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Boies > Chapter 12: Diseases of the Nose > Flashcards

Chapter 12: Diseases of the Nose Flashcards

1
Q

Indicative of suppurative disease in the maxillary antrum, anterior ethmoid cells or frontal sinus

A

Purulent discharge in the middle meatus

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2
Q

Indicate an infection in the posterior ethmoid cells

A

Discharge in the superior meatus

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3
Q

Is valuable to visualize abnormalities such as choanal polyps, hypertrophic turbinates and purulent discharge from the nose and paranasal sinuses which has been swept posteriorly through the action of the cilia

A

Posterior rhinoscopy

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4
Q

Are obligate nose-breathers and may need an alternate airway established at birth

A

Neonates

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5
Q

Nasal deformities

A
  1. Septal deflections
  2. Asymmetric lower lateral cartilage and soft tissues of the nasal alae
    Results in…
    Nose with inadequate tip projection
    Acute nasolabial angle
    Sagging of the nasal ala on the cleft side
    Irregularities in the position of the nostril sills
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6
Q

Contain all elements of skin: hair follicles, hair, sweat glands, sebaceous glands, connective tissue
Arise out of ectodermal elements of the fetal trilaminar septum which fail to degenerate

A

Nasal dermoid cyst

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7
Q

Then sinus opening of the nasal dermoid cyst when present is located at

A

Osteocartilaginous junction of the nasal dorsum

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8
Q

Diagnostic tool of choice for nasal dermoid cyst

A

CT scan

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9
Q

Therapy for nasal dermoid cyst

A

Complete excision

Optimum age: 5-6 years

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10
Q

Rare lesion

Composed of extradural glial tissue

A
  1. Nasal glioma: not connected to CNS
  2. Encephalocele: connected to CNS
    Therapy: excision
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11
Q
  1. Solid, noncompressible, nonpulsatile gray or purple mass
  2. Negative Furstenberg sign
  3. Noticed at, or shortly after birth
  4. 60% extranasal (along the nasomaxillary suture or near the midline)
  5. 30% intranasal
  6. 10% both components
A

Glioma

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12
Q
  1. Associated with other midline fusion defects such as cleft lip or palate
  2. Extracranial herniation of meninges and brain (cranial degect is always present
  3. Bluish, compressible, pulsatile
  4. Positive Furstenberg sign
A

Encephaloceles

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13
Q

Associated with genetic syndromes or may result from teratogenic influences

A

Uncommon nasal anomalies

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14
Q

Is a frequent prodromal syndrome of measle, rubella and chickenpox

A

Rhinitis

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15
Q

Is a frequent precursor to suppurative rhinitis

A

Viral rhinitis

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16
Q
  1. An extensive and invasive infection of sebaceous glands or hair follicles with some involvement of subcutaneous tissues
  2. Caused by Staphylococcus aureus
A

Furuncle or boil

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17
Q

Causative organism for nasal vestibulitis, a mild inflammation with recurrent crusting and pain

A

Staphylococcus aureus

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18
Q

Bacterial infection secondary to a traumatic or surgical hematoma
Treatment: I and D with appropriate systemic antibiotic
Complications of delayed treatment: saddling of the nasal dorsum and columellar retraction

A

Septal abscess

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19
Q
  1. Primarily associated with the use of vaginal tampoons during menstruation
  2. Also reported after nasal packing
  3. Caused by sStaphylococcus aureus
  4. Headache, lethargy, myalgia, nausea and vomiting, fever, hypotension, tachycardia, generalized erythema of the skin and mucous membranes, delayed desquamation of the epithelium of the hands
A

Toxic shock syndrome

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20
Q
  1. Occur as a chronic granulomatous infection of the paranasal sinuses, nose, middle ear and external auditory canal
  2. Debilitated or immunosuppressed
  3. Green-brown discharge
A

Aspergillosis

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21
Q

Treatment of Aspergillosis

A

Chronic, noninvasive: debridement and topical antifungal drugs
Acute, life-threatening: debridement and systemic antifungal drugs (amphotericin B)

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22
Q
  1. Malignant, opportunistic infection
  2. Caused by Rhizopus oryzae
  3. Diabetic acidosis, debilitated or immunosuppressed
  4. Inhalation of the microorganism inoculates the nasal turbinates or ethmoid sinuses, where it spreads along the blood vessels to the retro-orbital areas and cerebrum
  5. Headache, fever, internal and external ophthalmoplegia, paranasal sinusitis, thick, dark bloody nasal discharge
  6. Black or brick-red nasal turbinate
A

Mucormycosis

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23
Q

Treatment of Mucormycosis

A
  1. Immediate IV or even intrathecal administration of amphotericin B
  2. Debridement of necrotic tissue
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24
Q
  1. Granulomatous disease of the nose
  2. Caused by Klebsiella rhinoscleromatis
  3. Involves the nose primarily but may later extend to involve any area of the upper respiratory regions, including larynx
  4. Begins with an early acute inflammatory reaction with a purulent, foul smelling rhinorrhea
  5. Followed by nasal crusting and slow growing, hard, insensitve nodules that may eventually obstruct the nose
  6. Lower nose and upper lip become prominent if left untreated, causing extensive disfigurement
A

Rhinoscleroma

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25
Q

Diagnostic finding of rhinoscleroma

A

Mikulicz cells and rod shaped,bacteria within the cytoplasm

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26
Q
  1. Activity of the parasympathetic nerves cause engorgement of the vascular bed with resultant congestion and increase mucous production
  2. Activity of the sympathetic nerves causes vasoconstriction with its resultant nasal patency and decreased mucous production
A

Vasomotor rhinitis

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27
Q 
Characterized by:
1. Soft tissue swelling
2. Excessive secretion
Long standing cases:
1. Hypertrophy of mucosa
2. Thickening of periosteum
3. New bone formation
Result from:
1. Repeated acute nasal infections
2. Recurrent attacks of suppurative sinusitis
3. Vasomotor states independent of local disease
A

Chronic hypertrophic rhinitis

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28
Q
  1. Form of hypertrophic rhinitis

2. Psychosomatic factors

A

Vasomotor rhinitis

29
Q
  1. Form of hypertrophic rhinitis

2. Overuse of topical nasal medication

A

Rhinitis medicamentosa

30
Q
  1. Includes elements of hypertrophic rhinitis

2. Associated with nasal polyposis

A

Chronic hyperplastic rhinitis

31
Q
  1. Disorder of altered nasal physiology

2. Related to environmental changes particularly dry inspired air

A

Rhinitis sicca

32
Q

True atrophy of intranasal structures with secondary crusting

A

Atrophic rhinitis (ozena)

33
Q

Chronic nasal symptoms from a variety of causes

A

Nasal “catarrh”

34
Q

Consequences of prolonged use of topical decongestants

A
  1. Rebound vasodilation (rhinitis medicamentosa)

2. Congestion

35
Q

May cause nasal congestion

A
  1. Antihypertensive drugs

2. Sympathetic blocking agents

36
Q

Drugs implicated in vasomotor rhinitis

A
  1. Rauwolfia serpentina
  2. Alcohol
  3. Tobacco
  4. Hashish
37
Q

Stimulate vascular congestion of the nasal membranes as well as engorgement in the uterus

A

Estrogen

38
Q

Levels of estrogen rise, symptoms of nasal congestion usually begin during the 4th to 5th month and progress to term, paralleling the increased production of estrogen

A

Pregnancy

39
Q

Another endocrine cause of nasal congestion

A

Hypothyroidism or myxedeme

40
Q

Fear and dejection result in…

A

Shrinkage and pallor of the nasal mucosa

41
Q

Anxiety, conflict, frustration and resentment result in…

A

Hyperemia, swelling and hypersecretion

42
Q
  1. Focal necrotizing, granulomatous lesion in the upper and/or lower respiratory tracts
  2. Systemic vascular focal necrosis
  3. Focal necrotizing glomerulitis
A

Wegener’s granulomatosis

43
Q
  1. Long standing cold
  2. Recurrent sinusitis
  3. Epistaxis
  4. Progressive nasal obstruction
  5. COM
  6. Hearing loss
    Unresponsive to treatment
A

Wegener’s granulomatosis

44
Q

Treatment of Wegener’s granulomatosis

A
  1. Corticosteroid

2. Cyclophosphamide

45
Q
  1. Rare disease
  2. Local inflammation and destruction of the tissues of the
    midface
  3. Symptoms and clinical findings are very similar with Wegener’s granulomatosis
  4. Biopsy: dense, midpxed lymphoid infiltration
A

Polymorphic reticulosis

46
Q
  1. Rare connective tissue disease

2. Episodic inflammation and subsequent destruction of the cartilaginous structures of the body

A

Relapsing polychondritis

47
Q
  1. Associated with pulmonary manifestations
  2. Generalized granulomatous disorder primarily affecting young adults
  3. Crusting and thickened mucosa on the inferior turbinate and septum
  4. Biopsy: noncaseating granuloma
  5. Other systemic signs: hypergammaglobulinemia, reduction of serum albumin
A

Sarcoidosis

48
Q
  1. Formation of vascular lesion around the lips, oral cavity and nose
  2. Common presenting symptom: recurrent epistaxis (requires multiple transfusion)
A

Osler-Weber-Rendu syndrome (hereditary hemorrhagic telagiectasia)

49
Q
  1. Dye eyes
  2. Dry mouth and nasopharynx
  3. Chronic arthritis
A

Sjögren’s syndrome

50
Q

Keystone to proper treatment of nasal hemorrhage

A

Application of pressure to the bleeding vessel

51
Q

90% of episode of anterior epistaxis are easily treated by firm, continuous pressure applied to both sides of the nose just superior to the nasal alar cartilages
With the patient sitting in an upright position (reduces the vascular pressure, patient can more easily expectorate any blood in the pharynx)

A

Nasal hemorrhage

52
Q

Nasal blood supply: 2 major contributors

A
  1. Internal carotid artery

2. External carotid artery

53
Q
  1. Derived from the internal carotid artery
  2. Give rise to the anterior and posterior ethmoid vessels
  3. They supply the superior portion of the nose
A

Ophthalmic artery

54
Q

Brings blood to the lower half of the lateral nasal wall and the posterior part of the septum

A

Sphenopalatine artery

55
Q

A vascular plexus along the anterior portion of the cartilaginous septum incorporates many of the anatomoses

A

Little’s area or Kiesselbach’s plexus

56
Q

Nasal examination in patient with recurrent minor epistaxis

A

Prominent vessels traversing the anterior septum, with small amounts of clotted blood

57
Q

Avoid cauterizing both sides of the septum

A

As cilia are destroyed and squamous epithelium overlying scar tissue replaces normal respiratory mucosa, stowage points in the flow of the mucous blanket develop

58
Q

Posterior epistaxis is believed to exist when:

A
  1. Majority of the blood loss is occurring into the pharynx
  2. Anterior pack fails to control the hemorrhage
  3. It is evident from nasal exam that the hemorrhage is posterior and superior
59
Q
  1. Dyskeratosis
  2. Lesions: mucocutaneous junction in the anterior noses, esp. on the anterior caudal margin of the septum
  3. Treatment: excision
A

Squamous papilloma

60
Q
  1. Most originate on the lateral nasal wall
  2. Treated like premalignant tumor
  3. May resemble a common nasal polyp but may contain areas of carcinoma
A

Inverted papilloma

61
Q

Two reasons why inverted papilloma is treated like a premalignant tumor

A
  1. Locally invasive, at times it involves extensive bone erosion, and if conservatively removed, shows a high incidence of local recurrence
  2. Focal areas of squamous cell carcinoma are found within the papilloma in approx. 10% of the cases
62
Q

Treatment of inverted papilloma

A

Wide surgical excision, with selected approach having the capability of further extension to provide wide exposure to the paranasal sinuses when required
Most often chosen route: lateral rhinotomy (starts with an incision in the nasal-alar fold and can be carried upward along the nasal-facial groove)

63
Q
  1. Is a primary tumor of lymphoid tissue

2. Solitary mass confined to soft tissues

A

Extramedullary plasmacytoma

64
Q
  1. Nonencapsulated fibro-osseous tumors involving the facial bones with frequent impingement on the paranasal sinuses of the nose
  2. Slow-growing tumor
  3. Rarely associated with pain and tends to appear around the time of puberty
  4. Patient presenting for cosmetic reasons due to facial asymmetry
A

Fibrous dysplasia

65
Q
  1. Benign tumor
  2. Originates in the nasal chambers near the sphenopalatine foramen
  3. Diagnosis should be considered: young boy with a long history of epistaxis and nasal obstruction
A

Juvenile nasopharyngeal angiogibroma

66
Q

Symptoms of nasal perforations

A
  1. Nasal crusting
  2. Whistling
  3. Bleeding
67
Q
  1. Special type of foreign body usually observed in adults

2. Insoluble salts of the nasal secretions form a calcareous mass

A

Rhinoliths

68
Q

Red thickening of the nasal tip with hypertrophy of the sebaceous glands associated with acne rosacea

A

Rhinophyma

Boies (27 decks)

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