Rhinology

Question 1

How might patient present to Rhinology ?

Answer 1

Nasal obstruction 
Nasal discharge
Facial pain
Epistaxis 
Loss of smell 
Sneezing 
Nasal deformity

Question 2

What imaging technique can be used to look inside the nose ?

Answer 2

Nasal endoscopy

Question 3

Which blood tests are done ?

Answer 3

FBC, RAST, ACE, ANCA

Question 4

Which other imaging techniques are used to image the nose ?

Answer 4

CT/MRI

Question 5

What is rhinomanometry ?

Answer 5

A technique used to measure the pressure within the nasal cavity

Question 6

What other tests can be done to detect allergies ?

Answer 6

Skin tests and RAST blood test

Question 7

What is the treatment for nasal polyps ?

Answer 7

Oral/nasal steroids and immunotherapy
Polypectomy
Endoscopic sinus surgery and microdebridement

Question 8

Deine Hallitosis

Answer 8

Bad breath

Question 9

Define acute sinusitis

Answer 9

< 12 weeks duration and symptoms resolve completely

Question 10

Define recurrent acute sinusitis

Answer 10

> 1 to <4 episodes per year, symptom free period >8 weeks between attacks

Question 11

Define chronic sinusitis

Answer 11

> 12 week duration no symptom free periods. Inflammatory changes seen after 4 weeks after starting therapy

Question 12

Which bacteria usually cause sinusitis ? (2)

Answer 12

H. influenza and S.pneumoniae

Question 13

Which antibiotic is used to treat S.pneumoniae ?

Answer 13

Penicillin

Question 14

Which antibiotic is used to treat H.influenza ?

Answer 14

Clarithromycin

Question 15

How is sinusitis managed ?

Answer 15

Steroidal nasal spray 
Saline solution 
Antihistmines
Analgesics 
Steam therapy

Question 16

What are the most common causes of epistaxis ?

Answer 16

Trauma
Idiopathic
Drug induced

Question 17

How is epistaxis managed ?

Answer 17

ABC
IV fluids
Blood transufsion
Endoscopy

Question 18

What is done if bleeding cannot be controlled from nose ?

Answer 18

Packing

Endoscopic ligation

Question 19

What is Hereditary haemorrhagic telangiectasia (HHT) ?

Answer 19

Its a genetic disorder in which people have blood vessels which haven’t developed properly and cause bleeding, known as arteriovenous malformations (AVMs).

Question 20

How is HHT treated ?

Answer 20

Laser coagulation
Iron supplements
Septodermoplasty - skin graft
Young’s procedure - flap closure

Question 21

What is an angiofibroma ?

Answer 21

A vascular neoplasm of the nasopharynx that can cause obstruction and bleeding

Question 22

How is angiofibroma treated ?

Answer 22

Surgery and preoperative embolisation

Question 23

If there is hearing loss and epistaxis what do you need to think ?

Answer 23

Cancer

Question 24

Define allergy

Answer 24

An immune system response to a foreign substance that not typically harmful to the body

Question 25

What are the risk factors for allergies ?

Answer 25

``` Genetic Age Race Enviromental factors - Childhood infections, exposure to allergens and pollution. Dietary changes Occupational exposure - Flour and latex ```

Question 26

How does allergy in the skin present ?

Answer 26

As a rash (urticaria) and angio-oedema

Question 27

How does allergy in the URT present ?

Answer 27

Rhinitis

Question 28

How does allergy in the LRT present ?

Answer 28

Asthma

Question 29

How does allergy present systemically ?

Answer 29

Anaphylaxis

Question 30

Define allergen

Answer 30

An antigen that causes an allergic reaction

Question 31

What type of hypersensitivity reaction is allergy ?

Answer 31

Type 1

Question 32

What antibody is produced ?

Answer 32

IgE

Question 33

What does IgE do ?

Answer 33

Binds to mast cells when it detects antigen and causes them to release histamines, leukotrienes and prostaglandins

Question 34

What happens acutely when histamines and other inflammatory mediators are released ?

Answer 34

Vascular dilation and permeability Smooth muscle contrasts WBC infiltrate

Question 35

What happens after a few hours when histamines and other inflammatory mediators are released ?

Answer 35

Macrophages and neutrophils migrate to the area

Question 36

How is allergic rhinitis classified ?

Answer 36

ARIA Mild - No impairment on daily activities, no sleep disturbance Moderate/Severe - Sleep disturbance and troublesome symptoms, impairment of daily activities

Question 37

What is intermittent defined as ?

Answer 37

<4 days per weeks for < 4 consecutive weeks

Question 38

What is persistent defined as

Answer 38

>4 days per week and > 4 consecutive weeks

Question 39

What is found on skin tests in those with allergic rhinitis ?

Answer 39

High IgE NPV

Question 40

What other tests can be done to test for allergies ?

Answer 40

Nasal allergen challenge Nasal cytology Total serum IgE