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Year 2- Head and Neck > ENT Rhinology > Flashcards

ENT Rhinology Flashcards

1
Q

What is the commonest cause of nasal obstruction?

A

Deviated septum

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2
Q

What is rhinitis?

A

Reaction which causes nasal discharge, congestion, sneezing, etc.

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3
Q

What is the most common type of rhintitis?

A

Allergic rhinitis

e.g. after exposure to pollen, etc.

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4
Q

Epistaxis?

A

Nosebleed

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5
Q

Anosmia?

A

Total lack of smell

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6
Q

Hyposmia?

A

Reduced sense of smell

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7
Q

In which part of the nose is there olfactory epithelium meaning you can smell things?

A

Upper 1/3 of nose

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8
Q

Describe the physiology behind allergic rhinitis.

A

Patient develops IgE antibodies against certain antigens in things like like dust, pollen, cats, dogs, etc.
Every time a person in exposed to the antigen, there is a release of histamine leukotrienes prostaglandins from the nose which causes allergic reactions e.g. sneezing.

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9
Q

Which technique can be used to look fully at the nose?

A

Nasal endoscopy

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10
Q

What would be done in those with a septum deviation in terms of endoscopy?

A

A flexible endoscope may be used instead of a rigid one

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11
Q

Which blood tests would be done in rhinology patients?

(rare to do blood tests in rhinology cases however).

A

FBC
ANCA (type of antibody)
ESR
ACE (levels of angio-tensin converting enzyme)
RAST (allergen specific IgE)

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12
Q

Imaging is rarely used in rhinology, unless surgery is reuqired.
Which imaging may be used if surgery may be required in a rhinology case?

A

CT

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13
Q

When may skin tests be used?

A

Can be used to test against different allergens by putting a small sample on needle, prick the skin and then check reaction.
Commonly done for food allergies.

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14
Q

What must always be carried out during skin testing?

A

Positive and negative control

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15
Q

Give an example of a positive control during skin testing.

A

Histamine- if you do not react to histamine, you are unlikely to react to anything.

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16
Q

Give an example of a negative control used during skin testing.

A

Saline- if you react to saline, you will likely react to everything.

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17
Q

What is rhinomanometry?

A

Investigation which can be used to measure air breathed in and the pressure of the air in the nasal space

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18
Q

A patient presents with a broken nose. He got injured during a rugby game last week and comes to the hospital to see the you.
What is the possible treatment?

A

As it has been less than two weeks, local anaesthetic can be given and you can try and move the nasal bones back into position.

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19
Q

What would the treatment be if someone presents with a broken nose but it’s been more than two weeks?

A

Rhinoplasty may be carried out- changes shape of nose

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20
Q

If a patient has undergone nasal trauma, which complication must you be aware of?

A

Blood clot forming in septum- septal haematoma

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21
Q

What van happen if septal haematoma is not treated?

A

If blood is not drained, reduced blood supply to cartilage which then can become necrotic and may perforate.
Nasal dorsum may become deformed

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22
Q

What can be a common nasal issue in those with asthma?

A

Nasal polyps

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23
Q

What is the cause of nasal polys?

A

Unknown

->possibly inflammation, genetics…

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24
Q

Which conditions are nasal polyps predisposed in?

A

Cystic fibrosis
AFS (Allergic fungal sinusitis)
Churg-Stauss Syndrome

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25
Q

What would you test if you suspect cystic fibrosis?

A

Sweat test to check chlorine

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26
Q

If a child came in with nasal polys, which condition would you need to rule out?

A

Cystic fibrosis

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27
Q

Which test may be done is someone has severe allergic rhinitis?

A

Skin tests
RACE blood test

->if severe reactions, best patient knows specifically what they are allergic to so that they can avoid it.

28
Q

If doing a nasal smear and there are predominantly neutrophils in the sample, which condition may this be?

A

Chronic sinusitis.

29
Q

If doing a nasal smear and there are predominantly eosinophils in the sample, what would this suggest?

A

Allergy based

30
Q

When would you send a patient with nasal issues for an MRI?

A

If you suspect any intracranial involvement.

31
Q

What is the treatment for nasal polpys?

A

Oral and nasal steroids
Dietary changes to increase vitamins to increase immuinity

->steroid sprays for nasal use are efficient in some, need to be used everyday

32
Q

There lower bioavailability in modern nasal steroids. What is meant by bioavailability?

A

Amount of drug systemically delivered to the body compared with how much drug the body actually absorbs.

33
Q

If a patient has surgery to remove nasal polyps, which treatment will they still need to take after?

A

Nasal steroid spray for rest of their lives to reduce chances of them coming back

34
Q

If medical treatment for nasal polyps doesn’t’ work, which surgery may be considered?

A

Endoscopic sinus surgery to remove polyps

35
Q

Describe the symptoms of acute sinusitis.

A

Nasal blockage
Nasal congestion
Nasal discharge
Facial pain
Reduction or loss of smell

36
Q

When would acute sinusitis become chronic sinusitis?

A

Symptoms <4wks= acute
>4wks=chronic

37
Q

Majority of acute sinusitis patients do not require antibiotics. However, would would be some indications that a patient does require antibiotics?

A

Developing complications e.g. orbital oedema, severe headaches, double vision, pus coming from nose.

38
Q

In patients with acute sinusitis with complications, what would be done?

A

Hospital admission, IV antibiotics, scan, work out if something else is going on

39
Q

Which two strains of bacteria are the most common cause of bacterial rhinosinustitis?

A

S.pneumoniae
H.influenzae

40
Q

Which symptoms would be present in those with chronic sinusitis?

A

Presence of at least two of the following for at least 12 consecutive weeks:
-Nasal obstruction
-Nasal drainage
-Facial pain
-Hyposmia/ anosmia

41
Q

What is the usual medical treatment for chronic sinusitis?

A

Topical steroids

42
Q

When may a scan be carried out in patients with chronic sinusitis?

A

If they are not responding to medical treatment

43
Q

Acute sinusitis can have a complication of orbital swelling. This can mean that there is an abscess behind the eye. What is the treatment for this?

A

Immediate drainage, if not, could result in vision loss

44
Q

What may be the cause of severe headaches as a complication of acute sinusitis?

A

Pus collections e.g. at front of head.
Will need to be drained.

45
Q

What is a mucocele?

A

Build up of mucus as sinus does not drain it

46
Q

What is the treatment for a mucocele?

A

Surgically drain mucous via FESS (functional endoscopic sinus surgery).

47
Q

Those on which medications are more likely to have nosebleeds?

A

Anticoagulants like warfarin

48
Q

Why is the nose one of the most common sites of bleeding?

A

Exposed to many irritants

49
Q

What are some of the various categories of causes of epistaxis?

A

Trauma
Inflammatory
Neoplastic
Infective
Congenital
Genetic

50
Q

Which types of infection may cause a nosebleed?

A

Rhinitis
Sinusitis
Nasopharyngitis

51
Q

What is the initial management of epistaxis?

A

Hold nose to stop bleeding

52
Q

In those with a nosebleed, which part of a history is particular important?

A

Medical history- which drugs they’re on, if they have any bleeding disorders.

53
Q

If bleeding doesn’t stop, which procedure can be done in epistaxis?

A

Cauterisation

54
Q

If you cannot find the blood vessel causing the nasal bleed, cauterisation cannot be done.
What may be done instead?

A

Nasal packing

55
Q

Name an inherited condition which can affect blood vessels and cause bleeding.

A

HHT
(Hereditary haemorrhagic telangiectasia)

56
Q

What may you see upon examination in those with HHT?

A

Visible red spots on parts of the body like fingers and lips.

57
Q

What is the treatment for those with HHT?

A

Laser coagulation
Septodermoplasty

58
Q

What is angiofibroma?

A

Rare benign tumour which forms in the nose

59
Q

Who might get an angiofibroma?

A

Male teenagers
Never see in females, nobody knows why

60
Q

What should be done if you suspect angiofibroma?

A

Biopsy

61
Q

What is the treatment for angiofibroma?

A

Preoperative embolism
Surgery

62
Q

An elderly man presents with mild epistaxis and hearing loss. Upon examination, you see there is fluid in the ear.
What might be happening here? Describe your thought process.

A

Elderly man- children often get fluid but not elderly.
Fluid in ear= Eustachian tube not working properly. Connects nose and ear…

Tumour= would explain blockage and bleeding

63
Q

How would you confirm the diagnosis of a nasal tumour?

A

Endoscope, if seen, biopsy tumour

64
Q

What is the treatment of a nasal tumour?

A

Combined radiotherapy and surgery

65
Q
A

Year 2- Head and Neck (13 decks)

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