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ENT > 2: Rhinitis and Nasal Polyps > Flashcards

2: Rhinitis and Nasal Polyps Flashcards

1
Q

Define rhinitis

A

Inflammation of the nasal mucosa

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2
Q

What are the two broad categories of rhinitis

A
  • Allergic

- Infectious

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3
Q

What is allergic rhinitis

A

IgE-mediated type I hypersensitivity reaction

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4
Q

What are the two-types of non-allergic rhinitis

A

Vasomotor

Infective

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5
Q

What is infectious rhinitis

A

Inflammation nasal mucosa due to infection

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6
Q

What is vasomotor rhinitis

A

Inflammation nasal mucosa due to changes in sympathetic-parasympathetic NS, hormones

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7
Q

What are causes of vasomotor rhinitis

A
  • Cold weather
  • Medications (ACEi, B-blockers)
  • COCP
  • Hypothyroidism
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8
Q

What are risk factors for allergic rhinitis

A

Personal or family history of atopy

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9
Q

How does rhinitis present clinically

A
  • Post-nasal drip
  • Congestion
  • Sneezing
  • Rhinorrhoea
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10
Q

What may long-standing rhinitis increase the risk of

A

Sinusitis

Otitis media

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11
Q

What are additional symptoms of allergic rhinitis

A
  • Allergic conjunctivitis
  • Itching throat
  • Atopic dermatitis
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12
Q

What is a sign of long-standing vasomotor rhinitis

A

Enlarged turbinates

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13
Q

How is rhinitis usually diagnosed

A

Clinically

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14
Q

What is indicated for allergic rhinitis

A

Allergy Testing: skin prick or serum-specific IgE

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15
Q

What is first line for allergic rhinitis

A

Intra-nasal anti-histamine

Intra-nasal decongestants (Oxymetazoline)

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16
Q

what is the MOA of oxymetazoline

A

a1 antagonist

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17
Q

how long should oxymetazoline be given for

A

3d

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18
Q

why is oxymetazoline given for maximum 3d

A

as on withdrawal it can cause rebound nasal congestion

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19
Q

what is rebound nasal congestion called

A

rhinitis medicamentosa

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20
Q

how is vasomotor rhinitis addressed conservatively

A

medication review - stop offending medications

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21
Q

how is vasomotor rhinitis addressed medically

A

Topical nasal decongestants

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22
Q

how is vasomotor rhinitis addressed surgically

A

Resection of enlarged turbinates

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23
Q

Why are nasal polyps considered on a spectrum of rhinosinutitus

A

As they are caused by chronic inflammation and thickening of the nasal mucosa

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24
Q

What are nasal polyps

A

Oedema of nasal mucosa which then prolapses

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25
Q

What are nasal polyps often called

A

Chronic rhinosinusitus with nasal polyps

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26
Q

What is the typical age-range for nasal polyps

A

Males >40

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27
Q

What are the symptoms of nasal polyps

A
  • Watery anterior rhinorrhoea
  • Purulent post-nasal drip
  • Nasal obstruction
  • Mouth breathing
  • Snoring
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28
Q

How do polyps usually appear

A

Bilateral

Adjacent to middle meatus

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29
Q

What triad is associated with nasal polyps

A

Samter’s triad

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30
Q

What is samter’s triad

A
  1. Aspirin Hypersensivity
  2. Late-Onset Asthma
  3. Nasal polyps
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31
Q

What is used to investigate nasal polyps

A

Anterior Rhinoscopy

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32
Q

How can nasal polyps be differentiated from turbinates on anterior rhinos copy

A

Polyps:

  • Pink
  • Mobile
  • Non-tender

Turbinates:

  • Pale
  • Non-mobile
  • Insensitive
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33
Q

If a polyp is unilateral what is required and why

A

Biopsy - risk nasopharyngeal cancer

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34
Q

When are nasal polyps rare

A

Children

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35
Q

What is a nasal polyp in a child likely to be

A

CF, mucocele, neoplasm

36
Q

What 3 medications are given in medical management of nasal polyps

A
  1. Intra-nasal betamethaosone
  2. Intra-nasal fluticasone
  3. Doxycycline
37
Q

What surgical procedure is indicated for nasal polyps

A

Functional endoscopic sinus surgery (FESS)

38
Q

If more than a polypectomy is indicated, what imaging is required

A

CT

39
Q

What are complications of functional endoscopic sinus surgery

A

Optic.N damage

CSF Leak

40
Q

What is the criteria for rhinosinusitus

A

Nasal congestion and one of

```
PEDALS
Pain in face
Endoscopy
Discharge
ALl remember CT findings
Smell loss
~~~

41
Q

how can rhinosinusitus be divided

A

Acute or Chronic

42
Q

what defines chronic rhinosinusitus

A

> 12W

43
Q

Define acute rhinosinusitus

A

Inflammation of nasal passage and paranasal sinuses lasting less than 12W

44
Q

What are the 3 types of acute rhinosinusitus

A

Viral
Post-Viral
Bacterial

45
Q

What are the 2 viral causes of acute rhinosinusitus

A

Coronavirus

Rhinovirus

46
Q

What causes post-viral rhinosinusitus

A

Residual inflammation following viral infection

47
Q

What causes bacterial rhinosinusitus

A

Often viral infection causes inflammation predisposing to secondary bacterial infection

48
Q

What are risk factors for bacterial rhinosinusitus

A
  • Virus

Direct spread:

  • Dental infection
  • Swimming

Odd anatomy:

  • Septal deviation
  • Large ethmoidal bull
  • Mechanical ventilation
49
Q

What is the diagnostic criteria for acute rhinosinusitus

A

Onset of two or more of the following:

  • Congestion
  • Discharge
  • Facial Pain
  • Loss sense smell
50
Q

What factors indicate bacterial rhinosinusitus

A

Local pain
Purulent discharge
Worsening after improvement (post-viral)

51
Q

How is rhinosinusitus usually diagnosed

A

Clinically

52
Q

If rhinosinusitus persists beyond 10-days, who should the person be referred to

A

Refer to ENT

53
Q

What may ENT order to investigate rhinosinusitus

A
  • Nasal endoscopy

- CT paranasal sinuses

54
Q

If symptoms less than 5d, how is someone with rhinosinusitus managed

A

Analgesia

Nasal decongestant

55
Q

What is used as a nasal decongestant

A

Oxymetazoline

56
Q

If symptoms 5-10d, what is used to manage rhinosinusitus

A

Nasal Steroid

Oral Abx

57
Q

If symptoms persist beyond 10d what should be done

A

Refer ENT: CT paranasal sinus, nasal endoscopy.

IV Abx
Oral steroids
Surgery

58
Q

Give 5 complications of rhinosinusitus

A 
Abscess 
Osteomyelitis 
Intracranial abscess 
Venous sinus thrombosis 
Pre-septal cellulitus 
Orbital cellulitus 
Pott's puffy tumour
59
Q

What is pre-septal cellulitis also known as

A

Peri-orbital cellulitus

60
Q

What is the most common cause of orbital cellulitis

A

Rhinosinusitus

61
Q

What is the commonest cause of abscess

A

Rhinosinusitus

62
Q

What is the problem with osteomyelitis secondary to rhinosinusitus

A

Can spread to cause intracranial infection

63
Q

What is Pott’s Puffy Tumour

A

Osteomyelitis of the frontal sinus

64
Q

How will Potts Puffy Tumour present

A

Boggy forehead swelling

65
Q

What is orbital cellulitis

A

Infection soft-tissue posterior to orbital septum

66
Q

How does orbital cellulitis typically occur

A

Secondary to paranasal sinus infection

67
Q

How will orbital cellulitis present clinically

A

child with:

  • Inflammation
  • Lid swelling
  • Diplopia on eye movements
  • Fever
68
Q

What is a complication of orbital cellulitis

A
  • Abscess

- Intracranial extension

69
Q

Why may orbital cellulitis cause loss of vision

A

Optic neuritis

70
Q

How can orbital cellulitis be distinguished from peri-orbital cellulitis

A 
Proptosis 
Painful eye movements 
Visual loss 
Loss colour vision 
RAPD
71
Q

How is orbital cellulitis managed in adults

A

IV Tazocin

72
Q

How is orbital cellulitis managed in children

A

IV Co-amoxiclav

73
Q

What investigation should be ordered in orbital cellulitis

A

CT

74
Q

What is chronic rhinosinusitus

A

Inflammation mucosa of nose and paranasal sinuses for more than 12W

75
Q

What are the two types of chronic rhinosinusitus

A

With and Without Polyps

76
Q

What increases the risk of chronic rhinosinusitus

A

Samters triad: aspirin sensitivity, late-onset asthma

Ciliary dysfunction:

  • Primary ciliary dyskinesia
  • Cystic fibrosis
77
Q

What is the criteria to diagnose chronic rhinosinusitus

A

2 or more for 12W:

  • Congestion
  • Discharge
  • Pain
  • Smell loss
78
Q

What is first-line for chronic rhinosinusitus

A

Nasal endoscopy

79
Q

to make a diagnosis of rhinosinusitus on nasal endoscopy what must be present

A
  • Inflammation
  • Polyp
  • Mucopurulent discharge
  • Mucosal occlusion middle meatus
80
Q

What scoring system is used to grade severity of chronic rhinosinusitus

A

Visual analogue score

81
Q

How are visual analogue score 0-3 managed

A
  • Nasal Saline

- Intra-nasal corticosteroids

82
Q

How are visual analogue score >3 managed

A
  • Antibiotics
  • Intranasal corticosteroids
  • CT
  • FESS
83
Q

What is a complication of chronic rhinosinusitus

A

Mucocoele

84
Q

Where are mucoceles more common

A

Frontal sinus

85
Q

How do mucoceles present

A

Lump on the head

86
Q

What is the risk of mucocoeles

A

Eroding bone

ENT (16 decks)

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