Nose

Question 1

What can cause septal deformity?

Answer 1

• Congenital
• Trauma
• Inflammatory conditions (Granulomatosis polyangiitis arteritis, Sarcoidosis)
• Infective

Question 2

What are the symptoms of rhinosinusitis?

Answer 2

• Nasal blockage/congestion/obstruction
• Facial pain/pressure
• Anosmia or hyposmia
• Nasal polyps
• Mucopurulent discharge

Question 3

What might you find on examination in a patient with rhinosinusitis?

Answer 3

• Purulent discharge
• Mucosal oedema
• Tenderness over sinuses
• Fever

Question 4

What is acute rhinosinusitis?

Answer 4

<12 weeks with complete resolution of symptoms

Question 5

What is the management of acute rhinosinusitis?

Answer 5

• Advise that it is normally a viral infection and should resolve within 2-3 weeks
• Symptoms >10 days indicates bacterial cause
o High dose nasal corticosteroid 14 days for adults

Question 6

What is chronic rhinosinusitis?

Answer 6

=>12 weeks without complete resolution of symptoms

Question 7

What is the management of chronic rhinosinusitis?

Answer 7

• Topical nasal steroid
• Antihistamine
• Saline nasal irrigation

Advice:
o	Avoid allergic triggers
o	Stop smoking
o	Practice good dental hygiene
o	Avoid underwater diving

Question 8

What is rhinitis medicamentosa?

Answer 8

rebound congestion

long-term use of decongestants can cause this

Question 9

What are the symptoms of polyps?

Answer 9

• Bilateral nasal obstruction – difficulty breathing through nose
• Chronic rhinosinusitis
• Snoring
• Nasal discharge
• Anosmia

Question 10

What are polyps associated with?

Answer 10

• Chronic rhinitis/sinusitis
• Asthma
• Samter’s triad (Nasal polyps, Asthma, Aspirin allergy)
• CF
• Eosinophilic granulomatosis with polyangiitis

Question 11

What would you find on nasal endoscopy with nasal polyps?

Answer 11

Grey/yellow growths on mucosal wall

Question 12

What is the management for nasal polyps?

Answer 12

• Intranasal topical steroid
• Short course of prednisolone
• Surgical management when medical fails

Question 13

What are the first aid measures for epistaxis?

Answer 13

• Sit with upper body tilted forward and mouth open
• Avoid lying down, unless feeling faint
• Pinch cartilage and hold firmly for 10-15 minutes without releasing pressure
• Breathe through mouth

Question 14

What is the management for epistaxis if bleeding stops with first aid?

Answer 14

• Silver nitrate cautery to area

* Naseptin ointment

Question 15

What do you have to ask patients before prescribing naseptin?

Answer 15

Peanut allergy

Question 16

What epistaxis advice do you give after cautery?

Answer 16

o Do not blow or pick your nose for 1 week
o Avoid hot baths and showers
o Let food cool down
o Do not drink hot drinks for first 72hrs
o No strenuous exercise for 1 week

Question 17

When do you suspect a posterior bleed?

Answer 17

• Profuse bleeding
• Both nostrils
• Bleeding site cannot be identified upon speculum examination
• Bleeding first started down throat

Question 18

What are the steps to manage heavy epistaxis?

Answer 18

• ABC
• Anterior rhinoscopy
• Bloods (FBC, Coagulation profile, G&S)
• Anterior packs
• Posterior packs