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year two - ENT > nose and sinuses > Flashcards

nose and sinuses Flashcards

1
Q

what type of cartilage is the external nose composed of

A

avascular hyaline cartilage

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2
Q

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

A
  • ethmoid bone
  • vomer bone
  • hyaline cartilage
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3
Q

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

A

ethmoid bone

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4
Q

what are the anterior parts of the nasal conchae composed of

A

nasal vestibule

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5
Q

what is the blood supply to sphenopalatine

A

branch of maxillary (external carotid)

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6
Q

what is the blood supply to anterior ethmoidal

A

branch of ophthalmic (internal carotid)

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7
Q

what is the blood supply to posterior ethmoidal

A

branch of ophthalmic (internal caotid)

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8
Q

what is the blood supply to posterior ethmoidal

A

branch of ophthalmic (internal caotid)

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9
Q

what is Kiesselbach’s area

A

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

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10
Q

what are the functions of the paranasal sinuses

A

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

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11
Q

where does the spehnoid sinus drain to

A

spheno-ethmoid sinus

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12
Q

where do the ethmoid air cells drain to

A

superior and middle meatus

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13
Q

where does the frontal sinus drain to

A

middle meatus

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14
Q

where does the maxillary sinus drain to

A

middle meatus

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15
Q

where does the naso-lacrimal duct drain to

A

inferior meatus

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16
Q

how does the sensation of smell work

A
  • 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
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17
Q

what is anosmia

A

inability to smell

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18
Q

what is hyposmia

A

reduced sensation of smell

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19
Q

what is dysosmia

A

altered sensaiton of smell

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20
Q

what is rhinosinusitis

A

inflammation of the nose and paranasal sinuses

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21
Q

what is mild rhinosinusitis

A

minimal symptoms with no disturbance of daily life or sleep

22
Q

what is moderate rhinosinusitis

A

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

23
Q

what is acute rhinosinusitis

A

lasting < 12 weeks

24
Q

what is chronic rhinosinusitis

A

lasting > 12 weks

25
Q

what is intermittent rhinosinusitis

A

less than 4 days per week for > 4 weeks

26
Q

what is persistent rhinosinusitis

A

> 4 days per week for > 4 weeks

27
Q

rhinosinusitis presentation

A

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

28
Q

rhinosinusitis diagnosis

A

IgE - RAST testing

29
Q

rhinosinusitis management

A
  • inhaled steroids
  • decongestants (pseudoephedrine)
30
Q

why can decongestants only be used in the short term

A

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

31
Q

what is allergic rhinitis

A

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

32
Q

allergic rhinitis presentation

A
  • personal or family history of atopy
  • sneeze and itch
  • allergic crease
33
Q

allergic rhinitis diagnosis

A
  • skin prick test
  • RAST to identify allergen
  • assess turbinates
34
Q

allergic rhinitis management

A
  • 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
35
Q

infective sinusitis causes

A
  • usually viral and follows on from upper respiratory tract infection
  • bacterial causes include strep. pneumonia and H. influenzae
36
Q

infective sinusitis complications

A
  • orbital cellulitis
  • intra-cranial infection
37
Q

infective sinusitis presentation

A
  • can occur secondary to viral infection of following dental surgery
  • usually associated with more severe pain/tenderness, purulent discharge and systemic upset
38
Q

infective sinusitis management

A
  • 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
39
Q

what is vasomotor sinusitis

A

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

40
Q

vasomotor sinusitis management

A

inhaled ipratropium

41
Q

what are nasal polyps

A

oedematous swellings under nasal mucosa

42
Q

nasal polyps most commonly affect

A

women in their 40s

43
Q

are nasal polyps usually bilateral or unilateral

A

develop bilaterally (unilateral -> more sinister cause)

44
Q

name 6 conditions nasal polyps are associated with

A
  • allergic rhinitis
  • non-allergic rhinitis
  • aspiring hypersensitivity
  • non-atopic asthma
  • nasopharyngeal malignancy
  • cystic fibrosis (consider along with malignancy if in child under 10)
45
Q

nasal polyps presentation

A

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

46
Q

nasal polyps diagnosis

A

rhinoscopy showing translucent, insensitive pale grey and mobile mass

47
Q

nasal polyps management

A
  • 1st line: topical steroid (possibly with montelukast)
  • 2nd line: endoscopic polypectomy
48
Q

what is the most common site for epistaxis

A

Kiesselbach’s plexus

49
Q

epistaxis management (after failure of first aid)

A
  • 1st: cautery
  • 2nd: anterior nasal pack
  • 3rd: posterior nasal pack
  • 4th: endoscopic ligation of sphenopalatine artery
  • 5th: ligation of external carotid
  • 6th: embolization
50
Q

what is choanal atesia

A

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

year two - ENT (17 decks)

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