Nose and Paranasal Disorders

Question 1

Nasal polyps - Etiology

Answer 1

higher with allergic rhinitis and aspirin allergy

Question 2

Samter’s Triad

Answer 2

co-occuring allergic rhinitis, ASA allergy, and nasal polyps

Question 3

Nasal polyps - Presentation

Answer 3

visible pale, edematous mucosa; con - gestion, obstruction, and phonation

Question 4

Nasal polyps - Treatment

Answer 4

Intranasal or oral corticosteroids, surgery if no reduction

Question 5

Nasal foreign body - complications

Answer 5

battery or magnet = medical emergency

Question 6

Nasal foreign body - Etiology

Answer 6

commonly children 2-4 years old

Question 7

Nasal foreign body - Presentation

Answer 7

known ingestion, unilateral foul smelling discharge or bleeding, foul smelling breath, septal perforation

Question 8

Nasal foreign body - Treatment

Answer 8

Visualize (directly, fiber optic, X-ray) Medications for vasoconstriction and anesthesia Positive pressure (block and blow or “big kiss” Alligator forceps, balloon catheter, suction ENT consult

Question 9

Epistaxis - Complication

Answer 9

Posterior bleed (Woodruff plexus) = airway risk, medical emergency

Question 10

Epistaxis - Etiology

Answer 10

Trauma, forceful blowing, intranasal corticosteroids, dryness, genetic coagulopathy, anticoagulation medication =damage to Kiesselbachs plexus

Question 11

Epistaxis - Presentation

Answer 11

Bleeding from the nose, relevant history (time, cause, previous bleeds)

Question 12

Epistaxis - Treatment

Answer 12

Hold pressure for 10-15 minutes Visualize source of bleeding Decongestant Cauterize (analgesic and silver nitrate) Pack (tamponade or balloon) ENT consult

Question 13

Allergic Rhinitis - Eitology

Answer 13

allergy predisposed individual exposed to allergens

Question 14

Allergic Rhinitis - Presentation

Answer 14

Clear nasal drainage, sneezing, tearing, itching, redness Coughing and bronchospasm Pale, violant nasal mucosal Worse near allergen

Question 15

Allergic Rhinitis- Treatment

Answer 15

Avoid allergen Intranasal corticosteroids (aim at the ear) Antihistamines Cromylon soution Saline drops Immunotherapy

Question 16

Acute Viral Sinusitis

Answer 16

Common cold

Question 17

Acute Bacterial Sinusitis - Complications

Answer 17

Malignant form osteomyelitis, cellulitis, brain abscess

Question 18

Acute Bacterial Sinusitis - Etiology

Answer 18

Decreased mucociliary clearance and obstruction, mucus accumulation secondary to infection

Question 19

Acute Bacterial Sinusitis - Presentation

Answer 19

Yellow-green purulent discharge Pain and pressure in face or sinuses Nasal obstruction, cough, fever, headache Tender palpation and unilateral decreased trans-illumination 1-4 weeks long (generally 2 week)

Question 20

Acute Bacterial Sinusitis - Treatment

Answer 20

NSAID (10-14 days) Decongestants (oral/ intranasal) Intranasal corticosteroids Amoxicillin (7-10 days)

Question 21

Chronic Bacterial Sinusitis - Etiology

Answer 21

Inflammation of the sinuses for greater than 12 weeks Must show evidence of mucus and 2 of the 4 cardinal signs for diagnosis

Question 22

Chronic Bacterial Sinusitis - Presentation

Answer 22

Cardinal signs: anterior/posterior mucus/pus drain Nasal blockage/obstruction/congestion Facial pain/pressure Decreased sense of smell

Question 23

Chronic Bacterial Sinusitis - Treatment

Answer 23

Intranasal saline Intranasal or systemic glucocorticosteroids Amoxicillin (7-10 days) Antileukotrienes Surgery (ENT)