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Y2 ENT > Nose > Flashcards

Nose Flashcards

1
Q

What is allergic rhinitis

A

IgE mediated allergic reaction

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2
Q

Which type of hypersensitivity is allergic rhinitis part of

A

Type 1 immediate hypersentivity- since it is IgE mediated

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3
Q

What is considered as intermittent allergic rhinitis

A

Symptoms <4 days per week or symptoms <4 weeks

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4
Q

What is considered as persistent allergic rhinitis

A

Symptoms >4 days per week AND symptoms >4 weeks

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5
Q

Common triggers for intermittent allergic rhinitis

A

Grass pollen
Tree pollen
Fungal spores

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6
Q

common triggers for persistent allergic rhinitis

A

House dust mite
Cats
Dogs

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7
Q

Allergic rhinitis is often associated with

A

Allergic conjunctivitis

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8
Q

An atopic patient with allergic rhinitis is likely to

A

Also have atopic eczema / asthma / allergic conjunctivitis

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9
Q

Symptoms of allergic conjunctivitis

A

red eyes
puffy eyes
watery discharge

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10
Q

Symptoms of allergic rhinitis

A

Sneeze
Nasal itching
Nasal discharge
Nasal congestion
Allergic crease

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11
Q

What is allergic crease

A

hyper pigmented skin line on nose caused by constantly rubbing the nose in an upwards motion = indicates repeated itching of nose

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12
Q

Investigations for allergic rhinitis

A

Clinical - symptoms may show seasonal variation
IgE level, skin prick test if in doubt

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13
Q

Management for mild allergic rhinitis

A

Avoid allergen
Nasal irrigation
Oral / intra-nasal anti-histamines
Intranasal chromone if antihistamine is contraindicated

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14
Q

Management for moderate-severe allergic rhinitis

A

Intranasal steroids
Intranasal steroids + oral antihistamines if symptoms persist
Short course oral steroids if severe, uncontrolled symptoms significantly affecting quality of life

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15
Q

Example of intranasal antihistamine used for allergic rhinitis

A

Azelastine

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16
Q

Example of oral anti-histamines

A

Loratadine
Cetirizine

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17
Q

What is used for a patient with allergic rhinitis if topical antihistamine is contraindicated

A

Intranasal chromone - sodium cromoglicate

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18
Q

Example of intranasal steroids

A

Mometasone furoate
Fluticasone furoate
Beclometasone

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19
Q

What is non-allergic rhinitis

A

inflammation of the inside of the nose that is not caused by an allergy

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20
Q

Causes of non-allergic rhinitis

A

Infections - viral
Vasomotor rhinitis
Occupational rhinitis
Hormonal rhinitis
Drug-induced

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21
Q

What is vasomotor rhinitis

A

Non-allergic rhinitis due to parasympathetic overdrive (autonomic dysfunction)

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22
Q

Triggers of vasomotor rhinitis

A

Chemical irritants
Changes in weather
Excess humidity
Very dry atmosphere
Stress

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23
Q

What is occupational rhinitis

A

Non-allergic rhinitis symptoms only occur in workplace due to inhaled irritants such as latex, wood dust

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24
Q

What drugs can cause drug induced rhinitis

A

ACEi
Beta blockers
NSAID
Cocaine

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25
Q

Symptoms of non-allergic rhinitis

A

Runny nose, clear discharge
Sneezing
Itchy nose
Nasal congestion

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26
Q

Management of non-allergic rhinitis

A

Supportive for viral cause
Avoid triggers
Consider anticholinergics for vasomotor rhinitis

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27
Q

Complications of non-allergic rhinitis

A

Sinusitis
Nasal polyps

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28
Q

What is acute sinusitis

A

Inflammation of paranasal sinuses with symptoms lasting less than 12 weeks

29
Q

Acute sinusitis can be preceded by

A

Rhinitis
Viral URTI
Dentition

30
Q

Acute sinusitis is most commonly preceded by

A

Rhinitis

31
Q

Causative pathogens of acute sinusitis

A

Strep pneumoniae
H influenza
Moraxella catarrhalis

32
Q

Symptoms of acute sinusitis

A

Nasal blockage / discharge + facial pain/pressure
Pain worse when bending / leaning forward
Reduction of smell

33
Q

Investigations for acute sinusitis

A

Clinical

34
Q

Management for acute sinusitis

A

Analgesics
Nasal decongestants
Saline irrigation
High dose intranasal steroids if symptoms > 10 days
Antibiotics if severe

35
Q

What antibiotics are used for severe acute sinusitis

A
  1. Phenoxymethylpenicillin
  2. Doxycyline
36
Q

Contraindication of doxycycline

A

Children under 8 years old because it can cause discoloured teeth, photosensitivity

37
Q

Complications of acute sinusitis

A

Orbital cellulitis
Periosteal abscess - Pott’s puffy tumour
Thrombosis of cavernous sinus
Thrombosis of superior sagittal sinus
Osteomyelitis

38
Q

What is chronic sinusitis

A

Painless sinusitis causing bilateral nasal obstruction due to mucosal hypertrophy with purulent discharge

39
Q

Management of chronic sinusitis

A

intranasal corticosteroids
nasal irrigation with saline solution

40
Q

What may suggest that this condition isn’t sinusitis

A

If nasal blockage is unilateral

41
Q

What are nasal polyps

A

Painless, non-cancerous growths on the lining of nasal or sinus passages

42
Q

Are nasal polyps common in children

A

No

43
Q

Causes of nasal polyps

A

Non-allergic rhinitis
Allergy
infection
Aspirin sensitivity
Nickel exposure
Cystic fibrosis

44
Q

Symptoms of nasal polyps

A

Nasal obstruction
Runny nose
Reduced sense of taste or smell

45
Q

Investigations for nasal polyps

A

Nasoendoscopy

46
Q

Management of nasal polyps

A

Topical steroids
Routine ENT referral

47
Q

ENT symptoms of granulomatosis with polyangiitis

A

Sinusitis
Epistaxis
Mouth ulcers
Sensorineural hearing loss
Saddle nose deformity
Otitis media

48
Q

Management of GPA

A

If early - methotrexate + steroids
If late - IV cyclophosphamide + steroids

49
Q

What are the benign lesions of the nose

A

Squamous cell papillomas
Sinonasal papillomas
Recurrent respiratory papillomatosis

50
Q

Which benign lesion is the most common

A

Squamous cell papilloma

51
Q

Sinonasal papillomas tend to occur in patients who are

A

Over 50
Male

52
Q

Subtypes of sinonasal papillomas

A

Inverted
Exophytic
Oncocytic

53
Q

Where are inverted sinonasal papillomas located at

A

Lateral walls / paranasal sinuses

54
Q

Where are exophytic sinonasal papillomas located at

A

Lateral walls / paranasal sinuses

55
Q

Where are oncocytic sinonasal papillomas located at

A

Nasal septum

56
Q

What is recurrent respiratory papillomatosis

A

Papillomas occurring at aerodigestive tract

57
Q

What does the aerodigestive tract consist of

A

Airway (nasal cavity -> lungs)
Oesophagus

58
Q

Recurrent respiratory papillomatosis is associated with

A

HPV

59
Q

Recurrent respiratory papillomatosis usually presents in

A

Children, causing hoarse voice and progressive SOB

60
Q

What are the malignant lesions in the nose

A

Squamous cell carcinoma
Nasopharyngeal carcinoma
Primary adenocarcinoma
Neuroblastoma
Lymphoma

61
Q

Which type of malignant lesion of the nose is the most common

A

Squamous cell carcinoma

62
Q

Risk factors of nasopharyngeal carcinoma

A

Males
Far east descent
EBV
HPV
Volatile nitrosamines in food
Smoking, alcohol
Family history

63
Q

Examples of food that has volatile nitrosamines

A

Cured meat
Beer
Processed fish

64
Q

How aggressive is nasopharyngeal carcinoma

A

Highly aggressive - extensive local spread and early metastasis

65
Q

What is subglottic stenosis

A

Narrowing of the airway below the vocal cords and above the trachea

66
Q

Cause of subglottic stenosis

A

Idiopathic
May be associated with vasculitis in adults

67
Q

Symptoms of subglottic stenosis

A

Progressive breathing difficulty
Breathing difficulty exacerbated by exertion

68
Q

Management of subglottic stenosis

A

Division of stenosis
Resection and reconstruction if severe

Y2 ENT (7 decks)

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