Lec -2 Nose Flashcards
Inflammation of nose
1- skin :
Localized : furncle
Diffuse : vestibulitis
2- mucosa
Acute : specific: diphtheria
: non specific: common cold , corona
Influenza , exanthemata
Chronic : non specific: atrophic, hypertropic
Specific ( granuloma) : rhinoscleroma
Lupus
Leprosy
Sphilis
Fungal infection
Talk about furnculosis of nose
(5)
1- cause : scratch , sugar ( diabetes)
2- symptoms: (3) pain , swelling , purulent discharge if ruptured
3- signs : (3) redness, hotness, tenderness
4-complications :
Cavernous sinus thrombosis
Septal abscess
5-treatment :
Medical
Systemic antibiotics, analgesics
Antibiotic ointment
Surgical
Incision, drainge of it is abscess
Talk about Vestibulitis
(4)
1- acute diffuse inflammation of skin of vestibule
2- cause : 2ry to nasal discharge ( by common cold )
3- clinical picture
Redness and excoriation of the skin
4- treatment:
Systemic antibiotic
Antibiotic ointment
Talk about diphtheria
(3)
1- acute specific rhinitis
2- 2ry to faucial ( pharyngeal) infection
3- causes UNIlateral pseudo membrane ~> unilateral nasal obstruction and serosanginous discharge
Talk about common cold
(8)
1-causative organism : rhinovirus ( more than 100 type so vaccination is of no value )
2- mode of transmission : droplet infection
3- predisposing factors : overcrowding , low immunity , change in temperature
4- incubation period : 1:3 days
5- symptoms: 4 stages
* prodromal stage
General : bonache
Local : sneezing , dryness, burning sensation
- catarrhal stage
General
FAHM
LOCAL
bilateral nasal obstruction
Bilateral basal watery discharge - 2ry bacterial infection stage
Discolorued mucopurulent nasal discharge
Persistent nasal obstruction - recovery stage
About 3 days except if there is 2ry infection
6- signs
Congested mucosa either with watery or mucopurulent discharge ( according to stage)
7- complications
Spread
* recurrent sinsits
* recurrent otits media
* recurrent pharyngitis
* recureent laryngitis.
Anosmia which is permant sometimes( viral peripheral neuritis).
8- treatment
Prophylactic
* avoid predisposing factors
* personal protection ( mask )
* vaccination is of no value
Curative (6)
1- complete bed rest with plenty if warm fluids
2- systemic antibiotics
3- analgesics
4- antipyretics
5- antihistamine
6- vitamin c ( support local immunity )
Talk about infleunza
(6)
1- caustive organism : inflenza virus A,B,C
2- vaccination is available
3- its similar to common cold except
4- clinical picture is more severe
5- complications are more common
6- treatment
Prophylactic
Avoid predisposing factors
Personal protection ( face mask )
Vaccination
Curative (8)
1- complete bed rest with plenty of warm fluids
2- systemic antibiotics
3- analgesic
4- antipyretic
5- anticoagulants in elevated d dimer
6- treat chest stmptoms
7- vitamin c
8- zinc
Talk about exanthemata
Similar to inflenza but with skin rash
Eg : measles
Talk about corona virus
(10)
1-covid 19
2-caustive organism : SARS COVID 2
Severe Acute Respiratory Syndrome covid 2
3- predisposing factors : low immunity , overcrowding, change in temperatures
4- mode of transmisson : droplet infection
5- incubation period : 2:14 days
6- clinical picture : pandemic higly infectious virus
• respiratory symptoms + inflenza like symptoms +_ GIT symptoms
Covid
~ cough , chills
~ olfactory symptoms ( anosmia , loss of taste which is temporary)
~ fever +_ vomiting
~ general illness + immune response ( lymphopenia +_ cytokine storm ).
~ dyspnea +_ diahrrea
7- complications: pneumonia, blood clotting ( fatal )
8- risk factors : obesity, diabetes , hypertension, old age
9- investigations ;
Cbc , d dimer , nasopharyngeal swab for pcr
10- treatment
Prophylactic
Avoid predisposing factors
Personal protection ( face mask )
Vaccination
Curative (8)
1- complete bed rest with plenty of warm fluids
2- systemic antibiotics
3- analgesic
4- antipyretic
5- anticoagulants in elevated d dimer
6- treat chest symptoms
7- vitamin c
8- zinc
Talk about hypertrophic rhinitis
(5)
1- chronic non specific rhinitus with hypertrophy of nasal mucosa especially turbinates
2- cause
* allergic rhintis
*Recurrent acute rhinits ( common cold , inflenza)
* persistance of predisposing factors
* prolonged use of nasal decongestant ( rhintis medicamentosa )
3- symptoms (2)
Bilateral nasal obstruction
Bilateral MUCOID nasal discharge
4- signs (2)
Hypertrophied nasal mucosa
Does not shrink with local vasoconstrictor
5- treatment
Treat the cause
Medical : steroid spray
Surgical : sub mucous diathermy
Partial turbinectomy ( avoid total ~> atrophic rhintis ) either laser or surgical
Atrophic rhinits
(8)
1- offesive nose 😉
2-chronic non specific rhintis with atrophy of nasal mucosa especially turbinates
3- bilateral
4- more in females
5- causes
Primary : unknown but may be due to
( dahab)
Deficiency of iron , vitamin A
AUTOIMMUNE
Hormonal ( oestrogen deficiency)
Autonomic imbalance ( sympathetic overtone)
Bacilis ( klebsiella) ozanae infection
Secondary : destruction of nasla mucosa due to
- granuloma
- irradiation
- total turbinectomy
- deviated septum ( in wider side )
6- symptoms (4)
•Bilateral nasal obstruction despite roomy spaces
Due to loss of airway sensation due to atrophy of nerve or excessive crusts
• bilateral nasal discharge : crusty , greenish black , offensive ( not perceived by the patient )
• epistaxis when removal of crusts
• anosmia : atrophy of olfactory nerve
7-signs (4)
• atrophic nasal mucosa with its structures
• dryness
• roomy cavities ( very wide )
• crustations : greenish black , offensive and epistaxis when removal
8- treatment
Treat the cause
Medical (8)
1- alkaline nasal douche ( crusts)
2- mucolytics ( crusts )
3- menthol paraffin oil nasal drop ( offensive odor)
4- postassium iodide ( systemic ) ~> stimulate mucus gland secretion
5- oestrogen ( local ) ~> stimulate mucus gland secretion
6- iron & vitamin a
7- systemic antibiotics
8- 25% glucose in glycrin nasal pack ~> - protoletic organisms
Surgical :
Aim ~> narrowing nasal cavity till mucosa is regenerated
Sub mucus augmentation by bone , cartilage
Young operation : closure of one nostril for about one year then repeat the same on other nostril helping mucosa to regenerate
Talk about rhinoscleroma
(10)
1- the commenst granuloma in egypt
2- endemic in many areas as sharkia governate
3- more in female ( 15:25)
4- caustive organism : klebsiella rhinoscleromatis ( g - ve , intracellular, diplobacili)
5- pathology (3 stages )
- atrophic stage : like atrophic rhinits
- active hypertrophic ( nodular ) stage :
Characterised with formation of inflammatory cells
Russell bodies : degenerated red plasma cells
Mikulicz cells : vaculated foamy cells ( engulfing organism )
- the diagnostic stage
- fibrotic stage : fibrosis ( collagen bundles + fibroblasts)
6,7 -atrophic stages
Sympo, signs are the same as atrophic rhinitis
- active hypertrophic stage
Symptoms:
Bilateral nasal obstruction
Bilateral nasal discharge ( crusts )
Signs
Bilateral nasal masses especially at muco cutineus junction
- fibrotic stage
Bilateral nasal obstruction ( internal fibrosis )
Deformity ( external fibrosis )
8-complications
Extension
~Suncutaneus : ulceration + fibrosis
~ lacrimal sac : dacryoscleroma
~ pharynx : pharyngeoscleroma
~ larynx : laryngeoscleroma ( sub glottic )
Fibrosis
Malignancy : if radiotherapy is used in treatment
9- investigation
Biopsy : russel bodies , muckuliks cells ( diagnostic stage )
Culture and sensitivity
10- treatment
Medical
•Rifampcin : 600 mg / day
Side effects : red urine , hepatotoxicity
•Streptomycin : 1 gm IM / day for 40 days
Side effects : otonephrotoxic
•Alkaline nasal douche for crusts
Surgical
Surgical removal of masses by LASER
( acoid radiotherapy as its carcinogenic )
Talk about lupus
(4)
1- from attuniated tb bacili
2- site : anterior cartilagneus part of septum at muco cutaneus junction
3- pathology : apple jelly nodule ~> ulcer ~> perforation ~> deformity
4- treatment
Antituberculosis : rifampcin
Alkaline nasal douche
Deformity surgical correction
Talk about leprosy
(3)
1- by mycobacterium leprae
2- pathology & site : anterior cartilage part ulcerate ~> perforation ~> deformity
3- treatment
Antilepramatous : rifampcin , dapson
Alkaline nasal douchec
Deformity sugrical correction
Talk about sphyilis
(5)
1- by trepanoma pallidim
2- congenital , acquired
3- granuloma ( gumma ) happens in tertiary syphilis
4- pathology & site : posterior bony part of septum ( as itis blood disease) ulcerate ~> perforation ~> deformity ( saddle nose )
It may invade hard palate
5- treatment
Antisyphilitc : penicillin
Alkaline nasal douche
Surgical deformity correction
Talk about fungal infection ( rhinosinusitis)
1- non invasive
• fungus ball (7)
- mycetoma
- affect immunocompetent
- organism : asperigallis
- symptoms: persistent post nasal discharge
-Signs : no specific changes
- investigations: CT shows fungus ball in sinus , heterogenous opacity ( calcification )
- treatment : ESS : surgical removal of fungus ball
• allergic fungal sinusitis (6) 2222
- immunocompetent with atopy
- organism: aspargillus
- symptoms :
Bilateral or unilateral ( common) nasal obstruction
Atopic manifestations
- signs : nasal endoscopy : bilateral or unilateral ( common) polyp
Greenish mud ( mucin ) - investigations : CT SHOWS
Bone expansion
Heterogenous opacity ( calcification) - treatment:
Combined treatment of
Antiallergic ( steroid)
ESS : Surgical removal of polyp
( cant use antifungal it is contraversial )
2- non invasive
•Chronic ( endolent) type (8)
1- immunocompetent
2- organism : aspragillus
3- 2 types : granulomateus , non
It invades orbital , cerebral cavities anyways
4- symptoms: nasal obstruction, headache , proptosis, cranial nerve paralysis
5- signs : nasal endoscope shows polypoid mucosa with granuloma sometimes
6- investigations:
•CT SHOWS orbital , cerebral invasions , heterogenous opacity
• biopsy with histopathological examination
• cullture and sensitivity
7- treatment : combined treatment of
Antifungal
ESS : surgical removal of polyps
8- prognosis: recurrence occurs so long follow up is needed
• acute fulminant type (8) 3333
1- mucormycosis
2- in immunocomprimised ( diabetes , AIDS )
3- organism : mucorace that invades arterioles causing thrombosis, necrosis
4- symptoms:
~nasal obstruction
~ orbital symptoms ( proptosis , diminution of vision )
~ cerebral symptoms ( headache , cranial nerve paralysis)
5- signs :
Nasal endoscopy shows black necrotic tissue , ulcerations , crusts
6- investigations:
CT shows
- bone destruction
- orbital , cerebral invasion
- heterogeneous opacity ( calcification)
7- treatment :
Control of diabetes
Antifungal ( ampotericin )
ESS surgery ( debridement of necrotic tisse )
8- prognosis : high mortalitiy , so aggressive treatment is needed
