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ENT > Nose > Flashcards

Nose Flashcards

1
Q

What is the pathophysiology of allergic rhinitis?

A

IgE mediated type 1 hypersensitivity reaction

Initial inhalation of antigen causes B cells to form antigen-specific IgE.

Allergen is cleared and the residual IgE bind to Fc receptors on mast cells.

On subsequent inhalation of antigen, it binds to IgE coated mast cells which then degranulate releasing vasoactive mediators (e.g. histamine)

Inflammatory mediators cause acute allergic symptoms

Delayed recruitment of immune cells causes nasal congestion

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2
Q

How does allergic rhinitis present?

A

Rhinorrhoea

Itching

Nasal obstruction

Sneezing

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3
Q

What are the two classifications of allergic rhinitis and how do they differ?

A

Intermittent:
- symptoms less than 4 days a week or under 4 week duration

Persistent:
- symptoms more than 4 days a week or more than 4 weeks duration

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4
Q

What are the two severities of allergic rhinitis?

A

Mild (no disruption of daily life)

Moderate-severe (disruption of daily life)

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5
Q

What kind of antigens tend to cause intermittent allergic rhinitis?

A

Antigens present at a certain time of year

often summer, e.g. grass pollen - hayfever

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6
Q

What kind of antigens tend to cause persistent allergic rhinitis?

A

Antigens present all year round (e.g. dog, cat, dust mite antigens)

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7
Q

What tests can be done to identify the causative antigen in allergic rhinitis?

A

Skin prick test (prick small amount of various common antigens into skin and observe for allergic response)

RAST blood test (blood test for specific IgE associated with common antigens)

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8
Q

What is the treatment of allergic rhinitis?

A

Stepwise treatment

  1. antigen avoidance
  2. antihistamines (cetirizine)
  3. topical steroids (beclomethasone)
  4. antihistamines and steroids
  5. immunotherapy (in selected patients with severe disease)

Other treatments include leukotriene blockers (montelukast) or decongestants (pseudoephedrine)

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9
Q

What is non-allergic rhinitis?

A

Inflammation of nasal mucosa with no apparent cause

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10
Q

How does non-allergic rhinitis present?

A

Congested nose
Rhinorrhoea
Congestion

(no itch, differentiates from allergic rhinitis)

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11
Q

What is a nasal complication of non-allergic rhinitis?

A

Nasal polyps

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12
Q

What are nasal polyps?

A

Soft, non-cancerous growths of nasal lining

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13
Q

What causes nasal polyps?

A

Chronic inflammation of nasal mucosa

  • non-allergic rhinitis
  • asthma
  • aspirin sensitivity
  • cystic fibrosis
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14
Q

How do nasal polyps present?

A

In older people

Anosmia
Rhinorrhoea
Nasal congestion

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15
Q

What condition do you suspect if a young patient presents with nasal polyps?

A

Cystic fibrosis

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16
Q

How do you treat non-allergic rhinitis?

A

Steroids

Anti-cholinergic (ipratropium)

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17
Q

How do you treat nasal polyps?

A

Steroid spray

Surgery (if steroids don’t shrink)

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18
Q

What are the names and locations of the paranasal sinuses?

A

2 frontal sinuses located behind brow ridges
(formed from one frontal bone and separated by bony septum)

Ethmoidal sinuses situated between upper nasal cavity and orbits
(complex shape of ethmoid divides them into anterior, middle and posterior air cells)

2 sphenoidal sinuses located posterior to nasal cavity
(two sphenoidal sinuses formed from one sphenoid bone)

2 maxillary sinuses/antra located in maxillary bones
(two maxillary sinuses, one in each maxillary bone)

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19
Q

Which meatus does the frontal sinus drain into?

A

Middle meatus

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20
Q

Which meatus does the ethmoidal sinus drain into?

A

Superior and middle meatuses

21
Q

Which meatus does the sphenoidal sinus drain into?

A

Sphenoethmoidal recess

22
Q

Which meatus does the maxillary sinus drain into?

A

Middle meatus

23
Q

Where is the inferior meatus and what drains into it?

A

Inferior to inferior concha

Lacrimal fluid

24
Q

Where is the middle meatus and what drains into it?

A

Inferior to middle concha

Frontal sinuses, ethmoidal air cells and maxillary sinuses

25
Q

Where is the superior meatus and what drains into it?

A

Inferior to superior concha

Ethmoidal air cells

26
Q

Where is the sphenoethmoidal recess and what drains into it?

A

Superoposterior to superior concha

Sphenoidal sinus

27
Q

What is sinusitis?

A

Inflammation of mucosa lining paranasal sinusitis

28
Q

How does sinusitis present?

A

Fever

Headache

Nasal congestion

Facial pain

Toothache

29
Q

What sinus is most commonly affected by sinusitis and why?

A

Maxillary sinus

Largest and has to drain against gravity

30
Q

How can a dental abscess cause sinusitis?

A

Spread of infection from tooth to maxillary sinus

31
Q

Why do patients with sinusitis sometimes present with toothache?

A

Referred pain from shared CN V innervation of teeth and maxillary sinus

32
Q

What is the treatment of sinusitis?

A

Analgesia and decongestants

If severe and lasting more than 10 days, antibiotics (penicillin or doxycycline)

33
Q

What is a complication of ethmoidal sinusitis?

A

Orbital cellulitis

Spread of infection into orbit

34
Q

What is a potential complication of sphenoidal sinusitis?

A

Cavernous sinus thrombosis

35
Q

How does nasal fracture present?

A

Deviated, bruised, swollen, tender nose with history of trauma

36
Q

How are nasal fractures managed?

A

Manipulation under anaesthetic within 2 weeks of injury

37
Q

Name 2 potential complications of nasal fracture.

A

Septal haematoma

Cerebrospinal fluid leak

38
Q

How do you differentiate septal haematoma from septal deviation?

A

Haematomas are soft and boggy

Septal deviations are firm

39
Q

How do you manage septal haematomas?

A

Drainage under anaesthetic and prophylactic antibiotics

40
Q

What can an untreated septal haematoma progress to?

A

Septal abscess and become necrotic

41
Q

How does a cerebrospinal fluid leak present?

A

Clear, unilateral watery discharge

42
Q

What causes cerebrospinal fluid leak?

A

Cribriform plate fracture

43
Q

How are cerebrospinal fluid leaks managed?

A

Usually settle within 10 days

44
Q

What can untreated cerebrospinal fluid leaks progress to?

A

Meningitis

45
Q

What is the commonest origin site for epistaxis and where is it?

A

Kiesselback’s plexus (Little’s area)

Plexus of arteries in anteroinferior nasal septum

46
Q

What can be done to manage epistaxis resistant to conservative management (i.e. compression, ice)?

A

Nasal cautery

Nasal packing (Rapid Rhino packs)

47
Q

What is the commonest nasopharyngeal cancer?

A

Nasopharyngeal carcinoma

48
Q

What type of cells are nasopharyngeal carcinomas made up of?

A

Squamous cells

Squamous cell carcinoma

49
Q

What 3 things are nasopharyngeal carcinomas associated with?

A

Middle east

Epstein-Barr virus (infectious mononucleosis)

Nitrosamines in food

ENT (7 decks)

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