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Yr4 - Neuro + SS > Nose > Flashcards

Nose Flashcards

1
Q

Define epistaxis

A

Bleeding from the nose

- most causes insignificant but small proportion can result in massive haemorrhage and shock

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2
Q

Causes of epistaxis

A 
Local
- idiopathic
- traumatic - nose-picking
- iatrogenic
- foreign body
- inflammatory - rhinitis, polyps
- neoplastic
Systemic
- hypertension
- coagulopathies
- vasculopathies
- hereditary haemorrhagic telangiectasia
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3
Q

Mx of epistaxis

A 
A-E assessment
- bleeding into oropharynx can compromise breathing
- massive bleed can cause hypotension
First aid
- pinch soft part of nose
- lean head forward
- spit out blood of mouth
Cautery
- silver nitrate or bipolar diathermy
- topical adrenaline to control bleeding before cautery
- anterior = anterior rhinoscopy
- posterior = rigid endoscopy
Nasal packing if cautery fails
Surgical ligation or radiological embolisation of vessels
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4
Q

Define nasal trauma

A

Fracture of nasal bones complicated by

  • septal haematoma
  • CSF leak with associated basal skull fracture
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5
Q

Mx of nasal trauma

A

A-E assessment
Examine for septal haematoma
No x-ray required
If nose deviated consider manipulation under anaesthetic within 2 weeks
- nerve block of external nasal branch of anterior ethmoid nerve, infraorbital nerve and nasopalatine nerves

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6
Q

Define acute rhinosinusitis

A

Inflammation of mucosal lining of the nose and paranasal sinuses
- lasting less than 4 weeks

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7
Q

Types of rhinosinusitis

A

Viral - most common
- symptoms last less than 10 days
Bacterial
- often secondary to viral sinusitis
- commonly strep pneumoniae, haemophilus influenzea, morexella catarhalis
- symptoms longer than 10 days but less than 4 weeks

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8
Q

Epidemiology of rhinosinusitis

A

Affects 16% of adult population each year

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9
Q

Pathophysiology of rhinosinusitis

A

Colonisation of nasal mucosa by viruses causes increased oedema and mucus production
Sinuses become obstructed, blocking normal ventilation and drainage
Decreased clearance, stasis of secretion occurs
Secondary bacterial infection

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10
Q

Presentation of rhinosinusitis

A

Purulent nasal discharge
Nasal obstruction - swollen septal or turbinate mucosa on examination
Facial pain/pressure - worse on leaning forward
Cough, myalgia and hyposmia

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11
Q

Ix for rhinosinusitis

A

Clinical diagnosis
Nasal endoscopy - signs of polyps, mucopurulent discharge, oedema in middle meatus
Sinus culture
CT sinuses (non-contrast) - mucosal changes within osteomeatal complex or sinuses

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12
Q

Mx of rhinosinusitis

A

Supportive therapy - oral fluids, simple analgesia
Oxymetazoline nasal or pseudoephedrine - decongestant
Mometasone nasal - steroids if congestion persists longer than 5 days
Amoxicillin if bacterial

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13
Q

Define chronic sinusitis

A

Inflammation of paranasal sinuses lasting > 12 weeks

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14
Q

Types of chronic sinusitis

A

Without polyps
With polyps
- abnormal mass arising in nose due to chronic inflammation
- normally bilateral
- unilateral polyps require biopsy for histological diagnosis

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15
Q

Epidemiology of chronic sinusitis

A

25 cases per 100,000 per year in UK

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16
Q

Risk factors for chronic sinusitis

A 
Allergy/atopy
Ciliary dysfunction
- cystic fibrosis
- primary ciliary dyskinesia
Airway hyperactivity/asthma
Previous sinus surgery
Immunodeficiency
Anatomical abnormalities
- mid-septal deviations
- concha bullosa deformity
- paradoxically bent middle turbinates
- craniofacial abnormalities
Foreign bodies
Smoking or other environmental irritants
17
Q

Pathophysiology of chronic sinusitis

A

Osteomeatal complex obstruction due to local inflammation within the channels
Sinus outflow tract obstruction
Impaired mucus clearance by respiratory cilia
Bacterial growth - staph aureus, haemophilus influenzae, group A strep

18
Q

Presentation of chronic sinusitis

A

Nasal obstruction - swollen septal/turbinate mucosa
Facial pain/pressure - worse on leaning forwards
Nasal discharge/post nasal drip
Headache, fatigue, cough

19
Q

Ix for chronic sinusitis

A

Anterior rhinoscopy
- intranasal purulence, posterior oropharyngeal purulence, polyps, structural abnormalities
Nasal endoscopy
CT sinuses - if surgery planned

20
Q

Mx of chronic sinusitis

A

Supportive therapy
- avoid allergens
- simple analgesia
- nasal saline irrigation
Oral abx - amoxicillin
Intranasal corticosteroids - mometasone nasal
Antihistamines if allergic rhinitis present
Consider endoscopic sinus surgery if no improvement

21
Q

Define allergic rhinitis

A

IgE mediated type 1 hypersensitivity reaction in mucus membranes of nasal airways

22
Q

Pathophysiology of allergic rhinitis

A

Allergic reaction leads to synthesis and release of prostaglandins, leukotrienes and histamine
Capillary permeability increases
Leads to oedema, rhinorrhoea, congestion, sneezing and irritation

23
Q

Epidemiology of allergic rhinitis

A 
30% of Western population
Strong association with asthma
Can be seasonal or perennial
Commonest allergens
- pollen
- mould
- dust mites
- animal epithelia
24
Q

Classification of allergic rhinitis

A

Duration
- intermittent = symptoms < 4 days a week lasting < 4 weeks
- persistent = symptoms > 4 days a week lasting > 4 weeks
Severity of symptoms
- mild = normal daily activities and sleep not interupted
- moderate to severe = impairment of daily activities and sleep, troublesome symptoms

25
Q

Ix for allergic rhinitis

A

Skin prick test for specific allergens

RAST (radioallergosorbent test) - blood test using radioimmunoassay to detect specific IgE antibodies

26
Q

Mx of allergic rhinitis

A

Allergen avoidance
Antihistamines
Topical nasal steroids
Immunotherapy

27
Q

Define orbital cellulitis

A

Site-threatening emergency
Infection/inflammation within orbital cavity
Often results from direct spread of pus from ethmoid sinus or from thromboephlebitis of mucosal vessels

28
Q

Presentation of orbital cellulitis

A

Pain followed by oedema of eyelid and orbital collection
Eye becomes proptosed and eye movements reduced
Risk of blindness as result of tension and septic necrosis of optic nerve
Colour blindness early sign

29
Q

Ix for orbital cellulitis

A

CT scan - confirm collection and extent of disease

30
Q

Mx of orbital cellulitis

A

IV abx
Nasal decongestants
Urgent surgical drainage of any abscess

31
Q

Causes of non-allergic rhinitis

A 
Infection
Environmental triggers
- smoke
- perfume
- paint fumes
- changes in weather
- alcohol
- spicy foods
- stress
Medicines and recreational drugs
- ACEi
- beta-blockers
- NSAIDs
- snorting cocaine
Overuse of nasal decongestants
Hormone imbalance
Nasal tissue damage

Yr4 - Neuro + SS (9 decks)

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