clavulanic), do the differential diagnosis with
bacterial tonsillitis
● An antibiotic will cause skin rash and the symptoms will not get better

**NO se debe iniciar antibiótico hasta tener mono test o biometría hemática para buscar linfocitosis (común en estos pacientes)

69
Q

Signs and symptoms of mononucleosis

A

Symptoms
● High fever
● Adenopathies
● Pain Signs
● Enlarged tonsils
● Yellow/gray exudate
● Nodules
● Hepatosplenomegaly → Search with
USG

70
Q

Streptococcus

A

copiar tabla de pdf

71
Q

seguir estudiando este tema en pdf

A
72
Q

INICIA RHINITIS

A

:)

73
Q

Rhinitis is defined as an inflammatory condition that affects the nasal mucosa. The symptoms of rhinitis include:

A

nasal obstruction, hyperirritability, and hypersecretion.

74
Q

Types of rhinitis:

A

-Allergic: seasonal and perennial
-Infectious rhinitis: viral and bacterial
-nonallergic, noninfectious:

75
Q

The symptoms of nonallergic rhinitis include:

A

nasal obstruction, hypersecretion, and irritability, none of which is due to allergy.

76
Q

Nonallergic rhinitis typically presents with:

A

clear rhinorrhea and nasal obstruction, there is an increasing incidence of nonallergic rhinitis with advancing age.

77
Q

Patients with nonallergic rhinitis should always be questioned about:

A

the use of over­the­counter nasal sprays, previous trauma, work or chemical exposure, and previous intranasal drug use. Epistaxis, pain, and unilateral symptoms may be harbingers of a neoplasm and should be noted.

78
Q

Viral rhinitis is very common and often associated with other manifestations of viral illness, which can include:

A

headache, malaise, body aches, and cough. Nasal drainage in viral rhinitis is most often clear or white and can be accompanied by nasal congestion and sneezing.

79
Q

Occupational rhinitis
A number of different indoor and outdoor pollutants may affect the nose. These agents include dust, ozone, sulfur dioxide, cigarette smoke, garden sprays, and ammonia. Irritant agents can be found in a variety of work environments. Typically, these agents cause:

A

nasal dryness, reduced airflow, rhinorrhea, and sneezing.

80
Q

Patients with vasomotor rhinitis present with symptoms of:

A

nasal obstruction and clear nasal drainage. The symptoms are often associated with changes in temperature, eating, exposure to odors and chemicals, or alcohol use.

81
Q

Nonallergic rhinitis with eosinophilia (NARES) is a recently described syndrome in which patients present with:

A

nasal obstruction and congestion; these patients frequently experience more severe exacerbations, including the development of sinusitis and polyposis. These patients also display marked eosinophilia on nasal smears (> 25%) but are not allergic to any inhalant allergens by skin testing or in vitro testing.

82
Q

Patients with rhinitis medicamentosa often present with:

A

nasal obstruction that has worsened over a number of years.

83
Q

Patients with rhinitis medicamentosa typically have been using over­-the-­counter topical_____

A

vasoconstrictive nasal sprays. Many times these patients need increasing doses of these sprays as tachyphylaxis occurs.

84
Q

Treatment of Nonallergic Rhinitis

A
  1. Irritant avoidance
  2. Saline irrigation: help avert intranasal stasis and reduce crusting. The use of saline not only increases the efficacy of intranasal topical medications but also improves ciliary function.
  3. Topical steroids: reduce eosinophil and neutrophil chemotaxis; they also reduce inflammation

Other treatments for nonallergic rhinitis include adrenergic agents. The 2 main families of adrenergic drugs are: (1) phenylamines and (2) imidazolines

85
Q

Surgical Measures in Nonallergic Rhinitis

A

1) septal procedure: The surgical treatment for nonallergic rhinitis is focused on correcting structural abnormalities that may contribute to patient symptoms
2) used to counteract nonallergic rhinitis

86
Q

ALLERGIC RHINITIS

ESSENTIALS OF DIAGNOSIS

A
  • May be seasonal, perennial, or both.
  • Characterized by sneezing, itching, rhinorrhea, and congestion.
  • Can be associated with other chronic conditions, including asthma, otitis media with effusion (OME), rhinosinusitis, and nasal polyposis.
  • Typical symptoms of sneezing, rhinorrhea, and nasal congestion can be associated with viral, bacterial, allergic, and nonallergic etiologies.
  • Can have multiple triggers, both inhaled and ingested.
87
Q

Allergic rhinitis is an inflammation of the nasal mucous membranes caused by:

A

an IgE­ mediated reaction to 1 or more allergens

88
Q

The allergic response is mediated primarily by:

A

Type I hypersensitivity reaction. This response involves the excess production of IgE antibodies and is termed an atopic reaction.

89
Q

the early­phase or humoral reaction and occurs within 10 to
15 minutes of allergen exposure; the release of histamine causes the symptoms of:

A

sneezing, rhinorrhea, itching, vascular permeability, vasodilatation, and glandular secretion.

90
Q

The development of atopy may be influenced by the following:

A

(1) genetic susceptibility (ie, family history); (2) environmental factors (eg, dust and mold exposure); (3) exposure to allergens (eg, pollens, animal dander, and foods); (4) passive exposure to tobacco smoke (especially in early childhood); and (5) diesel exhaust particles (in urban areas)—among other factors.

91
Q

Characteristic symptoms of seasonal allergies include:

A

sneezing; watery rhinorrhea; itching of the nose, eyes, ears, and throat; red and watering eyes; and nasal congestion. Symptoms are usually worse in the morning and are aggravated by dry, windy conditions when higher concentrations of pollen are distributed over a wider area.

92
Q

The symptoms of perennial allergic rhinitis are usually constant, with little seasonal variation, although they may vary in intensity. Characteristic symptoms are:

A

predominantly nasal congestion and blockage, and postnasal drip.

93
Q

Common allergens that cause perennial allergic rhinitis are:

A

indoor inhalants, predominantly dust mites, animal dander, mold spores, and cockroaches (in inner cities).

94
Q

In children with allergies, there may be a higher incidence of respiratory tract infections, which in turn tend to aggravate allergic rhinitis and may lead to the development of complications, especially:

A

rhinosinusitis and otitis media with effusion

95
Q

classifications of allergic rhinitis: Symptoms are classified (1) as being intermittent (< ___ days/week or < ___ weeks’ duration) or persistent (> ___ days/week or > ___ weeks’ duration)

A

intermittent (< 4 days/week or < 4 weeks’ duration) or persistent (> 4 days/week or > 4 weeks’ duration)

96
Q

Perennial symptoms usually mean an allergy to:

A

dust mites, mold, or animals.

97
Q

A physical examination should include:

A

inspection of the ears, throat, and nasal passages (including after decongesting with a topical decongestant).

98
Q

Typical findings in the nose in patients with seasonal allergic rhinitis include:

A

bluish, pale, boggy turbinates; wet, swollen mucosa; and nasal congestion with nasal obstruction.

99
Q

With perennial allergies, ______ is the predominant sign, but the nasal examination may appear normal.

A

nasal congestion
Anatomic abnormalities, such as a deviated nasal septum, concha bullosa, and nasal polyps, may be present

100
Q

ALLERGIC RHINITIS

Special Tests

A

Allergy testing is performed to establish objective evidence of atopic disease: Two major types of testing are available for identifying and quantifying allergen sensitivity: skin testing and in vitro serum assays.

101
Q

Skin testing

A

Skin testing can be epicutaneous, intradermal, or a combination of both

102
Q

The ____ is the most common epicutaneous test used. In general, it is a quick, specific, safe, and cost­effective test.

A

skin­-prick test

103
Q

Using quantitative 1:5 serial dilutions, is the skin
testing method used by most otolaryngic allergists but it is time consuming and costly.
- Is an excellent quantifier of allergen sensitivity
- Is of benefit in the preparation of safe subcutaneous immunotherapy
treatment.

A

Intradermal testing (ID)

104
Q

test - For kids over 2 years and high history of allergies and it is cheap
- Allergen specific serum IgE testing
- Clinical evaluation + miniscreen
- Nonatopic → No further testing is needed
- Atopic → Search for the specific allergen testing
- Microarray a. Used to find the molecular component(s) which cause the sensitivity

A

In vitro testing

105
Q

treatment of allergic rhinitis

A

Depends on the component causing the allergy
There are 3 options:
- Avoidance and environmental Controls
- Pharmacotherapy
- Immunotherapy

106
Q

Avoidance and environmental controls

A
  • reduce household humidity to below 50%
  • wash bed linens in hot water
  • remove carpets and pets from the most often used living areas, especially bedrooms
  • encase pillows, mattresses
  • box springs in hypoallergenic coverings
  • in poor and urban settings, eliminate cockroaches
  • air purifiers can be used
107
Q

Pharmacotherapeutic Measures

_____are frequently used as a first­line therapy; most are available without a prescription

A

Antihistamines

They block H1 receptor sites and prevent
histamine­induced reactions

108
Q

First­ generation antihistamines :

A

diphenhydramine (eg, Benadryl), hydroxyzine (eg, Atarax), chlorpheniramine, and brompheniramine.

Are effective in early-phase reactions and therefore reduce sneezing, rhinorrhea, and itching.

109
Q

Second Generation antihistamines have a better safety profile
- Are used as a first line therapy
- they have little affinity for central H1 receptors
- rapid onset of action and symptom relief usually within 1 hour
Examples:

A
  • Acrivastine
  • Azelastine
  • Loratadine
  • Desloratadine
110
Q

Most effective medications for the overall control of allergic rhinitis symptoms:

A

Intranasal corticosteroids

111
Q

Intranasal corticosteroids

A

triamcinolone (eg, Nasacort), budesonide (eg, Rhinocort), fluticasone propionate (eg, Flonase), and mometasone (eg, Nasonex).

  • They relieve sneezing, itching, rhinorrhea, and also nasal congestion.
  • Maximal effect may take from 1 to 2 weeks after the onset of their use.
112
Q

Systemic corticosteroids

A

-Systemic corticosteroids may be necessary for severe, intractable symptoms.
- a tapering dose is usually given over 3 to 7 days.
-significantly reduce all the symptoms of allergic rhinitis. The repeated use of these agents can cause serious side effects, such as HPA axis suppression, as well as other common side effects of steroid use.

113
Q

Decongestants

A

-act on α­adrenergic receptors of the nasal mucosa, producing vasoconstriction and thus reducing turbinate congestion. They improve nasal patency but do not relieve rhinorrhea, pruritus, and sneezing.
-Intranasal decongestants (eg, oxymetazoline) can cause rebound nasal congestion and cause dependency if used for more than 3 to 4 days, a condition called rhinitis medicamentosa.

114
Q

Intranasal anticholinergics

A

One of the most commonly used intranasal anticholinergics is ipratropium bromide (eg, Atrovent).

intranasal cromolyn (eg, Nasalcrom) must be used before the onset of symptoms to be effective. The recommended dosage is 4 times daily.

115
Q

Leukotriene
modifiers

A

Antagonize the action of leukotriene receptors or inhibit 5 lipoxygenase and the formation of leukotrienes
- Example: Montelukast (singulair)

116
Q

Intranasal Cromolyn of sodium

A
  • Must be used before the onset of symptoms to be effective. - must be used throughout the entire exposure
  • Is be very safe
  • The recommended dosage is 4 times daily.
  • Example: Nasalcrom
117
Q

tx for Intermittent Allergic Reaction

A

Antihistamine and then corticosteroids

118
Q

Tx for persistent allergic rhinitis

A

corticosteroids and then antihistamine

119
Q

IMMUNOTHERAPY

indications

A
  • Long term pharmacotherapy for prolonged periods of time
  • Inadequacy or intolerability of shrug therapy
  • Significant allergen sensitivities

It takes from 3-5 years

120
Q
  • Before beginning immunotherapy, the physician must first confirm the atopic diagnosis by testing ___ specific to the offending allergen
A

IgE

121
Q

______ is a new, safe, efficacious and more convenient method for delivering immunotherapy.

A

Sublingual immunotherapy (SLIT)

122
Q

IMMUNOTHERAPY

  • It blocks the production of IgE in the mast cell → block anaphylaxis cascade
  • Most use and it is expensive
A

Omalizumab

123
Q

Estudiar TREATMENT ARIA 2008

A

.

124
Q

INICIA ACUTE AND CHRONIC SINUSITIS

A

:)

125
Q

ESSENTIALS OF DIAGNOSIS

A

-The vast majority of cases of acute rhinosinusitis are self­limiting viral events.
-Chronic rhinosinusitis is an inflammatory disease whose causes are often multifactorial.
-In chronic rhinosinusitis, nasal endoscopy and/or computed tomography (CT) scan may be necessary to make the diagnosis if symptoms do not correlate well with findings.

126
Q

Rhinosinusitis is broadly defined as:

A

symptomatic inflammation of the paranasal sinuses (frontal, maxillary, sphenoidal and ethmoidal) and nasal cavity.

127
Q

Acute rhinosinusitis: Duration ≤ _____
Subacute rhinosinusitis: Duration_____ weeks

A
  • Acute rhinosinusitis: Duration ≤ 4 weeks
  • Subacute rhinosinusitis: Duration 4 to 12 weeks
128
Q

Chronic rhinosinusitis: Duration ≥ ______

A
  • Chronic rhinosinusitis: Duration ≥ 12 weeks or longer of 2 or more of the following symptoms:
  • Mucopurulent drainage (anterior, posterior, or both)
  • Nasal obstruction (congestion)
  • Facial pain­pressure­fullness
  • Decreased sense of smell
    And inflammation as seen by 1 or more of the following:
  • Purulent mucus or edema in the middle meatus or ethmoid region - Polyps in the nasal cavity or the middle meatus
  • Radiographic imaging showing inflammation of the paranasal sinuses.
129
Q

Recurrent acute rhinosinusitis: ____ or more episodes of acute rhinosinusitis per year, with each episode lasting ≥ ____ days, with symptom resolution between episodes

A

Recurrent acute rhinosinusitis: Four or more episodes of acute rhinosinusitis per year, with each episode lasting ≥ 7 to 10 days, with symptom resolution between episodes

130
Q

Acute rhinosinusitis (ARS) is most often caused by an infectious agent. ARS is defined as up to 4 weeks of purulent nasal drainage accompanied by:

A

nasal obstruction, facial pain, facial pressure, or fullness.

131
Q

The clinician must then distinguish between the more common entity of ____ rhinosinusitis and the less common acute ___ rhinosinusitis

A

viral and bacterial

This distinction is made based on illness pattern and duration.

132
Q

Viral rhinosinusitis

A

Symptoms of ARS are present less than 10 days. Symptoms are not worsening.

133
Q

Acute bacterial rhinosinusitis

A

Signs or symptoms of ARS are present 10 days or more beyond the onset of upper respiratory symptoms. Signs or symptoms of ARS worsen within 10 days after an initial improvement (“double­worsening sign”).

134
Q

In most cases, ABRS is preceded by a ___ upper respiratory infection. Other common conditions that can predispose a patient to ARS are:

A

viral

cigarette smoke, anatomical factors such as nasal septum deformities, concha bullosa, and allergie

135
Q

Aspirin exacerbated respiratory disease or triada de samter or Widal Syndrome, in 10% of px
with asthma.

triada de sastre:

A
  • Nasal polyposis
  • Asthma
  • Aspirin intolerance
136
Q

Three cardinal symptoms have been found to have high sensitivity and specificity for ABRS:

A

purulent rhinorrhea, facial pain/pressure, and nasal obstruction

137
Q

ABRS

Secondary symptoms that support the diagnosis include:

A

hyposmia, maxillary dental pain, fever, aural fullness, and cough.

138
Q

The most common organisms responsible for ABRS include:

A

Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis

139
Q

The most common organisms responsible for Chronic bacterial rhinosinusitis

A
  • P. aeruginosa
  • S. aureus
  • H. influenzae
140
Q

Chronic rhinosinusitis

CRS is defined as:

A

inflammatory condition of the nasal cavity and paranasal sinuses lasting for longer than 12 weeks

141
Q

signs and symptoms of CRS:

A

Nasal obstruction (81%–95%) is the most common symptom, followed by facial congestion­pressure­fullness (70%–85%), discolored nasal discharge (51%–83%), and hyposmia (61%–69%).

142
Q

The pathophysiology of CRS remains incompletely understood, but it is believed to be multifactorial.

Numerous factors have been proposed as contributing to the etiology of CRS, including:

A

Biofilms
Osteitis
Perturbation of the sinonasal microbiome Allergy
Bacterial superantigens
Fungi
General host factors

143
Q

Biofilms

A
  • 3-dimensional aggregates of bacteria encased in a protective extracellular
    matrix
    -Are 1000 time more resistant to antibiotic treatment
144
Q

Most Common biofilm formers in CRS

A
  • Pseudomonas aeruginosa
  • S. aureus
  • Haemophilus influenzae.
145
Q

DIAGNOSIS MAJOR AND MINOR CRITERIA
★2 or more major factors or 1 major + 2 minor

MAJOR:

A
  • Facial pain or pressure
  • Facial congestion or fullness
  • Nasal obstruction
  • Purulent discharge
  • Hyposmia or anosmia
  • Purulence on examination
  • Fever (acute only)
146
Q

DIAGNOSIS MAJOR AND MINOR CRITERIA
★2 or more major factors or 1 major + 2 minor

MINOR

A
  • Headache
  • Fever
  • Halitosis
  • Fatigue
  • Dental pain
  • Cough
  • Otalgia or aural fullness
147
Q

DIFFERENTIAL DIAGNOSIS

  • Viral rhinosinusitis
A

(it is the most common, 90% present it)
- The viral infection should improve in NO MORE than 10 days, if it passes more than 10
days you suspect that it is a bacterial infection

  • Temporomandibular joint pain
  • Headache
  • Trigeminal pain
148
Q

Allergic and odontogenic causes

A
  • Facial pressure and pain
  • Purulent nasal discharge
  • Nasal congestion
  • Hyposmia
  • Tooth pain
  • Poor response to nasal decongestants
149
Q

Sinus neoplasms

A
  • Uncommon
  • Critical to exclude
  • Unilateral nasal obstruction
  • Epistaxis
  • CT scans and nasal endoscopy
  • Changes in vision
  • Cranial nerve deficits
  • Palatal numbness or dry eyes
  • Lesions in the pterygopalatine fossa
150
Q

Acute invasive fungal rhinosinusitis

A

(black fungal → mucormycosis), in px with covid they die
from immunosuppression
- Rapidly progressive
- Extension of the infection
- Immunosuppressed patients or poorly controlled diabetes

151
Q

Noninfectious rhinitis

A

Allergic rhinitis and nonallergic vasomotor rhinitis
- sneezing , rhinorrhea, nasal congestion, nsal itching

152
Q

Projections of CT Scan

A

● Caldwell (to visualize the frontal and ethmoid sinuses)
● Waters (for the maxillary sinuses)
● Lateral (for the anterior and superior walls of the frontal, maxillary, and sphenoid sinuses), and submental vertex views (for the ethmoid and sphenoid sinuses).

153
Q

LUND MACKAY STAGING SYSTEM OF CRS

A

(score for CT SCAN to calculate the stage of the disease) →parasinusitis = score of 24 in Lund Mackay

ESTUDIAR

154
Q

Treatment ARS

A

-Saline irrigations
(do not give)
-Nasal steroids for inflammation → Mometasone
or Fluticasone
- Antibiotics
- Antihistamines
- Systemic steroids (do not give)
- Decongestants (do not give)
● 1 line therapy = amoxicillin with clavulanate

155
Q

Treatment CRS (chronic rhinosinusitis with polyps or without polypes)

A
  • Antibiotics (levofloxacin y moxifloxacin → quinolones, azithromycin and doxycycline →are
    macrólidos, etc, a
    moxicillin (macrólido) with clavulanic
    , gram positive, gram negative…
  • Nasal steroids
  • Saline irrigations
  • Leukotriene antagonist
  • Oral steroids
  • Antihistamines
  • Monoclonal antibodies → Omalizumab, Mepolizumab, Reslizumab, Dupilumab
  • Antifungic (do not give)
  • FESS (functional endoscopic sinus surgery)
  • Take out bone structures to make a pathway
156
Q

EMPIEZA EPISTAXIS

A

The most common otolaryngologic emergency and affects up to 60%

157
Q

6% require medical attention, when:

A

caused by another patology (tumor, cuagulopatía, etc)

158
Q

Causes of epistaxis

A
  • Idiopathic (most common)
  • Traumatic
  • Iatrogenic
  • Primary neoplasms (SQUAMOUS CELL CARCINOMAis the most frequent) also angiofibroma
159
Q

ESTUDIAR EPISTAXIS DE PDF

A

.

160
Q

EMPIEZA NASAL TRAUMA

A

ESSENTIALS OF DIAGNOSIS
History of recent trauma to midface; should assess mechanism of injury, presence of epistaxis or rhinorrhea, history of previous injury, and new onset of nasal airway obstruction or deformity.
On examination, note any mucosal laceration, septal disruption, or septal hematoma.
Depending on severity of insult, must rule out concurrent injury to eyes, lacrimal system, paranasal sinuses, teeth, and oral cavity

7MO SEMESTRE (22 decks)

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