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Year 3 - primary care + medicine > ENT (nose) > Flashcards

ENT (nose) Flashcards

1
Q

What is epistaxis?

A

Nosebleeds

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2
Q

Where is the most common source of bleeding in nosebleeds?

A

Kiesselbach’s plexus which is in Little’s area. This is at the front of the nasal cavity and contains a lot of blood vessels that are prone to bleeding.

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3
Q

What can trigger nosebleeds?

A

Nose picking
Colds
Sinusitis
Vigorous nose blowing
Trauma
Changes in weather
Coagulation disorders - e.g. thrombocytopenia, HHT
Anticoag medications - e.g. aspirin, DOACs, warfarin
Foreign body - e.g. something up the nose, snorting drugs
Tumours

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4
Q

What may bilateral epistaxis suggest?

A

That the bleeding is posterior to the nose - most commonly from the sphenopalatine artery

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5
Q

Which artery most commonly causes posterior, more severe nosebleeds?

A

Sphenopalatine artery

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6
Q

How are nosebleeds managed?

A 
Sit up, tilt head forwards, squeeze soft part of nostrils for 10-15 mins.
If still doesn't stop then
- anterior packing
- cautery with silver nitrate
- posterior packing
Then consider surgical ligation.
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7
Q

What are nasal polyps?

A

Growths of the nasal mucosa that occur in the nasal cavity or sinuses. They grow slowly and gradually cause obstruction.

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8
Q

What are nasal polyps often associated with?

A

Chronic rhinitis or sinusitis
Asthma
Cystic fibrosis

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9
Q

How may nasal polyps present?

A 
Chronic rhino-sinusitis
Difficulty breathing through the nose
Snoring
Nasal discharge
Loss of sense of smell (anosmia)
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10
Q

What is anosmia?

A

Loss of sense of smell

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11
Q

How are nasal polyps managed?

A

Nasal douching
Intranasal topical steroid sprays
Surgery - polypectomy or FESS (functional endoscopic sinus surgery - to improve drainage of sinuses)
If unilateral refer to exclude malignancy

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12
Q

What is sinusitis?

A

Inflammation of the paranasal sinuses in the face.

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13
Q

What is the difference between acute and chronic sinusitis?

A

Acute < 12 weeks
Chronic >12 weeks

Chronic > 12 weeks

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14
Q

Name the different paranasal air sinuses

A

Frontal
Ethmoidal
Sphenoid
Maxillary

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15
Q

What are paranasal air sinuses?

A

Hollow spaces within the bones around the nasal cavity.

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16
Q

What is the physiology behind sinusitis?

A

The paranasal air sinuses produce mucous which drains into the nasal cavities via holes called ostia. When these ostia get blocked the mucous builds up causing sinusitis.

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17
Q

What can cause sinusitis?

A

Infection - particularly following upper respiratory tract infections
Allergies
Obstruction of drainage - due to foreign body, polyps or trauma
Smoking

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18
Q

How does acute sinusitis present?

A 
Recent upper resp infection
Nasal congestion
Nasal discharge
Facial pain, pressure, swelling
Headaches
Loss of smell
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19
Q

How does acute sinusitis present?

A 
Recent upper resp infection
Nasal congestion
Nasal discharge
Facial pain, pressure, swelling, tenderness
Headaches
Loss of smell
Fever
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20
Q

How is acute sinusitis managed?

A

Most acute are viral - self limiting.
If not improving by 10 days then
- high dose corticosteroid nasal spray for 14 days - e.g. mometasone 200mg bid (twice a day)
- antibiotics - most commonly phenoxymethylpenicillin 500mg qid (4 times a day) for 5 days.
If patient has systemic infection or sepsis then admit to hospital.

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21
Q

How is chronic sinusitis managed?

A

Advice - avoid triggers, stop smoking, good dental hygiene
Saline nasal irrigation
Intranasal corticosteroids - e.g. mometasone/ fluticasone for up to 3 mnths
Refer to specialist - Functional endoscopic sinus surgery

22
Q

Describe the correct nasal spray technique

A
  • Tilt head slightly forwards
  • Use opposite hand to nostril (left hand to spray up right nostril ) so the spray is away from the septum
  • Don’t sniff hard during the spray
  • Gently inhale through the nose after the spray
23
Q

Describe the correct nasal spray technique

A
  • Tilt head slightly forwards
  • Use opposite hand to nostril (left hand to spray up right nostril ) so the spray is away from the septum
  • Don’t sniff hard during the spray
  • Gently inhale through the nose after the spray
24
Q

What is allergic rhinitis?

A

IgE mediated type 1 hypersensitivity reaction which cases an inflammatory response in the nasal mucosa

25
Q

What are some common causes of allergic rhinitis?

A

Hayfever - tree pollen or grass
House dust mites
Pets
Other allergens

26
Q

How does allergic rhinitis present?

A

Running, blocked and itchy nose
Sneezing
Itchy, red and swollen eyes

Often in someone with a family history of atopy.

27
Q

How is allergic rhinitis managed?

A

Avoid triggers
Nasal saline irrigation
Nasal corticosteroid sprays - e.g. fluticasone
Nasal antihistamines
Oral antihistamines e.g. non sedating - loratadine, sedating - promethazine

28
Q

What is a septal haematoma?

A

When blood collects between the lining and cartilage of the nasal septum

29
Q

What causes a septal haematoma?

A

Trauma - fracture, recent surgery etc.

30
Q

How are septal haematomas managed?

A

Urgent drainage to prevent permanent deformity

31
Q

What can occur if a nasal septal haematoma is not treated?

A

Saddle nose deformity (the cartilage in-between the nostrils can become necrotic as it gets it blood supply from the overlying tissue)
Infection
Abscess

32
Q

How may a nasal septal haematoma present?

A 
Often after trauma.
- congestion / blockage
- difficulty breathing
- bruising
- swelling
- overall change in shape of nose
- headache
Visible buldge on examination up the nose
33
Q

What are the symptoms of a deviated nasal septum?

A
  • obstruction
  • difficulty breathing
  • nosebleeds
  • facial pain
  • noisy breathing/ snoring during sleep
  • preference for sleeping on one side due to narrowing of one nostril
34
Q

What can cause a deviated nasal septum?

A

Congenital - present at birth
Trauma - mainly in childhood

Trauma

35
Q

How is a deviated nasal septum managed?

A

Management of symptoms with decongestants, antihistamines and nasal steroid sprays.

Surgical repair - sepatoplasty to straighten the nasal septum. May also need rhinoplasty to reshape the nose.

36
Q

If a child presents with a nasal fracture what must be thought about?

A

safeguarding

37
Q

What antibiotic is given for acute bacterial sinusitis if the patient is allergic to penicillin?

A

Doxycycline 200 mg on first day and then 100mg once daily for 4 days
OR
Clarithromycin 500mg bid (2x daily) for 5 days

38
Q

What antibiotics are given for acute sinusitis that lasts > 10 days?

A

Phenoxymethypenicillin (penicillin 5) - 500mg 4x daily for 5 days

39
Q

When is someone with chronic sinusitis referred to a specialist?

A

Unilateral symptoms
Persistent symptoms after 3 months of treatment
Nasal polyps
Recurrent episodes of otitis media or pneumonia
Unusual opportunistic infections

40
Q

What are some adverse reactions to intranasal corticosteroids?

A

Dryness, irritation and nosebleeds

Also dryness and irritation of the throat

41
Q

Describe the nasal spray technique

A
  • blow the nose to clear it
  • close off one nostril and put the nozzle in the other
  • tilt head forwards slightly
  • breathe in slowly as you squeeze the mist into the nose - avoid sniffing
  • breathe out through the mouth
  • repeat for the other nostril if necessary
42
Q

What should be monitored when a child has prolonged treatment with corticosteroids?

A

Growth - as can suppress growth.

43
Q

What drug treatments should be given to someone presenting with mild rhinitis symptoms?

A

Intranasal antihistamine such as azelastine - one spray twice daily
or oral antihistamines such as loratadine - 10mg once daily

44
Q

What add on drug treatments can be given to someone with moderate to severe allergic rhinitis?

A

On top of intranasal or oral antihistamines
- add intranasal steroids

- Intranasal corticosteroids - e.g. fluticasone to be used during exposure.

45
Q

What is the function of the nose?

A
  • sense of smell
  • warms and humidifies air
  • aids breathing
  • immune defence
  • vocal resonance
46
Q

How should allergic rhinitis be managed?

A

Nasal saline irrigation
Avoid triggers
Intranasal or oral antihistamines
Intranasal or oral steroids if severe

47
Q

Where do the paranasal air sinuses drain?

A

Sphenoid sinus = spheno-ethmoidal recess
Posterior ethmoid cells = superioor meatus
All other sinuses = middle meatus

48
Q

Where does the nasolacrimal duct drain into?

A

The inferior meatus

49
Q

What are some complications of rhinosinusitis?

A

Chronic infection.
Periorbital infection (orbital cellulitis)#
Intracranial involvement - meningitis / encephalitis / brain abscess

50
Q

What are complications of sinus surgery?

A
  • infection
  • bleeding
  • pain
  • damage to the orbit
  • anterior skull base injury - can lead to a CSF leak

Year 3 - primary care + medicine (20 decks)

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