Upper Airway Disorders Flashcards
how many paired sinuses in sinus anatomy?
- 4
how many turbinates or concha
- 3-4
what is the main epithelium of the mucosal lined surfaces in the sinus
- psueodostratified columnar ciliated epithelium
respiratory cilia are effective in transporting
- mucus
- trapped inhaled particles
- bacteria
respiratory cilia are altered by what kind of changes
- chemical
- thermal
- mechanical
- hormonal
- pH
rhinosinusitis is characterized by
- inflammation of the mucosa of the paranasal sinuses
3 cardinal symptoms of rhinosinusitis
- purulent rhinorrhea
- facial pain/pressure
- nasal obstruction
which classification of rhinosinusitis lasts up to 4 weeks, with total resolution of symptoms
- acute
which classification of rhinosinusitis persists more than 4 weeks, but less than 12 weeks, with total resolution of symptoms
- subacute
which classification of rhinosinusitis lasts 12 weeks or more of signs/symptoms?
- chronic
which classification of rhinosinusitis has 4 or more episodes per year, with resolution of symptoms between attacks
- recurrent acute
most common cause of acute rhinosinusitis
- viral
viral causes acute rhinosinusitis
- rhinovirus
- coronavirus
- influenza
- RSV
- parainfluenza
most common bacterial causes of acute rhinosinusitis
- streptococcus pnuemoniae
- haemophilus influenzae
- moraxella catarrhalis
treatment of acute rhinosinusitis
- symptom management
treatment of acute rhinosinusitis with persistent or severe symptoms
- 10-14 days of antibiotics
result of intranasal steroid for treatment of acute rhinosinusitis
- may reduce time and intensity of symptoms
result of saline irrigations and nasal decongestants for treatment of acute rhinosinusitis
- improve symptoms
complications of acute sinusitis
- loss of anatomic border
- hematologic spread
chronic rhinosinusitis is considered more of an ________ disorder than ___________ like ARS
- considered more of an inflammatory disorder than an infectious disorder
classification of chronic rhinosinusitis (CRS)
- CRS without nasal polyposis
- CRS with nasal polyposis
symptom based diagnosis of CRS
- unreliable
gold standard diagnosis of CRS
- computed tomography (CT)
predisposing factors for CRS
- systemic
- local
- microorganisms
- pollutants
- medications
most common predisposing factor in CRS
- allergies
- IgE mediated
allergic rhinitis leads to
- mucosal inflammation and hypertrophy
- blocking the ostiomeatal complex
- nonaeration of sinus cavity
- additional inflammation
genetic predisposition to chronic sinusitis
- primary ciliary dyskinesia
- cystic fibrosis
primary ciliary dyskinesia genetic pattern
- autosomal recessive
result of primary ciliary dyskinesia
- disorganized microtubules
- absent dynein arms
what is the name of the condition where the organs are on the opposite side of the body?
- situs inversus
conditions suffered by those with primary ciliary dyskinesia
- chronic sinusitis
- bronchiectasis
- pneumonia
- otitis media
- infertility
- situs inversus
indications for Kartagener’s syndrome
- situs inversus
- nasal polyps (sinusitis)
- bronchiectasis
conditions suffered by those with cystic fibrosis
- bilateral nasal polyps
- chronic sinusitis
common bacterial cause of cystic fibrosis
- pseudomonas aeruginosa
mechanical treatment of CRS
- saline irrigations
- mucolytics
result of saline irrigations in treatment of CRS
- increase mucociliary flow
- mechanically rinse
anti-inflammatory treatment of CRS
- antihistamine
- oral corticosteroids
- topical steroids
result of topical steroids in treatment of CRS
- improve latency of ostiomeatal complex
- reduce mucosal swelling
antimicrobial treatment of CRS based on
- culture results
antimicrobial treatment of CRS treatment duration
- 3-6 weeks
systemic conditions of sinuses
- granulomatosis with polyangitis
- sarcoidosis
cause of granulomatosis with polyangitis
- idiopathic vasculitis and autoimmune process
result of granulomatosis with polyangitis
- necrotizing granulomas
result of sarcoidosis
- chronic granulomatous disease
- primary pulmonary
allergic fungal sinusitis is a subset of
- CRS
allergic fungal sinusitis due to
- allergic mucin
- eosinophils
- fungal hyphae
treatment of allergic fungal sinusitis
- primarily surgical
- postop medical treatment
result invasive fungal sinusitis
- ENT emergency
invasive fungal sinusitis most commonly impacts which population
- immunocompromised individuals
invasive fungal sinusitis caused by which organisms
- rhizopus
- mucor
- aspergillus
treatment of invasive fungal sinusitis
- surgical debridement
- IV antifungals
- reverse immunocompromised state
indications for functional endoscopic sinus surgery
- disease refractory to medical management
- anatomic obstruction resulting in CRS
goals of functional endoscopic sinus surgery
- remove inflammatory mediator load
- restore sinus ventilation/drainage
- restore mucociliary clearance system
- preserve functional integrity of mucosa
is surgery a cure for CRS
- no
worrisome symptoms for a sinonasal tumor
- frequent, unexplained nosebleeds
- sinonasal discharge
- sinus pain
- visual changes
- neck nodes
- excessive tearing
common symptoms of pharyngiitis
- sore throat
- inflammation of the pharynx
most common etiology of pharyngitis
- viral
CENTOR criteria symptoms for bacterial pharyngitis
- severe sore throat with fever
- lymphadenopathy
- tonsillar exudate
- absence of cough
most common cause of bacterial pharyngitis in adults
- Group A beta hemolytic streptococcus pyogenes
physical exam findings of pharyngitis
- erythema and white tonsillar exudates
- petechiae on the soft palate
- swollen tonsils
- bad breath
treatment of bacterial pharyngitis
- penicillin or amoxicillin X 10 days
what treatment for bacterial pharyngitis do we give for those allergic to penicillin
- macrolide or clindamycin
complications of bacterial pharyngitis
- post-streptococcal glomerulonephritis
- acute rheumatic fever
common cold viruses that cause pharyngitis
- rhinovirus
- coronavirus
- parainfluenzae
- influenza virus A, B, C
other viral causes of viral pharyngitis
- HIV
- adenovirs
- coxsackivirus
- HSV
monospot test is accurate when after EBV infection
- 2-3 weeks after sore throat
treatment of mono
- supportive care
- rest
- anti-pyretics
- analgesics
what should people with mono avoid
- contact sports
what antibiotics do we not give for mono
why
- ampicillin amoxicillin
- cause maculopapular rash
peritonsillar abscesses occur where
- between capsule of tonsils and pharyngeal constrictors
peritonsillar abscess associated with what symptoms
- trismus (lockjaw)
- hot potato voice
- drooling
treatment of peritonsillar abscess
- incision and drainage
- antibiotics
complications of untreated peritonsillar abscess
- airway obstruction
- necrotizing mediastinitis
- carotid artery aneurysm
- lemierre’s syndrome
retropharyngeal abscess extends where
- superiorly to base of skull
- inferiorly to mediastinum
characteristic symptom of retropharyngeal abscess
- neck stiffness
- shortness of breath
cause of retropharyngeal abscess
- polymicrobial
- aerobic/anaerobic gram neg
treatment of retropharyngeal abscess
- incision and drainage
- antibiotics
complications of retropharyngeal abscess
- mediastinitis
- airway obstruction
- lemiere’s
- necrotizing fasciitis
- sepsis
where is the danger space located
- between alar fascia and prevertebral fascia
result of Ludwig’s angina
- inflammation and cellulitis of the submandibular space
- floor of mouth becomes indurated
- tongue forced upward and backward and obstructs
how does Ludwig’s angina spread to the sublingual space
- via fascial planes
source of Ludwig’s angina
- typically dental in origin
main symptom of Ludwig’s angina
- compromised airway due to displacement of the tongue
treatment of ludwig’s angina
- tracheotomy
- IV antibiotics
- incision and drainage
bacterial causes of ludwig’s angina
- strep
- staph
- bacteriodes
what is lemierre’s
- internal jugular vein thrombosis
