nose and sinuses

Question 1

what type of cartilage is the external nose composed of

Answer 1

avascular hyaline cartilage

Question 2

what are the medial walls of the nasal cavities (i.e. nasal septum) composed of

Answer 2

• ethmoid bone
• vomer bone
• hyaline cartilage

Question 3

what are the superior and middle parts of the nasal conchae composed of

Answer 3

ethmoid bone

Question 4

what are the anterior parts of the nasal conchae composed of

Answer 4

nasal vestibule

Question 5

what is the blood supply to sphenopalatine

Answer 5

branch of maxillary (external carotid)

Question 6

what is the blood supply to anterior ethmoidal

Answer 6

branch of ophthalmic (internal carotid)

Question 7

what is the blood supply to posterior ethmoidal

Answer 7

branch of ophthalmic (internal caotid)

Question 8

what is the blood supply to posterior ethmoidal

Answer 8

branch of ophthalmic (internal caotid)

Question 9

what is Kiesselbach’s area

Answer 9

area of anastomosis of these three arteries on the nasal septum which is susceptible to nosebleeds

Question 10

what are the functions of the paranasal sinuses

Answer 10

air filled chambers in the bones of the face that help to lighten the skull and resonate sound to improve phonation and produce mucous

Question 11

where does the spehnoid sinus drain to

Answer 11

spheno-ethmoid sinus

Question 12

where do the ethmoid air cells drain to

Answer 12

superior and middle meatus

Question 13

where does the frontal sinus drain to

Answer 13

middle meatus

Question 14

where does the maxillary sinus drain to

Answer 14

middle meatus

Question 15

where does the naso-lacrimal duct drain to

Answer 15

inferior meatus

Question 16

how does the sensation of smell work

Answer 16

• specialised olfactory mucosa lines the superior aspect of the nasal cavity
• olfactory neurons pass through the cribriform plate and unite to form the olfactory nerve
• sensation of smell is then processed in the temporal lobe

Question 17

what is anosmia

Answer 17

inability to smell

Question 18

what is hyposmia

Answer 18

reduced sensation of smell

Question 19

what is dysosmia

Answer 19

altered sensaiton of smell

Question 20

what is rhinosinusitis

Answer 20

inflammation of the nose and paranasal sinuses

Question 21

what is mild rhinosinusitis

Answer 21

minimal symptoms with no disturbance of daily life or sleep

Question 22

what is moderate rhinosinusitis

Answer 22

troublesome symptoms with impairment of ability to carry out daily activities and to sleep

Question 23

what is acute rhinosinusitis

Answer 23

lasting < 12 weeks

Question 24

what is chronic rhinosinusitis

Answer 24

lasting > 12 weks

Question 25

what is intermittent rhinosinusitis

Answer 25

less than 4 days per week for > 4 weeks

Question 26

what is persistent rhinosinusitis

Answer 26

> 4 days per week for > 4 weeks

Question 27

rhinosinusitis presentation

Answer 27

two or more of: - nasal congestion - nasal discharge - nasal crusting - facial pain or fullness - reduced sense of smell - associated sneezing, itch and fever - possible conjunctivitis

Question 28

rhinosinusitis diagnosis

Answer 28

IgE - RAST testing

Question 29

rhinosinusitis management

Answer 29

- inhaled steroids - decongestants (pseudoephedrine)

Question 30

why can decongestants only be used in the short term

Answer 30

can cause rebound congestion and necrosis of septum due to constriction of blood vessels

Question 31

what is allergic rhinitis

Answer 31

IgE mediated hypersensitivity that can be intermittent (hay fever/atopy) or permanent

Question 32

allergic rhinitis presentation

Answer 32

- personal or family history of atopy - sneeze and itch - allergic crease

Question 33

allergic rhinitis diagnosis

Answer 33

- skin prick test - RAST to identify allergen - assess turbinates

Question 34

allergic rhinitis management

Answer 34

- allergen avoidance - 1st line: antihistamines (non-sedating types include cetirizine and loratadine) - 2nd line: topical steroid (beclomethasone, fluticasone, mometasone) - 3rd line: both antihistamine and topical steroids - 4th line: systemic immunosuppression

Question 35

infective sinusitis causes

Answer 35

- usually viral and follows on from upper respiratory tract infection - bacterial causes include strep. pneumonia and H. influenzae

Question 36

infective sinusitis complications

Answer 36

- orbital cellulitis - intra-cranial infection

Question 37

infective sinusitis presentation

Answer 37

- can occur secondary to viral infection of following dental surgery - usually associated with more severe pain/tenderness, purulent discharge and systemic upset

Question 38

infective sinusitis management

Answer 38

- most resolve within 2 weeks - inhaled decongestants (pseudoephedrine) - inhaled steroids (beclometasone) - antibiotics only if worsening symptoms after 7-10 days, 1st line: penicillin 500mg TDS 7/7, 2nd line: doxycycline 100mg BD 7/7

Question 39

what is vasomotor sinusitis

Answer 39

chronic form of sinusitis that presents similarly to allergic sinusitis but isn’t caused by allergy

Question 40

vasomotor sinusitis management

Answer 40

inhaled ipratropium

Question 41

what are nasal polyps

Answer 41

oedematous swellings under nasal mucosa

Question 42

nasal polyps most commonly affect

Answer 42

women in their 40s

Question 43

are nasal polyps usually bilateral or unilateral

Answer 43

develop bilaterally (unilateral -> more sinister cause)

Question 44

name 6 conditions nasal polyps are associated with

Answer 44

- allergic rhinitis - non-allergic rhinitis - aspiring hypersensitivity - non-atopic asthma - nasopharyngeal malignancy - cystic fibrosis (consider along with malignancy if in child under 10)

Question 45

nasal polyps presentation

Answer 45

chronic sinusitis with - bilateral nasal congestion - water anterior rhinorrhoea - purulent post-nasal drip - taste disturbance - mouth breathing and snoring

Question 46

nasal polyps diagnosis

Answer 46

rhinoscopy showing translucent, insensitive pale grey and mobile mass

Question 47

nasal polyps management

Answer 47

- 1st line: topical steroid (possibly with montelukast) - 2nd line: endoscopic polypectomy

Question 48

what is the most common site for epistaxis

Answer 48

Kiesselbach's plexus

Question 49

epistaxis management (after failure of first aid)

Answer 49

- 1st: cautery - 2nd: anterior nasal pack - 3rd: posterior nasal pack - 4th: endoscopic ligation of sphenopalatine artery - 5th: ligation of external carotid - 6th: embolization

Question 50

what is choanal atesia

Answer 50

congenital abnormality in which there is a blockage of the posterior nasal cavity