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ENT > Rhinology > Flashcards

Rhinology Flashcards

1
Q

What occupations are at risk of nasal disorders? [1]

A

Woodworkers

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2
Q

What bloods are appropriate for nasal disorders? [5]

A
  • FBC
  • ESR
  • Radioallergosorbent blood Test (RAST)
  • ANCA (Anti-neutrophil cytoplasmic antibody) for vasculitis
  • ACE (angiotensin Converting Enzyme)
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3
Q

Why would you use an ACE test for nasal disorders? [2]

A

Rhinosinusitis could be related to TB [1] or Sarcoid [1] which would show up on an Angiotensin Converting Enzyme test.

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4
Q

What is the RAST test [2]

What is its clinical significance [1]

A

Radioallergosorbent Test [1]
It tests the blood for specific IgE levels. [1]
Can identify allergic rhinosinusitis [1]

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5
Q

Define Choanal Atresia? [3]

How does it present?

A

Congenital [1] blockage of the posterior nasal aperture [1] by either a membrane or bone. [1]

Bilateral; tends to show up in babies with trouble feeding. [1]
If unilateral may not show up till later [1]

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6
Q

Whats the relevance of aspirin sensitivity?

A

Related to lots of atopic disease such as aspirin sensitive asthma or rhinitis

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7
Q

An URTI infection can causes periorbital swelling, how would we handle this situation? [5]

A
  • Emergency ENT referral
  • Ophthalmology Opinion to assess colour vision, its the first to go when the optic nerve is damaged
  • Urgent CT to show up abscess
  • IV antibiotics and Steroids
  • Emergency Surgery
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8
Q

What is Pott’s puffy tumour?

Clinical features [4]

A 
Its a complication of sinusitis, basically a subperiosteal abscess. [1]
Sinusitis 
Fever
Frontal headache
Central forehead swelling
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9
Q

How do we treat Pott’s Puffy Tumor? [3]

A

Frontal Sinus Surgery or Endoscopic Sinus Surgery (ESS) followed by Abx

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10
Q

What is mucocele? [2]

Management [1]

A

A benign cyst lesion of a minor salivary gland [1] containing mucous [1] . Needs to be removed with endocopic sinus surgery

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11
Q

What would you see on sinusitis CT or MRI [2]

A
  • Sinus opacification
  • Or a visible air/fluid level
  • and/or mucosal thickening
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12
Q

What is rhino sinusitis? [1]

How do we classifiy rhinosinusitis? [3] Define each classification

A

Rhinosinusitis is inflammation in nose and paranasal sinuses.

Into Acute, Recurrent Acute, Chronic and Acute exacerbation of chronic.

Acute = <12 wks & Symptoms resolve completely

Recurrent Acute = 1-4 episodes a yr with completely recovery and 8wks symptom free between episodes.

Chronic = >12wks with persistant inflammatory changes on imaging for >4wks

Acute Exacerbations of Chronic: = Worsening or new symptoms with the acute ones resolving completely but not the chronic ones

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13
Q

What microorganisms cause rhinosinusitis? [3]

A

Strep Pneumonia -31%
Haemophilus Influenzae - 21%
Both - 5%

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14
Q

What symptoms come with rhinosinusitis?
Main symptoms [2]
Associated symptoms [4]

A

Main symptoms:

  • Nasal congestion
  • Nasal discharge

Also possible to get:

  • Facial pain/pressure
  • Hyposmia/Anosmia
  • Purulent postnasal drain
  • Cough
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15
Q

How would you treat rhinosinusitis? [4]

A
  • Topical CCS, nasal douching
  • B-lactams (e.g. penicillins or cephalosporins)
  • Macrolides (E.g. Erythromycin/Clarythromicin)

Or sinus surgery

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16
Q

Nasal polyps
Presenting features [6]
Histology [3]
Sites [3] and describe where an antrochoanal polyp can be found [1]

A

Presentation

  • watery anterior rhinorrhea
  • purulent postnasal drip
  • nasal obstruction, change in voice
  • smell/taste disturbance
  • sinusitis, headaches
  • mucocele

Ciliated columnar epithelium
Thickened basement membrane
Avascular edematous stroma

Sites:

  • Middle turbinates
  • Middle meatus
  • Ethmoids
  • Antrochoanal polyp - single maxillary polyp arising in maxillary antrum prolapsing to fill nasopharynx/
17
Q

What is churg-strauss [2]

A

An allergic (i.e. autoimmune) granulomatosis causing vasculitis [1] of people with a history of airway allergic hypersensitivity. [1]

18
Q 
Nasal polyps
Signs on examination [3]
Investigations [4]
Clinical significance of eosinophils vs neutrophils on nasal smear [2]
Association with [4]
A

Signs

  • Pale
  • Mobile
  • Insensitive to gentle palpation
  • Sweat test in case of CF
  • RAST/allergic skin tests for atopic disease
  • Coronal CT/MRI
  • Flexible or Rigid Nasoendoscopy

Can also do a nasal smear for eosinophils (allergic component) or neutrophils (chronic sinusitis)

Association with:

  • Rhinitis, sinusitis
  • CF
  • Aspirin hypersensitivity
  • Asthma
19
Q

How do we treat nasal polyps?
Complications of surgery [2]
Post-op advice [4]

A
  • 1% bethametasone 48h
  • Education on use of nasal sprays
  • Oral prednisolone for short term benefit 50mg/day for 2w
  • LTRA and continuous low dose clarithromycin
  • Surgery (either a nasal polypectomy or Functional Endoscopic Sinus Surgery - FEST)
    Complications: CSF leak, optic nerve damage
    Post-op advice
  • Don’t blow your nose until better
  • Watch for bleeding
  • Topical steroids
  • Saline douching to relieve crusting
20
Q

What causes Epistaxis? [7]

A
  • Infection, trauma, idiopathic
  • Allergic rhinitis, atrophic rhinitis
  • Vascular (Atherosclerosis/hypertension)
  • Blood dyscrasias
  • Tumor
  • Hereditary Hemorrhagic Telangiectasia
  • Septal perforation
21
Q

What could cause blood dyscrasias? [3]

A
  • Drugs
  • Disease
  • Alcoholism
22
Q

What is hereditary Hemorrhagic Telengiectasia? [2]

A

Autosomal Dominant [1] condition leading to abnormal blood vessel formation [1]
One manifestation is Epistaxis

23
Q

Management of epistaxis [4]
When to refer to ENT? [1]
Difference in management if anterior [2] vs posterior epistaxis [2]

A
  • Remember this is an ENT emergency
  • ABCDE
  • Silver cautery
  • Nasal Packs
  • Surgery

Refer to ENT when you cannot see the bleeding point or >10-15 minutes with continuous pressure

Anterior epistaxis - almost always septal in Little’s area, silver cautery is usually adequate
Posterior epistaxis require more invasive procedures - examination under anesthesia, endoscopic ligation of maxillary/sphenopalatine artery

24
Q

What types of nasal packs are there? [3]

Which one would you use first?

A
  • Ant Nasal Packs*
  • Post Nasal Pack
  • Ant/Post Pack, uses balloons
25
Q

What kind of surgery is there for epistaxis? [3]

A

Arterial Ligation

  • Sphenopalatine
  • Internal Maxillary
  • Ant/post ethmoids
  • ECA

Laser Ablation + Septodermoplasty

Embolisation (blocking abnormal vessels)

26
Q

How do we treat Hereditary Haemorrhagic Telangectasia? [3]

A
  • Laser Coagulation
  • Septodermoplasty
  • Young’s Procedure
27
Q

What is youngs procedure? [1]

A

Involves closing the nasal cavity with mucocutaneous flaps.

28
Q

How would a patient present with an angiofibroma? [3]
Epidemiology [1]
Should you biopsy such a tumor? [1]

A

Exclusively adolescent males

Profuse unilateral epistaxis.
Facial swelling
Nasal airway obstruction

Don’t Biopsy before excision as its a vascular tumor and theyll bleed.

29
Q

Management of angiofibroma [3]

A

CT to assess intracranial extension
Pre-op Embolisation of feeder blood vessels to reduce operative hemorrhage
Surgery

30
Q

Causes of nasal congestion
Child [5]
Adult [4]

A

Child:

  • Big adenoids
  • Choanal atresia
  • Rhinitis
  • Postnasal space tumor - angiofibroma
  • Foreign body

Adult:

  • Granuloma
  • Deflected nasal septum
  • Tricyclics
  • Topical vasoconstrictors
31
Q

Allergic rhinosinusitis
Type [2]
Cause [3]

A

Types: seasonal or perennial (dust mites)
Cause
- IgE mediated inflammation [1] from allergen exposure [1] to nasal mucosa causing inflammatory mediator release from mast cells [1]

32
Q

Allergic rhinosinusitis Rx [3]

Indication for immunotherapy and what type [2]

A

Antihistamines systemic
Systemic decongestants
Nasal spray - sodium cromoglicate or beclonase
Use LTRA when rhinitis coexists with asthma

33
Q

What should you watch out for when using decongestants [4]

A

Rhinitis medicamentosa [1] can occur from prolonged use of topical nasal decongestant substances [1]
Rebound vasodilation once stopped using pseudoephedrine [1]
Resulting in turbinate hypertrophy [1]

34
Q

Adenoids (anatomy) [3]

A

A collection of loosely arranged lymphoid tissue
Lies at the post nasal space, attached to posterior wall of nasopharynx
Size increases gradually from birth until 6yo when it will atrophy

35
Q

Adenoidal problems
Enlarged adenoids clinical features [4]
Infected adenoids [2]

A

Enlarged adenoids may cause:

  • nasal obstruction
  • nasal quality voice, mouth breathing
  • Runny nose as nasal secretions are not properly cleared
  • snoring

Infected adenoids

  • Anterior rhinnorrhea may become profuse and offensive
  • Otological sequelae due to ET dysfunction > glue ear

ENT (15 decks)

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