Sinusitis Camilla Curren, M.D. The Ohio State University College of Medicine Division of General Internal Medicine

Learning Objectives  In adult patients with symptoms of illness, abnormal physical findings, or abnormal lab findings, identify age appropriate diagnoses.  Identify the differential diagnoses for common issues in ENT(hoarseness, pharyngitis, hearing loss, nasal obstruction, epistaxis and inflammatory disorders of the nose and nasal cavity).

Learning Resources  Practice Guidelines, August 9, ACR Practice Guidelines for the Performance of Computed Tomography(CT) of the Extracranial Head and Neck in Adults and Children.  Sinonasal Disease, November 13, 2013, ACR Appropriateness Criteria for diagnostic imaging.  An Overview of the Treatment and Management of Rhinosinusitus, 2012, US Pharmacist  Chronic Sinusitis, Brooks, I. Updated 4/7/2014 from e- medicine.com

Module Instructions Articulate Module Review Module content Complete Quiz Utilize Learning Resources Virtual Patient Interview the patient and obtain a Full Patient History IHIS Learn Access the Patient Chart Review Physical Findings Interpret Patient Data Place Appropriate Orders Document Encounter

Patient Centered Medical Home Concepts Enhance Access and ContinuityIdentify and Manage PopulationsPlan and Manage CareProvide Self Care SupportMeasure and Improve Performance

IHIS Instructions 1.View the articulate module associated with this activity, “Sinusitis” and review basic IHIS navigation information including the creation and documentation of a patient encounter. You may access the IHIS Ambulatory Modules via the NetLearning site at mylearning.osumc.edu. Please be sure you are familiar with access to IHIS Learn before beginning. 2.Interview the patient “Alexander XX Spiros” by performing a full patient history for documentation in your Progress Note. You may click on the blue oval link on the last slide to access a hyperlink to meet the patient and perform your interview. 3.Access IHIS Learn and review your assigned patient chart “Alexander XX Spiros” documenting Chief Complaint, Vital Signs, Allergies, Medication Documentation, History, and Progress Note in the appropriate sections. 4.Review and document the Physical Examination findings using the dot phrase “.EXAMALEXANDERSPIROS” in the Objective section of your progress note. 5. Review and document lab testing results using the dot phrase “.LABALEXANDERSPIROS.” 6.Review and document imaging results using the dot phrase “.IMAGEALEXANDERSPIROS.” 7.Create an assessment based upon the findings of the History and Physical Examination, lab and imaging, and choose an appropriate diagnosis in IHIS Learn Dx and Orders. 8.Select additional orders as indicated, and associate a corresponding diagnosis to each order. 9.Create a plan in the Progress Note, documenting orders placed, medication ordered, patient education and follow up instructions given in the appropriate sections. Remember to include any plans you may have for the patient for routine preventive or self care and return appointment. 10.Enter “NCNC” and desired follow up for the patient in the LOS &Follow-up section. 11.Close the encounter by clicking on the appropriate tab at the bottom of the Navigation bar on the lower left column on the screen.

Sinus Disease Rhinosinusitis AcuteChronicRecurrentAllergic

Sinus Disease

Causes Allergy ViralBacterial Fungal

Complications of Sinus Disease  Periorbital Cellulitis  Abscess

Imaging Congenital anomaliesFacial traumaProptosis on examDiplopia or visual field changeChronic inflammation, infection or obstructionPost surgerySphenoid involvement suspected

Referral AllergyOtolaryngology Infectious Disease Respiratory Therapy Pharmacy

Treatment Abx Nasal Saline Antiinflammatory Hydration, rest

Risk Factors For Chronic Disease Anatomic Intubation Anomalies Tumor obstruction Kartagener syndrome (ciliary dyskinesia) Dental Disease GERD Systemic Cystic Fibrosis Sarcoidosis Granulomatosis Vasculitis Immunosuppressive disease, HIV Immunotherapy Smoking Immunologic Allergy Aspirin Sensitivity Hormonal (Pregnancy, oral contraceptives)

Summary  Acute, chronic and recurrent sinusitis  Common presentations and clinical findings  Risk Factors for Chronic Disease  Common Causes  Imaging and Referral Indications  Utilization of Care Teams For Patient Care

Thank you for completing this module Questions? Contact me at: Access IHISLearn Access IHISLearn Interview Alexander Spiros

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