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ENT-HNS > Epistaxis > Flashcards

Epistaxis Flashcards

1
Q

This is the most common otolaryngologic emergency

A

Epistaxis

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2
Q

Most of the blood supply of the nose and sinuses would come by the way of the (internal/external) carotid artery through your (internal/external) ________ and _________ artery

A

External Carotid Artery
Internal Maxillary and Facial Artery

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3
Q

Blood supply via ECA (Some Anatomists Like Freaking Out Poor Medical Students)

A

Superior Thyroid Artery
Ascending Pharyngeal Artery
Lingual Artery
Facial Artery
Occipital Artery
Posterior Auricular Artery
Maxillary Artery
Superficial Temporal Artery

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4
Q

Internal Maxillary artery gives off to __________ and ________________

Which of the two arteries supply the:
- lower mid septum
- posterior middle turbinate
- posterior septum

A

Internal Maxillary artery gives off to sphenopalatine artery and descending palatine artery

  • lower mid septum: descending palatine artery
  • posterior middle turbinate AND posterior septum: sphenopalatine artery
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5
Q

This is the only extracranial branch of the ICA

This branch gives off to ____ and _______

Which of the two arteries supply the:
- Nasal tip
- Nasal Septum
-Lateral wall of the nose
-Superior Turbinate
-Superior Septum
-Posterior lateral wall of the nose

A

OPHTHALMIC ARTERY
his branch gives off to ANTERIOR ETHMOID ARTERY and POSTERIOR ETHMOID ARTERY

Which of the two arteries supply the:
- Nasal tip, Nasal Septum and Lateral wall of the nose: ANTERIOR ETHMOID ARTERY
-Superior Turbinate, Superior Septum, and Posterior lateral wall of the nose: POSTERIOR ETHMOID ARTERY

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6
Q

T/F: ICA supplies the posterior portion of the nose

A

F
Superior

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7
Q

Most frequent site of epistaxis

Where does it receive blood from?

A

Little’s area or Kiesselbach’s plexus

both ICA and ECA

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8
Q

T/F: The posterior epistaxis is more common of the two types of epistaxis

Site of bleeding of the more common form of epistaxis:
Source of bleeding of the more common form of epistaxis : ___________ , originating from the __________________

A

F- anterior

Site of bleeding: nostrils
Source of bleeding: Little’s Area ,originating from the ethmoid artery system

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9
Q

Most common reason for epistaxis in pediatrics

A

Digital manipulation

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10
Q

The posterior epistaxis originate from this artery through the back

How does infection/inflammation in the nose cause epistaxis?

Source of bleeding of posterior epistaxis

Most common reason for posterior epistaxis in adults

A

Internal maxillary artery

There is blood vessels is close to the nasal mucosa; since the mucosa is thin, when there is infection, the resulting inflammation makes the mucosa edematous, which makes it more sensitive and fragile. Nose blowing could then irritate the vessels and cause bleeding

Woodruff’s plexus / Nasal-nasopharyngeal plexus

Hypertensive bleeds

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11
Q

T/F: epistaxis is exclusive to just anterior or posterior type

A

F - no, especially if the patient’s condition is systemic

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12
Q

Most important thing to do when a patient comes with epistaxis

A

IDentify site of bleeding through anterior rhinoscopy or nasal endoscopy

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12
Q

Differential diagnosis for epistaxis

A

New growth (nasopharyngeal carcinoma)
Anatomic deformities (septal spur)
Trauma
Inflammation (rhinitis)
Vascular malformation
Environmental factors

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13
Q

T/F: Most of the time, tumors in the sinonasal area that bleed are considered malignancies

A

T

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14
Q

Most common locations of new growths

A

Fossa of Rosenmuller

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15
Q

T/F: Eustachian tube opening, nasopharynx, and rosenmuller fossa are seen via posterior endoscopy

A

T
they can’t be seen using anterior rhinoscopy

16
Q

T/F: Nasopharyngeal carcinoma is common in Asia, very common in the PH especially the North

T/F: This disease has a bimodal age distribution

T/F: This has high prevalence in Hong Kong

What is a strong risk factor for this disease?

A

T
T- 1st peak late childhood, 2nd peak 50-60yo
T- aka Canton Tumor

Dietary factors

17
Q

T/F: EBV titers are used for prognostication and monitoring of new growths

A

F - NPCA

18
Q

This is the most common clinical presentation for NPCA

A

Neck masses (lymph node metastasis) Level 2 lymph nodes

19
Q

How does aural fullness occur in NPCA?

A

Since the neck mass starts from the Rossenmuller fossa, it tends to block the drainage of the eustachian tube > the normal secretions of the middle ear can’t drain properly (decreased ventilation) > secretions pool into the middle ear > aural fullness

20
Q

How does Diplopia occur in NPCA?

A

Lateral rectus palsy > affects lateral rectus > diplopia

21
Q

Gold standard for diagnosis of NPCA

MRI is better for _____ visualization and early bone invasion
CT is better for _______ visualization

A

Nasopharyngeal biopsy (except in adolescent males due to possible excessive bleeding)

This is only done among adolescent males if vascularity of the tumor cannot be determined through imaging or radiology

MRI- soft tissue
CT- bone

22
Q

T/F: Surgery is the definitive treatment for NPCA

A

F: surgery is NOT DONE
instead, chemo and radiotherapy are done

23
Q

T/F: Chemotherapy acts as a radioensitizer that sensitizes tumor cells to radiation > increases efficacy of radiotherapy

A

T

24
Q

How does bleeding occur in septal spur?

A

The mucosa in the edges of septal spur becomes very thin and sensitive > source of bleeding

25
Q

T/F: Immediate reduction of nasal fracture is the best treatment

A

T

26
Q

T/F: Juvenile Nasopharyngeal Angiofibroma is an example of a vascular malformation that can cause epistaxis

A

T

27
Q

T/F: Juvenile nasopharyngeal angiofibroma may cause hyponasal voice and recurrent severe epistaxis

1st choice diagnostic modality:

Tx:?

A

T
Carotid Angiography (map out feeding vessel > embolize > remove tumor) done in 1 day

-surgical excision

28
Q

First and most effective management of Epistaxis

A

Digital PRessure on the NARES, not the nose bridge

29
Q

What are the does and donts in applying digital pressure?

A

DO: put pressure on the nares; position neutral or bow slightly
DON’TS: do not put pressure on the nose bridge; do not look up

30
Q

Putting gauze inside the nose for anterior nasal packing must extend to the __________

A

posterior choanae

30
Q

T/F: Electrocautery is suggested for mucosal bleeds

A

F- NOT suggested as it can cause further lateral damage to mucosa

31
Q

This management is used for worst case scenarios

A

Artery Ligation (for internal maxillary artery and sphenopalatine artery)

31
Q

Used for kids: (absorbable/nonabsorbable) nasal packings

A

Absorbable- disappears after a couple of weeks

32
Q

What is the likely cause of epistaxis even after cauterization?

A

PAtient may have removed the crust that formed after cauterization > lining gets injured > new epistaxis

ENT-HNS (8 decks)

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