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Part 3 – PM3A > (PM3A) ENT - Nose > Flashcards

(PM3A) ENT - Nose Flashcards

1
Q

Where are hairs in the nose that help to filter particles?

A

Nasal vestibule

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2
Q

What are the 3 bones in the nasal cavity?

A

Turbinates

(1) Superior turbinates
(2) Middle turbinates
(3) Inferior turbinates

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3
Q

What are the components of the nasal-associated lymphoid tissue?

A

(1) Tonsils

(2) Nasopharynx

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4
Q

Where is the respiratory mucosa?

A

On the turbinates (3 bones) in the nasal cavity

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5
Q

What sinuses are there in the nose?

A

(1) Frontal sinus (two of these)

(2) Sphenoid sinus

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6
Q

What is the cribriform plate?

A

Between the olfactory mucosa + olfactory bulb in brain

Bone-like structure

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7
Q

What are some of the key roles of the nose?

A

(1) Breathing
(2) Air-conditioning
(3) Filtration + purification
(4) Sinus ventilation
(5) Nasal resistance
(6) Vocal resonance
(7) Olfaction - smell

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8
Q

What is the role of the nose in breathing?

A

Nose is primary way to breathe

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9
Q

What is the role of the nose in air-conditioning?

A

Nasal mucosa adjusts temperature + humidity

Before entering lungs

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10
Q

What is the role of the nose in filtration and purification?

A

Hairs filter + trap

Mucous captures smaller particles

Swallow particles in nasopharynx

Secretions (IgA) to kill microorganisms

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11
Q

What is the role of the nose in sinus ventilation?

A

Sinuses make mucous to moisturise the nose

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12
Q

What is the role of the nose in nasal resistance?

A

Maintain positive pressure for respiratory system

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13
Q

What is the role of the nose in vocal resonance?

A

Chamber helps to produce different sounds

m, n, ng

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14
Q

What is the role of the nose in olfaction?

A

Olfactory neuroepithelium

Olfactory nerves and bulbs control olfaction (smell)

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15
Q

What is olfaction?

A

Smell

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16
Q

How does smell work? What is the mechanism?

A

(1) Detection of odour by olfactory receptor neurons in the olfactory epithelium
(2) Transmits signal through cribriform plate to mitral cells in the olfactory bulb in the brain
(3) Olfactory receptor neurons are supported by sustentacular cells (SuC) in olfactory epithelium
(4) Stem cells in olfactory epithelium can replace sustentacular cells and olfactory receptor neuron cells

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17
Q

How can sense of smell be affected?

A

Damaged/ loss of:

(1) Olfactory receptor neurons
(2) Sustentacular cells
(3) Mitral cells

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18
Q

Which cells in the nasal cavity are affected by SARS-CoV-2?

A

Sustentacular cells

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19
Q

What is anosmia?

A

Lack of smell

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20
Q

What is a sustentacular cell?

A

Supportive cells in the olfactory epithelium

Support olfactory receptor neurons

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21
Q

What are some of the drug targets delivered through the nose?

A

(1) Innervation from PNS
(2) Adrenergic receptors - dilation of nose vessels
(3) mAchRs - secretions
(4) Glucocorticoid receptors - inflammation
(5) Histamine H1 receptors/ mast cells - allergy

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22
Q

What are some of the key drugs classes to act on the nose?

A

(1) Decongestants - sympathomimetic amines
(2) Decongestants - sodium chloride solution 0.9%
(3) Anti-inflammatory glucocorticoid - beclometasone
(4) Suppressors of inflammatory mediator release
(5) Anti-histamines
(6) Anti-cholinergic (parasympatholytic)

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23
Q

What are some of the conditions that affect the nose?

A

(1) Rhinitis - allergic/ non-allergic
(2) Polyps
(3) Bacterial sinusitis
(4) Nasal staphylococci
(5) Nasal congestion
(6) Rhinorrhea

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24
Q

What is nasal congestion?

A

Blockage of the nasal cavity

Can be caused by:

  • Rhinitis
  • Polyps
  • Infections (cold/ flu etc)
  • Sinusitis
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25
Q

What is rhinorrhea?

A

Runny nose - excessive production of watery nasal mucous secretions by nasal mucosa

Can be caused by:

  • Infections (cold/ flu etc)
  • Cold temperature
  • Rhinitis
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26
Q

What is allergic rhinitis?

A

Acute/ chronic inflammation of the nasal mucosa

Caused by allergens

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27
Q

How is inflammation caused in allergic rhinitis?

A

(1) IgE binds to allergens in the nasal cavity

(2) Leads to release of inflammatory mediators (histamine) from mast cells

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28
Q

What is non-allergic rhinitis?

A

Acute/ chronic inflammation of the nasal mucosa

NOT caused by allergens

Vasomotor rhinitis

29
Q

What is vasomotor rhinitis?

A

Acute/ chronic inflammation of the nasal mucosa

NOT caused by allergens

Non-allergic rhinitis

30
Q

What is infectious rhinitis?

A

Acute/ chronic inflammation of the nasal mucosa

Caused by infection

31
Q

What are some of the symptoms of rhinitis and rhinorrhea?

A

(1) Blocked nose
(2) Runny nose
(3) Post-nasal drip
(4) Sneezing

32
Q

What is the treatment for allergic rhinitis?

A

(1) Removal of allergen
(2) Oral anti-histamine
(3) Nasal decongestants
(4) Intranasal anti-inflammatory corticosteroid

33
Q

What is the treatment for non-allergic rhinitis?

A

Congestion - treated with sympathomimetic decongestants (ephedrine/ pseudoephedrine)

Rhinorrhea - iprattropium bromide spray (topical)

34
Q

What are the common anti-histamines used for treatment of allergic rhinitis?

A

(1) Cetirizine
(2) Loratidine
(3) Fexofenadine
(4) Acrivastine
(5) INTRANASAL - azelastine

35
Q

What are common treatments for nasal blockage/ polyps?

A

(1) INTRANASAL - anti-inflammatory corticosteroid

- e.g. beclometasone/ fluticasone/ mometasone

36
Q

What are the common treatments for sneezing/ nasal discharge?

A

(1) ORAL - anti-histamine

(2) INTRANASAL - corticosteroid
- e.g. fluticasone/ mometasone/ beclometasone

37
Q

How long is the onset of action of intranasal anti-histamines?

A

Within 15 minutes

38
Q

How long is the onset of action of oral non-sedating anti-histamines?

A

Within 1 hour

39
Q

How long is the onset of action of intranasal corticosteroids?

A

Within 12 hours

40
Q

What is the dosing frequency of intranasal anti-histamines?

A

BD-QDS

41
Q

What is the dosing frequency of oral non-sedating anti-histamines?

A

OD

42
Q

What is the dosing frequency of intranasal corticosteroids?

A

OD

43
Q

What drugs target nasal blood flow?

A

Sympathomimetic agents

(1) Ephedrine
(2) Pseudoephedrine
(3) Xylometazoline

44
Q

What drugs target anti-inflammatory mediators?

A

Corticosteroids

(1) Becometasone
(2) Fluticasone
(3) Mometasone

45
Q

What drugs target suppression of mediator release?

A

Cromolyn sodium

Omalizumab

46
Q

What drugs target the mediator receptor blockade?

A

(1) H1 Receptor antagonists
- e.g. azelastine

(2) Leukotriene antagonists
- e.g. montelukast

47
Q

What is the mechanism of action for the targeting of nasal blood flow by sympathomimetic agents?

A

Vasoconstriction

Limitation of histamine effects

48
Q

What is the mechanism of action for the targeting of anti-inflammatory processes by corticosteroids?

A

Suppression of inflammation as corticosteroids are anti-inflammatory steroids

49
Q

What is the mechanism of action for the targeting of suppression of mediator release by cromolyn sodium and omalizumab?

A

Inhibit histamine release

Monoclonal antibody (mAB) prevents IgE interaction

50
Q

What is the mechanism of action for the targeting of the mediator receptor blockade by H1 receptor antagonists?

A

Blocks vasodilation

51
Q

What is the mechanism of action for the targeting of the mediator receptor blockade by leukotriene antagonists?

A

Block inflammation

52
Q

Give some examples of sympathomimetics.

A

(1) Ephedrine
(2) Pseudoephedrine
(3) Xylometazoline hydrochloride

53
Q

What is the indirect mechanism of action of sympathomimetics?

A

(1) Sympathomimetic taken up via noradrenaline transporter in the neurone
(2) Taken into vesicles via vesicular monoamine transporter in exchange for noradrenaline
(3) Released noradrenaline acts on downstream cells by binding to adrenergic receptors

54
Q

What is the direct mechanism of action of sympathomimetics?

A

Sympathomimetics act directly on adrenergic receptors

55
Q

What are nasal polyps?

A

Non-cancerous growth

Soft growths

Inside the nose sinuses

56
Q

What is the cause of nasal polyps?

A

Linked with chronic inflammation

e.g. asthma, infections, etc

57
Q

What are some of the symptoms of nasal polyps?

A

(1) Nasal congestion
(2) Rhinorrhea
(3) Nasal drip
(4) Loss of smell/ taste
(5) Nosebleeds
(6) Snoring

58
Q

What is the treatment for nasal polyps?

A

(1) Corticosteroid nasal drops/ spray
- to reduce size

(2) Sodium chloride wash
(3) Oral steroids - short-term only
(4) Surgical removal to relieve symptoms

59
Q

What is sinusitis?

A

Inflammation of the nasal sinuses

60
Q

What are the causes of sinusitis?

A

Usually viral - e.g. rhinovirus

61
Q

Is sinusitis self-limiting?

A

Yes

2-3 weeks

62
Q

What are some of the symptoms of sinusitis?

A

(1) Blocked nose
(2) Impaired smell
(3) Sinus headache
(4) Green/ yellow mucous
(5) Runny nose
(6) High temperature (>38ºC)
(7) Facial pain
(8) Bad breath
(9) Toothache

63
Q

What is the treatment for sinusitis?

A

(1) Self-care - pain management

Only if symptoms have lasted for less than 10 days

64
Q

What is the treatment for sinusitis if the patient is systemically unwell?

A

(1) Immediate ABx
- phenoxymethylpenicillin 500mg QDS 5 days

(2) Referral to hospital

65
Q

What is the first line treatment for severe cases of sinusitis?

A

(1) Co-amoxiclav 500/125mg TDS 5 days

66
Q

What is the treatment for sinusitis in patients with symptoms for more than 10 days?

A

High dose intranasal corticosteroid

No ABx

Consider back-up prescription

67
Q

What is nasal staphylococci?

A

Carriage fo staphylococci in the nose

May require admission to hospital

68
Q

What is the treatment for nasal staphylococci?

A

(1) Chlorhexidine (broad-spectrum anti-septic) + neomycin (aminoglycoside ABx) cream QDS for 10 days

(2) Mupirocin
- Inhibits bacterial protein and RNA synthesis
- Nasal ointment to eradicate nasal carriage of MRSA
- 2% ointment BD-TDS for 5 days

Part 3 – PM3A (28 decks)

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