Adult Med

Front 1

What is rhinitis?

Back 1

Edema & vadodilation of the nasal muccous membrane, nasal discharge, & obstruction.

Front 2

What are some causes of acute rhinitis?

Back 2

Common cold
Streptococcal Infections
Pneumococcal Infections
Staphylococcal Infections

Front 3

What are some causes of chronic rhinitis?

Back 3

Syphillis, TB, Rhinoscleroma, Rhinosporidiosis, Leishmaniasis, Blastomycosis, Histoplasmosis, & Leprosy.

Front 4

What are the S/Sx of Rhinitis?

Back 4

H/A, Nasal congestion, Watery rhinorrhea, Mucoid rhinorrhea, Sneezing, Scratchy throat, & Generalized malaise.

Front 5

What is the Management & Tx of Acute Rhinitis?

Back 5

Based on pathogen identification & ABX sensitivities. Topical vasoconstriction w/sympathomimetic amine. Pseudoephedrine 30mg q 4-6h.

Front 6

What is the Management & Tx of Chronic Rhinitis?

Back 6

Dx is based on demonstrating the causative microorganism by culture or biopsy. Tx consists of appropriate antimicrobial drugs.

Front 7

What is Allergic Rhinitis?

Back 7

IgE-mediated rhinitis, characterized by seasonal or perennial sneezing, rhinorrhea, nasal congestion, pruritus, & often, conjunctivitis & pharyngitis.

Front 8

What is the Allergic Salute?

Back 8

Transverse crease at the junction between the cartilage & bone of the nose. May indicate chronic nasal itching & allergies.

Front 9

Allergic Rhinitis D/Dx;

Back 9

Eosinophillic nonallergic rhinitis or nonallergic rhinitis w/eosinophilla.
Vasomotor rhinitis.
Rhinitis medicamentosa.

Front 10

Allergic Rhinitis Labs;

Back 10

Eosinophilla on nasal smear.
Skin test may identify responsible allergen.

Front 11

Allergic Rhinitis Tx;

Back 11

Avoid Allergen, Oral antihistamines & sympathomimetics, Phenylephrine or pseudoephedrine (can raise BP). 4% cromolyn by nasal spray 5.2mg tid or qid, Intranasal glucocorticoid spray (Rhinocort, Nasonex, Flonase) Allergen immunotherapy tx is advised if the allergen cannot be avoided, drug tx is poorly tolerated, or systemic glucocorticoids are needed.

Front 12

Name the Sinuses;

Back 12

Frontal-over eyes in brow line.
Maxillary-inside each cheekbone.
Ethmoid-behind the bridge of the nose, between the eyes.
Sphenoid-behind the ethmoids in the upper region of the nose & behind the eyes.

Front 13

Sinusitis S/Sx;

Back 13

Hx of current or recent URI, Fever, Weakness, Fatigue, Cough (more severe at PM), Rhinitis or nasal congestion, H/A upon awaking, Pain upon palpation of forehead or sinuses.

Front 14

What are the S/Sx of infection of the Maxillary sinuses?

Back 14

Upper jaw & tooth pain, & cheeks are tender to touch.

Front 15

What are the S/Sx of Inflammation of the Ethmoid Sinuses;

Back 15

Swelling of the eyelids
Swelling of the tissues around the eyes.
Pain between the eyes.

Front 16

What are the S/Sx of Inflammation of the Ethmoid sinuses?

Back 16

Tenderness when the sides of the nose are palpated.
Loss of smell
Stuffy nose

Front 17

What are the S/Sx of Inflammation of the Sphenoid Sinuses?

Back 17

Earaches
Neck pain
A deep aching at the top of the head.

Front 18

What X-ray should be ordered for Frontal sinuses?

Back 18

Caldwell

Front 19

What X-ray should be ordered for Maxillary sinuses?

Back 19

Waters

Front 20

What X-ray should be ordered for Sphenoid sinuses?

Back 20

Lateral

Front 21

What X-ray should be ordered for Ethmoid Sinuses?

Back 21

Submentovertical

Front 22

Sinusitis Tx;

Back 22

Oral decongestants & pain control.
ABX; HD Amoxicillin 90mg/kg qd in divided doses q 12-8hrs, Augmentin ES, Septra DS BID, Quinolones if PCN allergy.

Front 23

Sinusitis Local Complications;

Back 23

Mucocele
Osteomyelitis

Front 24

What is the Tx for Mucolcele?

Back 24

Surgical, requiring either drainage intranasally or its complete excision.

Front 25

What is the Tx for Osteomyelitis?

Back 25

Prolonged ABX & removal of necrotic bone.

Front 26

Which facial bones are fractrued the most?

Back 26

Nasal

Front 27

What can a nasal fx affect?

Back 27

The ascending processes of the maxilla & the septum.
Torn muccous membrane results in epistaxis.

Front 28

What are the S/Sx of a nasal fx?

Back 28

Blunt injury that causes bleeding from the nose; Deformity, Instability, Crepitus, Point tenderness, Most common is deviation of the dorsum to one side & depression of the nasal bone & ascending process of the maxilla on the other side.

Front 29

Nasal Hemotoma PE;

Back 29

Requires immediate medical attention! Septal cartilage has no blood supply & necrosis will occur. If bilateral cartilage will die in 24hrs.

Front 30

Nasal Hemotoma Tx;

Back 30

Surgical Drainage
Packing
ABX

Front 31

What are the complications of septal hematomas?

Back 31

Infection
Abscess formation
Septic necrosis of the cartilage.
Saddle deformity of the nose.

Front 32

Nasal Trauma Tx;

Back 32

Refer to ENT.
Reduction of Fx
Tx of septal hematoma (surgical drainage, packing, ABX.

Front 33

Nasal Foreign Body S/Sx;

Back 33

Nasal Drainage
Unilateral
Foul odor
Sometimes Epistaxis

Front 34

Nasal Foreign Body PE;

Back 34

Usually soft things;
Tissue
Clay
Pieces of toys or erasers
Food

Front 35

Nasal Foreign Body Management & Tx;

Back 35

Have pt forcefully blow nose.
Use a blunt hook to pull the object forward.
Alligator forceps
Kiss the baby

Front 36

Epistaxis Etiology;

Back 36

Most nasal bleeding originates from a lexus of vessels in the anteroinferior septum (Kiesselbach's area)

Front 37

Where do the majority of nosebleed originate?

Back 37

The nasal septum & erupt when the thin nasal mucosa overlying a dilated septal vessel dries, scabs, & falls off.

Front 38

What is the second most common cause of nosebleeds?

Back 38

Trauma
A force sufficient to deform the nasal skeletal structures can cause mucosal disrution & bleeding anteriorly on the septum, laterally along the nasal walls.

Front 39

What is the third most common type of nosebleed?

Back 39

Posterior Epistaxis (rare)
Its etiology is debated.

Front 40

Epistaxis Risk Factors;

Back 40

Trauma, Hot dry climate, URI, Allergies, Exposure to irritation chemicals, Medical conditions, Heavy ETOH use, Meds.

Front 41

What is a Nasal Polyp?

Back 41

Fleshy outgrowth of the mucous membrane of the nose.

Front 42

Nasal Polyp Risk Factors;

Back 42

Allergic Rhinitis
Acute & Chronic Infections
Cystic Fibrosis
ASA Allergy

Front 43

Nasal Polyp S/Sx;

Back 43

Form at the site of massive dependent edema in the lamina propria of the mucous membrane. Usually around the ostia of the maxillary sinuses. A Developing polyp is tear drop shaped, Mature resembles a grape, Sometimes bleeding.

Front 44

Are Nasal polyps associated with neoplasms?

Back 44

Yes, Unilateral polyps may occur in association with or represent benign or malignant neoplasms.

Front 45

Nasal Polyps PE;

Back 45

Round elongated mass projecting into the nasal cavity.

Front 46

Nasal Polyps Management & Tx;

Back 46

Corticosteroids (nasal spray bid), Surgical removal, Tend to recur if underlying allergy or infection is not controlled.

Front 47

Nasal Polyps Management & Tx Post Removal;

Back 47

Topical beclomethasone, flunisolide, or cromolyn therapy tends to retard recurrence.
Maxillary sinusotomy or ethmoidectomy may be indicated