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Clinical medicine HEENT > Quiz 2 > Flashcards

Quiz 2 Flashcards

1
Q

symptoms and signs of allergic rhinitis?

A

-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

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2
Q

what are 2 types of allergic rhinitis?

A

seasonal and pereniel

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3
Q

other names for allergic rhinitis

A

hay fever, ige mediated rhinitis

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4
Q

perennial diagnosis time line?

A

> 2 hours per day for > 9 months

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5
Q

how to confirm allergic rhinitis diagnosis?

A

-skin intradermal test, RAST IgE, sinus CT if truly persistant

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6
Q

Allergic differential diagnosis?

A

URTI, medicalmentosa, sarcodosis, wegeners granulomatosis

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7
Q

sarcoidosis

A

lymph node enlargement

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8
Q

wergners granulomatosis

A

inflammation of the bv, blood stained mucosa, must confirm with a biopsy

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9
Q

allergic rhinitis antihistamine treatment options

A

antihistamins: loratadine and cetirizene

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10
Q

allergic rhinitis adjunct treatments:

A

-monteleukast, cromolyn, ipratropium, immunotherapy

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11
Q

complication of allergic rhinitis?

A

-facial deformaties, serous otitis media, secondary rhinosinusitis, nasal congestion, nasal speech, euschian tube dysfunction, URTI susceptibility, laryngeal edema

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12
Q

common pathogens causing bacterial rhinosinusitis

A

-streptococcus pneumoniae, heamophilus influenza, moraxella, catrrhalis

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13
Q

pathogens causing chronic bacterial rhinosinusitis

A

pseudemonus auregenosa, group A streptococcus, s. aureus, anaerobes
-can happen in hospital from ng tubes, oxygen etc

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14
Q

bacterial rhinosinusitis causing what rhinorrhea?

A

purulent and cloudy

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15
Q

acute bacterial rhinosinusitis symptoms

A

-cough, fever (101), fatigue, hyposmia, anosmia, maxillary dental pain, ear pressure/ fullness, double worsening

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16
Q

acute bacterial rhinosinusitis symptom management?

A

pseudophedrine (sudafed), guafenesin (mussinex/ tussin), oxymetazoline (affrin), fluticasone

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17
Q

acute bacterial rhinosinusitis antibiotic options? first line

A

-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

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18
Q

acute bacterial rhinosinusitis antibiotic options? second line

A

-clindamycin, levoflaxin, azithromycin, trimethoprim, dupilumab

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19
Q

acute bacterial rhinosinusitis not improving, what do you do to meds

A

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

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20
Q

acute bacterial rhinosinusitis complication?

A

-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)

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21
Q

test for hyposmia or aposmia

A

UPSIT scratch and sniff

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22
Q

treatment of epistaxis

A

antibiotics, analgesics, decrease activity

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23
Q

epistaxis complications:

A

septal hematoma perforating the septum, aspiration of blood, nasal deformity from the hematoma collapsing the cartilage, necrosis

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24
Q

nasal poly associated with?

A

allergic rhinitis, samter triad, and CF

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25
Q

samter triad

A

aspirin sensitivity reaction, asthma and nasal polyp
-chronic condition

26
Q

nasal polyp treat?

A

topical corticosteroid and surgery

27
Q

nasal polyp complication?

A

hyposmia and aposmia and nasal obstruction

28
Q

aural foreign body symptoms:

A

hearing loss, pain, leeding, or can be asymptomatic

29
Q

nasal foreign body symptoms:

A

nasal occlusion, fetid purulent mucus, bleeding

30
Q

must check what in FB?

A

-chest xray to look for obstruction
-blood gasses to check respiratory
-blood lead levels

31
Q

treatment for FB?

A

-lidocaine and vasoconstrictors
-extract the FB
-epi can vasoconstrict BV

32
Q

FB complications

A

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

33
Q

look for what in nasal trauma

A

CSF leak and bruising indicating a skill fracture

34
Q

sinusitis is caused by?

A

ostea that is superior to the maxillary sinus where the mucus will accumulate, hard to drain

35
Q

potential causes of sinusitis?

A

-immotile cilliary dysfunction where the cilia can’t stop particulates
-foreign body
-rhinitis
-polyps
-tumor
-anything that blocks the ostea

36
Q

kartageners syndrome

A

-immotile cilia
-can also cause situs incersus where the organs are on the wrong side of the body

37
Q

acute rhinosinusitis

A

< 4 weeks, purulent nasal discharge, facial pain and pressure, diagnose clinically with history

38
Q

acute rhinosinusitis complications

A

-bacterial, viral, chronic or subacute, infection can spread to localized tissue *especially when immunocomp

39
Q

uri symptoms

A

-clear nasal rhinorrhea, congestion, hyposmia, cough, congestion, erythematous/red and enlarged mucosa

40
Q

uri risk

A

can turn into viral rhinosinusitis

41
Q

acute viral rhinosinusitis symptoms

A

-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

42
Q

acute viral rhinosinusitis signs

A

-tenderness over sinuses, increased secretions, purulent secretions, red mucosa, water discharge, dark circles

43
Q

sinusitis differential

A

URTI, nasal polyp, orbital cellulitis, wergener syndrome, neoplasm, immotile cilia

44
Q

acute viral rhinosinusitis treat

A

-nsaid, acetamenophen, irrigation, corticosterois/ decongestant, antihistamines, mucolytics to thin mucus and zinc lozenges

45
Q

acute viral rhinosinusitis at risk population

A

-smockers, pollution, UTRI, allergic rhinitis, polyps

46
Q

acute viral rhinosinusitis complications

A

-more than 3 days of decongestant: medical mentosa
-euschian tube dysfunction
-middle ear effusion

47
Q

medical mentosa

A

red beaffy mucus, enlargement of mucosa, pain from rebound of vasoconstriction

48
Q

medical mentosa treat

A

topical intranasal corticosterois and oral prednisone

49
Q

chronic sinusitis

A

-clear discharge, facial tenderness, mucosal edema, septal perfomation/ deviation

50
Q

chronic sinusitis investigation

A

-nasal endoscopy, CT, mri (tumor or fungal), sweat chloride (CF), cilliary function study, plain films

51
Q

preseptal orbital cellulitis

A

lid edema and redness
-NO ptosis, muscle restiction or fever

52
Q

postseptal orbital cellulitis

A

-emergent, hospitalize, IV antibiotics and surgery
-progresses to ptosis, chemosis and opthalmoplegia

53
Q

mucormycoses

A

-diabetees or immuno comp
-90% fatal
-invasion of the VASCULAR CHANNEL causing hemorrhagic ischemia and necrosis
-turbinate engorgement and ischemia and necrosis of nose

54
Q

mucormycoses treat

A

**-surgical derbreidment, amphoterecin B and immunosupressents

55
Q

why does mucormycoses like diabeetes

A

acidic environment, diabetic ketoacidosis is perfect

56
Q

mucormycoses risk

A

vision loss

57
Q

what is the risk of sinusitis spread to cavernous sinus

A

-cavernous thrombosis *high mortality rate
-blood clot and progressive chemosis
-fever over 105
-damage brain, eyes and nerves

58
Q

cavernous sinus cause

A

retrograde transmission through valveless veins

59
Q

cavernous sinus treat

A

-drain and IV antibiotics
-heparin but that is controversial

60
Q

intracranial complications

A

subdural abscess, meningitis, intracranial abscess
-most common type of meningitis in kids

61
Q

intracranial complications first symptom

A

nuchal rigidity

62
Q

intracranial complications treat

A

-neurosurgery, surgical drainage

Clinical medicine HEENT (10 decks)

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