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Clin Med I > Sinus and Allergy Disorders > Flashcards

Sinus and Allergy Disorders Flashcards

1
Q

What can a patient with rhinitis present with?

A

congestion, rhinorrea, sneezing and pruritus

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2
Q

A patient presents to the office with a history of nasal congestion, rhinorrhea, sore throat and a fever that has lasted 5 days. Upon doing the PE, you note that the patient has nasal mucosa edema, clear rhinorrhea, and pharyngeal injection/cobble-stoning. What is the dx?

A

Viral URI (common cold)

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3
Q

What can you give/recommend to a patient for a cold?

A

decongestants, antihistamines, NSAIDs (Ibuprofen), Tylenol for fever, saline spray/nasal irrigations, intranasal corticosteroids, beta agonists (albuterol) if wheezing present.

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4
Q

What causes rhinitis medicamentosa?

A

intranasal decongestants (Afrin- dont use more than 3 days in a row), cocaine, rebound nasal congestion.

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5
Q

What medications can cause rhinitis?

A

NSAIDs, Aspirin, ACEI, phosphodiasterase 5 selective inhibitors, alpha receptor antagonists

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6
Q

An elderly patient comes in and complains of having a constant runny nose for the past 2 months. The patient states that they experience it when eating certain foods. What is the likely dx?

A

vasomotor rhinitis

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7
Q

This is the abnormal autonomic responsiveness and vascular dilation of submucosal vessels

A

vasomotor rhinitis

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8
Q

Deviated septum

A

snoring, nasal blockage, history of nasal fracture

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9
Q

Foreign body

A

unilateral obstruction, purulent nasal discharge, malodorous

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10
Q

Neoplasm

A

unilateral bloody discharge unresponsive to antibiotic

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11
Q

Nasal polyp

A

pearly, gray sac-like growths consisting of inflamed nasal mucosa, mobile and non-tender

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12
Q

What is Samter’s Triad as it pertains to nasal obstruction?

A
  1. Aspirin sensitivity/allergy
  2. asthma
  3. nasal polyps
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13
Q

What are the treatments for nasal obstruction?

A

oral/nasal steroids, leukotrine inhibitors, sx, aspirin, desensitization

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14
Q

A pregnant patient presents with nasal vascular poolin, vascular dilation and increasing blood volumes. What is the dx and what are the treatment options?

A

Dx: rhinitis gravidarum (starts before 6 weeks and ends 2 weeks post partum)
Tx: delivery, 1st and 2nd gen antihistamines, rhinocort-category B, saline

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15
Q

A patient presents to the office complaining of having a sweet taste following a trauma they had to the head. They recently have been experiencing HA’s for the past two weeks. When taking their sx history they mention that they had ear surgery in the past. What is the likely dx?

A

CSF rhinorrhea

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16
Q

With CSF Rhinorrhea, when the CSF dries on filter paper, what does it produce?

A

ring or halo sign

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17
Q

CSF Rhinorrhea can cause _________ or __________

A

headache, meningitis

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18
Q

__________ Rhinitis is a type of Gell and Combs Type I hypersensitivity reaction

A

Allergic

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19
Q

Explain the pathophysiology of allergic rhinitis

A

mast cells bind to antigen specific IgE molecules > mast cell degranulates > releases mediators such as histamine, leukotrines, kinins

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20
Q

What are the 5 comorbidities of allergic rhinitis?

A

asthma, otitis media, sinusitus, atopic dermatitis, allergic conjunctivitis

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21
Q

A patient presents complaining of sneezing, itching/watery eyes, congestion and rhinorrhea. They mention that this only occurs when they are outdoors during the spring time. What is the dx?

A

allergic rhinitis

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22
Q

What are likely PE findings as it pertains to the eyes for a pt that has allergic rhinitis?

A

allergic lashes - long, silky lashes.
dennie’s lines (meuller’s muscle spasm)
allergic shiners: venous stasis and hemosiderin deposits

22
Q

What are likely PE findings as it pertains to the nose for a pt that has allergic rhinitis?

A

inferior turbinate hypertrophy
deviated septum
pale nasal mucosa
nasal polyp

23
Q

What are likely PE findings as it pertains to the pharynx for a pt that has allergic rhinitis?

A

posterior pharyngeal cobbblestoning

24
Q

Discuss what the different types of allergy tests are and which is the gold standard?

A
  1. RAST- serum sample, measures antigen specific IgE antibodies and total serum IgE level, low sensitivity, high specificity
  2. Skin Test- Gold Standard- intradilutional testing (IDT), skin prick, intradermal, patch test
25
Q

What does pale/blue color of the turbinates indicate?

A

allergies

26
Q

What are some of the treatment options for allergies?

A
  1. avoidance- pets, dust mites, mold, environmental irritants
  2. meds- topical steroids are first line, they have very little adverse rxns (however can get nosebleeds), leukotriene inhibitors (singulair-montelukast)
    - intranasal steroids e.g. flonase (fluticasone)
    -intranasal antihistamines e.g. astelin (azelastine)
    -oral antihistamines e.g. claritin (loratadine), zyretic (cetrizine)
    -combo- Dysmista- fluticasone/Azelastine
  3. Immunotherapy- develop tolerance to environmental allergens, increases IgG4 which blocks the antigen from binding to IgE molecule, decreases antigen specific IgE molecules
27
Q

What are the two types of routes for allergy immunotherapy?

A
  1. SubQ
    -efficacy and safety well studies
    -risk for anaphylaxis
  2. Sublingual
    -Multi-allergen- not FDA approved
    -but no risk for anaphylaxis and people tend to be more compliant
28
Q

____________ epistaxis is more common and less severe.

A

Anterior

29
Q

When does epistaxis occur?

A

when the mucosa is eroded and vessels become exposed and break

30
Q

What are the differences between anterior and posterior epistaxis?

A

anterior occurs in the kiesselbach plexus or can also be from an inferior turbinate whereas the posterior has arterial origin and it is more difficult to control, risk of airway compromise

31
Q

What is the most common cause of epistaxis?

A

digital trauma

32
Q

What is the acute management of epistaxis?

A

control HTN (if hypertensive)
labs: CBC, PT, PTT, platelets (in recurrent cases)
ENT FU

33
Q

What is the treatment for minor anterior epistaxis?

A

minor: spray afrin into side of bleed then soak a piece of cotton with afrin to anterior cavity and apply pressure to cartilage. respray every 5 min until stopped

minor but recurrent: anesthetize septal area with lidocaine, apply silver nitrate to bleeding vessels. do not overspray bc can cause septal perforation

if bleeding doesnt stop consider nasal pack

antibiotics to prevent sinusitis/infection

electrocautery for bulging vessels > refer to ENT

34
Q

In posterior epistaxis bleeding, the bleeding is mainly down the back of the throat. The bleeding is most often from the ________________

A

internal maxillary artery (IMA)

35
Q

What are the reasons as to why patients can die from posterior epistaxis?

A

because their airway is compromised, aspiration, uncontrolled hemorrhage

36
Q

What is the most common cause of posterior epistasis?

A

HTN

37
Q

What is the tx plan for posterior epistaxis?

A

posterior nasal pack, hospitalize for ENT referral for nasal endoscopy, may require IMA embolization, arterial ligation (sphenopalatine, ethmoid)

38
Q

A 5 year old presents with a unilateral nose obstruction with persistent malodorous mucopurulent nasal drainage. Based on this, one can say that it is a ___________ until proven otherwise.

A

foreign body

39
Q

When removing FB’s you want to take precautions to prevent dislodgment into __________________

A

lower airway

40
Q

What is sinusitis, what does it lead to?

A

it is the inflammation of the sinuses which are air filled cavities in the skull.

The inflammation leads to blockade of the normal sinus drainage pathways (sinus ostia)

Leads to mucus retention, hypoxia, decreased mucociliary
clearance, predisposition to bacterial growth

41
Q

What is the etiology of sinusitus?

A
  1. viral
  2. bacterial (strep, H influenza, M catarrhalis), atypicals (mycoplasma, pseudomonas), resistant bacteria
  3. fungal (aspergillus)
    immunocompromised pts
    foul smelling, nasal discharge
42
Q

What are the differential dx associated with sinusitus?

A

viral rhinitis
TMJ
HA syndrome, migraine, sinus migraines
allergic rhinitis
dental infection
trigeminal neuralgia
sinus neoplasm- visual changes, unilateral nasal obstruction, unilateral epistaxis, CN deficits

43
Q

A patient presents with acute sinusitus. What would you expect their clinical presentation to be?

A

persistent symptoms for more than 7-10 days
nasal congestion
purulent nasal discharge- thick green/yellow mucus
post nasal drip
sinus pressure
may result from a dental infection

44
Q

A patient presents with chronic sinusitis. What would you expect their clinical presentation to be?

A

same sx as acute plus chronic cough, HA, halitosis, decreased smell, ear pressure

45
Q

A patient presents with sinusitus. What are you documenting for the physical exam?

A

face: possible localized tenderness

nasal: mucosal edema, inferior turbinate hypertrophy, mucosal erythema, mucopus

Ear: normal TM’s

Pharynx: thick postnasal drip, posterior pharyngeal cobble-stoning

Neck: cervical adenopathy

Lungs: clear

46
Q

What is the duration for acute sinusitus?

A

less than 4 weeks

47
Q

What is the duration for chronic sinusitus?

A

infection causing sx for more than 3 months

48
Q

Which diagnostic tool is used to evaluate sinuses, nasal cavity, air fluid levels and ostia?

A

CT scan

49
Q

A patient with acute sinusitus comes back to the office after 7 days complaining that their symptoms are getting worse. They state that when they last took their temperature, they had a fever of 102 degrees. What is the appropriate treatment?

A

Antibiotics- initial should be augmentin
PCN allergy should take doxycycline or clindamycin
Respiratory fluoroquinolone should be reserved for those who dont have alt tx options
Flonase
Prednisone

50
Q

What are the surgical options for sinusitus?

A

functional endoscopic sinus surgery (FESS)
Balloon sinuplasty
Septoplasty
Turbinate Reduction (Coblation)

51
Q

What are the complications of sinusitus?

A

orbital infection (orbital cellulitis)
pott’s puffy tumor- osteomyelitis with bone destruction “doughy” edema over involved frontal bone
cavernous sinus thrombosis
epidural abscess
invasive fungal sinusitus

52
Q

A patient presents with rhinitis. What do you want to tell them in regards to how their quality of life will change?

A

they can experience fatigue, headaches, sleep disturbances, cognitive impairment, and can complicate respiratory conditions. Due to this, they will have reduced work/school.

Clin Med I (20 decks)

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