Nose

Question 1

Risks of nose and paranasal neoplasms?

Answer 1

Wood, Nickle industry, industrial fumes, leather tanning,

Most common site: maxillary sinus

Question 2

When to investigate nasal polyps?

Answer 2

When it’s unilateral or bleeding

Question 3

What’s the first line Rx for nasal-Sinusitis congestion?

Answer 3

Intranasal steriods eg fluticasone

Question 4

What is the treatment for choanal atresia?

Answer 4

Congenital nasal blockage - baby’s nasal breathers.

If bilateral needs surgery ASAP

Question 5

What’s the management for nasal fractures of children and adults?

Answer 5

If minimal oedema- reduction in 3 hours
If oedema
Adults - 6-10days once swelling has resolved
Children - 3-7days once swelling has resolved

Question 6

When is nasal manipulation contraindicated in fractures?

Answer 6

Severe cominution of bones and septum
Assoc with orbital or ethmoid fractures
Nasal pyramid deviated >half nasal width 
Open septal fractures 
Over 3wks since injury

Question 7

Two areas of nose bleeds?

Answer 7

Anterior - kisselbach plexus/ littlest area (more common)

Posterior - bleed into mouth (more severe)

Question 8

What factors are associated with nasal polyps?

Answer 8

Asthma, aspirin, CF, kartageners syndrome (cillary dyskinesia), churg-Strauss syndrome (eosinophilia with polyangitis)

Question 9

What’s the problem with using long term topical decongestants?

Answer 9

Tachyphylaxis - increased dose needed for same effect

Question 10

What is the management for bilateral nasal septal swelling?

Answer 10

Urgent ENT review - boggy swelling

Needs drainage and IV abx