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ICM Unit 3 HEENT > Rhinitis/Sinusitis > Flashcards

Rhinitis/Sinusitis Flashcards

1
Q

Rhinitis 3 types

A

Allergic
Vasomotor
Viral

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2
Q

Allergic Rhinitis

A

AKA “hay fever”

seasonal vs perennial causes (pollen/spores; flower shrub/tree; and dust; household mites, air pollution)

atopic derm commonly associated

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3
Q

Allergic Rhinitis Clin Pres

A

CLEAR, watery rhinorrhea

tearing, irritation, pruritus (eye sympt)

think allergy symptoms

nasal mucosa swollen, boggy, pale (even blue) or violaceous

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4
Q

Allergic Rhinitis PE

A

“allergic salute” may lead to nasal crease

allergic “shiners”

nasal polyps

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5
Q

Allergic rhinitis dx

A

clinical w/ good hx and PE

for definitive cause can do skin prick test/ IgE immunoassay

distinguish from vasomotor rhin

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6
Q

Allergic Rhinitis Tx

A

AVOID ALLERGEN

environmental measures (remove carpets, curtains, etc)

Nasal saline rinses

CS nasal sprays - Flonase (fluticasone) {tx both nostrils, head down, and spray hoirzontally}

antihistamines - in tolerance, switch classes
Leukotriene inhibitor
Desensitization immunotherapy (“allergy shots”)

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7
Q

Vasomotor Rhinitis

A

causes by increased sensitivity of vidian nerve

can be form multiple stimuli (warm cold air, scents, light)

clear rhinorrh in elderly

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8
Q

Vasomotor Rhinitis 2 forms

A

Wet “runners” rhinorrhea
Dry - nasal obstruction, airflow resist little rhinorrhea

my see post nasal drip on PE

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9
Q

Vasomotor rhinorrhea TX

A

Step 1
(rhinor, sneezing, post nasal drip = topical antihist - Azelastine)

(rhino only = topical anticholinergic (ipratropium)

nasal obstruction and congestion = topical CS
(mometasone- Nasonex)

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10
Q

Viral Rhinitis

A

AKA; “common cold”

self-limited - may create latent infxn (2 bacter sinusitis, OM,etc)

adenoviruses, rhinoviruses

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11
Q

Viral Rhinitis HX/clin pres

A

clear to green mucus ; symptoms last <10 days, self-limited ; low or no fever

other common rhinitis symp

NO sinus tenderness

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12
Q

Viral Rhinitis TX

A

(supportive) fluids and rest
nasal saline rinses
oral and nasal decongestants

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13
Q

Bacterial Sinusitis

…compared to viral
can be …
MC causes….

A

uncommon compared to viral

can be COMPLICATION of viral URI or allergic rhinitis

S. pneumo, H. influ, M. cat MC

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14
Q

Bacterial sinusitis Clin Pres

A

facial pain/pressure (sinus pressure)
Alt. smell (“bad smell”) / Anosmia/hyposmia
+/- cough/F
nasal congestion
purulent nasal drainage ***

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15
Q

Bacterial Sinusitis Acute

A

<4 weeks

imaging not indicated - unless complication suspected

symptoms PLUS facial pain/pressure or dental pain at least 10 days beyond onset URI

double worsening w/i 10 days

3+ days high fever, specific sinus cavity

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16
Q

Bacterial Sinusitis Chronic

A

> 12 weeks

clinical sympt. - confirm w/ OBJECTIVE documentation
- anterior rhinoscopy
- nasal endoscopy
- CT (need to ENT)

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17
Q

Bacterial Sinusitis HX and PE

A

facial pain above or below eye (ask does pain increase w/ bending forward)

tenderness w/ tapping maxillary teeth

check ears for OM/serous otitis, nasopharynx, cervical lymph nodes

smoking/second hand smoke

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18
Q

Bacterial sinusitis TX

A

abx + decongestant + analgesics
- (amox, augmentin, doxycyline) 5-10 days

no improvement 72 hrs, change class

intranasal steriods - recurrent sinusitis

Refer ENT for continued sinusitis

19
Q

Complication of acute Bact. sinusitis

A

Preseptal Cellulitis
Orbital cellulitis
Subperiosteal abscess
Intracranial abscess
Meningitis
Septic cavernous sinus thrombosis
Osteomyelitis

20
Q

Viral vs Bacterial

A

DURATION OF SYMPTOMS
<10 days likely VIRAL
>10 days likely BACTERIAL

“double worsening”; recurrent symp; High grade fever; purulent nasal discharge

21
Q

Nasal Foreign Bodies Clin Pres

A

usually KIDS

UNILATERAL thick, FOUL-SMELLING nasal discharge
No fever or other symptoms

nasal obstruction

22
Q

Nasal foreign bodies Tx

A

Remove object (alligator forceps) - if seen NOT BLINDLY

close unaffected nostril and blow

check for signs of trauma and other nostril

23
Q

Epistaxis Causes/Risk factors

A

DIGITAL TRAUMA
external trauma to nose
dry nasal mucosa/ nose blowing
HTN (must rule out)

24
Q

Epistaxis Anterior

A

Bleeding from Kiessalbach’s Plexus or ant. septum

MC site 90-95%

kids/young adults
Less severe

25
Q

Epistaxis Posterior

A

usually ethmoid artery, internal maxillary, or branches (WOODRUFF’S plexus)

MORE SERIOUS

elderly

HTN, atherosclerosis, blood thinners

Hospitalization, post. pack

26
Q

Epistaxis TX

A

direct control - press nares together 10-15 mins sitting up and leaning slightly FORWARD

if 2 attempts fail = cautery, nasal tampon, anterior balloon, Gauze, thrombogenci foams and gels

27
Q

Epistaxis Tx PACKING

A

Anterior = use if pressure, cautery/vasoconstri. unsuccessful and gels/foams unavail.

Posterior = longer packing material (call ENT for help); surgical ligation or embolization of sphenopalatine a.

complications of packing = pressure necrosis, hypoxia, infxn - need ICU if bilateral post packs

28
Q

Benign tumors of Nose

A

Nasal polyps
Papillomas
Angiofibromas

29
Q

Nasal Polyps

MC ..?
appearance
suggest what in kids
SAMTER’S TRIAD

A

MC benign tumor of nose and sinuses

pale, edematous mucosal masses

nasal polyps in kids suggest CF!

SAMTER’S TRIAD = nasal polyps, asthma, aspirin sensitivity

30
Q

Nasal Polyps Tx

A

Topical nasal steroids
(improves quality of life, chronic sinusitis, use 1-3 mos.)

Oral steroids (2-3 weeks) when topicals fail

Surgical removal is above unsuccess. or ‘massive” ENT

31
Q

Inverted Papilloma

A

Locally aggressive tumor

HPV causing; 10% assoc. with SCC

lateral nasal wall

CAULIFLOWER like growths in/around middle meatus

32
Q

Inverted Papilloma - Clin Pres

A

Unilateral nasal obstruction
Occass. hemorrhage
Decreased sense of smell

33
Q

Inverted Papilloma- Tx

A

Complete excision
F/u (20% recurrence)

34
Q

Benign Juvenile Angiofibroma

A

very VASCULAR TUMOR originates in NASOPHARYNX

benign, can expand into sinuses and skull base

MC adolescent males

35
Q

Benign Juvenile Angiofibroma - Clin Pres

A

nasal obstruction and hemorrhage (heavy epistaxis)

36
Q

Benign Juvenile Angiofibroma - Dx

A

Avoid bx b/c profuse bleeding
Nasopharyngoscopy
CT/MRI

37
Q

Benign Juvenile Angiofibroma - Tx

A

Embolization techniques
Surgical excision
Radiologic f/u

38
Q

Malignant tumors of nose/sinuses

A

Rare

SCC MC

Chinese at higher risk; nasopharynx obstructs eustachian tube causes serous otitis media

high index suspicion important for early dx!

39
Q

Malignant tumors of nose/sinuses - Early Pres

A

UNILATERAL nasal obstruction
Serous otitis media
Dysgeusia/Anosmia
Discharge/Epistaxis
Decreased hearing (unilateral)

40
Q

Malignant tumors of nose/sinuses - Late Pres

A

Pain and recurrent “hemorrhage”
Expansion of cheek (facial asymm.)
Proptosis
Cheek hyperesthesia
Poorly fitting dentures, change unilaterally
Cranial nerve palsies

41
Q

Malignant tumors of nose/sinuses - When to work up

A

esp. smokers/drinkers

NEW UNIlateral nasal symp, UNILATERAL otitis media or serous otitis refractory to tx - presume nasopharngeal carcinoma until proven otherwise

42
Q

Malignant tumors of nose/sinuses - DX

A

Nasal endoscopy and nasopharygnoscopy
Bx needed for def dx
MRI

43
Q

Malignant tumors of nose/sinuses - TX

A

Depends on type of CA and extent

Very early = radiation
Advanced = concurrent radiation chemo
Surgical resection (combo w/ radiation; cranial base; endoscopic)

ICM Unit 3 HEENT (6 decks)

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