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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, 2013. 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 Continuity
Identify and Manage Populations
Plan and Manage Care
Provide Self Care Support
Measure 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
Acute Chronic Recurrent Allergic
Sinus Disease
Causes
Allergy
ViralBacterial
Fungal
Complications of Sinus Disease
Periorbital Cellulitis Abscess
ImagingCongenital anomalies
Facial trauma
Proptosis on exam
Diplopia or visual field change
Chronic inflammation, infection or obstruction
Post surgery
Sphenoid involvement suspected
Referral
Allergy
Otolaryngology
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
Interview Alexander Spiros
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