Term
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Definition
common cold
non-specific illness |
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Term
what are the viral agents of viral rhinitis? |
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Definition
rhinovirus, adenovitus and other |
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Term
what are the s/s of viral rhinitis? |
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Definition
clear rhinorrhea, nasal congestion; decresed ability to smell/taste |
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Term
problems associated with viral rhinitis: |
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Definition
headache, cough, scratchy throat, generalized malaise |
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Term
Physical Exam of patient with viral rhinitis: |
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Definition
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Term
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Definition
no curative Tx = maily supportive à no value for antiviral chemotherapy
- Edu pts that they do not need an antibiotic -will only develop resistance
- Decongestants – psudoephedrine 30-60 mg q 4-6º prn (or 120 mg BID)
- Nasal prep (careful not to abuse --- no more than 3 days)
Oxymetazoline (Afrin, Vicks, Sinex); Phenylephrine (Neo-Synephrine
- Fluids, analgesic and anti-inflamm. Meds |
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Term
Complications of viral rhinitis: |
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Definition
bacterial sinusitis;
acute otitis media,
acute exacerbations: asthma, COPD-related,
immunocompromized |
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Term
What is "Hyposmia"?
(olfactory dysfunction) |
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Definition
– most commonly occurs w/common cold
- Blockage of the olfaction sensory receptors:
20% idiopathic
Other causes:
CNS neoplasms, endocrine, Parkinson’s & Alzheimer’s, multiple meds |
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Term
(T/F)
sinusitis can be referred as rhinitis |
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Definition
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Term
(T/F)
Acute sinusistis
is less common than the common cold |
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Definition
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Term
What conditions does acute sinusitis follow? |
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Definition
- Follows respiratory illness:
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Viral or allergic rhinitis
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2’ to impaired mucocilliary clearance & obstruction of the osteomeatal complex
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Term
How long do the symptoms of acute sinusitis persist: |
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Definition
longer that 7-10 days but less than 4 weeks |
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Term
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Definition
-
toothacke type pain in maxillary region
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pain and pressure over the cheeks
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less symptoms with frontal and ethmoid/sphenoid sinuses
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change in secretion from watery to purulent (green or thick yellow) or mucoid discharge
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Term
What sinus is effected the most in acute sinusitis? Should it be considered an emergency? |
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Definition
Maxillary sinus
it is an emergency!!! |
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Term
what are the sites of infection in acute sinusitis? |
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Definition
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Maxillary sinus effected the most
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Dental infections can be the original site of infection
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If ethmoid is infected, will usually also have maxillary infection
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2’ cellulitis can result
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Sphenoid sinusitis most commonly present in pansinusitis
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Term
Acute Sinusitis typical pathogens include: |
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Definition
- S. pnemoniae
- H. influenzae
- less common: S. aureus and M. catarrhalis
Note: 25% of healthy people harbor these bacteria in the sinuses!!! |
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Term
How to diagnose acute sinusitits? |
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Definition
- imaging not routinely performed
- based on PE and S/Sx
- if needed, coronal CT best viewed
- if suspected malignancy, MRI with galoinium preferred
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Term
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Definition
- 2/3 of untreated pts resolve w/o Tx in ~14 days
- Antibiotics à reduce incidence of clinical failure by 50% for clinically lasting symptoms > 10-14 days
- Symptomatic Tx w/nasal preps & decongestants (oxymetazoline “Afrin”, pseudoephedrine “PSE”)
- ABX duration for 10-14 days: Amoxicillin 500mg PO 3×day; Augmentin 875 mg 2×day
- Penicillin allergy: Trimethoprim-sulfamethoxazole (Bactrim) 160/800 or Doxycycline 100mg ×2 a day
- Quinolones: Cipro, Levaquin, Avelox, Zegam
- Macrolides: Azithromycin (Zithromax), Clarithromycin (Biaxin)
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Term
Recurrent symptoms of acute sinusitis:
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Definition
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Term
Complications of acute sinusistis include: |
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Definition
- orbital cellulitis
- osteomyelitis of the frontal bone from chronic sinusitis
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Term
What does nasal vestibulitis result from? |
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Definition
- results from folliculitits of the nasal region:
- nasal manipilation
- trimming of nasal hairs
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Term
What is a causative agent of nasal vestibulitis?
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Definition
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Term
Tx of nasal vestibulitis: |
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Definition
- Dicloxacillin 250 mg QID × 7-10 days;
- topical mupirocin (Bactroban)
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Term
what is Rhinocerebral Mucormycosis? |
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Definition
- very rare condition !!!
- Fungus spreads rapidly thru the mucosa and vascular channels:
- lethal if not treated
- Immuno-compromised or post bone marrow transplant pts are more susceptible
- Medical and surgical emergency :
- presents a lot like rhinitis and sinusitis à black eschar on middle turbinate
- maintain a high degree of suspicion knowing there is a low likelihood
- Tx with Amphotericin B IV following surgical debridment
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Term
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Definition
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Term
What are the S/S of allergic rhinitis? |
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Definition
- same symptoms as viral rhinitis but last longer and can be seasonal depending on allergic (IgE) sensitivities
- pollens (spring)
- grass (summer)
- ragweed (fall)
- pale mucosa on nasal turbinates -- yellowish
- nasal polyps
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Term
S/s of allergic rhinitis: |
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Definition
- same nasal symptoms as in viral rhinitis
+
- pale mucosa on nasal turbinates - yellow, boggy, nasal polyps
- eye irritation, tearing, itchy throat, itchy ears and buzzing
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Term
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Definition
- OTC antihistamins:
- brompheniramine (Dimetapp)
- chlorpheniramine "Actifed" - PO
- clemastine "Tavist" - PO
- H1 receptor antagonists:
- Cetirizine "Zyrtec" - PO
- Fexofenadine "Allegra" - PO
- Loratadine "Claritin" - PO
- Nasal spray
- Levocabastine "Livostin"
- Azelastine "Astelin"
- Intranasal corticosteroids (mainstay Tx of AR):
- beclomethasone "Beconase"
- flunisolide "AeroBid"
- mometasone furoate "Nasonex"
- fluticasone propionate "Flonase"
- leukotriene inhibitors
- mast cell stabilizers
- maintain allergy free environment
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Term
are nasal polyps malignant or benign? |
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Definition
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Term
what are nasal polyps and who has them? |
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Definition
- pale, edematous, mucosal covered masses
- seen in pt with allergic rhinitis
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Term
nasal polyps can result in: |
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Definition
nasal obstruction and diminished smell |
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Term
what should you remember when treating an asthma patients for nasal polyps? |
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Definition
avoid NSAIDs and ASA to prevent bronchospasm |
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Term
what is the most common site of epistaxis? |
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Definition
- Anterior portion of the nose
- Kiesselbach's plexus
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Term
what is the most common reason of epistaxis? |
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Definition
- nasal trauma: nose picking, forceful nose blowing or sneezing
- rhinitis
- dry mucosa
- deviated septum
- anticoagulant use
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Term
list all sites of epistaxis and point which one is NOT in Kiesselbach's plexus |
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Definition
- anterior ethmoidal (ophtalmic)
- posterior ethmoid (opthalmic) -- NOT in Kiesselbach's plexus
- sphenopalatine (maxillary)
- greater palatine (maxillary)
- branch of superior labial (facial)
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Term
How to examine for epistaxis? |
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Definition
- determine site: anterior or posterior...
- if cannot see any site of bleeding, inspect the oropharynx (pt should be sitting upright)
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Term
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Definition
- 1st onset - apply direct pressure to the nares (pt in sitting position, head leaning fwrd to prevent aspiration)
- topical nasal preps:
- Phenylephrine (Neo-Synephrine)
- Vasoconstriction agent:
- Cocaine 4% (topical, cotton ball/gauze) or oxymetazoline (Afrin)
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Term
Tx for prolonged epistaxis: |
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Definition
- pack with sponge product MeroCel or balloon of ther products
- control anterior sites with cautery (electrocatery or chemical catery-Silver Nitrate Sticks)
- if pt has HTN, get BP under control!
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Term
Tx of posterior epistaxis |
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Definition
refer to ENT
- some sites need to be cauterized or ligated to prevent further bleeding - |
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Term
nasal trauma - interesting fact |
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Definition
most frequently fractured bone in the body |
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Term
Exam of nasal trauma often reveals: |
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Definition
crepitus and mobility of the bony fragments |
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Term
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Definition
epistaxis, pain, soft tissue hematoma
Note: septal hematoma can cause erosion of septal cartilage - saddle-nose deformity |
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Term
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Definition
- maintain airway for patency for long term
- closed reduction w/i 1 week of injury
- usually best to wait for swelling reduction
- if suspected septal hematoma, quick referral to ENT for definitive management (I&D, drain)
- plastic surrgery, cosmetic repair
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Term
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Definition
- inverted papilloma - HPV etiology
- juvenile angiofibroma - consider in adolescent males with recurrent epistaxis
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Term
Malignant Nasopharyngeal and Paranasal sinus tumors |
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Definition
- Initially present as allergic / viral rhinitis
- late diagnosis = poor prognosis
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Term
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Definition
- Wegner's Granulomatous - necrotizing granulomatous vasculitis of the upper and lower respiratory tract, glomerulonephritis, and a varialbe degree of small0vessel vasculitis
- NK Cell & T Cell EBV-Positive lymphoma - rare but present in young, most commonly
Asian pts with non-Hodgkin Lymphoma
- Sarcoidosis - microscopic, inflammatory granules that can occur in tissues and organs anywhere in the body
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