CMI - Fall 2011
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| Non-specific URI aka? | Common cold
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| Avg duration of URI? | ~1wk
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| Most common cause of URI? | Rhinovirus
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| What to caution involving nasal decongestants? | Only use 3 days MAX!! at a time.
Nasal passages get used to the med and will have bad rebound if use too long and then stop.
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| Who should not use decongestants? | Young children, Htn, tachy
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| Length of course of acute viral rhinitis? | 7-14 days
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| Bacteria in sinuses can? | ^ mucus production
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| What is the ostio-meatal complex? | Anterior Ethmoid, Frontal, Maxillary sinuses drain into this to the middle meatus
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| Acute bacterial rhinosinusitis involves? | Swelling of nasal and sinus mucosa near the drainage pores of the sinuses
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| MC pathogen of acute bacterial rhinosinusitis? | H.flu, S.pneumo
M.Cat more common in children
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| Which sinus is MC affected in acute bacterial rhinosinusitis? | Maxillary sinus (is the largest)
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| Major signs for acute bacterial rhinosinusitis? | Facial pain, Nasal obstrux, nasal or postnasal d/c / purulence, Anosmia, Fever, Duration of sxs>10 days
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| Time frame for acute vs subacute vs chronic rhinosinusitis? | <4wks, 4-12 wks, >12 wks
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| 4 or more episodes of acute rhinosinusitis per yr is termed? | Recurrent Acute
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| Sinus CT: w/ or w/o contrast? | W/O
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| Abx for acute bacterial sinusitis? | Start w/ amoxicillin
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| Maxillary sinus is MC for acute and chronic bacterial sinusitis, what is the 2nd MC? | Ant Ethmoid
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| Which complication is more likely to occur with an infection involving the ethmoid sinuses? | Orbital cellulitis/abscess
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| What is a risk for a critically ill pt that has had a NG tube for a prolonged pd of time? | Nosocomial bacterial sinusitis
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| What is a rare infection that you may see in those w/ poorly controlled DM or immunocomp? | Acute Invasive fungal sinusitis
(spreads rapidly-can be lethal)
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| Sxs for how long in chronic rhinosinusitus? | 12 wks or more
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| What are the 4 cardinal signs of chronic rhinosinusitis along with mucosal inflamm? | 1. Ant/Post mucopurulent drainage
2. Nasal obstruction/congestion
3. Facial pain, pressure, or fullness
4. Decrsd sense of smell
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| With repeated failures of abx therapy and a course that meats chronic criteria...what may is be? | Chronic FUNGAL sinusitis (non-invasive: colonizes in mucus, not cells)
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| What condition may involve a hx of nasal polyposis and asthma and possibly multiple sinus surgeries? | Allergic fungal sinusitis
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| Some ex's of systemic meds that can cause rhinitis? | OCP, ED drugs, some anti-HTN, aspirin, NSAIDs, SSRIs
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| If child has many exposures to various viruses when young, it will decrease the likelihood of what? | Having allergic [rhinitis] issues
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| Allergic rhinitis involves? | Specific proteins being inhaled and binding to IgE in the nasal mucosa and causing symptoms
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| Allergic rhinitis is similar to viral rhinitis, except? | May be seasonal; often accompanied by eye sxs
(no fever, bc not infectious)
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| What is assoc with long-standing allergic rhinitis? | Polyps
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| What are the dark circles around the eyes (esp under the eyes) called and what causes them? | Allergic shiners
-D/t allergic rhinitis (^d blood flow around the sinuses)
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| WHat are Dennie-Morgan lines and what are they assoc w/? | Creases below the lower eyelids, secondary to edema or thickening (allergic rhinitis)
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| What is the nasal crease called that is usually caused by repeatedly wiping the nose in an upward direction d/t persistent rhinorrhea? | Allergic salute
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| WHat will nasal cavity look like in allergic rhinits? | Pale bluish-gray nasal mucosa; multiple stringy mucous bands
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| If an inhaled corticosteroid cannot be used an allergic rhinitis pt, what may be used? | Leukotriene receptor antagonist (Singulair)
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| What is the non-allergic, idiopathic rhinitis that involves an enhanced reactivity of nasal mucoas to various triggers? | Vasomotor rhinitis (NO IgE response)
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| Etiology of vasomotor rhinitis? | D/t imbalance in fxn of nerves that cause mucous glands to secrete fluid and BVs to swell or contract
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| Vasomotor rhinitis may be mixed with? | Allergic rhinitis
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| Distinguishing features of vasomotor rhinitis? | -Less common to see sneezing, itching, eye sxs
-Typically dev later in life; >20
-Usually no fam hx of atopy
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| Vasomotor rhinitis is a common cause of what, in the elderly? | Clear rhinorrhea
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| What condition can result from prolonged use of nasal decongestants? | Rhinitis medicamentosa
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| Pharyngeal tonsils AKA? | Adenoids
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| What is the MC cause of nasal obstrux in children? | Adenoid hypertrophy
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| Adenoids in adulthood? | Typically absent; regress just b4 puberty
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| Location of adenoids? | Back of throat, just above palate
(when enlarged-cuts off drainage passageway)
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| What composes Waldeyer's ring? | Adenoids (Pharyngeal tonsils), Tubal tonsils, Palatine tonsils, Lingual tonsils
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| WHat is adenoid facies? | Characteristic facial appearance caused by persistent mouth breathing d/t nasal obstrux in childhood-elongated face, high arched palate, prominent front upper teeth
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| What is Samter's triad? | Asthma, Aspirin allergy, Nasal polyps
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| What condition is pretty commonly assoc w/nasal polyps? | CF
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| What is the congenital blockage or narrowing of the posterior nasal airway by membrane or bone? | Choanal Atresia
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| Babies are obligate.....breathers? | Nasal
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| What is the benign highly vascular tumor condition that can arise in males age 7-19 yo? (in nasopharynx) | Juvenile Nasal Angiofibroma
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| What are the MC presenting sxs w/ juvenile nasal angiofibroma? | Recurrent epistaxes, obstruction
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