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ENT > Rhinosinusitis + other random > Flashcards

Rhinosinusitis + other random Flashcards

1
Q

What is rhinosinusitis

A

Inflammatory and infective process affecting nasal mucous membranes and sinuses

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2
Q

What are RF

A 
Nasal obstruction 
Polyps
Septal deviation
Recent local infection 
Swimming
Smoking
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3
Q

What are the major symptoms of rhino sinusitis

A

Facial pain and pressure - frontal, worse bending forward
Nasal discharge / rhionorrea - thick and purulent
Nasal congestion / obstruction
Anosmia
Post nasal drip
Cough due to post nasal drip

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4
Q

What are minor features

A 
Headache - worse leaning forward 
Fever
Fatigue
Halitosis
Dental pain as can be a cause of spread
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5
Q

How do you Dx

A 
Need +1 of nasal discharge or blockage then +_
Facial pain
Headache
Reduction or loss of smell
Endoscopic or CT signs
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6
Q

What is acute rhinosinusitis and how do you treat

A

Acute onset
Bacterial cause
<12 weeks
Symptoms resolve completely

Rx
Simple analgesia
Nasal irrigation
Intranasal decongestant for 1 week only

If symptoms >5 days
Intranasal corticosteroid
Avoid Ax unless severe or worsening symptoms as most likely viral

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7
Q

What is recurrent acute

A

> 1 but <4 episodes per year
8 weeks symptom free between attacks
Refer to ENT
May do CT of paranasal sinus and nasal endoscopy to conifirm Dx

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8
Q

What is chronic rhinosinusitis

A

> 12 weeks
Persistent inflammatory changes >4 weeks after therapy
Can be subdivided into
+- nasal polyps
allergic vs non allergic
Get acute exacerbations
Must refer ENT for specialist management/ surgery

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9
Q

What are most common infectious agents

A

S.pneumonia = most common
H.influenza
M.catarrhalis
S>aureus

If viral
Rhinovirus
RSV
Parainfluenza

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10
Q

How do you Dx and Rx chronic sinusitis

A

CT sinus to assess extent of disease and plan for surgery
Analgesia
Intranasal decongestant = short term only
Nasal saline + intranasal steroid = central
Anti-histamine if underlying allergy
Oral steroid if polyp followed by topical
Topical steroid if no polyps followed by intra-nasal maintenance

Ax only if conservative doesn’t work / systemically unwell / at risk of complications e.g. severe COPD

Endoscopic sinus surgery if max medical and ongoing severe symptoms

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11
Q

When do you give intra-nasal steroid

A

If symptoms >10 days but never long term

Give 2 week dose of steroid spray

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12
Q

What Ax

A

B-lactam - penicillin / cephalosporin 5 days

Macrolide - clarithromycin

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13
Q

What do you do if nothing helps

A

Sinus surgery

Remove disease tissue and obstruction

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14
Q

What are important relations and what do they relate too

A

Frontal and ethmoid sinus - anterior cranial fossa
Maxillary sinus - orbit of eye
Sphenoid bone - optic nerve / ICA / cavernous sinus

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15
Q

What is NOT offered for sinusitis

A

Oral steroid
Anti-histmiane - except if associated allergic rhinitis
Anti-histamine

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16
Q

How do you investigate sinusitis

A

Bloods + culture if systemically unwell
If complicated / not responding
- Swab for MC+S
- High definition CT with contrast for complications

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17
Q

What are surgical emergency

A

Intra-orbital complication as sight threatening

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18
Q

Why is this important / complications

A 
Spread of infection
Meningitis
Encephalitis 
Cavernous sinus thrombosis 
Intracranial abscess - can press on optic nerve 
Orbital cellulitis / sepsis 
OM 
Pott's Puffy 
Risk of CSF leak / orbital complications
19
Q

What is a post nasal drip

A

Body usually produces mucous which mixes with silva and drips down back of throat
Occurs when body produces more e.g. after an infection

20
Q

What are the Sx

A

Constant need to clear throat
Cough, worse at night
Sore scratchy throat
Can get painful ear infection if blocks Eustachian tube

21
Q

How do you Rx

A

Anti-histamine
Decongestant / saline nasal spray
Steroid nasal spray
Ax to clear bacterial infection

22
Q

What are DDX facial pain

A

Trigeminal neuralgia
Cluster headache
Temporal arteritis

23
Q

What is Pott’s Puffy tumour

A

Life threatening complications of infectious sinusitis or trauma
OM of frontal bone leading to abscess formation

24
Q

How do you Dx

A

CT

25
Q

What are the features

A

Nasal discharge
Headache
Acute onset fever
Frontal swelling

26
Q

How do you Rx

A

Ax

Frontal sinus surgery - drains abscess

27
Q

What is an ethmoidal mucocele

A

No drainage and blockage of air cells
Expands forming a cyst
Can press on orbit causing diplopia

28
Q

How do you Dx

A

CT
Not X-ray as poor visualisation of sinus + high false +ve due to air fluid level / mucous thickening and sinus opacification

29
Q

How do you Rx

A

Endonasal sinus surgery

30
Q

What is black hairy tongue

A

Defective desquamation of filiform papillae of tongue

May go brown / green or pink

31
Q

What are predisposing features

A 
Poor oral hygiene
Ax
Head and neck radiation
HIV
IVDU
32
Q

How do you Dx

A

Swab to exclude Candida

33
Q

How do you Rx

A

Tongue scraping

Anti-fungal if Candida

34
Q

What is gingival hyperplasia

A

Overgrowth of gum tissue around teeth

35
Q

What causes

A 
Poor oral
Phenytoin
Ciclosporin
CCB
AML
36
Q

What is gingiivtis

A

Infections of gums usually due to poor hygiene

37
Q

If systemic upset what do you give

A

Paracetamol
Oral metronidazole
Chlorhexiidine mouthwash
Refer to dentist

38
Q

How does simple present

A

Red, painless swelling of gums which bleed

39
Q

What is severe

A

Painful bleeding gums
Halitosis
Ulcers

40
Q

What are other causes of nasal congestion in children

A

Large adenoids
Choanal atresia
Foreign body - refer same day if unilateral + foul discharge

41
Q

What are causes of nasal congestion in adults

A 
Deflected nasal septum 
Polyp 
Fracture
Olfactory tumour = rare 
Granuloma
42
Q

What symptoms would make you refer urgently

A

Bleeding
Unilateral obstructing mass
Numbness
Tooth loss

43
Q

When are nasal polyps rare and what should you rule out

A

<10 years
Menigocele / encephalocele if unilateral and <2
Neoplasm

44
Q

When do you suspect cancer of the paranasal sinus

A

If chronic sinusitis for the first time in later life

Blood stained nasal discharge

ENT (14 decks)

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