Term
|
Definition
| inflammation &/or infection of the paranasal sinus mucosa |
|
|
Term
|
Definition
| inflammation of nasal mucosa |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| sx last longer than 8 wks |
|
|
Term
|
Definition
| 3 or more acute episodes a year |
|
|
Term
| Risk Factors for Sinusitis |
|
Definition
air pollution, pollen, fumes;
common cold & cigarette smoke;
food allergies & sensitivities;
dry air & cold air;
dental infection;
immunodeficiency;
malformations (polyps, cysts, deviated septums) |
|
|
Term
| Clinical Features of Sinusitis in Adults |
|
Definition
nasal discharge/congestion;
maxillary tooth pain, facial or sinus pain that may radiate |
|
|
Term
| Clinical Features of Sinusitis in Children |
|
Definition
nasal discharge & cough for greater than 10-14 days;
temperature >= 39 C (102.2 F)
facial swelling or pain |
|
|
Term
| Type 1 Acute Bacterial Sinusitis |
|
Definition
persistent symptoms >10 days without improvment;
Sx: periorbital edema, malodorous breath, low-grade fever, nasal discharge varies |
|
|
Term
| Type 2 Acute Bacterial Sinusitis |
|
Definition
onset of severe symptoms;
Fever + purulent nasal discharge for 3-4 days;
Pt appear ill |
|
|
Term
| Type 3 Acute Bacterial Sinusitis |
|
Definition
Initial regression of symptoms that worsen within 10 days of illness;
Worsening symptoms accompanied by new onset fever, increasing nasal discharge, congestion, & daytime cough |
|
|
Term
| Chronic Bacterial Sinusitis |
|
Definition
chronic unproductive cough;
laryngitis;
HA;
recurrent infections 3-4x/yr;
unresponsive to steam & decongestants;
purulent postnasal drainage or rhinorrhea;
fatigue; |
|
|
Term
| Complications associated w/ Sinusitis |
|
Definition
periorbital abscess;
meningitis;
osteomyelitis of frontal bone |
|
|
Term
|
Definition
caused by viral infection;
usually precedes bacterial sinusitis;
resolves within 7-10 days |
|
|
Term
|
Definition
caused by bacterial pathogens;
symptoms persists >7-14 days;
may require treatments w/ antibiotics; |
|
|
Term
| Most Common Bacterial Pathogens associated with Sinusitis |
|
Definition
| S. pneumoniae, H. influenzae, M. catarrhalis |
|
|
Term
| Goals of Sinusitis Treatment |
|
Definition
eliminate S/Sx;
achieve patency of ostia;
minimize duration of illness;
appropriate antimicrobial therapy & duration of therapy;
prevent complications & progression of disease; |
|
|
Term
| OTC Pharmacologic Therapy for Sinusitis |
|
Definition
| pseudoephedrine (Sudafed) 60 mg PO q4-6 hr (MAX 240 mg/day) |
|
|
Term
|
Definition
nasal irrigation for tx of sinusitis;
hypertonic saline mixed in apparatus; tip of apparatus placed just inside one nostril, pinching it to form a seal; irrigate w/ mouth open, allowing fluid to drain out either through mouth or nose; repeat procedure in other nostril |
|
|
Term
|
Definition
| OTC product that may be used to decrease viscosity of secretions |
|
|
Term
|
Definition
| OTC product that should NOT be used for acute bacterial sinusitis (dries mucosa) |
|
|
Term
| Tx of Uncomplicated Bacterial Sinusitis |
|
Definition
1st Line:
- Amoxicillin 500 mg TID
Type I PCN Allergy:
- Azithromycin 500 mg PO on day 1, then 250 mg PO daily for days 2-5;
- sulfamethoxazole/trimethoprim 800/160 mg q12 hr
- levofloxacin (those who have recently received Abx, severe infection, MDRSP, AVOID IN CHILDREN)
Non-immediate PCN Allergy:
- cefuroxime 250-500 mg BID
- cefpodoxime 200 mg BID |
|
|
Term
| Tx of Bacterial Sinusitis after previous Tx Failure in last 4-6 wks |
|
Definition
| amoxicillin-clavulanate 500/125 mg TID |
|
|
Term
| Tx of PCN-Resistant Strep. pneumoniae Sinusitis |
|
Definition
|
|
Term
| Tx of Complicated Bacterial Sinusitis |
|
Definition
| requires hospitalization & broad-spectrum antibiotics to cover: MRSA, Pseudomonas, anaerobes, Gram-Neg rods, fungal pathogens |
|
|
Term
| adenovirus, human herpes viruses (Epstein-Barr, Herpes simplex virus) |
|
Definition
| main etiologies for viral pharyingitis |
|
|
Term
|
Definition
| acute infection of the oropharynx or nasopharynx |
|
|
Term
| Group A beta-hemolytic streptococci (GABS) |
|
Definition
main etiology of bacterial pharyngitis;
only bacterial form that REQUIRES antibiotics; |
|
|
Term
| Risk Factors for GABS Pharyngitis |
|
Definition
ages 5-15 most susceptible;
immunocompromised;
history of close contact to person w/ GABS |
|
|
Term
| Clinical Symptoms of GABS Pharyngitis |
|
Definition
sore throat (sudden onset);
pain on swallowing;
fever/rash;
HA, N/V, abd pain;
erythema/inflammation of tonsils & pharynx;
enlarged, tender lymph nodes;
red swollen uvula;
petechiae on soft palate;
scarlatiniform rash |
|
|
Term
| Clinical Symptoms of Viral Pharyngitis |
|
Definition
conjunctivitis;
coryza;
cough;
hoarseness;
myalgia;
diarrhea |
|
|
Term
| Potential Complications of Pharyngitis |
|
Definition
peritonsillar abscess;
sinusitis;
otitis media;
mastoiditis;
invasive infections;
RHEUMATIC FEVER;
glomerulonephritis |
|
|
Term
|
Definition
GOLD STANDARD for diagnosing pharyngitis;
requires 24-48 hrs for results;
Sensitivity: 90-95% |
|
|
Term
| Rapid Antigen Detection Test (RADT) |
|
Definition
developed to detect GABS directly from throat swabs;
Sensitivity: 80-90%; Specificity: >95%
Negative tests prevent unwarranted Abx use |
|
|
Term
| Higher suspicion for GABS Pharyngitis if: |
|
Definition
temp. >38 C
absence of cough;
swollen tender anterior cervical nodes;
tonsillar swelling or exudates;
age 3-14 years |
|
|
Term
| Goals of Pharyngitis Treatment |
|
Definition
improve S/Sx;
reduce risk of transmission;
decrease risk of complications;
minimize potential for adverse effects of inappropriate antimicrobial therapy |
|
|
Term
| Withholding Treatment for GABS |
|
Definition
self-limited dx which S/Sx dissolve in 3-4 days without treatment;
Abx therapy can wait up to 9 days post Sx onset & still prevent complications associated w/ disease |
|
|
Term
| Tx of GABS Pharyngitis in Adults |
|
Definition
1st line:
- penicillin VK 250 mg PO BID to TID or 500 mg BID;
Use in Children:
- amoxicillin 500 mg PO TID --> may want to use suspension;
PCN Allergy:
- cephalexin 250-500 mg QID
Duration: 10 days |
|
|
Term
| Tx of Recurrent Episodes of Pharyngitis |
|
Definition
clindamycin 600 mg BID to QID (used if macrolide resistance);
amoxicillin/clavulanate 500/125 mg PO BID --> max bacterial eradication |
|
|
