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ENT > Rhinology > Flashcards

Rhinology Flashcards

1
Q

What is rhinosinusitis?

A

inflammatory process involving the mucosa of the nose and sinuses

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2
Q

What are the 3 stages of rhinosinusisits?

A

acute = <4 weeks
sub acute = 4-12 weeks
chronic = >12 weeks

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3
Q

What are the factors contributing to chronic sinusitis?

A

bacterial infection
allergy
mucocilliary impairment
swelling of the mucosa

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4
Q

What are the clinical features of acute rhinosinusitis?

A 
acute viral URTI 
severe unilateral pain over infected sinus
malaise
pyrexia
nasal obstruction 
mucopurulent rhinorrhoea
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5
Q

What investigations can be carried out on a patient with suspected rhinosinusitis?

A

rarely required

plain sinus xrays can be used

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6
Q

What are the treatment options for rhinosinusitis?

A

simple analgesics
steam inhalation
decongestant
antibiotics in severe cases

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7
Q

When is surgical treatment an option for rhinosinusitis?

A

when medical treatment fials and if periorbital cellulitis, severe headaches, focal neurological signs and meningitis symptoms are seen then refer to ENT

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8
Q

What are the clinical features of chronic rhinosinusitis?

A

nasal obstruction
discoloured nasal discharge for more than 12 weeks
smell disturbance
intermittent frontal pain

diagnosis can be made from history

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9
Q

What are the clinical features of allergic rhinitis?

A

nasal obstruction
hyposmia
nasal irritation
sneezing

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10
Q

What are the treatment options for chronic sinusitis?

A

a course of broad spectrum antibiotics for 3 weeks
topical nasal steroids given for 2 weeks followed by steroid nasal spray
nasal douching
other coexisting pathologies should be treated - nasal polyps/allergic rhinitis, give steroid spray and antihistamines

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11
Q

When should surgical intervention be considered for chronic rhinosinusitits?

A

refer to ENT after 8 weeks of no improvement
nasoendoscopy
CT
FESS surgery can be performed to help drain the sinuses

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12
Q

What are the serious complications of infective sinusitis?

A

chronic sinusitis
peri-orbital cellulitis and orbital abscess
facial cellulitis
mucoceles

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13
Q

What are the serious intracranial complications of infective sinusitis?

A 
meningitis
cavernous sinus thrombosis 
brain abscess 
extradural abscess 
subdural abscess
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14
Q

What is laryngotracheobronchitis?

A

common infective condition affecting the larynx in children

characterized by oedema and vascular engorgement of airways particularly subepiglottis

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15
Q

What are important question to ask in a nasal history?

A 
Nasal obstruction 
Sneezing 
Rhinorrhoea 
Nasal discharge 
Post nasal drip
Anosmia
Facial pain
Epistaxis
Snoring/OSA
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16
Q

What do you have to look out for with a fractured nose?

A

Nasal examination for septal haematoma!

v important to spot

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17
Q

What is needed if a nasal FB is suspected ?

A

Unilateral bloody or foul smelling discharge

examination under GA may be needed

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18
Q

What are the symptoms of nasal perforation?

A

nasal obstruction
whistling
crusting
epitaxis

19
Q

What are the causes of septal perforation?

A

Trauma
Avascular Necrosis
Granulomatous inflammation
T cell lymphoma of nasal cavity

20
Q

What are the two types of allergic rhino sinusitis?

A

Perennial

Seasonal

21
Q

Which sinuses does rhino sinusitis effect the most?

A

Maxillary>Ethmoid>Frontal>Sphenoid

22
Q

How do nasal polps present?

A

Nasal obstruction
Anosmia
Ant rhinorrhoea

23
Q

What do nasal polyps look like on examination?

A

usually bilateral
in m,iddle meatus
grey/white and slightly translucent
soft and mobile

24
Q

What is a antrochoanal polyp?

A

benign solitary polyp originating from the maxillary antrum

seen in young men

obstructs posterior chonana and gives valve effect

surgical removal and avulsion needed

25
Q

What are the 3 types of benign neoplasms of the nose?

A

simple papillomas (viral warts)

Inverted papilloma

Juvenile angiofibroma

26
Q

What are the 5 types of malignant neoplasms of the nose?

A 
SCC
Adenocarcinoma 
Adenoid Cystic Carcinoma 
T Cell Lymphoma 
Nasopharyngeal Carcinoma
27
Q

How does a deviated nasal septum present?

A

chronic nasal blockage symptoms (blockage, headache, post nasal drip, epistaxis, obstructive sleep apnoea)

28
Q

How is a deviated septum managed?

A

Septoplasty

29
Q

What is OSA?

A

Obstructive sleep apnoea

30
Q

Define snoring

A

disruptive snoring without impact on sleep

31
Q

Define upper airway resistance syndrome

A

sleep disturbance and daytime sleepiness

32
Q

Define sleep apnoea hypopnoae syndrome

A

repeated collapse of airway during sleep, associated de sats

mild = 5-14 events per hour
moderate = 15-30 
severe = >30
33
Q

What are the RFs for obstructive sleep apnoea?

A 
Age
Obestiy 
Facial abnormalities 
Adenotonsilar hypertrophy
smoking 
alcohol
neuromuscular disease
34
Q

What are the consequences of OSA?

A

sleepiness
decreased cognition
systemic HTN
GORD

35
Q

What is the treatment for OSA?

A 
CPAP
Lifestyle changes
Conservative - nasal splints/elastic tapes/jaw advancement 
medication to reduce the amount of REM  
Adenotonsillectomy 
Polpectomy 
Septoplasty
36
Q

What are adenoids?

A

collection of lymphoid tissues at eh back of the post nasal space on the posterior wall of the nasopharynx

they gradually increase in size from birth up to 6 and are gone by 12

37
Q

What happens if adenoids block the posterior choanae?

A

nasal voice
mouth breathing which interfere with breathing
runny nose
can cause OSAS

38
Q

What other difficulties can adenoids cause?

A

Eustachian tube blockage –> glue ear pr repeated AOM attacks

snoring/sleep apnoea

39
Q

What are local cause of epistaxis?

A

idiopathic
trauma
infection
tumours

40
Q

What are systemic causes of epistaxis?

A

HTN
anti-coagulation
coagulopathy
hereditary haemorrhage telangiectasia

41
Q

What is epistaxis?

A

Nose bleeds

42
Q

What is the first aid management of nose bleeds?

A

lean forward
pinch nose
avoid swallowing
apply icepack to nasal bridge

43
Q

How should nose bleeds be managed in GP or hosp?

A

Thidcum speculum to examine Littles area. If bleeding point is found, numb with lidocaine spray and cauterise with silver nitrate

44
Q

How should a nose bleed be managed in GP/hosp when the bleeding point cannot be seen?

A

If no bleeding point seen, pack nose with nasal pack for 24-48hrs. Usually prophylactic Abx also given. Many patients need to be admitted and lightly sedated for this.

ENT (6 decks)

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