Nose

Question 1

What is the management for epistaxis?

Answer 1

First aid:
- Sit forward with MOUTH OPEN (spit blood out from mouth)
- avoid lying down unless feeling faint
- Pinch the cartilaginous area of the nose - for at least 20 minutes

Second line: (if bleeding doesn’t stop after 10-15 mins)
- Cautery if bleeding is visible (silver nitrate stick)
- Packing if bleeding point can’t be visualised or cautery not suitable

Failed emergency management:
- Sphenopalantine ligation in theatre

Question 2

What is the cause of anterior epistaxis?

Answer 2

Anterior source of bleeding is most common
Bleeding from capillaries from Kiesselbach’s plexus

Question 3

What is the cause of posterior epistaxis?

Answer 3

Deeper structures like the sphenopalatine artery

Question 4

What are the main causes of epistaxis?

Answer 4

Benign
Nose picking/blowing
Trauma
Insertion of foreign bodies
Bleeding disorders: immune thrombocytopenia, waldenstroms macroglobulimaeia
Juvenile angiofibroma
Cocaine use
Hereditary haemorrhage telangiectasia
Granulomatosis with polyangiitis

Question 5

What are red flag symptoms for chronic rhino sinusitis?

Answer 5

UNILATERAL SYMPTOMS

Question 6

What is Samter’s triad?

Answer 6

Asthma
Aspirin sensitivity
Nasal polyposis

Question 7

When do nasal polyps always require further investigation?

Answer 7

Bleeding or UNILATERAL symptoms

Question 8

What is the management of nasal polyps

Answer 8

Referral to ENT for examination
Topical corticosteroids - shrink polyps in 80% of cases

Question 9

What is the management of chronic sinusitis?

Answer 9

Intranasal corticosteroids
Nasal irrigation with saline solution

Question 10

What is the signs of a nasal septal haematoma?

Answer 10

Bilateral Red swelling arising from the nasal septum
Boggy on probing
Occur after minor trauma
Pain and rhinorrhoea
Most common symptom - sensation of nasal obstruction

Question 11

What is the treatment for a nasal septal haematoma?

Answer 11

Surgical drainage
IV antibiotics

To prevent irreversible septal necrosis - saddle-nose deformity

Question 12

What are the most common causes of acute sinusitis?

Answer 12

Streptococcus pneumoniae
Haemophilus influenza
Rhinoviruses

Question 13

Wha are the signs of acute sinusitis?

Answer 13

Facial pain - worse when leaning forward
Nasal discharge - thick and purulent
Nasal obstruction

Question 14

What is the management of acute sinusitis?

Answer 14

If symptoms last <10 days:
Analgesia
Intranasal decongestants or nasal saline

If symptoms last >10 days:
- Intranasal corticosteroids

If very unwell: very rare
Phenoxymethylpenicillin
Co-amoxiclav if systemically unwell

Question 15

How long must sinusitis be present to be chronic rhino sinusitis?

Answer 15

At least 12 weeks

Question 16

What are the signs of chronic rhino sinusitis?

Answer 16

Facial pain - worse when leaning forward
Nasal discharge - usually clear, thicker and more purulent if secondary infection
Nasal obstruction - mouth breathing
Post nasal drip + chronic cough

Question 17

What is the treatment for chronic rhino sinusitis?

Answer 17

Avoid allergen
Intranasal corticosteroids
Nasal irrigation with saline solution

Question 18

What are the red flag symptoms of chronic rhino sinusitis?

Answer 18

Unilateral symptoms
Persistent symptoms despite 3 months of treatment
Epistaxis