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Otolaryngology > Rhinology, Nasal obstruction and sinusitis > Flashcards

Rhinology, Nasal obstruction and sinusitis Flashcards

1
Q

Causes of rhinorrhea and post nasal drainage

A

allergic rhinitis, nonallergic rhinitis, vasomotor rhinitis, and acute and chronic rhinosinusitis

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2
Q

Causes of nasal obstruction and pain

A
  1. anatomic deformities (including septal and external nasal deviation, nasal valve compromise, turbinate hypertrophy, nasal polyps)
  2. inflammatory changes resulting in mucosal edema
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3
Q

Patients with what kinds of rhinitis present with clear rhinorrhea, no other allergic symptoms or history, and allergy tests are negative?

A
  1. Vasomotor (food, temp and sudden bright light trigger it)

2. nonallergic rhinitis

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4
Q

Best tx for nonallergic and vasomotor rhinitis

A

Intranasal steroid sprays

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5
Q

What virus is acute viral rhinosinusitis frequently attributed to?

A

Rhinovirus (common cold)

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6
Q

Which is false regarding the common cold?
A. pathophysiology involves infection, inflam, mucosal swelling and inc mucus
B. High grade fever, facial discomfort and purulent nasal drainage
C. Symptomatic tx w/antipyretics, hydration, analgesics, decongestion
D. Spontaneous resolution in 7-10days
E. Abx discouraged

A

B - low grade

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7
Q

Prolonged mucosal edema can cause sinus obstruction and retention of secretions. This is called what?

A

Acute bacterial rhinosinusitis

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8
Q 
Which is not a major symptom of acute rhinosinusitis?
A. Ear fullness/pressure
B. Facial pressure/pain
C. Facial congestion/fullness
D. Purulent nasal discharge
E. Nasal-obstruction, anosmia
A

A. Minor symptom. Other minor include headache, fever, cough, fatigue, toothache, halitosis

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9
Q

Over ___% of patients with viral URI also have an abnormal sinus CT scan?

A

80% - this means plain films or CTS do not differentiate acute bacterial rhinosinusitis from a viral URI

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10
Q

How can you differentiate between a viral vs bacterial infection?

A

Viral takes 7-10 days to resolve

Symptoms >7-10 days or worsens after 5 days suggests bacterial

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11
Q

organisms that cause acute otitis media?

A

S pneumonia
H influenza
Moraxella catarrhalis

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12
Q

How do you break down acute, subacute and chronic rhinosinusitis?

A

Acute: less than 1 mo
Subacute: more than 1 mo but less than 3mo
Chronic: more than 3 mo(diff underlying microbiology w/inc # anaerobes)

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13
Q

What is the tx of choice for acute rhinosinusitis (as well as AOM)?
What if there is resistance?

A
  1. 10 day course of amoxicillin or trimethoprim/sulfamethoxazole
  2. Amoxicillin/clavulanate or 2nd gen cephalosporin or macrolide or quinolone
    Must cover H influenza
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14
Q

Oxymetazoline is what kind of adjuvant tx for acute rhinosinusitis?

A

Topical decongestant

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15
Q

Guaifenisen is what kind of adjuvant tx for acute rhinosinusitis?

A

Mucolytic

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16
Q

Which is correct about when you should call oto about acute rhinosinusitis?
A. 5-6 infections/yr
B. Infection doesn’t respond to one 3 week course of abx
C. Nasal polyps
D. Must have at least 2 complications of sinusitis

A

C.
A. 3-4
B. two 3 week courses
D. Any complications of sinusitis

17
Q

What kind of sinusitis can result in orbital cellulitis or abscess and presents with eyelid swelling, proptosis and diplopia? Tx?

A

Ethmoid sinusitis

Surgical drainage ASAP if abscess present, IV abx and decongestants if no abscess.

18
Q

What kind of sinusitis can cause ophthalmoplegia (eye mm paralysis), meningitis, and cavernous sinus thrombosis?

A

Sphenoid sinusitis

19
Q

Cavernous sinus thrombosis is a complication with even more grave implications than meningitis or brain abscess, and it carries a mortality of ~__ %. Can be caused by what?

A

50%

Sphenoid sinusitis

20
Q

Pt w/ double vision and rhinosinusitis is assumed to have what until ruled out by CT or MRI?

A

Cavernous sinus thrombosis

21
Q

Tx of sphenoid sinusitis?

A

High dose IV abx

Surgical drainage of paranasal sinuses.

22
Q

allergic disorder to fungi can result in severe symptoms of chronic sinusitis and significant inflammation in the sinonasal mucosa due to a preponderance of _____ ?

A

eosinophils

23
Q

Fungal spores can also get trapped in a sinus, where they germinate and fill the sinus with debris, forming a “fungal ball” or _____

A

mycetoma

24
Q

In what pts can certain fungal infections (e.g. mucormycosis) become invasive?

A

Immunocompromised or diabetic

ENT emergency!

25
Q

Frequent cause of nasal obstruction?

Tx?

A

Septal deviation
May also snore and have obstructive sleep apnea
Rhinoplasty and septoplasty

26
Q

What is this? Localized, extremely edematous nasal or sinus mucosa (microscopically full of water) Most common nasal mass

A

Nasal polyps

27
Q

__% of patients with polyps also have allergies. What else do these patients have?

A

50

Asthma

28
Q

Tx polyps?

A

Systemic steroids, intranasal steroid sprays

Surgery if polyps recur

29
Q

Signs of polyps?

A

Grapelike swellings that protrude into lumen –> obstruction and anosmia

30
Q

What is Samter’s triad?

A

Asthma
Allergy to aspirin
Nasal polyposis
Hard to tx

31
Q

Unilateral nasal polyps may be a manifestation of what?

A

Neoplasm. Refer to oto

32
Q

Polyps in kids is uncommon and should prompt a work up for what?

A

CF

33
Q

Condition that develops when people repeatedly use decongestant nasal sprays over a long period and can cause nasal blockage.

A

Rhinitis medicamentosa

34
Q

Why does rhinitis medicamentosa occur?

Tx?

A

Mucosa becomes inflamed due to spray. May be related to cocaine abuse
Stop spray use

35
Q

Why might cocaine induce ischemic necrosis in the nasal septum?

A

Vasoconstricts –> nasal septal perforation

36
Q

Why might a pt suffer from chronic rhinosinusitis even though they have a straight septum and no nasal polyposis or inflammation?

A

Blockage of sinus drainage (e.g. uncinate process is close to ethmoid bulla, forming the infundibulum where maxillary sinus drains) Swelling of the mucosa can block the sinus ostium.

37
Q

How might a nasal polyp lead to sinusitis?

A

• Obstruction of the natural ostium of the sinus will cause a backup and may lead to sinusitis.

38
Q

What are 3 intranasal masses with inflammatory etiologies?

A
  1. pyogenic granuloma
  2. wegner’s granulomatosis
  3. Sarcoidosis
39
Q

What are 5 neoplasms of the nose/sinus?

A
  1. Inverting papilloma
  2. juvenile nasopharyneal angiofibroma
  3. Sinonasal undifferentiated carcinoma
  4. adenocarcinoma
  5. Esthesioneuroblastoma

Otolaryngology (15 decks)

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