Nasal DO Flashcards
Unilateral discharge, unilateral
blockage
Foreign body
Facial pain, toothache, nasal
discharge, postnasal drip
Acute sinusitis
Sneezing, rhinorrhoea, itch,
eye irritation
Allergic rhinitis
Blockage, purulent discharge,
postnasal drip
Infective rhinitis
Blockage, postnasal drip
Deviated septum
Blockage, reduced sense of smell
Nasal polyps
Blockage, unilateral discharge,
epistaxis
Nasal tumour
Bilateral blockage, snoring,
halitosis
Adenoidal hypertrophy
Local pain, crusting, malodour
Nasal vestibulitis
Nature of d/c
Bloody
Neoplasia, trauma, bleeding disorder,
rhinitis, infection, hypertension
Nature of d/c
Mucopurulent
Bacterial rhinitis, foreign body
Nature of d/c
Neoplasia, foreign body
Serosanguineous
Nature of d/c
Watery/mucoid
Viral rhinitis, allergic rhinitis,
vasomotor rhinitis, CSF
red flags for nasal DO
• Unilateral nasal ‘polyp’ • Unilateral blood-stained discharge • Toddler with offensive nasal discharge esp. unilateral • Post-traumatic periseptal swelling • Rhinitis medicamentosa • Chronic sinusitis + LRTI = ? Wegener granulomatosis
Disorders of smell can be caused by ______ or _________ disturbances or considered as idiopathic
conductive or
sensorineural
Most cases of idiopathic anosmia are considered to be __________ and may last from a few days to several
months.
viral neuropathies
Head trauma, which can cause conductive
or sensorineural disturbances, is considered to be caused either from a fracture of the skull involving the _______ or, more commonly, by posterior head
trauma.
cribriform plate
Causes of conductive defect
Head trauma
Nasal polyps
Septal deviation
Rhinitis and sinusitis
Examples of central defects
Ageing
Chemicals (e.g. benzene, chlorine, formaldehyde, cement dust)
Cigarette and other smoking/inhalation
Drugs
Endocrine disorders (e.g. diabetes, hypothyroidism)
Frontal lobe tumour
Parkinson disease
Head trauma
Kallmann syndrome (anosmia + hypogonadism)
Nutritional deficiencies
Viral infections
_________ is inflammation of the nose causing sneezing, nasal discharge or blockage for more than an hour
during the day
Rhinitis
Classification of rhinitis accdg to season
— seasonal rhinitis: occurs only during a limited period, usually springtime
— perennial rhinitis: present throughout the
year
Classification of rhinitis accdg to pathophysiology
— allergic rhinitis: an IgE-mediated atopic
disorder
— vasomotor rhinitis: due to parasympathetic
overactivity
Both allergic and vasomotor rhinitis have a strong association with ______
asthm a
Allergic rhinitis—nasal allergy:
• detection of ________(not specific)
• _______or skin testing for specific allergens (can get false negatives)
allergen-specific IgE antibodies
RAST test
_________—following overuse of
OTC decongestant nasal drops or oxymetazoline sprays
Rhinitis medicamentosa
Drug-induced rhinitis
— various antihypertensives — aspirin — phenothiazines — oral contraceptives — cocaine, marijuana
Factors aggravating rhinitis (vasomotor)
- Emotional upsets
- Fatigue
- Alcohol
- Chilly damp weather
- Air-conditioning
- Sudden changes in temperature and humidity
_________is acute inflammation in the mucous membranes of the paranasal sinuses
Acute sinusitis
About ________ of URTIs are complicated by an acute sinusitis
5%
In __________ the symptoms
and signs of inflammation persist for more than 8–12 weeks and are more likely to be associated with factors that impair drainage via the osteomeatal complex, including nasal polyps
chronic sinusitis
Abx for chronic sinusitis
Amoxycillin 500 mg (o) 8 hourly for 10–14 days, possibly for longer periods of 3–6 weeks
How to use decongestant?
Consider decongestant spray (e.g.
xylometazoline) for maximum of 5 days and
intranasal steroid
Indications for surgery of chronic rhinosinusitis
- for surgical drainage if there is no response to the above regimen
- those with orbital or facial cellulitis
_______ are round, soft, pale, pedunculated
outgrowths arising from the nasal or sinus mucosa
Nasal polyps
Nasal polyps are basically prolapsed, congested, oedematous
mucosa, described by some as ______
‘bags of water
Nasal polyps may be associated with _____ and _____
asthma and aspirin sensitivity
_______should be considered in any child with nasal polyps
Cystic fibrosis
_______ should be considered in any child with nasal polyps
Cystic fibrosis
A polyp that does not have the typical smooth pale appearance may be _______
malignant
How to Tx polyp medically
A medical ‘polypectomy’ can be achieved with oral steroids, for example, prednisolone 50 mg daily for 7 days
What is the aim of surgical removal of polyps
to remove the polyp with the mucosa of the sinuses (often ethmoidal cells) from which it arises
Cause of epistaxis
The common situation is intermittent anterior bleeding from_______, seen in children and the young adult (90% of episodes), while posterior epistaxis (10%) is more common in the ________
Little area
older hypertensive patient
Mx of Persistent anterior bleed
Merocel (surgical sponge) nasal tampon or Kaltostat pack
Mx ‘Trick of the trade’ for intermittent minor anterior epistaxis
topical antibiotic (e.g. Aureomycin ointment) bd or tds for 10 days or (better option) Nasalate nasal cream tds for 7–10 days or Rectinol ointment or Vaseline
Tx of nasal folliculitis
Treatment is with bacitracin or preferably mupirocin (intranasal) ointment topically
for 5–7 days.
Furunculosis of the nasal vestibule is usually due to ________. It starts as a small superficial abscess in the skin or the mucous membrane and may develop into a spreading cellulitis of the tip
of the nose
Staphylococcus aureus
Painful fissures often develop at the
_________. They may become crusted and chronic
mucocutaneous junction
Fissures can be treated by :
keeping the
area moist with petroleum jelly (Vaseline) or saline gel, using hot compresses and the use of an antibiotic or antiseptic ointment if necessary.
This disfiguring swelling of the nose is due to
hypertrophy of the nasal sebaceous glands
Rhinophyma
Association of Rhinophyma
There is no specific association with alcohol. It is almost exclusive to men over the age of 40 years.
Rhinophyma may be associated with rosacea.
Mild septal deviation tends to cause _______ while severe deviation causes ________on one side.
alternating blockage
persistent blockage
The septum can be divided into anterior and
posterior segments. The anterior portion is necessary to support the _________of the nose whereas the posterior portion has_________
cartilaginous pyramid
no supporting role and can be removed without disturbing the support
The ________operation
is therefore suitable for posterior septal deviations
classic submucous resection
A hole in the nasal septum is caused commonly by
1
2
3
chronic infection including tuberculosis, repeated trauma such as vigorous nose ‘picking’ or following nasal
surgery
If a deformity is present in pts with nasal fx, refer the patient within
________
7 days, ideally from days 3–5.
Skin lacerations, i.e. __________, usually require early repair
compound fracture
The optimal time to reduce a fractured nose is about 10 days after injury. There is a window period of ______weeks before the fracture unites
2–3
________ is more suitable for bilateral
fractures with significant septal deviation,
bilateral fractures with major dislocations or
fractures of the cartilaginous pyramid
Open reduction
It is easily diagnosed as
a marked swelling on both sides of the septum when inspected through the nose
Haematoma of nasal septum
There is a________in which there is nasal congestion and decongestion that alternates from side to side and leads to rhinorrhoea.
‘nasal cycle’
This is a common, distressing problem in the elderly, caused by failure of the vasomotor control of the mucosa. It may be associated with a deviated septum
and dryness of the mucosa.
Senile rhinorrhoea
Senile rhinorrhoea TX
The treatment is to keep the nasal passages lubricated with an oily based preparation, for example, insufflation with an oily
mixture (a sesame oil based preparation, e.g. Nozoil, is suitable) or petroleum jelly
Following head injury, clear dripping fluid ( + ve for glucose) may indicate a fracture of the __________
roof of the ethmoid
_________which is uncommon, may cause nasal discharge which may be clear at first, becoming thick and offensive
Malignant nasal disease,
_________ occur exclusively in males between the ages of 9 and 24. Patients present with unilateral nasal obstruction and recurrent epistaxis
Fibroangiomas
Malignant tumours include nasopharyngeal
carcinoma, with the ______ being the
most common site
maxillary sinus
MC cause of NPCA
Squamous cell carcinoma is
the most common, followed by adenocarcinoma
melanoma and lymphoma
Malignant or non-healing granuloma, sometimes called ________ is
a slowly progressing ulceration of the face starting in the region of the nose
‘midline granuloma’,
_______ is uncommon in children under
the age of 10 and allergic nasal polyps are relatively rare.
Sinusitis
If a child presents with polyps, consider the
possibility of ____ or _______
cystic fibrosis or neoplasia
Acute bilateral nasal obstruction may occur in
newborns with ______
congenital bilateral choanal atresia
Red flags for sinusitis requiring consideration include ____
a sick child, pyrexia, rapid onset, unilateral and deteriorating airway obstruction.
If a fracture is undisplaced the treatment is 1 2 3
pain relief, ice compresses and res
If Fx is displaced, what is the tx?
refer for closed reduction under general
anaesthetic within 1–2 weeks (ideally at 10 days).
In normal children these problems are almost always due to adenotonsillar hypertrophy and most cases are relieved by surgery
Snoring and obstructive
sleep apnoea
T or F
‘a child with unilateral nasal discharge has a foreign body (FB) until proved
otherwise’.
T
A_______may develop in time on the foreign
body
rhinolith
Removal of FBs from the nose in children is a relatively urgent procedure because of the risks of _______
aspiration
