Eent

Front 1

the nares are surrounded by the cartilaginous ________ and ________________

Back 1

ala nasi, columella

Front 2

convergence of small, fragile arteries and veins located superficially on the anterior inferior portion of the septum

Back 2

Kiesselbach plexus

Front 3

referes to any inflammation of the the nasal mucosa

Back 3

rhinitis

Front 4

better known as the common cold

Back 4

viral rhinitis

Front 5

Headache, nasal congestion, watery rhinorrhea, sneezing, and a scratchy throat, accompanied by general malaise are typical

Back 5

viral rhinitis

Front 6

presence of purulent nasal discharge suggests what type of infection:

Back 6

bacterial infection

Front 7

there is no curative treatment for viral rhinitis: T or F

Back 7

T

Front 8

Supportive measures such as decongestants (pseudoephedrine [Sudafed], 30 to 60 mg Q 4 to 6 hours) may provide some relief of rhinorrhea and nasal obstruction.

Back 8

viral rhinitis

Front 9

Nasal sprays such as oxymetazoline (Afrin) or phenylephrine (Neo-Synephrine) are also helpful and are rapidly effective.
They should not be used for more than a few days at a time, since chronic use leads to a rebound congestion that is often worse than the original symptoms.

Back 9

viral rhinits

Front 10

Episodic rhinorrhea of clear, watery discharge; sneezing; and obstruction of the nasal passages; with lacrimation and pruritis of the conjunctiva, nasal mucosa, and oropharynx, are the hallmark symptoms

Back 10

allergic rhinits

Front 11

nasal mucosa is pale and boggy

Back 11

allergic rhinitis

Front 12

“Allergic shiners” (a bluish discoloration below the eyes) may be present.

Back 12

allergic rhinitis

Front 13

a “nasal crease” (a horizontal line just distal to the tip of the nose as a result of wiping the nose in an upward motion) may also be seen.

Back 13

allergic rhinitis

Front 14

Treatment includes avoidance of any known allergens, and the use of antihistamines, cromolyn sodium (NasoCrom), nasal or systemic steroids, nasal saline drops, and immunotherapy.

Back 14

allergic rhinitis

Front 15

consists of bogginess of the nasal mucosa associated with a complaint of stuffiness and rhinorrhea.
The symptoms are labile and can clear quickly.
Treatment is avoidance of the irritant.
(similar to walking through perfume section)

Back 15

vasomotor rhinitis

Front 16

chronic nasal stuffiness that results in rebound congestion secondary to the overuse of nasal decongestant sprays such as Afrin and Neo-Synephrine.
Treatment requires complete cessation of the sprays.
This triggers a period of severe nasal congestion that usually lasts 1 to 2 weeks

Back 16

rhinitis medicamentosa

Front 17

Topical intranasal corticosteroids such as fluticasone (Flonase), 2 sprays in each nostril QD, or a short tapering dose of oral prednisone may help during the process of withdrawal. (won't work as quickly or as effectively as nasal decongestant sprays - pt must be aware of this, and this can be frustrating)

Back 17

rhinitis medicamentosa

Front 18

is a bacterial infection involving inflammation of any the paranasal sinuses as a result of impaired mucociliary clearance and obstruction of secretions, usually following a viral infection of the upper respiratory tract

Back 18

sinusitis

Front 19

Physical exam reveals secretions that are purulent green or yellow, and occasionally, visible swelling over a sinus.

Back 19

sinusitis

Front 20

the most common form of sinusitis:

Back 20

maxillary sinusitis

Front 21

It is associated with pain and pressure over the cheeks, retroocular pain, temporal headache that is exacerbated by leaning forward, maxillary dental pain, purulent rhinorrhea, and conjunctivitis.

Back 21

sinusitis

Front 22

_______ sinusitis can cause a severe headache above the eyes, which is exacerbated by assuming a supine position and alleviated with an upright position.
It also causes pain and tenderness of the forehead, most easily elicited by palpation of the orbital roof just below the medial end of the eyebrow; a low-grade fever; upper lid edema; and rhinorrhea.

Back 22

frontal

Front 23

______ sinusitis is more common in children than adults.
It produces a low-grade fever and periorbital, retroorbital, frontal, or medial canthal pain that is worse when supine, coughing, or straining

Back 23

ethmoid

Front 24

__________ cellulitis may be present with sinusits and pt needs to be admitted

Back 24

periorbital

Front 25

With sphenoid sinusitis (which is relatively rare), patients classically complain of a deep-seated retroocular pain and headache at the occiput, vertex of the skull, or behind the eye which is worse when supine or bending forward, and better with the head upright.
-It requires a CT scan for diagnosis.
-When acute, this is a medical emergency, and all patients should be admitted to the hospital!

Back 25

sphenoid

Front 26

With ________ sinusitis, suspect nasal foreign bodies (especially in children) and cancer

Back 26

unilateral

Front 27

Recurrent sinusitis in children may indicate ______ fibrosis or Kartageners syndrome (complete situs inversus associated with bronchiectasis and chronic sinusitis associated with ciliary dysmotility and impaired ciliary mucous transport in the respiratory epithelium).

Back 27

cystic

Front 28

Important complications of sinusitis include osteomyelitis and periorbital and orbital _______.

Back 28

cellulitis

Front 29

Common bacterial isolates are Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pyogenes, Staphylococcus pyogenes, and Moraxella catarrhalis.

Back 29

sinusitis

Front 30

Imaging modalities include plain radiographs and CT.
The radiographic hallmarks of acute _________ are: air-fluid levels, soft tissue density (opacification) without bone destruction, and mucosal thickening > 5 mm.
CT is the most sensitive and specific technique, and allows for better delineation of the sphenoid and ethmoid sinuses.

Back 30

sinusitis

Front 31

Water Posteroanterior View

Back 31

Best view for visualizing the maxillary sinus

Front 32

Caldwell Posteroanterior View

Back 32

Most useful for visualizing the frontal and ethmoid sinuses

Front 33

Chamberlain-Towne View

Back 33

Most useful for visualizing the frontal sinuses and also the occipital bone

Front 34

Submental-Vertex Base View

Back 34

Valuable for visualizing the ethmoid and sphenoid sinuses, as well as the skull base. *CT may be better.

Front 35

For treating __________________, amoxicillin, macrolides, and trimethoprim-sulfamethoxazole are appropriate agents.
Refractory cases or immunocompromised patients require broader spectrum antibiotics such as amoxicillin with clavulanate (Augmentin) and second or third generation cephalosporins.
Treatment is usually for 10 to 14 days, but up to 3 weeks may be necessary.
Decongestants reduce local edema, increase air movement within the sinuses, and decrease local secretions.
Humidified air, steam, or nasal saline sprays also facilitate drainage.
Patients should be strongly encouraged to stop smoking. (slows mucociliary action)

Back 35

acute bacterial sinusitis

Front 36

pale, edematous, mucosally covered masses commonly seen in patients with allergic rhinitis.

Back 36

nasal polyps

Front 37

They may result in chronic nasal obstruction and a diminished sense of smell.

Back 37

nasal polyps

Front 38

The presence of in children should suggest the possibility of cystic fibrosi(as does recurrent sinusitis).

Back 38

nasal polyps

Front 39

Initial treatment with nasal steroids for 1 to 3 months is usually successful for small ______ and may reduce the need for surgery.
When medical management is unsuccessful, _______ should be removed surgically.

Back 39

nasal polyps

Front 40

Bleeding from the ____________, a vascular plexus on the anteroinferior nasal septum, is by far the most common type of epistaxis encountered.

Back 40

Kiesselbach plexus

Front 41

Predisposing factors include nasal trauma (nose picking, foreign bodies, forceful blowing), rhinitis, drying of the nasal mucosa from low humidity, alcohol use, and antiplatelet medications.

Back 41

epitaxis

Front 42

Most cases of _______________ can be successfully treated by direct pressure on the bleeding site.
This is accomplished by applying pressure to the nasal alae for at least 10 minutes with the patient in the sitting position to reduce venous pressure, and leaning forward to reduce the swallowing of blood.

Back 42

anterior epistaxis

Front 43

Short-acting topical nasal decongestant sprays such as phenylephrine (Neo-Synephrine), which act as vasoconstrictors, may also be helpful.

Back 43

epitaxis

Front 44

The nasal speculum should be inserted into the vestibule and spread in an __________ direction - do not spread laterally!

Back 44

inferior to superior

Front 45

For epitaxis, topical 4% _______ can applied by way of a cotton pledget serves both as an anesthetic agent and a vasoconstrictor.

Back 45

cocaine

Front 46

When visible, the bleeding site may be cauterized with ____________ or electrocautery. (need to clear the clot because the clot encourages more bleeding, have pt blow clot out)
Occasionally, a site of bleeding may be inaccessible to direct control, or attempts at direct control may be unsuccessful.

Back 46

silver nitrate

Front 47

Anterior nasal packing should remain in place for at least ___ hours, and for no more than __ days.

Back 47

48 hours, 4 days

Front 48

After nasal packing, a systemic _________ should be administered since the packing acts as a foreign body occluding the sinuses.
-Amoxicillin is a good choice.

Back 48

antibiotic

Front 49

A small percentage of cases of epistaxis involve bleeding in the posterior nasal cavity (_____________ plexus), most commonly behind the inferior and middle turbinates.
-The bleeding may compromise the airway and requires both posterior and anterior packing.

Back 49

Woodruff's

Front 50

Because this is uncomfortable for the patient, and because it requires oxygen supplementation to prevent hypoxia, hospitalization and ENT consultation are required.
-The packing usually remains in place for 5 to 7 days.

Back 50

epitaxis with bleeding in the post nasal cavity (Woodruff's plexus)

Front 51

the most frequently fractured bone in the body

Back 51

nasal pyramid

Front 52

Epistaxis and nasal pain are common, as are soft tissue hematomas (“black eyes”).

Back 52

nasal fracture

Front 53

Treatment is aimed at maintaining long-term nasal airway patency and nasal aesthetics.

Back 53

nasal fracture

Front 54

In the presence of marked nasal swelling, it is best to wait several days for the edema to subside before attempting reduction.
Persistent functional or cosmetic defects may be repaired by delayed reconstructive nasal surgery.

Back 54

nasal fracture

Front 55

Intranasal examination should be performed in all cases of nasal trauma to rule out ____________, which appears as a bluish, grapelike mass on the nasal septum.

Back 55

septal hematoma

Front 56

An untreated _____________ will result in loss of the nasal cartilage with resultant “saddle-nose deformity”.

Back 56

septal hematoma

Front 57

hematomas may also cause infection, abscess, and aseptic necrosis, followed by absorption of the septal cartilage, resulting in septal perforation.

Back 57

septal hematoma

Front 58

Treatment consists of incision and drainage via an intranasal septal mucosal incision.
It is important to be sure that both sides of the septal cartilage are adequately drained.
Packing is placed to prevent reaccumulation.
Antibiotic prophylaxis is recommended.

Back 58

septal hematoma