Quiz 2 Flashcards
symptoms and signs of allergic rhinitis?
-sneezing, inflammation, rhinorrhea, congestion, hyposmia, ear/eye/nose itch, scratchy throat from post nasal drip, fatigue, mouth breathing, shiners, dens lines, nasal salute, violet mucosa or white mucosa and nasal polyps
what are 2 types of allergic rhinitis?
seasonal and pereniel
other names for allergic rhinitis
hay fever, ige mediated rhinitis
perennial diagnosis time line?
> 2 hours per day for > 9 months
how to confirm allergic rhinitis diagnosis?
-skin intradermal test, RAST IgE, sinus CT if truly persistant
Allergic differential diagnosis?
URTI, medicalmentosa, sarcodosis, wegeners granulomatosis
sarcoidosis
lymph node enlargement
wergners granulomatosis
inflammation of the bv, blood stained mucosa, must confirm with a biopsy
allergic rhinitis antihistamine treatment options
antihistamins: loratadine and cetirizene
allergic rhinitis adjunct treatments:
-monteleukast, cromolyn, ipratropium, immunotherapy
complication of allergic rhinitis?
-facial deformaties, serous otitis media, secondary rhinosinusitis, nasal congestion, nasal speech, euschian tube dysfunction, URTI susceptibility, laryngeal edema
common pathogens causing bacterial rhinosinusitis
-streptococcus pneumoniae, heamophilus influenza, moraxella, catrrhalis
pathogens causing chronic bacterial rhinosinusitis
pseudemonus auregenosa, group A streptococcus, s. aureus, anaerobes
-can happen in hospital from ng tubes, oxygen etc
bacterial rhinosinusitis causing what rhinorrhea?
purulent and cloudy
acute bacterial rhinosinusitis symptoms
-cough, fever (101), fatigue, hyposmia, anosmia, maxillary dental pain, ear pressure/ fullness, double worsening
acute bacterial rhinosinusitis symptom management?
pseudophedrine (sudafed), guafenesin (mussinex/ tussin), oxymetazoline (affrin), fluticasone
acute bacterial rhinosinusitis antibiotic options? first line
-first line: augmentin (amoxicillin+clavulanate) 500mg/125mg 5-7 days every 8 hours OR 800/125 every 12 hours
-high risk pt: 2000 mg/125mg 7-10 days
acute bacterial rhinosinusitis antibiotic options? second line
-clindamycin, levoflaxin, azithromycin, trimethoprim, dupilumab
acute bacterial rhinosinusitis not improving, what do you do to meds
at 5 days change to broad spectrum antibiotic, no response in 3-4 weeks add clindamycin to cover anaerobes
-may also require surgical drainage, antral lavage with cocaine through the meatal window, frontal sinus draining irrigation or ethmoidectomy
acute bacterial rhinosinusitis complication?
-orbital cellulitis: warning signs include eyelid edema, redness, ptosis, chemosis and opthamoplegia
-osteomyelitis through the frontal sinus, abscess in that frontal bone, has to be drained and IV antibiotics (pott puffy tumor)
test for hyposmia or aposmia
UPSIT scratch and sniff
treatment of epistaxis
antibiotics, analgesics, decrease activity
epistaxis complications:
septal hematoma perforating the septum, aspiration of blood, nasal deformity from the hematoma collapsing the cartilage, necrosis
nasal poly associated with?
allergic rhinitis, samter triad, and CF
samter triad
aspirin sensitivity reaction, asthma and nasal polyp
-chronic condition
nasal polyp treat?
topical corticosteroid and surgery
nasal polyp complication?
hyposmia and aposmia and nasal obstruction
aural foreign body symptoms:
hearing loss, pain, leeding, or can be asymptomatic
nasal foreign body symptoms:
nasal occlusion, fetid purulent mucus, bleeding
must check what in FB?
-chest xray to look for obstruction
-blood gasses to check respiratory
-blood lead levels
treatment for FB?
-lidocaine and vasoconstrictors
-extract the FB
-epi can vasoconstrict BV
FB complications
if it was a battery can cause damage, septum perforation, necrosis, migrates to trachea in a failed removal, sinusitis or cellulitis, otitis media, barotrauma, epistaxis
look for what in nasal trauma
CSF leak and bruising indicating a skill fracture
sinusitis is caused by?
ostea that is superior to the maxillary sinus where the mucus will accumulate, hard to drain
potential causes of sinusitis?
-immotile cilliary dysfunction where the cilia can’t stop particulates
-foreign body
-rhinitis
-polyps
-tumor
-anything that blocks the ostea
kartageners syndrome
-immotile cilia
-can also cause situs incersus where the organs are on the wrong side of the body
acute rhinosinusitis
< 4 weeks, purulent nasal discharge, facial pain and pressure, diagnose clinically with history
acute rhinosinusitis complications
-bacterial, viral, chronic or subacute, infection can spread to localized tissue *especially when immunocomp
uri symptoms
-clear nasal rhinorrhea, congestion, hyposmia, cough, congestion, erythematous/red and enlarged mucosa
uri risk
can turn into viral rhinosinusitis
acute viral rhinosinusitis symptoms
-self limited
-kids: fatigue, irritable, cough, vomit sometimes from gagging on mucus
-normally no fever or nausea
-cough, sneeze, facial pressure, tooth ache, post nasal drip, malaise, headache
acute viral rhinosinusitis signs
-tenderness over sinuses, increased secretions, purulent secretions, red mucosa, water discharge, dark circles
sinusitis differential
URTI, nasal polyp, orbital cellulitis, wergener syndrome, neoplasm, immotile cilia
acute viral rhinosinusitis treat
-nsaid, acetamenophen, irrigation, corticosterois/ decongestant, antihistamines, mucolytics to thin mucus and zinc lozenges
acute viral rhinosinusitis at risk population
-smockers, pollution, UTRI, allergic rhinitis, polyps
acute viral rhinosinusitis complications
-more than 3 days of decongestant: medical mentosa
-euschian tube dysfunction
-middle ear effusion
medical mentosa
red beaffy mucus, enlargement of mucosa, pain from rebound of vasoconstriction
medical mentosa treat
topical intranasal corticosterois and oral prednisone
chronic sinusitis
-clear discharge, facial tenderness, mucosal edema, septal perfomation/ deviation
chronic sinusitis investigation
-nasal endoscopy, CT, mri (tumor or fungal), sweat chloride (CF), cilliary function study, plain films
preseptal orbital cellulitis
lid edema and redness
-NO ptosis, muscle restiction or fever
postseptal orbital cellulitis
-emergent, hospitalize, IV antibiotics and surgery
-progresses to ptosis, chemosis and opthalmoplegia
mucormycoses
-diabetees or immuno comp
-90% fatal
-invasion of the VASCULAR CHANNEL causing hemorrhagic ischemia and necrosis
-turbinate engorgement and ischemia and necrosis of nose
mucormycoses treat
**-surgical derbreidment, amphoterecin B and immunosupressents
why does mucormycoses like diabeetes
acidic environment, diabetic ketoacidosis is perfect
mucormycoses risk
vision loss
what is the risk of sinusitis spread to cavernous sinus
-cavernous thrombosis *high mortality rate
-blood clot and progressive chemosis
-fever over 105
-damage brain, eyes and nerves
cavernous sinus cause
retrograde transmission through valveless veins
cavernous sinus treat
-drain and IV antibiotics
-heparin but that is controversial
intracranial complications
subdural abscess, meningitis, intracranial abscess
-most common type of meningitis in kids
intracranial complications first symptom
nuchal rigidity
intracranial complications treat
-neurosurgery, surgical drainage
