nasal blockage

Question 1

blocked nose history Qs

Answer 1

SOCRATIES
one or both
intermittent or constant 
either/both sides ever clap
trauma
nasal surgery 
other nasal symptoms 
worse at any time of the year
any sense of smell
tried any medications?
any allergies
asthma?

Question 2

examination of a blocked nose

Answer 2

external inspection
anterior rhinoscopy
nasal endoscopy

Question 3

causes of septal deformity

Answer 3

infective
congenital
inflammatory conditions
trauma

Question 4

management of a deviated septum

Answer 4

septoplasty

Question 5

risks of septoplasty

Answer 5

numbness of upper teeth
septal perforation
failure to improve symptoms
loss or reduced sense of smell - rare
bleeding
infection
altered appearance
further procedure needed
numbness of nose

Question 6

chronic rhionsinusitis

Answer 6

chronic nasal inflammation >12 weeks
bilateral nasal obstruction
anterior rhinorrhoea and sneezing
examination shows oedema of nasal mucosa and a watery discharge in nose

Question 7

tests/investigations in rhinosinusitis

Answer 7

RAST - any specific allergies

CT sinuses for those who will require surgery

Question 8

treatment of rhino sinusitis

Answer 8

antihistamines - if clear evidence of allergy
saline nasal irrigation
topical nasal steroid
surgery reserved for those who don’t respond to medical treatment

Question 9

treatment of rhino sinusitis with nasal polyps

Answer 9

topical nasal steroid
short course of prednisone - often v.effective in severe polyps
functional endoscope sinus surgery may be required if above ineffective

Question 10

diagnosis of chronic rhino sinusitis

Answer 10

inflammation characterised by
nasal blockage/congestion/obstruction
plus one or more of: facial pain/pressure, reduced sense of smell. polyps +/ or discharge + or CT changes