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ENT Sure Success > Nose > Flashcards

Nose Flashcards

1
Q

Shape of nose is ……., divided into 2 parts by …..

A

Pyramidal in shape
Nasal septum

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2
Q

Define the nasal septum

A

Perpendicular plate of :

Ethmoid: above and behind
Vomer: below and behind
Quadrilateral or septal cartilage- anteroinferior.

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3
Q

Structures in the lateral wall of nose
What is concha?

A

3 turbinates and 3 meatus in between

Bony part of nasal septum
Concha + mucosa + submucosa = turbinate

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4
Q

…….turbinate is a separate bone.
……&…….turbinates are part of ethmoid
………..turbinate is present above superior t

A

Inferior
Middle and superior
Supreme turbinate

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5
Q

Structures that the meatus receives from: (4)

A
  1. Inferior meatus: from nasolacrimal duct
  2. Middle meatus:
    a. Frontal sinus
    b. Ant & middle ethmoid sinus
    c. Maxillary sinus
    —these together form osteomeatal complex or Picadle’s circle.
  3. Superior meatus: Receives posterior ethmoid sinus.
  4. Sphenoethmoidal sinus: receives sphenoid sinus.
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6
Q

Surgical opening for dacrocystitis:

Sphenoidal sinus lies in body of :……
Importance of sphenoid sinus

A

Middle meatus

Sphenoid bone

Has a depreession called sella turcica. Pituitary gland is on sella turcica.

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7
Q

Best surgical approach for pituitary adenoma

A

Transphenoidal endoscopic transnasal hypopysectomy.

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8
Q

What is Hasner’s valve?

A

Hasner’s valve: mucosal flap in distal end of nasolacrimal duct.

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9
Q

Importance of picadeli’s circle.

A

Area in middle meatus where sinus ostia open. Important site of pathogenesis in sinusitis.

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10
Q

Mc long term complication of nasal surgery:
Prevention is by …..

A

Adhesion formation.

Mitomycin C

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11
Q

Define concha bullosa

What is the dangerous area of face?

A

Pneumatization of middle turbinate

Area around nose,upper lip and vestibule.
Infection from here, drain into cavernous sinus via anterior facial and angular veins.

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12
Q

Intersection of frontal and nasal bones in the human skull is called….

Order of development of sinuses:

A

Nasion

Mastoid> ethmoid> sphenoid> frontal

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13
Q
  1. First sinus to appear is….
  2. Last sinus to appear is …..
  3. Sinus +ve at birth is ……
A
  1. Maxillary sinus
  2. Frontal
  3. Maxillary and ethmoid
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14
Q
  1. Most developed sinus at birth is ….
  2. Sinus that develops at 4 yrs age is ….
  3. Sinus that appears at 6 yrs age is …
A
  1. Ethmoid
  2. Sphenoid sinus
  3. Frontal sinus
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15
Q

Largest paranasal sinus is ….. Adult capacity is …..

A

Maxillary sinus aka Antrum of Highmore
15cc

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16
Q

Types of ethmoid air cells

Biggest anterior ethmoid hair cell is ….

A

Anterior: 2-8 nos
Posterior: 1-8

Bulla ethmoidalis

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17
Q

Anterior most hair cell is ……

Unusual locations of ethmoid air cells (3)

A

Aggarnasi

  1. Orbital floor: Haller cell
  2. Optic nerve: Onodi cells
  3. Inside middle turbinate: concha bullosa
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18
Q

……..can get obstructed in frontal sinus damage

……can be a source of persistent mucopurulent secretion

……should be identified to avoid optic nerve injury during FESS

A

Aggarnasi

Haller cell

Onodi cells in posterior ethmoidal air cells

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19
Q

Define choana

Features of choanal atresia

A

Posterior opening of nasal cavity

Neonatal emergency:
cyanosed at birth, turns pink on crying.
Secondary to deep inspiration with open mouth.

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20
Q

Dx of choanal atresia is by…(3)

A
  1. Presence of mucoid discharge in nose
  2. Absence of air bubbles in nasal discharge
  3. Inability to pass NG tube into the nose of newborn.
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21
Q

……is more common in choanal atresia.

Define CHARGE syndrome

A

Bony atresia

Coloboma
Heart defect
Atresia choana
Retarded growth
Genital abnormalities
Ear abnormalities

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22
Q

Rx for choanal atresia

A

Immediate mgt- mc grower technique- wide bore nipple into the mouth of neonate—> tracheostomy + recanalization after 1 year. - mitomycin C is given to prevent fibrosis

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23
Q

Most common organism for acute sinusitis

Sinuses involved in acute sinusitis

A

Strept pneumonia

Maxillary> frontal> ethmoid> sphenoid

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24
Q

Office headache and periodicity seen in….

…….sinusitis is common in children. …….is the complication.

A

Frontal sinusitis

Ethmoidal sinusitis
Orbital cellulitis

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25
Q

Post nasal drip is seen in ….sinusitis (2)

A
  1. Maxillary
  2. Sphenoid sinusitis
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26
Q

Trans illumination test used for ….

Complication of acute sinusitis. Sms

A

Acute sinusitis

Potts puffy Tumor:
Complication of acute frontal sinusitis
Mucosa of frontal sinus—> frontal bone—> osteomyelitis—> subperiosteal frontal abscess.

Sms: painful red forehead and swelling

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27
Q

Acute rhinosinusitis is ……duration.
Chronic rhinosinusitis is ……duration

A

<4weeks

> 12 weeks

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28
Q
  1. Mc xray for sinuses:
  2. Best X-ray for sinus :
  3. Waters view is ……view
A
  1. Waters view
  2. Waters view
  3. Occipitomental view
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29
Q
  1. Pierre’s view is …..
  2. Waters view shows …..sinus
  3. Waters view shows all sinus except …
A
  1. Waters view can be done with open mouth
  2. Maxillary sinus
  3. Posterior ethmoidal
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30
Q

What is caldwell view?

Xray for sphenoid sinus is ….

A

Occipitofrontal view.
Best for frontal and ethmoidal sinus.

Xray skull lateral view

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31
Q

What are the ethmoidal air cells?

A

Single bone in the body between 2 orbits.
Contains many air cells.

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32
Q

Allergic fungal rhinosinusitis is ….hypersensitivity

2 findings of allergic fungal rhinosinusitis

A

Type 1

  1. Allergic nasal mucin
    Thick peanut butter fungal hyphae. Charcot Leyden crystals.
  2. Nasal polyps
    Fungal debris present.
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33
Q

Ct scan for allergic fungal rhinosinusitis

Investigation for mucormycosis (4)

A

Double density nasal polyp

  1. Nasal endoscopy
  2. KOH smear
  3. Fungal culture
  4. Radiology
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34
Q

What are the major and minor criteria for allergic rhinosinusitis ?

A

Bent and Kuhn criteria
Major :
1. Type 1 HS ( by skin test/IgE)
2. Nasal prognosis
3. Ct: double density nasal polyp
4. Eosinophilic mucus that doesn’t invade sinus tissue

  1. Positive fungal stain

Minor criteria:
1. Bone erosion
2. Charcot Leyden crystals
3. U/L disease
4. Peripheral eosinophilia
5. + fungal culture

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35
Q

Young patient with roomy nasal cavities and nasal crusting has …..

Young patient with roomy nasal cavities and nasal crusting + hard woody nose is…

A

Atrophic rhinitis

Rhinoscleroma

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36
Q

Atrophic rhinitis is caused by ……organism

Rhinoscleroma caused by ……..

A

K.ozonae

K. rhinoscleromatosis

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37
Q

Nutrition deficiencies that can cause Atrophic rhinitis

Which race is more affected ?

Endocrine feature of Atrophic rhinitis

A

Vit A,D,E, iron

Yellow and white race

Starts at puberty and stops at menopause

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38
Q

Most characteristic symptom of Atrophic rhinitis is ….

Extensive crusting and fetor is known as…

Mc seen in …..

A

Foul odor- detected by others but not patient- merciful anosmia

Ozaena

Females,puberty,B/L condition

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39
Q

Medical rx for Atrophic rhinitis (6)

A

1 . alkaline nasal douches
2. 25% glucose in glycerine
3. Estradiol nasal spray
4. Human placental extract
5. Potassium iodide
6. Oral streptomycin-for klebsiella

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40
Q

Surgical Rx for Atrophic rhinitis :

A

Young’s operation: closure of anterior nares
Modified young’s: partial closure of ant nares

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41
Q

What is Lautenschlager’s operation?

What is Wilson’s operation?

A

Medialization of lateral nares, by submucus injection of paraffin.

Submucus injection of 50% teflon in glycerin paste.

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42
Q

Nasal perforation:
Bony part seen with ….
Cartilaginous part seen with …..(2)

Apple jelly nodules seen on diascopy s/o…

A
  1. Nasal syphillis
  2. Leprosy, SLE

Lupus vulgaris-TB

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43
Q

Etiology of rhinosporidiosis

Caused by …..organism

Lesion is …..like

A

Trauma, dust from dung/infected cattle
Contaminated water/pools

Rhinosporidium see beri

Strawberry like

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44
Q

Rx for rhinosporidiosis

Rhinoscleroma seen in ….region

A

Surgery - complete excision of mass
Dapsone

North India

45
Q

Pathological feature of rhinoscleroma (2)

Tapir nose seen with ….d/s

A

Mikulicz cells- large foam cells
Russell bodies- blue cells

Rhinoscleroma

46
Q

Antrochoanal polyps are due to ….
But ethmoidal polyps due to …

A

Infections

Allergies,vasomotor symptoms associated with asthma

47
Q

Antrochoanal polyps are ….. while ethmoidal are …..macroscopically

Antrochoanal polyps arise from ….while ethmoidal arise from …..

A

Solitary tumors
Multiple grape like

Maxillary sinus
Ethmoidal sinus

48
Q

Antrochoanal polps are ….(U/L or B/L)
Ethmoidal polyps are ….

Recurrence is …..in Antrochoanal while ….in ethmoidal

A

U/L
B/L

Uncommon
Common

49
Q

Rx of choice for Antrochoanal polyp
Rx of choice for ethmoidal polyp

A
  1. FESS-rx of choice
    Sometimes Caldwell-Luc
  2. Medical: intranasal CS spray
50
Q

Mc cause of CSF rhinorrhoea, mc site of leak….

2md mc cause of CSF rhinoorhoea

Spontaneous CSF rhinorrhoea seen in …

A

Accidental head injury
Cribriform plate

Iatrogenic

Idiopathic intracranial HTN.

51
Q

Mc site of CSF leak in trauma is …

C/f of CSF rhinorrhoea

A

Fovea ethmoidalis - roof of ethmoid bone

Clear watery fluid sweet in taste that can’t be sniffed back.

52
Q

Signs seen with CSF rhinorrhoea

A
  1. Handkerchief test:
    No stiffening of hanky with CSF.( nasal discharge stiffens).
  2. Reservoir test:
    Immediately rising from bed,ask patient to keep his chin over chest for a min-> CSF rhinorrhoea
  3. Double ring/target sign/ halo sign:
    Traumatic leaks- CSF blood in centre, CSF gravitates to periphery
  4. Paradoxical rhinorrhoea: midline structures that act as separating barriers are dislocated- crista galli, vomer
53
Q

Confirmatory test for CSF rhinorrhoea

Gold standard for localizing site of leak.

Imaging modality of choice

A

Beta 2 transferrin

CT cisternography

High resolution CT

54
Q

Rx for CSF rhinorrhoea

A
  1. Bed rest with semi sitting position- avoid coughing, sneezing, nose blowing
  2. Persistent cases: nasal endoscopic approach
55
Q

Mc cause of epistaxis in children
In adults

A

Nose picking
HTN

56
Q

Blood supply of nose

A

Internal C A : Ant ethmoid Post ethmoid

———middle turbinate ——-

ECA: Sphenopalatine
Greater palatine
Superior labial

57
Q

Mc artery of epistaxis

Mc area of epistaxis

A

Sphenopalatine artery

Little’s area-keisselbach’s plexus
Has 4 arteries: LEGS
Superior labial
Ant Ethmoidal
Greater palatine
Sphenopalatine

58
Q

Only branch of opthalmic artery in keisellback’s plexus is …

Mc site of bleeding
For children
For young people

A

Anterior ethmoidal artery

Children: Little’s area
Young people: retrocolumellar vein

59
Q

Difference between anterior and posterior epistaxis

A

Anterior:
1. Blood comes out of the nose
2. Mc
3. Mc cause: trauma
4. Bleeding site : Little’s area
5. Easy to identify
6. Mild bleeding
7. Rx: anterior nasal pack in OPD

Posterior epistaxis:
1. Blood flows back into pharynx and swallowed
2. Less common
3. Mc due to HTN/arteriosclerosis
4. Site of bleed: posteriosuperior
5. Difficult to identify bleeding point
6. Profuse bleeding
7. Rx: posterior nasal pack under GA

60
Q

Trotters method is ….

Posterior nasal packing in OT is done using …(3)

A

Ask patient to sit calmly placing head over the sink and spit any blood and breathe quietly from mouth.

Gauze
Foley’s Catheter
Nasal balloon

61
Q

Arterial ligation is in order: descending (4)

A

Sphenopalatine
Internal maxillary
External carotid
Anterior / posterior ethmoid artery

62
Q

Rx for refractory epistaxis

A

ESPAL: endoscopic Sphenopalatine artery ligation

63
Q

Septal Hematoma is due to …..
Sms
Rx
Complications

A

Trauma

Smooth round swelling

Immediate drainage and closure with septal buttons.

Else complications like : septal abscess- fever, pain, tenderness on bridge of nose

64
Q

Wegners granulomatosis causes perforation of ……

Sms (3)

A

Both cartilage and bony part

Epistaxis, sms of sinusitis, hemoptysis

65
Q

2 conditions caused by trauma to nose

A
  1. Deformity- nasal bone fracture
  2. B/L nasal block- septal Hematoma
66
Q

What is sluders neuralgia?

A

High deviated nasal septum pressing middle turbinate
Also known as anterior ethmoidal nerve syndrome

67
Q

Cottle’s test is done for …..

Procedure

A

Deviated nasal septum

Confirm narrowing in neck valve area, ask the patient to pull the cheek outwards, and this should decrease the block.

68
Q

Rx for DNS

What is crooked nose?

A

Septoplasty- conservative septal surgery

Deviation of cartilaginous dorsum, bony dorsum and tip on either side —> C or S shaped deformity.

69
Q

Classes of fracture nose (3)

A

1: Nasal fracture but septum not involved
2: Involves nasal septum
3: Nasooribitoethmoidal fracture with CSF leaks

70
Q

Blow from below nose causes …..fracture
Blow from front of nose causes ….#

A
  1. Chevallet
  2. Jarjavay
71
Q

Rx for nasal trauma

A
  1. No swelling- immediate closed reduction - walsham forceps
  2. Swelling- wait 7 days let edema subside then closed reduction.
72
Q

Walsham forceps used for ….
Asch’s septum forceps used for ….

A

Reducing nasal bone fracture
Reducing nasal septal fracture

73
Q

Fractures of maxilla/face

A

Le fort 1: transverse maxilla
Lefort2: pyramidal, over the nose
Damages infraorbital n
Lefort 3: through the orbit-> cranial facial dysfunction

74
Q

Mc fracture of body is …..
Second mx is ….
Third mx is …..

A
  1. Clavicle
  2. Wrist
  3. Nose
75
Q

Mc site of mandibular fracture is ….
When bone breaks at 3 places it’s called …

Tear drop sign on Ct is ….

A

Subcondylar region - dingman classification is used

Zygomatic fracture-tripod fracture

Blow out orbital fracture

76
Q

Mc cause of oroantral fistula

Inverted papilloma is also known as ….(3)

A

Extraction of upper first molar

Transitional cell papilloma/ schmeiderian papilloma/ ringertz Tumor

77
Q

Mc benign tumor of nasal cavity is …..
Premalignant condition ; leads to ….
Arises from …..

A

Inverted papilloma

SCC

Lateral wall of nose

78
Q

Sms of inverted papilloma (3)
Rx for inverted papilloma is …

A

Nasal obstruction
Rhinorrhoea
U/L epistaxis

Adequate local excision

79
Q

Ca paranasal sinus due to leather and nickel is …..
Ca paranasal sinus due to wood dust is …..

A

Squamous cell carcinoma

Adenocarcinoma

80
Q

Mc cancer of PNS is …at ……

What is ohngren’s line? Importance

A

Squamous cell cancer
Maxillary sinus

Theoretical line that connects medial canthus of eye to angle of mandible
Any tumor above line is poor prognosis- due to closeness to orbit.

81
Q
  1. Rx for maxillary sinus is …
  2. ………incision is used
  3. Ethmoidal sinus cancer is due to ….
  4. ……..invasion seen in adenoid cystic cancer
A
  1. Radical maxillectomy
  2. Weber Ferguson incision
  3. Extension of maxillary sinus cancer
  4. Perineural invasion
82
Q

Mc site for NPC cancer is ….in ……
Mc type of NPC cancer is….

A

Fossa of rosenmuller in lateral wall of NP
It’s a hidden area, can’t find cancer till it enlarges and causes glue ear

Squamous cell cancer

83
Q

Nasopharyngeal cancer is Common in …..regions

Risk factors for NPC

A

Southern China
Southeast Asia
Northeast India

  1. Consumption of salt cured fish— High in nitrosamines
  2. Smoking
  3. Vit C deficient diet
  4. Insence- polycyclic hydrocarbons
84
Q

EBV is ……..SCC

Earliest LN affected in NPC is ….

A

Non Keratinizing undifferentiated

Sentinel LN

85
Q

What is trotters triad?

A

Neuralgia in temporoparietal area- CN5
Palatal palsy - CN10
CHL - U/L- glue ear.

86
Q

Dx and rx for NPC
Ho’s triangle seen with …

A

Dx: nasopharyngeoscopy + Bx—-> chemoradiation.

Supraclavicular fossa- triangle between medial and lateral ends of clavicle and point where neck meets shoulder.

87
Q

Mc site of juvenile nasopharyngeal angiofibroma
Site of bleeding during surgery is from …

A

Superior margin of Sphenopalatine foramen.

Internal maxillary artery

88
Q

Signs seen with juvenile angiofibroma
What is the Holman miller sign?

A

Proptosis- frog like deformity
Cheek swelling

Bowing of posterior wall where tumor pushes maxilla forward- seen on CECT.

89
Q

MRI findings of angiofibroma

What is Hondusa sign? Suggestive of ….

A

Salt and pepper appearance- similar to glomus tumor!

Widening of gap between ramus of mandible and maxillary body. Right>left.
Suggestive of infratemporal fossa involvement.

90
Q

Rx of choice is …..
Recurrence via common.

Rx for angiofibroma is ….

A

Open excision

Preoperative estrogen/flutamide -shrink the tumor.
Angiofibroma is hormone sensitive tumor.

91
Q

Main source of blood supply for angiofibroma is ….

What is stage 1 of angiofibroma?

A

Maxillary artery - embolise this artery to prevent blood loss during surgery.

Limited to Np
Endoscopic approach

92
Q

Test for olfaction is …..

Define saccharine test

A

UPSIT- university of Pennsylvania smell identification test

Test for motility of cilia of nose.

93
Q

A patient of anosmia can smell ……agent?
What is cacosmia?

What is parosmia?

A

Ammonia-as it’s an irritant -irritates cn5

Perception of bad smell-Eg: foreign body in nose.

Distorted smell- fruit smelling like rotting flesh

94
Q

Phantomsmia seen in ….(2)

A

Perception of unpleasant smell in absence of any disease process.
Temporal lobe epilepsy
Streptomycin toxicity.

95
Q

What is stankiewick’s sign?

A

Injury to orbital nerve during FESS.
Fat protrudes into nasal cavity on compression of eyeball from outside

96
Q

Tea pot sign seen in ….

Dodd’s sign postive in ….negative in ….

A

CSF rhinorrhoea

Positive: Antrochoanal polyp
Negative: Angiofibroma

97
Q

Uvula pointing sign seen in …
Wood’s sign seen with …..

A

Rhinoscleroma

Jugulodigastric LN

98
Q

Rhinitis medicamentosa seen with …..

A

Reflex vasodilation secondary to prolonged use of decongestant drops like xylomethazoline/oxymethazoline.

99
Q

What is rhinophyma?

A

Complication of acne rosacea
Hyperplasia of sebaccous tissue on skin of external nose.

100
Q

Rhinitis sicca

Rhinitis caseosa

A

Crusting of nasal cavities in people who work in hot, dry,dusty environment.

Cheesy material drains into nose from maxillary sinus.

101
Q

Cortical olfactory area is …&….

Max perforation in disc battery seen in ….pole of battery

A

Prepyriform cortex
Amygdaloid nucleus

Negative

102
Q

Test for :
Lacrimation
Mucociliary flow

A

Ammonia test -greater petrosal n

Saccharin test

103
Q

Narrowest area of airway is …..

Mc carcinoma of nose skin is ….

Mulberry appearance of nasal mucus membrane seen with ….

A

Internal nasal valve.

BCC- rodent ulcer

Chronic hypertropic rhinitis

104
Q

Mc pediatric malignancy of upper respiratory tract

Mc fibrous dysplasia is ….

A

Rhabdomyosarcoma

Maxilla

105
Q

Mc site of osteoma in PNS is ….

Parasympathetic fibers carried by ….ganglion

A

Frontal sinus

Otic ganglion

106
Q

Kallaman’s syndrome

A

Anosmia+ congenital hypogoonadism

107
Q

What is Samters triad?

A

Aspirin sensitivity + asthma+ nasal ethmoidal polyposis.
Mostly PG induced.

108
Q

Define kartegeners syndrome ?

A

Recurrent sinusistis
Bronchiectasis
Situs inversus
Sterility- due to dynein defect

109
Q

Sluders sphneopalatine neuralgia define.

Vidian neurectomy. Define

What is NARES?

A

Rhinorrhoea
Increased lacrimation
Nasal stuffiness

Vasomotor rhinitis

Non allergic rhinitis with eosinophilia syndrome

ENT Sure Success (4 decks)

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