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ENT: Nose > ENT: Nose > Flashcards

ENT: Nose Flashcards

1
Q

Nasal Fracture

A
  • nasal bones, nasal septum, nasal turbinates

- restoring near normal anatomy for normal nasal physiology

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2
Q

Nasal Septal Deviation

A
  • if significant, can disrupt normal nasal airway & mucosal function
  • can predispose to secondary disorders (rhinitis, sinusitis)
  • Kesselbach’s plexus: nasal septal hematoma
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3
Q

Epistaxis

A

-most frequently mid to anterior nares (90%)

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4
Q

Anterior epistaxis

A
  • anterior/posterior ethmoid artemis-nasal roof & frontal, ethmoid sinuses
  • nasal arterioles: no elastic fibers to very responsive to environment
  • Kiesselbach’s plexus: trauma & nasal atrophy in elderly
  • if recurrent, nasal septal perforation
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5
Q

RX anterior epistaxis

A
  • local pressure 10 min
  • look for instigators
  • review meds
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6
Q

Juvenile nasopharygneal angiofibroma

A
  • refer to ENT immediately

- adolescent male-bleeding w/ co-existing nasal obstruction

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7
Q

Posterior epistaxis

A
  • 10%
  • sphenopalatine artery: balance of nose
  • rapid referral to ER or ENT
  • oxygen sat will probably drop
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8
Q

RX posterior epistaxis

A

-ENT referral

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9
Q

Nasal polyps

A
  • appear as boggy, masses on nasal mucosa (peeled grapes)
  • patients commonly also have allergic rhinitis
  • chronic congestion & decreased smell
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10
Q

What is contraindicated w/ nasal polyps because of causing sever bronchospasm?

A

-aspirin

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11
Q

RX of nasal polyps

A
  • 3 month course of topical nasal corticosteroid
  • oral steroids can help
  • surgical removal may be necessary if polyps are large
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12
Q

Etiologies of rhinitis

A
  • allergic
  • drug-caused
  • pregnancy
  • vasomotor
  • infectious
  • environmental factors
  • atrophic
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13
Q

Allergic rhinitis

A
  • nasal mucosa edema, congestion, rhinorrhea
  • allergic ‘salute’, nasal crease, allergic shiners
  • may have avascular polyps
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14
Q

RX allergic rhinitis

A
  • antihistamines
  • decongestants
  • nasal corticosteroid sprays
  • referral for immunotherapy
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15
Q

Drug-caused rhinitis

A

-cocaine, anticholinergic meds, overuse Afrin, resperone, beta blockers, hydralazine, oral contraceptives, ACE inhibitors, Viagra

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16
Q

RX drug-caused rhinitis

A

-change meds

17
Q

Pregnancy rhinitis

A

-nasal mucosal response to elevated hormone levels (estrogen receptors)

18
Q

RX pregnancy rhinitis

A

-saline NS

19
Q

Vasomotor rhinitis

A
  • imbalance of ANS activity in elderly
  • chronic dry nasal mucosa, clear rhinorrhea
  • often confused w/ allergic rhinitis
  • AR not common in elderly
20
Q

RX vasomotor rhinitis

A
  • non very satisfactory
  • saline NS
  • corticosteroids NS
  • Azelastine NS
  • Ipratroprium
  • avoid contributing meds
21
Q

Infectious rhinitis (viral)

A
  • common cold

- mild to moderate congestion & clear rhinorrhea

22
Q

Infectious rhinitis (bacterial)

A
  • more apt to be ethmoid sinusitis causing rhino sinusitis

- same bacteria that cause otitis media (S. pneumonia, H. influenza, M. catarhalis)

23
Q

RX infectious rhinitis (bacterial)

A
  • amoxicillin, augmentin, doxycycline

- 2nd line: augmentin, levofloxacin, moxifloxacin

24
Q

Environmental factors to rhinitis

A
  • dusty work place, toxic fumes
  • wood stove
  • irritants w/ hobbies/factories
25
Q

RX environmental rhinitis

A
  • saline NS

- corticosteroid NS

26
Q

Atrophic rhinitis

A
  • usually in elderly
  • anatomical deformity of nasal septum
  • turbinates exacerbates
  • dry nose, frequent minor anterior nose bleeds
27
Q

RX atrophic rhinitis

A
  • premarin cream

- corticosteroid NS

28
Q

Sinusitis

A
  • acute
  • chronic
  • barosinusitis
29
Q

Acute sinusitis

A
  • most viral, few bacterial
  • purulence, dental/facial pain, unilateral sinus tenderness
  • initial improvement but then worsening sxs
  • one or both nares
  • usually URI proceeds
  • 10 days -4 weeks of sxs
30
Q

Chronic sinusitis

A
  • presents as chronic obstructions, congestion (pain/pressure)
  • mucopurulent nasal d/c
  • mucosa typically damaged, thickened & cilia spotty throughout sinus mucosa
  • tobacco smokers
31
Q

RX chronic sinusitis

A
  • empiric, CT
  • address underlying nasal issues, stop tobacco
  • abx: amox, augmentin, doxy, levo
  • oxymetazoline, antihistamines, fluids
32
Q

Barosinusitis

A
  • negative aire pressure in one or more sinus cavity
  • acute forms w/ rapid change in ambient pressure
  • chronic forms w/ obstruction of maxillary sinus ostia (chronic pain)

ENT: Nose (1 decks)

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