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ENT > Rhinology > Flashcards

Rhinology Flashcards

1
Q

What is the function of the nose

A

smell
respiration
warms/humidifiesthe air we breathe
olfaction = 85% of taste

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2
Q

What are the regions of the nose

A 
External 
Nasal Vestibule 
septum 
lateral nasal walls 
nasopharynx
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3
Q

What is the upper 1/3 of the external nose made of

A

bone, the rest is cartilage

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4
Q

what is the nasal vestibule

A

nasal entrance

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5
Q

whats nasal hair called

A

vibrissae

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6
Q

what is the narrowest part of the nasal cavity

A

the nasal valve

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7
Q

what is the most common area for nose bleeds

A

littles area - anterior part of the nasal septum

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8
Q

what is choanal atresia

A

a thin membrane blocks the choanae (opening of nostrils)

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9
Q

why is choanal atresia an issue in children

A

children are obligate nasal breathers meaning death may quickly follow if an oral airway is not given

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10
Q

what is rhinosinusistis

A

inflammation of nasal mucosa and sinuses

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11
Q

what is acute vs subacute vs chronic

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

what are the types of rhinosinusitis

A 
allergic
infective
non-allergic
occupational
hormonal (pregnancy)
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13
Q

what sinuses are most affected in acute rhinosinusitis

A

most to least

maxilary
ethmoid
frontal
sphenoid

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14
Q

what usually precipitates rhinosinusitis and why

A

post-URTI infection, because the increase in blood flow and fluid in the mucosa leads toa blockage of sinus drainage

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15
Q

what percentage of viral URTIs are complicated by a bacterial infection and why

A

2%, due to secretory stasis

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16
Q

what are common organisms that cause a secondary bacterial infection on a viral URTI

A

S.pneumoniae

H.influenzae

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17
Q

what are clinical features of a secondary bacterial infection on top of a viral URTI

A 
severe unilateral sinus pain 
pyrexia
malaise
nasal obstruction 
mucopurulent rhinorrhoea 
decreased smell
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18
Q

where is pain usually felt for each sinus

A 
maxillary = cheek/upper teeth 
frontal = above eye/supraorbital margin 
sphenoid = retroorbital pain/vertex of head 
dental = molar
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19
Q

what is shown on anterior rhinoscopy for acute bacterial sinusitis

A

inflamed nasal mucosa with mucopurulent secretions

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20
Q

what is the treatment for acute sinusitis

A

analgesia
decongestant - topical FOR 5 DAYS ONLY
steam inhalation

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21
Q

what is the treatment for acute maxillary aterial sinusitis

A

7-14 days penicillin/amoxicillin

cefuroxime/co-amoxiclav/doxycycline if there isresistance after 3-5 days

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22
Q

what is the next step for treatment of acute sinusitis if the initial treatment isnt working

A

sinus drain

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23
Q

what are signs and symptoms of acute sinusitis complications

A

periorbital cellulitis
severe headaches
focal neurology
S+S meningitis

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24
Q

what is the most common type of acute sinusitis

A

infective

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25
Q

what is the difference between acute sinusitis and chronic sinusitis in presentation

A

acute = pyrexia, rhinorrhea, malaise

chronic = post-nasal drip, decreased concetration ‘muzzy head’

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26
Q

what are common features of acute and chronic sinusitis

A 
hallitosis
facial pain
headache
anosmia
obstruction in nose
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27
Q

what is the 2nd most common type of rhinosinusitis

A

allergic

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28
Q

what kind of reaction is rhinosinusitis

A

IgE hypersensitivity

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29
Q

what are signs and symptoms of allergic rhinosinusitis

A

vascular congestion
odema
rhinorrhoea
irritation

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30
Q

what would you see on examination of allergic rhinosinusitis

A

damp/pale mucosa with swollen tubinates

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31
Q

whats the treatment of allergic rhinosinusitis

A

avoid allergens
antihistamine (PO/topical)
steroids (topically, not long term)
sodium cromogylcate spray

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32
Q

what is the function of sodium cromoglycate spray

A

stabilises mast cells

33
Q

what are some non-allergic, non-infective causes of rhinosinusitis

A

vasomotor rhinitis
rhinititis medica mentosa
atrophic rhinitis

34
Q

how do you diagnose and treat vasomotor rhinitis

A

diagnosis of exclusion after testing negative for infection/allergens

treatment is same as allergic rhinitis:

avoid allergens
antihistamine (PO/topical)
steroids (topically, not long term)
sodium cromogylcate spray

35
Q

what is rhinitis medica mentosa

A

acquired sensitivity of the nasal lining due to the increased use of topical nasal decongestants, causing tubinate hypertrophy and rebound vasodilation

36
Q

what is the treatment for rhinitis medica mentosa

A

cessation of decongestant
topical steroid
tubinate surgery is necessary

37
Q

what is atrophic rhinitis

A

abnormal nostril patency due to surgery (usually) loss of ciliary epithelium causing thick secretions which dry and form an unpleasant crust + odour

causes frequent bleeding

more common in developing countries

38
Q

what is the best treatment for atrophic rhinitis

A

close off affected nostril which is poorly tolerated by patients

39
Q

apart from surgery, what is another cause for atrophic rhinitis

A

pregnancy

40
Q

what are common causative organisms for chronic rhinosinusitis

A

S.aureus
coagulase negative staph aureus
anaerobic gram -ve bacteria

41
Q

what are the characteristics of a nasal polyp

A

pale
pendulous
opalescent (many points of shifting colour)
painless

42
Q

whats the treatment of chronic rhinosinusitis

A

3 weeks Antibiotics - PO + broad (co-amox, clindamycin, metronidazole, penicillin

2 months topical steroids - betamethosone 2 drops tds (can be extended)

nasal toileting

treat any co-existing pathology

43
Q

what is the threshold for referral to ENT with chronic rhinosinusitis

A

> 8 weeks of requiring treatment

44
Q

what is the last resort treatment for chronic rhinosinusitis if medical management fails

A

CT paranasal sinuses for surgery and perform functional endoscopic sinus surgery to clear sinus drainage

45
Q

what is a differential for chronic rhinosinusitis presentation and what is the difference

A

midfacial segment pain - tension headache for midsegment of face

has the facial pain/pressure of rhinosinusitis but no nose symptoms

46
Q

how do you treat midfacial segment pain

A

amitryptaline - 6 weeks to work, 6 months to treat

47
Q

what are some complications of chronic rhinosinusitis

A 
frontal sinusitis 
abscesses
facial cellulitis 
periorbital cellulitis 
mucoceles 
ccavernous sinus thrombosis
48
Q

what is the most important complication of chronic sinusitis to recognise and how do you recognise it

A

frontal sinusitis, because it is sight and life threatening

tenderness on forehead, especially on percussion
severe frontal headache
worse on bending over

49
Q

what is the most common abscess formed as a complication of chronic rhinosinusitis

A

frontal lobe abscess

50
Q

how do you treat facial cellulitis

A

high dose antibiotics - penicillins tend to work as causative is usually staph
sinus drainage

51
Q

what is a mucocele

A

late complication of acute sinusitis, sterile mucous occupying an obstructed sinus, over years the sinus expands due to mucous

52
Q

how do you treat a mucocele

A

surgical drainage

53
Q

what is the most common complication of chronic rhinosinusitis

A

orbital cellulitis

54
Q

whats the most common intracranial complication of chronic rhinosinusitis

A

meningitis

55
Q

what causes a perforated nasal septum

A

trauma
septoplasty complication
wegners granulomatosis

56
Q

what are signs and symptoms of a perforated nasal septum

A

crusting
bleeding
whistling

57
Q

how do you manage a perforated nasal septum

A

vaseline (1st line)
douching (1st line)
septal button insertion

58
Q

what causes deviated nasal septums

A

trauma at birth or in later life

59
Q

why is a deviated nasal septum a problem

A

disrupts the air flow

60
Q

how do you treat a deviated nasal septum

A

surgical correction

61
Q

whats an important thing to avoid when treating a deviated nasal septum

A

do not remove anterior/dorsal septum as it causes a cosmetic deformity

62
Q

what are important symptoms to note in a nose break

A

epistaxis
CSF leakage
obstruction
septal haemoatoma

63
Q

why are X-rays valuable for the patient in a nose break

A

may be needed for legal purposes

64
Q

what is the acute management of a nose break

A

if epistaxis present - sit forward + pinch+ spit blood out, for 10mins then try and cauterise with silver nitrate/pack if severe/resus if very severe blood loss

septal haemoatoma = drainage under GA with antibiotic prophylaxis

65
Q

when should a nose break be reviewed in clinic and why

A

5-7 days after the break, to allow the soft tissue swelling to go down

66
Q

what does a septal haematoma look like

A

bilateral fluctuant swelling of septum

67
Q

what is the ideal management for epistaxis

A

initially sit forward and pinch bridge of nose for 10 mins whilst spitting blood out

give ice pack for bridge

attempt to visualise bleed and if visible spray with 5% lidocaine/1:20,000 adrenaline and cauterise with silver nitrate

if bleed not visualised/is too severe for cautery pack the nose

68
Q

what is common advice on discharge for epistaxis

A 
no heavy lifting
no hot showers
no picking 
gentle nose blowing 
vaseline 
look out for vestibulitis (s.aureus)
69
Q

what is the blood supply of littles area/keissalbachs plexus

A

anterior ethmoid artery (opthalmic aa)
posterior ethmoidal artery (opthalmic aa)
sphenopalatine artery (terminal branch of maxillary artery)
palatine artery (maxillary aa)
palatine branch of superior labial artery (facial aa)

70
Q

what is the technique for cauterization of epistaxis

A

start a few mm away from the bleeding point and work in a circle to cauterize the feeding vessels before attempting the main point

never cauterise heavily actively bleeding vessels

71
Q

what is the difference between sleep apnoea and snoring

A

sleep apnoea is upper airways resistance causing cessation of breathing, sleep disruption and daytime sleepiness whereas snoring may be completely harmless

72
Q

what is the aetiology of sleep apnoea

A 
increased age 
M>F (2-5:1) 
obesity (70% in BMI >40) 
obstructed upper airway 
social habits (alcohol + smoking) 
FHx
Neuromuscular disease
chronic lung disease
73
Q

what is obstructive sleep apnoea

A

a subtype of sleep apnoea that causes desaturations leading to sleep interruptions

74
Q

what is an apnoeic episode

A

30+ episodes of cessation of breathing, 10+ seconds each occuring over 7 hours sleep

75
Q

what are signs and symptoms of obstructive sleep apnoea

A 
excessive daytime sleepiness
decreased conciousness
snoring
unrefreshing sleep
choking during sleep
witnesses apnoea 
restless sleep
irritability 
nocturia
decreased libido
76
Q

what are the main investigations for obstructive sleep apnoea

A

sleep studies

endoscopy

77
Q

what may obstructive sleep apnoea lead to long term

A

pulmonary hypertension
RV strain
Cor pulmonale

78
Q

whats the treatment for obstructive sleep apnoea

A

lifestyle (weight loss, decreased alcohol)
drugs to decreased REM sleep
CPAP machine
adenotonsillectomy
surgery for adults focused to area of obstruction

ENT (8 decks)

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