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ENT > Nese > Flashcards

Nese Flashcards

1
Q

What drains into inferior meatus?

A

Nasolacrimal gland

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2
Q

What drains into middle meatus?

A
  1. Middle- and anterior ethmoidal cells

2. maxillary- and frontal sinus

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3
Q

What drains into the superior meatus?

A

Sphenopalatine foramen and posterior ethmoidal cells. NB. Sphenoid sinus opens above the superior turbinate and a bit posteriorly.

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4
Q

How can you check if there is an inflammatory process?

A

Transillumination test. Check for maxillary sinus inflammation (no light = inflammation). Maxillary sinus can hold up to 15mL in an adult.

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5
Q

Acute & Chronic sinusitis - Predisposing factors

A
  1. Blockage of osteomeatal opening by polyp
  2. Septum deviation
  3. Choncha bullosa(trapped air cell in a turbinate)
  4. Mucosal thickening
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6
Q

Acute & Chronic sinusitis - definition

A

Acute < 10 days

Chronic > 3 months

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7
Q

Acute & Chronic sinusitis - Symptoms

A 
Symptoms are usually BILATERAL(if unilateral -> think cancer). 
1. Facial pain 
2. Pressure sensation 
3. Decreased smell sensation
4. Mucopurulent discharge 
5. Polyps 
6. Fever
7. Nasal obstruction 
8. Headache
CT-changes - need >2 to set diagnosis
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8
Q

Acute & Chronic sinusitis - how to check severity

A

VAS scale -> gives recommendation on how to treat

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9
Q

Acute & Chronic sinusitis - Treatment

A
  1. Functional endoscopic sinus surgery (FESS): Restores osteomeatal meatus physiological state and thus proper drainage of sinuses.
  2. Endoscopic sinus surgery (ESS): When there is need to remove excessive tissue(e.g. a polyp).
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10
Q

Acute & Chronic sinusitis - Complications

A
  1. Orbital fractures
  2. Emphysema
  3. Bleeding
  4. Blindness
  5. CSF leak
  6. Meningitis
  7. Empty nose syndrome (after surgery, patient still feel congested, however tha nasal passages are clear. Psychosomatic disease? e.g. like fantom leg.
  8. Injury to lacrimal gland
    External approach of sinus surgery = Caldwell Luc’s operation.
  9. Orbital - cellulitis, abscess
  10. CNS - meningitis, abscess
  11. Osteomyelitis - cavernous sinus thrombosis (= proptosis, chemosis and optalmoplegia)
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11
Q

Rhinitis - Cause

A
  1. Primary allergy -> tx: antihistamines(local or systemic), leukotriene inhibitors “-lukast”, intranasal steroids, nasal decongestants + avoidance of allergen.
  2. Infection
  3. Hormonal rhinitis (estrogens)
  4. Senile rhinitis
  5. Vasomotor rhinitis
  6. Rhinitis medicamentosa - due to rebound effect when stopping long term anticongestant tx.
  7. Atropic rhinitis -> crust and smell really bad. Patient dont know due to “merciful anosmia” - effect. Tx: Young’s operation.
  8. Chronic purulent rhinitis -> tx: longterm amoxicillin therapy. If no improvement start to look for signs of immunodeficiency, cystic fibrosis or mucociliary dysfunction.
    ICF - Symptoms of discharge, and head trauma might be in history of patient. Quick test: Beta-2 transferrin + glucose (dipstick test) should be confirmed as they dont appear in nasal secretions. Blood containing CSF - halo sign. Beta 2 transferrin is most specific.
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12
Q

Acute Coryza (Common cold) - complications

A

Risk of acute sinusitis following.

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13
Q

Nasal vestibulitis

A

Carrier of S.pyogenes and their skin becomes infected. Tx: prolonged antiseptic/antibiotic ointment. Systemic flucloxacillin if really bad. In children - look for foreign body.

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14
Q

Nose bleed(Epistaxis) - Causes

A
  1. Local trauma (nose picking),
  2. Nasal septal deviation
  3. Iatrogenic
  4. Inflammation
  5. Foreign body
  6. Environmental factors (cold dry air)
  7. Malignancy
  8. HTN
  9. Blood disorders
  10. Ataxia teleangiectasia
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15
Q

Young boy with nosebleed, think of:

A

Juvenile angiofibroma

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16
Q

What to do with severe nosebleeds?

A

Get IV access and cross type blood just for security in case of fluid resuscitation.

17
Q

Blood supply to nose.

A
  1. ICA -> ophtalmic artery -> anterior and posterior ethmoidal arteries. Supplies the anterior and posterior superior nasal cavity and septum.
  2. ECA -> Maxillary artery and facial artery.
18
Q

Posterior nose-bleeds

A

10% - main source: Branches of sphenopalatine artery (Woodruff’s plexus)

19
Q

Anterior nose-bleeds

A

90% - main source: Kiesselbachs plexus that supply Little’s area. Recieves branches from both ICA and ECA:

20
Q

Anterior nose bleed - Treatment

A
  1. Pinch cartilaginous part of nose (10-12min)
  2. Nitrate application sticks for cauterization
  3. Sponge hemostatic pack
  4. Really severe that dont respond to above mentioned: ANTERIOR PACKING - should be kept for 48h. Hospitalization depend on state of patient.
21
Q

Posterior nose bleed - Treatment

A
  1. Balloon catheter (NB-risk of necrosis)
  2. Posterior back + anterior
    - keep posterior one for 72h(anterior for 48h) - Replace always due to risk of infection/sepsis. Still bleed?
  3. Arterial ligation
  4. Embolization
  5. Endoscopic cauteriation(ESPAL)
22
Q

Samter’s triad/Aspirin triad

A

Bronchial asthma + polyps + aspirin sensitivity

23
Q

Tumors and cancers in nose- M:F ratio

A

M:F ratio = 2:1

24
Q

Tumors and cancers in nose - Types

A
  1. Osteomas (Gardner syndrome if multiple)
  2. Inverted papilloma (malignant potential)
  3. Juvenile angiofibroma(adolescent males)
  4. SCC (80-85% - usually present late)
  5. Melanoma
25
Q

Tumors and cancers in nose - Symptoms

A

Depends on location:

  • Blockage on 1 side of nose
  • Epistaxis (that still persist despite treatment -> if no longer than 2-3 weeks = order MRI)
  • Rhinorrhea
  • Prolonged sinusitis (esp unilateral)
  • Numbness
  • Swelling
  • Loose upper teeth/poor dental prosthesis fitting of the elderly indicate maxillary tumor
  • Severe headache + diplopia might indicate ethmoid air cell tumor
  • Loose red color vision might follow optic nerve spread.
  • Most of them are overlapping sites in origin
26
Q

Tumors and cancers - Spread

A

Spread will tell much about prognosis

  • Superior and posterior = BAD (Goes to CNS)
  • Inferior and anterior = BETTER
27
Q

Tumors and cancers - Treatment

A

Endoscopic surgery or lateral rhinotomy. If scull base is destroyed need help from neurosurgery.

28
Q

Tumors and cancers - Prognosis

A

5 year survival = 50-70% (depend on type and spread)

- Always do follow up if unilateral inverted papilloma (because of malignant potential)

ENT (4 decks)

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