ENT: Rhinology Flashcards
1
Q
General approach
A
Organ of interest —> Adjacent organ —> Systemic cause e.g. Bleeding tendency (easy bruising)
2
Q
History taking
A
General:
- Age, Sex
- Past medical history
- Long term medications (OTC / prescribed?) —> Rebound congestion of nose
Nasal symptoms:
1. One side / bilateral
- Constant / intermittent
- Worse with trigger
- Discharge
- clear, purulent, coloured
- watery, mucoid
- foul smell - Epistaxis
- One side / Bilateral
- Amount
- Intermittent / Continuous
- Vomiting with blood as well? Swallowing blood?
- Anaemic symptoms e.g. chronic fatigue / after epistaxis?
- Precipitating factors e.g. trauma?
- Medical cause e.g. Steroid spray drying up mucosa? Tip of spray can injure nose?
- Recreational drugs e.g. Ketamine mixed with glass powder?
—> Anterior: Kiesselbach area, Posterior: Haemoptysis
—> Full nasal endoscopy if suspicion - Nose blockage symptoms: can lead to epistaxis
- Discharge
- Front (anterior nasal drip) / back (post nasal drip) - Trauma
- Fracture nasal bone, blowing nose too frequent - Smell sensation
- Partial loss (hyposmia) / Anosmia - Foul smell in nose
- Phantosmia (dried up secretions in nose?) - Coughing due to post nasal drip
- Rhinosinusitis
- location of pain headache, facial pain - Ear problems
- Eye symptoms
- Itchy eyes (allergic conjunctivitis related to allergic rhinitis)
- Diplopia (unilateral nasal obstruction)
3
Q
Physical examination
A
Inspection
- External nose: Surgical scars: e.g. nose implant
- Mist test: check patency of nose (can be even used for baby: Choanal atresia)
- Thudicum nasal speculum (only for looking at nostril) / Otoscope
Nasoendoscopy:
- Rigid (shorter) / Flexible (longer: for pharynx as well)
4
Q
Tumour vs Polyp
A
Tumour: - Irregular - Prominent blood vessels - Bleeding on contact - Head and neck SCC etiology: smoking - NPC etiology: EBV —> hearing loss, tinnitus, neck swelling (LN enlargement)
Nasal polyp:
- Smoother
- Less vascular
- Obstruction of drainage of sinus can lead to sinusitis
—> Steroid spray
—> Antihistamine to control allergy
—> Surgery to remove polyp to establish drainage pathway again
5
Q
Nasal packing
A
- Push against floor to go deeper
- Wash with water to swell up sponge
