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402 Ear, Nose & Throat > Nose > Flashcards

Nose Flashcards

1
Q

What are the bony projections on the lateral nasal wall called?

A

Turbinates

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2
Q

What is the tin plate of bone that separates the erythroid sinuses from the orbit called

A

lamina papyracea

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3
Q

The lamina papyracea is very thin, what are the implications of this regarding disease?

A

Infections from sinuses can spread to the orbit, brain and meninges

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4
Q

In what three pt groups does epistaxis commonly occur?

A

Children
Elderly
Middle aged

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5
Q

From what major blood artery are the blood vessels in the nose derived from?

A

Internal and external carotid

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6
Q

What name is given to the area in the nose where the blood vessels converge and what is the significance of this?

A

Little’s area

Common site of bleeding

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7
Q

What vascular feature is a common source of bleeding in children?

A

reterocolumellar vein - prominent vein running between the junction of the skin and mucosa of the nasal septum

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8
Q

3 steps to stopping a nosebleed

A

Pressure for 10 mins on fleshy part of nose
cautery with local anaesthetic
nasal packing

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9
Q

4 causes other than HTN and trauma that can lead to recurrent epistaxis?

A 
Anticoagulant therapy
Thrombocytopaenia 
Leukaemia 
Haemophilia 
Telangiectasia
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10
Q

What chemical is commonly used to cauterise the nose to prevent recurrent nose bleeds?

A

Silver nitrate

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11
Q

4 broad causes of septal perforation

A 
Trauma 
Surgery
Infections
Vasculitic conditions 
Recreational drug use
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12
Q

What infections can cause a septal perforation?

A

Syphilis

TB

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13
Q

Why is a septal haematoma bad news for the cartilage?

A

It’s a bleed under the perichondrium that lines the cartilage. So blood supply will be interrupted and necrosis can occur.

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14
Q

What is the treatment for a septal haematoma and why does this need to be done quickly?

A

Drain the blood.

Otherwise necrosis of the cartilage can occur

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15
Q

If necrosis occurs following a septal haematoma what is the possible consequence of this?

A

Septal perforation

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16
Q

If someone comes into A&E with a smashed nose, what do you need to check for?

A

Septal haematoma

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17
Q

If someone breaks their nose, when should they/you try and reset it?

A

Immediately following injury
Otherwise wait for 1 week for swelling to go down
After 3 weeks surgery will be required

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18
Q

How long have you got to treat a septal haematoma before necrosis occurs?

A

48 hours

19
Q

Other than obvious trauma, how does a septal haematoma present and what would you see in inspection?

A

Progressive nasal obstruction

Large, soft bluish, red swelling

20
Q

If there is clear nasal discharge following trauma what should you suspect is going on and what might be damaged ?

A

CSF leak

Cribriform plate

21
Q

If you suspect someone has a CSF leak, how can you test it to check?

A

Glucose test - should be similar to serum

2 transferrin - protein present in CSF and perilymph

22
Q

What is the management of CSF leak?

A

Most resolve themselves

Otherwise require surgical intervention

23
Q

What should pts be advised that there is a risk of until a CSF leak resolves?

A

Meningitis

24
Q

What is acute rhinosinusitis?

A

Acute inflammatory condition of the nose and paranasal sinuses

25
Q

ARS is defined as a sudden onset of two or more symptoms, one of which should be either…..?

A 
Nasal blockage/congestion/obstruction
nasal discharge (anterior or posterior)
26
Q

In addition to nasal symptoms, what else might the patient complain of?

A

facial pain/pressure

loss/reduction of smell

27
Q

To be diagnosed with ARS how long can the symptoms be going on for?

A

Less than 12 weeks

28
Q

What is ARS usually caused by?

A

preceding viral URTI which leads secondarily to a bacterial infection

29
Q

What are the 5 pathophysiological steps in the development of ARS?

A 
Viral URTI
Mucosal Oedema of nose and para nasal sinuses
Blockage of sinus drainage
Stasis of mucosal secretions
Secondary bacterial infection
30
Q

What are the most common bacterial pathogens in the development of ARS?

A

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

31
Q

A pt with preceding history of coryzal illness, clear rhinorrhoea, nasal congestion, fever and malaise will go on to develop what is they have ARS? 5

A 
Prurulent rhinorrhoea
Nasal congestion (more marked)
Facial pain/pressure
Hyposmia or altered taste
Dental pain
32
Q

3 principles of management of ARS/

A

Analgesia (NSAIDS)
Decongestants (topical or systemic)
Antibiotics (amoxicillin, cephalosporins)

33
Q

What is the most common complication of ARS, notably in children?

A

Peri orbital cellulitis

34
Q

How does periorbital cellulitis develop from ARS?

A

Infection spreads through lamina papyracea or via venous thrombophlebitis

35
Q

What are the implication if periorbital cellulitis is not treated promptly?

A

Orbital cellulitis - blindness
subperosteal/orbital bacess
cavernous sinus thrombosis - death

36
Q

What is the management of periorbital cellulitis?

A

hospital admission

IV antibiotics

37
Q

What is the most common intercranial complication of ARS?

A

Subdural abcess

38
Q

If ARS causes osteomylitis of the frontal bone what can this result in?

A

Subperiosteal abscess known as Potts puffy tumour

39
Q

Chronic rhinosinusitis is the nasal symtoms of ARS plus either…?

A 
Endoscopic signs of;
   polyps
   mucopurulent discharge 
   oedema
CT changes of mucosal complex
40
Q

Which meatus is usually affected in rhinosinusitis and what is this located lateral to?

A

Middle meatus

Middle turbinate

41
Q

Which sinuses drain through the middle meatus?

A

Maxillary
Frontal
anterior erythmoid

42
Q

Which sinuses drain through the superior meatus?

A

Posterior erythmoid

Sphenoid

43
Q

What aetiologial factors would predispose someone to CRS?

A 
Atopy
Ciliary dysfunction - cystic fibrosis
NSAID sensitivity 
Immune dysfunction
Airway disease
44
Q

What is the mainstay of CRS management?

A

Topical and oral steroids
antibiotics]saline nasal irrigation
Allergy investigation and avoidance

402 Ear, Nose & Throat (3 decks)

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