Nose Flashcards
What is rhinitis medicamentosa?
a condition of rebound nasal congestion brought on by extended use of topical decongestants
What is anosmia?
s the inability to perceive odor or a lack of functioning olfaction—the loss of the sense of smell.
What is parosmia?
an olfactory dysfunction that is characterized by the inability of the brain to properly identify an odor’s “natural” smell
What are the four arteries that form Kiesselbach’s plexus?
- Anterior ethmoidal artery (from the ophthalmic artery)
- Sphenopalatine artery (terminal branch of the maxillary artery)
- Greater palatine artery (from the maxillary artery)
- Septal branch of the superior labial artery (from the facial artery)
What is nasal vestibulitis?
The diffuse dermatitis of nasal vestibule. It is often caused by Staphylococcus aureus
What are juvenile nasopharyngeal angiofibromas? Who does it usually affect? What is the classic presentation?
Histologically benign but locally aggressive vascular tumor that grows in the back of the nasal cavity. It most commonly affects adolescent males. Patients with nasopharyngeal angiofibroma usually present with one-sided nasal obstruction and recurrent bleeding.
What causes the stuffy nose?
Engorgement of the nasal turbinates
What is the role of the nasal turbinates?
Humidify the incoming air
What is the uncinate process?
Process that sticks out from the lateral wall of the nose, between the inferior and middle turbinate
Which are more common: anterior or posterior nasal bleeds?
Anterior, by far
What is the usual presentation of epistaxis?
Intermittent, few times a week for a few months
What is the major artery that supplies the posterior nasopharynx?
Sphenopalatine
What is the major artery that supplies the anterior/middle nasopharynx?
Anterior ethmoid and posterior ethmoid arteries
What is the more appropriate type of drug to use with nasal congestion?
Steroid-based
What is the role of HTN in the development of nosebleeds?
can play a role, but not a huge factor
What is the defect in von Willebrand’s disease?
A qualitative or quantitative deficiency of von Willebrand factor (vWF), which is in endothelial walls, and tethers GPIb
What is the wind tunnel theory of epistaxis?
Chronic exposure of narrowed nasopharynx to the dry air leads to drying out
Why is there an increased incidence of epistaxis in the allergy season?
Inflammation of the arteries in the nose leaves them susceptible to damage
Most epistaxis is from what arteries?
Anterior arteries of Kiesselbach’s plexus
What is the pathogenesis of tears of blood with epistaxis?
blood backs up into the lacrimal duct
True or false: bilateral epistaxis is common
True, since one side can back up and come down the other side
What is the artery the supplies the tiny anterior portion of the nose from the philtrum? What is this a branch of?
- Superior labial artery
- Branch of the maxillary artery
What is the artery that supplies the inferior portion of the nasopharynx? What is this a branch of?
- Greater palatine artery
- Branch of the maxillary artery
What type of moisturizing agents can be applied to prevent dry noses?
Water based lubricants
Should nasal spray be continued with chronic dry nose/epistaxis?
No
What is a good treatment for acute nosebleeds that are not chronically recurrent?
Afrin (Oxymetazoline) a selective α1 adrenergic receptor agonist and α2 adrenergic receptor partial agonist
What is the role of silver nitrate in treating nasal bleeds?
Slow or recurrent bleeds-not actively bleedings
What is the general treatment for anterior nasal bleeds?
Anesthetize area with injectable lidocaine, then cauterize site
How long does nasal packing have to stay in for?
3 days
Who removes nasal packing?
ENT docs
What are the abx that should be used with nasal packing? Why?
- anti-staph
- Reports of TSST
What is the ultimate treatment for refractory anterior nasal bleeds?
Ligation or embolization of the internal maxillary artery
What are the general characteristics of posterior epistaxis as compared to anterior?
Usually much more rapid, and problematic
What is the general treatment for posterior epistaxis?
Rhino Rockets
What artery can be ligated to treat recurrent posterior epistaxis?
Anterior ethmoid
Young males with recurrent bleeding need to be evaluated for what?
JNA
Where do JNA’s sit in the nasopharynx?
Posteriorly–in the adenoids
What are the most common causes of anosmia?
Obstructive etiology or post viral etiology
What are the antithyroid drugs that can cause anosmia?
PTU
What are the two antifungal drugs that can cause anosmia?
Amphotericin B
Griseofulvin
What is the MOA of griseofulvin?
Inhibits microtubules
What is the MOA of AMP B?
As with other polyene antifungals, amphotericin B binds with ergosterol, a component of fungal cell membranes, forming a transmembrane channel that leads to monovalent ion (K+, Na+, H+ and Cl−) leakage, which is the primary effect leading to fungal cell death.
What, generally, is the diagnostic workup for altered smell?
CT scan to r/o paranasal path
True or false: most cases of anosmia are usually found
False
What is the medication that can be used to treat an altered sense of smell?
Topical nasal steroids
What is the usual presentation of nasal vestibulitis?
Dry, scabbing, bloody nose
What is the usual cause of nasal vestibulitis
Dry weather or manual irritation
What may result from nasal vestibulitis?
Squamous metaplasia
What is the treatment for nasal vestibulitis?
- Stop nasal spray and increase humidity
- Mupirocin ointment
What are the alternatives to rhinitis medicamentosa?
Nasal steroids or turbinoplasty
