Nasal and Sinus Disorders

Acute Viral Rhinosinusitis (common cold) is characterized by clear rhinorrhea/hyposmia/nasal congestion and _________.

typically self-limited (<10 days)

What is the first-line management for the "common cold"?

Symptomatic treatment

A patient presents with 5 days of clear runny nose and congestion. Nasal exam shows erythematous, engorged mucosa. What is the most likely diagnosis?

Acute Viral Rhinosinusitis

Purulent (colored) nasal discharge is a reliable indicator to differentiate bacterial from viral sinusitis.

False

What are the three most common bacterial pathogens involved in sinus infections?

• S. pneumoniae

• H. influenzae

• M. catarrhalis

The ______ sinuses are the most commonly involved in ABRS.

Maxillary sinuses

A patient had a cold that seemed to get better, but on day 7, they developed a high fever, purulent yellow nasal discharge, and severe facial pain. This is called ______.

"Double sickening"

What is the first-line antibiotic choice for ABRS in a patient without penicillin allergy?

Amoxicillin (high dose)

What is the recommended second-line treatment for ABRS if there is no improvement after 3 days of first-line therapy?

Augmentin XR or Moxifloxacin

Chronic Rhinosinusitis (CRS) is defined as a single infection characterized by prolonged inflammation _______________.

lasting for 12 weeks or longer

What adjunctive therapy should be considered for patients with CRS and nasal polyposis?

Montelukast (Singulair)

A patient has had continuous sinus pressure and discharge for 4 months despite multiple short courses of antibiotics. What is the next best step in management?

Referral to Otolaryngology

What is the goal of Functional Endoscopic Sinus Surgery (FESS)?

To enlarge drainage pathways by preserving diseased mucosa

__________ is a rare, lethal condition that spreads rapidly through vascular channels and most commonly found in immunocompromised patients.

Invasive Fungal Rhinosinusitis

What is the "classic finding" on physical exam for invasive fungal rhinosinusitis?

Black eschar on the middle turbinate

How is definitive diagnosis of fungal sinusitis made?

Biopsy with silver stains (shows hyphae)

What is the pharmacological "Gold Standard" for treating invasive fungal sinusitis?

Parenteral Amphotericin B

Allergic Rhinitis, also known as ______, is an IgE-mediated response to allergens.

"Perennial rhinitis"

______ refers to the bluish, pale, boggy appearance of the inferior turbinates.

Allergic shiners/boggy mucosa

What specific finding on a nasal smear is diagnostic for allergic rhinitis?

Eosinophils

What is now considered the first-line treatment for allergic rhinitis?

Nasal steroid sprays; may take 2 weeks for maximum benefit

A child presents with a horizontal crease across the lower bridge of the nose and dark circles under the eyes. They sneeze frequently around cats. What is the diagnosis?

Allergic Rhinitis

Vasomotor Rhinitis is also known as ______ rhinitis because it is non-IgE mediated.

"Non-allergic" rhinitis

Which non-steroid nasal spray is effective for the rhinorrhea associated with vasomotor rhinitis?

Ipratropium (Atrovent)

An older adult patient complains of a runny nose every time they go outside into the cold air or smell strong perfume. Allergy testing is negative. What is the diagnosis?

Vasomotor Rhinitis

Unlike allergic rhinitis, vasomotor rhinitis is ______ .

Non-IgE mediated

Rhinitis Medicamentosa is caused by the extended use of _________.

sprays like Oxymetazoline (Afrin) or Phenylephrine (Neo-Synephrine)

Topical decongestants should not be used for more than 3 days because they carry a high risk for development of __________.

rebound congestion

 A patient states their nasal spray "worked great" at first, but now they have to use it every 2 hours or they cannot breathe at all. What is the condition?

Rhinitis Medicamentosa

What is the recommended management to reverse Rhinitis Medicamentosa?

"Cold turkey" or "Weaning" ; Intranasal or oral steroids may be used to assist

Nasal polyps are pale, edematous, mucosal-covered masses that most commonly originate from the ___________.

Ethmoid sinuses and maxillary sinuses

A patient with chronic allergies complains of a "mass" in their nose. Examination shows a pale, teardrop-shaped growth that is not tender. What is the diagnosis?

Nasal Polyps

What is the first-line medical treatment to shrink polyps and provide relief?

Tapering oral steroids

If medical therapy fails for recurrent or severe polyps, what surgical procedure is indicated?

Functional Endoscopic Sinus Surgery (FESS)

Nasal foreign bodies are most commonly seen in children aged ______.

1-8 years

A 4-year-old presents with a foul-smelling, purulent, unilateral nasal discharge. What is the most likely cause?

Nasal Foreign Body

What is the name of the instrument used to gently pass beyond an object, rotate 90 degrees, and pull it out?

Attic hook

What is the most important clinical step after successfully removing a foreign body from a child's nose?

Look for another FB

A ______ surgery is performed to remove and reshape the septal bone or cartilage to improve the airway.

Septoplasty

A significant complication that can occur after septoplasty or nasal trauma is a ______.

Septal hematoma

Septal hematoma is defined as bleeding under the ______ caused by nasal fracture or contusion.

Septal perichondrium

What can an untreated Septal hematoma cause?

Necrosis of the cartilage and "Saddle nose" deformity

What is the required management for a septal hematoma?

I&D (Incision and Drainage)

While the nose is packed after hematoma drainage, the patient should be prescribed ______.

Anti-staphylococcal antibiotics.

Over 90% of nosebleeds occur in ______, which is located on the anterior septum.

Kiesselbach's area (plexus)

What is the first-line intervention a patient should perform for an active nosebleed?

Pinch nose shut for 10 minutes

An 80-year-old patient presents with a nosebleed that is draining down the back of their throat. What type of bleed is this?

Posterior Epistaxis

If direct pressure fails, what topical medication can be applied to a cotton ball to assist with vasoconstriction?

Afrin (Oxymetazoline)

Nasal fractures are the ______ fracture of the human skeleton.

3rd most common

If there is no displacement on palpation and only the nasal bone is involved, an X-ray may not be necessary.

True

If a nose looks broken, when should it be "fixed" (reduced)?

After swelling goes down (3–7 days)

What is a mandatory physical exam step during the evaluation of any nasal fracture?

Check for septal hematoma

Nasal vestibulitis usually results from an infected hair follicle caused by ______.

Staphylococcus (MRSA)

What is the first-line topical antibiotic for treating vestibulitis?

Mupirocin

______ is characterized by cauliflower-like growths usually found in the middle meatus area.

Inverted Papilloma

What is the significant clinical risk associated with an Inverted Papilloma?

Development of Squamous Cell CA

What is the treatment for an Inverted Papilloma?

Endoscopic medial maxillectomy

______ is the complete loss of the ability to perceive smells, while ______ is a partial loss.

Anosmia / Hyposmia

Approximately ______% of olfactory dysfunction cases will be idiopathic and may spontaneously resolve.

~20%

A patient presents with a loss of smell after falling and hitting the back of their head. What anatomical site is the likely cause of the damage?

Cribriform plate