ENT - Nose

Question 1

How do we compartmentalise the nose?

Answer 1

Upper
Middle
Lower zones

Question 2

What is the cartilage at the front of the nose made of?

Answer 2

Quadrangular cartilage

Question 3

What do you have in the nose which helps with air warming etc

Answer 3

Turbinate

Question 4

Different turbinates?

Answer 4

Superior
Middle
Inferior turbinate

Question 5

What else is there

Answer 5

paranasal air sinuses

Question 6

Nasal cavity is split up into

Answer 6

Inflow area

Functional area

Question 7

Functions of the sinuses(?)

Answer 7

Warming
Humidification
Olfaction
Respiration
Filtration

Question 8

Hx for nose/symptoms you’d ask for

Answer 8

Sneezing
Itching
Congestion
Rhinorrhoea 
Hyposmia
Anosmia
Any known allergies
Pain 
Bleeding
Related problem

Question 9

What is another name for runny nose?

Answer 9

Rhinorrhoea

Question 10

Why would you ask about pain?

Answer 10

Facial pain - sinusitis

Nose pain - cancer (it’s not normal)

Question 11

Unilateral glue ear is a red flag, why?

Answer 11

Could be cancer sitting in nasal cavity blocking eustachian tube

Question 12

Nasopharygneal cancers presentation?

Answer 12

Neck lump

Question 13

Where is the nasopharynx?

Answer 13

Back of hard palate to uvula

Question 14

Where are adenoids?

Answer 14

Back of the nose, above eustachian tube

Question 15

Describe the growth of adenoids in children

Answer 15

Normally they’re massive but they go down in size

However they often cause glue ear as they sit on top of the

Question 16

What is the device used for anterior rhinoscopy (o hold open the nose to look at it)?

Answer 16

Thudicum’s speculum

Question 17

Rhinitis classifications

Answer 17

Allergic

Non allergic

Question 18

Allergic rhinitis symptoms/hx vs non allergic

Answer 18

Allergic:
Seasonal
Rhinorrhoea (thick mucousy discharge)
Sneezing
itching 
Blueishness of nasal mucosa 

Non-allergic:
all round,
Pink mottled discolouration of nasal mucousa

Question 19

Diagnosis of rhinitis

Answer 19

Skin prick testing

Question 20

Diagnosis classification

Answer 20

Less than 4 days a week - intermittent

More than 4 days a week - severe

mild- affects work
Severe -

Question 21

Management of mild intermittent rhinitis?

Answer 21

Non-sedating antihistamine
Saline nasal douche
Allergen and irritant avoidance

Question 22

What is given for severe persistent rhinitis?

Answer 22

Intranasal steroids
Topical cromone/anithistamine
Immunotherapy (graded exposure of allergen under tongue)

Question 23

What does the saline do?

Answer 23

Washes out allergens and mucous

Question 24

Signs of rhinosinusitis

Answer 24

Polpys - exudates in the nasal mucosa

Question 25

Management of rhinosinusitis

Answer 25

Same as rhinitis + steroids | Surgery if complete blockage or if nasal meds can't get through

Question 26

Acute sinusitis signs

Answer 26

Mucopurulent discharge

Question 27

Viral vs bacterial sinusitis

Answer 27

Bacterial sinusitis lasts longer - puss-y discharge vs thick discharge from viral ifneciton

Question 28

Complication of acute sinusitis

Answer 28

``` Periorbital cellulitis (urgency as can cause blindness) Intracerebral abscess ```

Question 29

Complication of nasal trauma

Answer 29

Septal hematoma

Question 30

What is the golden window for referral after nose trauma?

Answer 30

within 21 days

Question 31

Where do nose bleeds most commonly originate from in the nose?

Answer 31

Kiesselback's plexus/Lithel's area

Question 32

What might you look for in the lips if someone has frequent nose bleeds?

Answer 32

Hereditary haemorrhagic telangiectasia

Question 33

Acute community management of nose bleeds

Answer 33

Lean forward | Ice on forehead/mouth/back of neck

Question 34

If this doesn't work, what do you do?

Answer 34

Silver nitrate cautery Nasal packing Surgery

Question 35

Risk factors for nasopharyngeal cancers

Answer 35

EBV

Question 36

Ethnicity exposure to nasopharyngeal cancers

Answer 36

SE asians who have exposure to EBV