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NURO 504 MODULE 3 EXAM LATEST UPDATE
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NURO 504 MODULE 3 EXAMLATEST UPDATE
Rhinosinusitis - Answer inflammation of the nares and paranasal sinuses, including
frontal, ethmoid, maxillary, and sphenoid sinuses; <4 weeks. Most cases are viral and
resolve spontaneously
Management INCS and nasal irrigation for 5-7 days
Acute Bacterial Rhinosinusitis - Answer Symptoms: 3 cardinal features: purulent
rhinorrhea, facial pain/pressure/fullness, nasal obstruction
o Dental pain and reduced/lack of sense of smell
o Last >/= 10 days or double sickening
· Management
o INCS can be helpful
o First line antibiotics (Amoxicillin-Clavulanate, Doxycycline, -mycins for pregnant folks)
Chronic Rhinosinusitis - Answer Diagnostic
· 12-week duration of more than 2 of the following: Nasal drainage (anterior, posterior,
or both), Nasal obstruction or congestion, Facial pain, pressure, or fullness,
Reduction/loss of smell
· Endoscopy & CT imaging
Types
· CRS with nasal polyps
· CRS without nasal polyps
Management
· Nasal steroid 4-6 weeks, oral antimicrobials in case of acute exacerbation, treat
comorbid allergy, avoid smoking/irritants, consider high volume nasal irrigation
o Oral steroid may be added in uncontrolled CRS
Consider long-term macrolides/doxycycline (to help with inflammation) and surgical
options
, Tinnitus - Answer sensation of sound in the absence of exogenous sound source
Diagnosis: essentials include phantom noise or sounds, persistent tinnitus often, though
not always, indicates the presence of hearing loss, and intermittent periods of mild,
high-pitched tinnitus lasting seconds to minutes are common in normal hearing people
Causes - Pulsatile tinnitus: listening to one's heartbeat; may be serious cause (vascular
abnormality)
Middle ear spasms: can cause "clicking" (myoclonus)
Tinnitus Dx and Tx - Answer Diagnostic testing: audiometry to R/O hearing loss
Unilateral tinnitus: MRI to R/O retrochochlear lesion
Treatment -
-Avoidance of excessive noise and ototoxic agents
-Masking with music
-Antidepressants (nortriptyline) for those struggling
Conjunctivitis - Answer inflammation of the mucus membrane that lines the surface of
the eyeball and inner eyelids; can be acute or chronic
Causes - viral, bacterial (gonococcal and chlamydial), keratoconjunctivitis sicca,
allergy, chemical irritants, and trauma
- Viral: adenovirus most common
Usually bilateral with copious watery discharge and follicular conjunctivitis; spreads
easily
- Lasts up to 2 weeks
- If from HSV, typically unilateral and may be associated with lid vesicles
· Only viral with treatment (topical or oral antivirals)
Bacterial: most commonly staph like MRSA, streptococci, pseudomonas,
Gonococcal conjunctivitis - Answer Usually acquired through contact with infected
genital secretions (assess for STIs)
- Copious purulent discharge
- Ophthalmic emergency (may lead to perforation)
- Diagnosis confirmed by smear and culture of discharge
- Systemic treatment required: single 500 mg dose of IM ceftriaxone if patient weighs
less than 150 kg or 1 g dose if over 150 kg
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