Nose

Question 1

Nasal Cavity: type of mucosa, and bones

Answer 1

nasal septum divides the nasal cavity (has anterior cartilage portion and posterior bony portion (perpendicular plate of the ethmoid bone, vomer, nasal conchae)

Question 2

Nasal Turbinates: function and location

Answer 2

• aka Conchae
• Function: increase turbulence of airflow, warms the air
• bony projections covered in mucosa
• normal: pink and moist
• abnormal: “boggy” (swollen), pale, bluish-grey, erythema

Question 3

Location of Nosebleeds and Structures Involved

Answer 3

• Anterior: Kiesselbach’s plexus (4 arteries anastomose here)
• Posterior: Woodruff plexus (sphenopalatine artery)

Question 4

Pathway of Olfactory Sensation

Answer 4

• chemical enters nasal mucosa and dissolve
• they are then detected by the olfactory epithelium which transmits info through the olfactory nerve (CNI) to the olfactory bulb of the CNS

Question 5

Olfactory Receptor Cells

Answer 5

• stretch down into nasal cavity
• very sensitive (at least 50 “primary smells” are recognized”
• **best known example of neuron replacement in adults**

Question 6

Location of Paranasal Sinuses

Answer 6

• Frontal Sinus (2)
• Ethmoid Sinus
• Sphenoid Sinus (2)
• Maxillary Sinus (2)

Question 7

Nasal Cavity Cranial Nerves

Answer 7

• CN I: olfactory sensation from olfactory epithelium
• CNV₁: (olfactory branch) somatic sensation of skin of nose, nasal mucosa, and paranasal sinuses
• CN V₂: (maxillary branch) somatic sensation of the nasal mucosa and maxillary sinuses

Question 8

Acute vs Subacute vs. Chronic (Rhino)sinusitis

Answer 8

• acute = < 4 weeks
• subacute = >4 weeks but < 3 months
• chronic = >3months (12 weeks)

Question 9

Chronic Bacterial Rhinosinusitis

Answer 9

• lasts longer than 12 weeks/3 months ***
• common bacteria: pseudomonas, klebsiella pneumonia, enterobacter spp. e.coli, and S. aureus
• 4 cardinal signs:
  
  1. mucopurulent drainage of the anterior or posterior portion of the nose
  2. nasal obstruction/ congestion/blockage
  3. facial/sinus pain, pressure, or fullness
  4. loss of sense of smell or reduced sense of smell (anosmia or hyposmia )
• tx: single agent: Augmentin
  
  • double agent:
    
    • metronidazole plus cefdinir or bactrim

1. CRS with nasal polyposis (with nasal polyps)
2. Allergic fungal rhinosinusitis (more common in DM patients)
3. CRS without nasal polyposis (without nasal polyps)

Question 10

What medication is contraindicated in an asthmatic patient with nasal polyps?

Answer 10

ASA - aspirin