Nose Problems

Question 1

what is epistaxis?

Answer 1

nose bleeding

Question 2

causes of epistaxis

Answer 2

idiopathic
trauma
inflammation
tumour 
drugs (warfarin, aspirin)
clotting abnormalities (haemophilia, leukaemia)
liver disease
Osler-Weber-Rendu
hypertension

Question 3

when may you have to resuscitate a patient with epistaxis?

Answer 3

hypovolaemic shock due to amount lost

Question 4

where should external pressure be applied in epistaxis?

Answer 4

cartilaginous portion of the nose for 15-20 minutes

Question 5

when to go to hospital with epistaxis?

Answer 5

if bleeding has not stopped in 15-20 minutes

Question 6

options for epistaxis management

Answer 6

external pressure
ice
cautery
nasal packing

Question 7

hospital management of epistaxis

Answer 7

topical vasoconstrictor +/- LA (lignocaine and adrenaline +/- co-phenylcaine)
remove clot (suction or blowing nose)
cauterise vessel (silver nitrate and diathermy)

Question 8

which vessel is usually responsible for epistaxis?

Answer 8

sphenopalatine artery

anterior ethmoidal artery

Question 9

systemic management of epistaxis

Answer 9

reversal of anticoagulants (takes longer if antiplatelets)
platelet transfusion
manage hypertension

Question 10

two types of rhinitis

Answer 10

1. non-infective

2. infective (rhinosinusitis)

Question 11

two types of non-infective rhinitis

Answer 11

allergic

non-allergic

Question 12

two types of allergic rhinitis

Answer 12

intermittent rhinitis

persistent rhinitis

Question 13

two types of non-allergic rhinitis

Answer 13

vasomotor rhinitis

polyps

Question 14

presentation of rhinitis

Answer 14

4S’s= stuffy, smell, snot and sore
sneezing in allergic
crusting and epistaxis
secondary symptoms= dry mouth, sore throat, snoring, halitosis, loss of taste

Question 15

criteria for intermittent rhinitis

Answer 15

symptoms for <4 days/7 or symptoms for <4 weeks

Question 16

criteria for persistent rhinitis

Answer 16

symptoms for more than 4/7 days or more than 4 weeks duration

Question 17

complications of rhinitis

Answer 17

orbital cellulitis

brain abscess from frontal sinus

Question 18

diagnosis of rhinitis

Answer 18

skin prick
RAST levels (IgE)= allergy test to cats, dogs, dust mites and grass pollen

Question 19

management of rhinitis

Answer 19

allergen avoidance
- Symptomatic therapy e.g. antihistamines (cetirizine), topical steroids (beclomethasone), decongestants (pseudoephedrine), anticholinergics (ipratropium) and LTR blockers (montelukast) and analgesics (antibiotics if infective

Question 20

what are nasal polyps associated with?

Answer 20

non-allergic asthma

Question 21

management of nasal polyps

Answer 21

topical steroids

surgery

Question 22

causes of a blocked nose

Answer 22

cold
adenoid swelling
foreign body
mucopiosed (frontal sinus swelling)
maxillary sinus tumour (space to grow so late presentation)

Question 23

risks in a broken nose?

Answer 23

septal haematoma (blood fills under perichondrium)
if occurs on both sides it causes cartilage death of the nose
there is loss of nose shape and on palpation is boggy
check nasal airflow

Question 24

management of broken nose

Answer 24

review 5-7 days post-injury due to swelling and consider digital manipulation if <3 weeks old, otherwise rhinoplasty

Question 25

complications of a broken nose

Answer 25

epistaxis
CSF leak/ meningitis (CSF can get out so bugs can get in)
anosmia (cribriform plate fracture)
cartilage death in haematoma

Question 26

who needs to be told about obstructive sleep apnoea?

Answer 26

DVLA

Question 27

management of obstructive sleep apnoea

Answer 27

weight loss if BMI >28

CPAP