Disorders Of Nose + Paranasal Sinuses Flashcards Preview

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Flashcards in Disorders Of Nose + Paranasal Sinuses Deck (34):
1

Acute sinusitis :

Diseases

*Acute viral/BACTERIAL rhinosinusitis
*Nasal Vestibulitis / S. Aureus nasal colonization
*Invasive fungal sinusitis

2

Acute Bacterial Rhinosinusitis:

Path

*Ostemeatal complex obstruction (sinus pore)
*Impaired mucocilliary clearance

3

Acute Bacterial Rhinosinusitis:

Top 4 bugs

S. PNEUMONIA
H. INFLUENZA
M. Catarrhalis
S. Aureus

also anaerobe, strep, fungus

4

Acute Bacterial Rhinosinusitis:

Etiology

Specific to community

5

Acute Bacterial Rhinosinusitis:

Presentation

Purulent discharge
Facial pain/pressure
Nasal obstruction
Acute s/s onset
Min 10 days

W/ cough, malaise, fever, headache

6

Dx Sinusitis:

2 major S/S
Or
1 major 2 minor S/S

7

Acute Bacterial Rhinosinusitis:

Tx

NSAID
Oral/nasal decongestants
(Pseudoeph/ oxymetazoline)
Intranasal corticosteroids 5 days
Systemic oral ABX (amoxi, TM-SLF)

8

Sinusitis

Acute vs. Chronic

Acute - <4 weeks
Chronic - >12 weeks

9

Chronic sinusitis

DX

>12 weeks
Objective (PE) evidence - mucosal inflammation
+
2/4 signs:
*Nasal mucupurulent drainage
*Nasal obstruction/cong
*Facial pain/pressure
*Smell loss (kids - cough)

10

Chronic Sinusitis :

Etiology

Children + adults

11

Chronic sinusitis:

Tx

No cure
*Intranasal saline
*Topical/systemic steroid
*ABX (topical/syst) - Amoxi-clav or clinda (allergy)
*Antileukotriene (Montelukast)
*Surgery - AFRS
*refer - refractory

12

Allergic rhinitis:

Etiology

1/6 - 1/2 americans

13

Allergic Rhinitis :

Path

Exposure airborne allergen
Immune response
Cells - proinflammatory mediators

14

Allergic rhinitis

Cause - early spring

Tree pollens

15

Allergic rhinitis :

Spring/summer

Grass pollens

16

Late summer

Weed pollens

17

Allergic rhinitis

Cause - Throughout year

Fungi
Household allergens

18

Allergic rhinitis :

Cause - occupational

Seed dusts, woods, furs, latex, flour, psyllium ...

19

allergic rhinitis:

Present

Clear rhinorrhea
Sneezing
Tearing, eye inflame
Pruritis
Ass S/S : cough, bronchospasm, eczematous dermatitis
PE: PALE TURBINATES

20

Allergic Rhinitis:

Tx

AVOID ALLERGEN
Intranasal steroid
Antihistimine
Antileukotrenes
Ipatroprium
Immunotherapy

21

Epistaxis:

Etiology

Before age 10
From age 45-65

22

Epistaxis:

Path

Trauma
Dryness
FB
Rhinitis
Intranasal steroid
Bleeding disorder

23

Epistaxis :

Hx - remember

Attempts at control
Prior episodes
Trauma/surgery
Meds/ herbs
Bleeding problems

24

Epistaxis:

Dx

IF uncertain about etiology or prolonged:
CBC
Crossmatch/type

25

Epistaxis:

Tx - initial tamponade

Lean forward
Blow nose
Spray decongestant
Pinch 15 mins

26

Epistaxis:

Tx - further treatment

Topical 4% cocaine
Gelatin/collagen sponge
Cautery
Fibrin glue
Nasal packing

27

Epistaxis:

Nasal tampon

ENT w/in 24-48 hrs
ABX

28

Nose FB :

etiology

Children 2-4 y/o
Noticed by caregiver

29

FB Nose:

Presentation

Unilateral nasal discharge
Halitosis
Epistaxis
Septal perf
Ingestion/Aspiration of FB

30

FB Nose:

FB location

Nasal floor/inferior turb
Anterior superior middle turb

31

FB Nose:

Tx

5 mins before, topical anesthetic/vasoconstrictor
Positive pressure
Balloon
Forceps
Suction

32

Nasal polyps :

Etiology

Allergic rhinitis patient

33

Nasal Polyps:

Tx

Intranasal corticosteroid 1-3 months
Oral corticosteroids 6 day
Surgery

34

Nasal trauma, PE see septum perf....

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