Rhinology Flashcards

1
Q

What is rhinosinusitis?

A

Defined as inflammation in the nose and paranasal sinuses with >/=2 symptoms, one of which must be nasal discharge or nasal congestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are features of rhinosinusitis?

A
  • Facial pain/pressure
  • Decreased olfaction
  • Rhinorrhoea
  • Nasal congestion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What would be classed as chronic rhinosinusitis?

A

Symptoms lasting >/= 12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are causes of nasal congestion in children?

A
  • Big adenoids
  • Rhinitis/rhinosinusitis
  • Choanal atresia
  • Postnasal space tumour
  • Foreign body
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are causes of nasal congestion in adults?

A
  • Deflected nasal septum
  • Granuloma
  • Tricyclic antidepressants
  • Topical vasoconstrictors/decongestants - rhinitis medicamentosa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the most comon cause of acute infective rhinitis?

A

Viral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How would you treat acute rhinosinusitis?

A
  • Topical corticosteroids - nasal sprays
  • Oral antibiotics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How would you treat chronic rhinosinusitis?

A
  • Topical steroids - nasal sprays
  • Nasal douching
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are red flag symptoms associated with nasal congestion?

A
  • Numbness
  • Tooth loss
  • Bleeding
  • Unilateral obstructing mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When assessing nasal congestion, what would you want to ask about it?

A
  • Symptom variation
  • Uni/Bilaterality
  • Affects speech, eating, smell, sleep
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When examining someone with nasal congestion, what would you look for?

A
  • Facial pain
  • Nasal polyps
  • Pus discharge from sinuses
  • Post-nasal space
  • Septal deviation/Nasal deflection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is allergic rhinosinusitis?

A

IgE-mediated inflammation from allergen exposure to nasal mucosa causing inflammatory mediator release from mast cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What substances are released by mast cells in allergic rhinosinusitis?

A

Histamines, prostaglandins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are symptoms of allergic rhinitsinusitis?

A
  • Sneezing
  • Pruritis
  • Rhinorrhoea (bilateral + variable)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are signs of allergic rhinosinusitis?

A
  • Swollen turbinates - pale mucosae
  • Nasal polys
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the following?

A

Nasal polyp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are typical allergens implicated in allergic rhinosinusitis?

A
  • Dust
  • Pollen
  • Moulds
  • Pets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What investigation(s) might you perform in someone presenting with features of allergic rhinosinusitis?

A

Skin prick test/RAST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How would you manage allergic rhinosinusitis?

A
  • Allergen avoidance
  • Antihistamines
  • Decongestants
  • Nasal steroids
  • Oral steroids - in severe attacks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is perrenial allergic rhinitis?

A

Allergic rhinitis which is caused by allergens which are present all year round

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is seasonal allergic rhinitis?

A

Caused by seasonal allergens e.g. pollen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

If nasal sprays were not working for someone diagnosed with allergic rhinitis, what could you consider using?

A

Montelukast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When allergic rhinitis co-exists with asthma, what would you consider giving as a part of your management?

A
  • Nasal steroids
  • Anti-leukotriene agent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the risk of allergic rhinitis in someone with asthma?

A

May trigger an asthma attack

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are causes of rhinorrhoea?

A
  • Allergies
  • Infection - bacteria, viruses
  • Foreign body
  • CSF
  • Primary ciliary dyskinesia
  • RA
  • Pregnancy
  • OCP
  • NSAIDs
  • Decongestant overuse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are nasal polyps?

A

Descriptive term for a pedunculated swelling arising in the nose or paranasal sinuses. They can develop in both benign and malignant conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Which type of polyp would cause more concern; unilateral or bilateral nasal polyps?

A

Unilateral - bilateral are more likely to occur in inflammatory conditions (e.g. infection etc.) whereas unilateral occur more commonly in malignancy

28
Q

What cranial structures can mimic polyps?

A
  • Meninges - meningocele
  • Brain tissue - encephalocele
29
Q

What are symptoms of nasal polyps?

A
  • Watery anterior rhinorrhoea
  • Purulent post-nasal drip
  • Nasal obstruction - Leads to mouth breathing
  • Change in voice
  • Anosmia/taste disturbance
  • Sinusitis
  • Headaches
  • Snoring
30
Q

What are nasal polyps associated with?

A
  • Allergic rhinitis
  • Non-Allergic rhinitis
  • CF
  • Aspirin hypersensitivity
  • ASthma
31
Q

What are signs of nasal polyposis?

A

Turbinates often mistaken for polyps!!! Don’t do this

  • Pale, mobile and insensitive to gentle palpation
  • May appear translucent
32
Q

What might childhood nasal polyposis point to as a cause?

A

Cystic Fibrosis

33
Q

How would you manage nasal polyps?

A

Mainstay - Steroids

Other:

  • Antihistamines
  • Nasal decongestants
  • Surgery - polypectomy
34
Q

What post-op advice would you give someone who had had a nasal polypectomy?

A
  • Don’t blow your nose
  • Watch for bleeding - abide epistaxis advice if bleeding
  • Topical steroids
  • Douched saline - relieve crusting
35
Q

What are the main symptoms assocaited with paranasal sinus disease?

A
  • Pain - maxillary, ethmoidal
  • Discharge - post nasal drip
  • Anosmia
  • Nasal obstruction/congestion
  • Systemic symptoms
36
Q

What would be your differential diagnosis for someone with symptoms like sinusitis?

A
  • Migraine
  • TMJ dysfunction
  • Neuralgias
  • Cervical spine disease
  • Temporal artertitis
  • Herpes zoster
37
Q

What can be complications of sinusitis?

A
  • Peri/Orbital cellulitis/abscess
  • Facial cellulitis
  • Osteomyelitis
  • Intracranial infection - meningitis, abscess, cavernous sinus thrombosis
  • Mucocele formation
38
Q

What tests might you do in someone with suspected sinusitis?

A

None usually needed, but may consider:

  • ESR, CRP
  • Endoscopy +CT
39
Q

Where do the frontal and maxillary sinuses drain into?

A

Middle meatus

40
Q

What is the pathophysiology of sinusitis?

A

Primary infection reduces ciliary function, causes oedema and increased nasal secretions. The stagnant secretions within the sinuses may become secondarily infected with strep or haemophilus

41
Q

How would you manage acute sinusitis?

A
  • Paracetamol
  • Decongestants
42
Q

What can be complications of acute frontal sinusitis?

A
  • Blindness with litte warning
  • Intracranial abscess
43
Q

How would you manage chronic sinusitis?

A
  • Antibiotics
  • Smoking cessation
  • Surgery - functional endoscopic sinus surgery
    • Post op Steroid nasal spray
44
Q

What drains into the middle meatus of the nasal cavity?

A
  • Maxillary sinus
  • Anterior ethmoidal sinus
  • Middle Ethmoidal sinus
  • Frontal sinus
45
Q

What drains into the superior meatus of the nasal cavity?

A

Posterior ethmoidal sinus

46
Q

What drains into the inferior meatus of the nasal cavity?

A

Nasolacrimal duct

47
Q

Where does the sphenoid sinus drain?

A

Sphenoethmoidal recess

48
Q

What are causes of epistaxis?

A
  • Trauma - local/facial
  • Hypertension
  • Infection - local
  • Dycarias/haemophilia/DIC
  • Alcohol intake
  • Septal perforation
  • Neoplasm
  • Medications - anticoagulants/antiplatelets
49
Q

How is epistaxis divided in terms of location?

A

Anterior and posterior epistaxis

50
Q

What is the most common cause of an anterior nose bleed (in terms of location)?

A

Bleed from little’s area

51
Q

What is little’s area in the nose?

A

Where ethmoidal, sphenopalatine and facial arteries anastamose to form anterior anastamotic arcade

52
Q

How would you initially manage epistaxis?

A
  • ABCDE
  • First aid - ask patient to hold nares together (see image), patient sitting forward, spitting any blood into a bowl
  • Ephidrine drops - vasoconstrict nasal vessels
  • Identify bleeding spot - clots over area
53
Q

What would do if initial management of epistaxis didn’t work?

A

Anterior/Posterior nasal packing

54
Q

How long would you wait before removing nasal packing for a nose bleed?

A

24 hours

55
Q

If packing the nose of someone failed to stop epistaxis, what would you consider doing?

A

GET HELP

  • Continue repeated ABCDE
  • Bloods - FBC, U+E’s, Group and Save
  • Surgery - ligation/diathermy
56
Q

What would you want to advise a patient about post epistaxis care?

A
  • Don’t blow your nose
  • Avoid bending/lifting/straining on the toilet
  • Sneeze through mouth
  • No hot food or drink
  • Avoid alcohol/tobacco
  • Recurrence advise
57
Q

How would you manage a displaced nasal fracture?

A

Reduction and post-op splintage - within 2 weeks fracture

58
Q

What is the risk of a nasal fracture?

A

Septal haematoma - can necrose septum if left untreated

59
Q

What would you want to establish in someone who had a nasal fracture?

A
  • C-spine injury?
  • Significant head injury?
  • Facial injury/fracture?
  • Septal haematoma?
60
Q

What is the time limit for manipulation of a nasal fracture?

A

2 weeks

61
Q

What are features of anterior epistaxis?

A

Bleeding through anterior nasal apeture

62
Q

What are features of posterior epistaxis?

A
  • Blood stained pharynx
  • Haematemesis
  • Failure of anterior packing to control bleeding
63
Q

What is the most common site of bleeding in posterior nose bleed?

A

Lateral and posterior walls of nasal cavity - woodruff’s plexus

64
Q

What are local causes of epistaxis?

A
  • Nasal trauma - pciking
  • Foreign body
  • Dry nosa
  • Nasal septum defects
  • Infections
  • Tumours
  • Vascular malformations
65
Q

What are systemic causes of nose bleed?

A
  • Bleeding disorders - Anticoagulant, Severe thrombocytopaenia, Haemophilia
  • Hypertension