Epistaxis and Allergic Rhinitis Overview

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Questions and Answers

What is the primary treatment plan for anterior epistaxis?

Initial tamponade followed by cauterization if necessary (correct)

Immediate surgery for blood vessel ligation

Liberal use of nasal sprays only

Daily antihistamine use only

Which symptom is NOT described by the patient with epistaxis?

Mild to moderate bleeding episodes

Recent upper respiratory infections (correct)

Visible crusting in the anterior septum

Nasal dryness and occasional crusting

What environmental condition exacerbates symptoms of allergic rhinitis in the presented patient?

Exposure to dust (correct)

Bright sunlight

Cold weather

High humidity levels

Which of the following is a risk factor for the patient experiencing epistaxis?

Uncontrolled hypertension Signup and view all the answers

What is the indication for urgent ENT consultation in epistaxis management?

Recurrent posterior epistaxis Signup and view all the answers

What is a common symptom associated with allergic rhinitis as reported by the patient?

Itchy eyes Signup and view all the answers

Which treatment modality would NOT typically be utilized for anterior epistaxis management?

Intravenous fluid therapy Signup and view all the answers

What is a significant detail in the patient's history regarding their health condition?

Smokes one pack of cigarettes per day Signup and view all the answers

What issue did the patient face after prolonged use of the nasal decongestant spray?

Increased nasal congestion Signup and view all the answers

Which treatment is recommended for the patient using intranasal decongestants excessively?

Withdraw usage of intranasal decongestants Signup and view all the answers

What symptom did the patient with acute rhinosinusitis report that is indicative of a bacterial infection?

Thick yellow-green nasal discharge Signup and view all the answers

What is a common cause of facial pressure in patients experiencing acute rhinosinusitis?

Nasal obstruction leading to sinus pressure Signup and view all the answers

What are the likely bacterial pathogens responsible for the acute rhinosinusitis symptoms?

S.pneumoniae, H.influenzae, M.catarrhalis Signup and view all the answers

Which symptom is NOT typically associated with a patient experiencing intranasal decongestant overuse?

Frequent sneezing Signup and view all the answers

What finding in the physical examination suggests a diagnosis of acute rhinosinusitis?

Erythematous nasal mucosa with edematous turbinates Signup and view all the answers

Which factor is NOT indicated for requiring urgent referral in cases of complicated rhinosinusitis?

Lack of recent sinus infections Signup and view all the answers

What are the first-line treatments for allergic rhinitis during pregnancy?

Intranasal cromolyn sodium Signup and view all the answers

Which symptom is NOT typically associated with non-allergic rhinitis?

Sneezing Signup and view all the answers

What treatment option is suggested for the management of rhinitis medicamentosa?

Intranasal corticosteroids Signup and view all the answers

Which medication is preferred for individuals suffering from seasonal allergies and asthma?

Montelukast Signup and view all the answers

What is the primary reason for avoiding certain medications in pregnant patients with allergic rhinitis?

Risk of adverse fetal effects Signup and view all the answers

Which statement regarding the management of nasal congestion is TRUE?

Combination treatment of fluticasone and azelastine is most effective. Signup and view all the answers

In a patient with persistent nasal congestion who has chronic exposure to strong odors, what diagnosis is most likely?

Non-allergic rhinitis Signup and view all the answers

What additional intervention is indicated for a patient experiencing persistent symptoms despite other treatments in allergic rhinitis?

Avoiding identified triggers Signup and view all the answers

Study Notes

Epistaxis (Nosebleeds)

Patient Presentation: 56-year-old male with recurrent nosebleeds primarily from the right nostril for the past week. Bleeding is mild to moderate, lasting 10-15 minutes, and stops with pressure. Last episode occurred while brushing teeth. Reports nasal dryness and occasional crusting. No trauma, recent upper respiratory infections, sinus congestion, or fever. Patient is otherwise well.
Past Medical History (PMH): Uncontrolled hypertension, seasonal allergic rhinitis
Social History: Construction manager, smoker of 1 pack per day for 20 years
Physical Exam (PE): Visible crusting in anterior septum; prominent vascularization noted in Kiesselbach's plexus.

Allergic Rhinitis (Hay Fever)

Patient Presentation: 28-year-old female with three-month history of nasal congestion, sneezing, and itchy eyes. Symptoms worsen in the morning and when exposed to dust or visiting her grandmother's house (cat). Intermittent clear nasal discharge and frequent throat clearing. Relief with antihistamines - no fever, chills or respiratory infections.
Past Medical History (PMH): Mild asthma controlled with PRN albuterol inhaler, seasonal allergies.
Physical Exam (PE): Pale nasal mucosa with clear rhinorrhea and turbinate edema, cobblestoning of the posterior pharynx.
Plan: Allergen avoidance, intranasal saline sprays, and intranasal corticosteroids (fluticasone). Do not use antihistamine nasal sprays, oral/nasal decongestants, or start immunotherapy during pregnancy.

Non-Allergic Rhinitis

Patient Presentation: 45-year-old female with one-year history of persistent nasal congestion and clear rhinorrhea. Symptoms are daily, non-seasonal, and not triggered by specific allergens. Exacerbated by strong odors and temperature changes. Little relief from over-the-counter antihistamines. No fever, chills, and no respiratory infections.
Past Medical History (PMH): Controlled GERD.
Physical Exam (PE): Nasal mucosa mild edema; no erythema or discharge.
Plan: Topical intranasal glucocorticoids, topical antihistamines, or combined use most effective. Nasal saline irrigation is another option.

Rhinitis Medicamentosa

Patient Presentation: 38-year-old male with three-month history of persistent nasal congestion worsened by using an over-the-counter nasal decongestant (Afrin). Now requires the spray multiple times a day for relief. Nasal congestion worsens when attempting to discontinue use. No fever, chills, or discharge.
Plan: Withdraw use of intranasal decongestants, and use intranasal glucocorticoids if needed.

Acute Rhinosinusitis (Common Cold)

Patient Presentation: 32-year-old male with a 10-day history of nasal congestion, facial pressure, and thick nasal discharge. Symptoms started after a common cold. Yellow-green discharge and occasional post-nasal drip. Mild headache and decreased sense of smell, but no fever or chills.
Plan: Likely bacterial (S. pneumoniae, H. influenzae, or M. catarrhalis), assess for complications or need for antibiotics.

Chronic Rhinosinusitis

Patient Presentation: 45-year-old female with six-month history of persistent nasal congestion, facial pressure, and postnasal drip, thick clear-to-mucoid discharge. Complaints of diminished smell and worsening of facial pressure with bending forward. No fever, chills, or acute worsening.
Plan: ENT/allergy referral, intranasal saline or corticosteroids, oral corticosteroids for 10-15 days, antibiotics/antileukotriene agents (if needed).

Invasive Fungal Rhinosinusitis

Patient Presentation: 57-year-old male with a one-week history of worsening facial pain, nasal congestion, and headache accompanied by fever, chills, and malaise. Black necrotic tissue observed on the nasal septum and turbinate. Decreased sensation, and blurry vision in the eye. History of poorly controlled diabetes.
Plan: Immediate hospital admission, ENT referral, IV antifungals (voriconazole or amphotericin B), and surgery.

Foreign Body in Nose

Patient Presentation: 4-year-old male with three-day history of foul-smelling yellow-green nasal discharge from the right nostril. Reports no pain or trauma, but an itchy nose. Mother recalls small toys being present.
Plan: Attempt to remove foreign body in the nose. Consider nasal decongestant and topical anesthetic initially; possible conscious sedation for more difficult retrievals.

Nasal Trauma

Patient Presentation: 32-year-old male with nasal pain, swelling, and breathing difficulty after a basketball game. No major bleeding noted but some mild spotting. No loss of consciousness or neck pain.
Plan: Nasal packing for septal hematomas, bilateral I&D, fluid culture, antibiotics (cephalexin, clindamycin) x 3-5 days. Closed reduction of fracture if necessary.

Polyp of Nasopharyngeal & Paranasal Sinus

Malignant Polyps: Squamous cell carcinoma (SCC) is most common. Early symptoms resemble rhinosinusitis (unilateral nasal obstruction, discharge, pain, or epistaxis). Poor prognosis for advanced tumors.
Benign Polyps: Often associated with allergic rhinitis. Pale, edematous, mucosal-covered masses. Possible chronic nasal obstruction. Topical intranasal steroids or surgery may be necessary for large polyps. Benign inverted papilloma (BIP) is primarily caused by human papillomavirus (HPV). Malignant potential; excision usually recommended.

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Description

This quiz covers the clinical presentation and management of epistaxis and allergic rhinitis, with case studies highlighting patient symptoms and backgrounds. Understand key factors such as previous medical history and environmental triggers. Test your knowledge on the differences and similarities between these two conditions.