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47 Cards in this Set

  • Front
  • Back
What is rhinitis?
Edema & vadodilation of the nasal muccous membrane, nasal discharge, & obstruction.
What are some causes of acute rhinitis?
Common cold
Streptococcal Infections
Pneumococcal Infections
Staphylococcal Infections
What are some causes of chronic rhinitis?
Syphillis, TB, Rhinoscleroma, Rhinosporidiosis, Leishmaniasis, Blastomycosis, Histoplasmosis, & Leprosy.
What are the S/Sx of Rhinitis?
H/A, Nasal congestion, Watery rhinorrhea, Mucoid rhinorrhea, Sneezing, Scratchy throat, & Generalized malaise.
What is the Management & Tx of Acute Rhinitis?
Based on pathogen identification & ABX sensitivities. Topical vasoconstriction w/sympathomimetic amine. Pseudoephedrine 30mg q 4-6h.
What is the Management & Tx of Chronic Rhinitis?
Dx is based on demonstrating the causative microorganism by culture or biopsy. Tx consists of appropriate antimicrobial drugs.
What is Allergic Rhinitis?
IgE-mediated rhinitis, characterized by seasonal or perennial sneezing, rhinorrhea, nasal congestion, pruritus, & often, conjunctivitis & pharyngitis.
What is the Allergic Salute?
Transverse crease at the junction between the cartilage & bone of the nose. May indicate chronic nasal itching & allergies.
Allergic Rhinitis D/Dx;
Eosinophillic nonallergic rhinitis or nonallergic rhinitis w/eosinophilla.
Vasomotor rhinitis.
Rhinitis medicamentosa.
Allergic Rhinitis Labs;
Eosinophilla on nasal smear.
Skin test may identify responsible allergen.
Allergic Rhinitis Tx;
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.
Name the Sinuses;
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.
Sinusitis S/Sx;
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.
What are the S/Sx of infection of the Maxillary sinuses?
Upper jaw & tooth pain, & cheeks are tender to touch.
What are the S/Sx of Inflammation of the Ethmoid Sinuses;
Swelling of the eyelids
Swelling of the tissues around the eyes.
Pain between the eyes.
What are the S/Sx of Inflammation of the Ethmoid sinuses?
Tenderness when the sides of the nose are palpated.
Loss of smell
Stuffy nose
What are the S/Sx of Inflammation of the Sphenoid Sinuses?
Neck pain
A deep aching at the top of the head.
What X-ray should be ordered for Frontal sinuses?
What X-ray should be ordered for Maxillary sinuses?
What X-ray should be ordered for Sphenoid sinuses?
What X-ray should be ordered for Ethmoid Sinuses?
Sinusitis Tx;
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.
Sinusitis Local Complications;
What is the Tx for Mucolcele?
Surgical, requiring either drainage intranasally or its complete excision.
What is the Tx for Osteomyelitis?
Prolonged ABX & removal of necrotic bone.
Which facial bones are fractrued the most?
What can a nasal fx affect?
The ascending processes of the maxilla & the septum.
Torn muccous membrane results in epistaxis.
What are the S/Sx of a nasal fx?
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.
Nasal Hemotoma PE;
Requires immediate medical attention! Septal cartilage has no blood supply & necrosis will occur. If bilateral cartilage will die in 24hrs.
Nasal Hemotoma Tx;
Surgical Drainage
What are the complications of septal hematomas?
Abscess formation
Septic necrosis of the cartilage.
Saddle deformity of the nose.
Nasal Trauma Tx;
Refer to ENT.
Reduction of Fx
Tx of septal hematoma (surgical drainage, packing, ABX.
Nasal Foreign Body S/Sx;
Nasal Drainage
Foul odor
Sometimes Epistaxis
Nasal Foreign Body PE;
Usually soft things;
Pieces of toys or erasers
Nasal Foreign Body Management & Tx;
Have pt forcefully blow nose.
Use a blunt hook to pull the object forward.
Alligator forceps
Kiss the baby
Epistaxis Etiology;
Most nasal bleeding originates from a lexus of vessels in the anteroinferior septum (Kiesselbach's area)
Where do the majority of nosebleed originate?
The nasal septum & erupt when the thin nasal mucosa overlying a dilated septal vessel dries, scabs, & falls off.
What is the second most common cause of nosebleeds?
A force sufficient to deform the nasal skeletal structures can cause mucosal disrution & bleeding anteriorly on the septum, laterally along the nasal walls.
What is the third most common type of nosebleed?
Posterior Epistaxis (rare)
Its etiology is debated.
Epistaxis Risk Factors;
Trauma, Hot dry climate, URI, Allergies, Exposure to irritation chemicals, Medical conditions, Heavy ETOH use, Meds.
What is a Nasal Polyp?
Fleshy outgrowth of the mucous membrane of the nose.
Nasal Polyp Risk Factors;
Allergic Rhinitis
Acute & Chronic Infections
Cystic Fibrosis
ASA Allergy
Nasal Polyp S/Sx;
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.
Are Nasal polyps associated with neoplasms?
Yes, Unilateral polyps may occur in association with or represent benign or malignant neoplasms.
Nasal Polyps PE;
Round elongated mass projecting into the nasal cavity.
Nasal Polyps Management & Tx;
Corticosteroids (nasal spray bid), Surgical removal, Tend to recur if underlying allergy or infection is not controlled.
Nasal Polyps Management & Tx Post Removal;
Topical beclomethasone, flunisolide, or cromolyn therapy tends to retard recurrence.
Maxillary sinusotomy or ethmoidectomy may be indicated