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Year 4: Special Senses > Rhinology > Flashcards

Rhinology Flashcards

1
Q

Name some local causes of epistaxis.

A
  • Idiopathic – 85%
  • Traumatic
  • Iatrogenic
  • Foreign Body
  • Inflammatory: Rhinitis, Polyps
  • Neoplastic
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2
Q

Name some systemic causes of epistaxis.

A
  • Hypertension
  • Coagulopathies
  • Vasculopathies
  • Hereditary Haemorrhagic Telangiectasia/Osler-Weber-Rendu disease
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3
Q

Describe the first aid management of epistaxis.

A
  • Pinch soft part of nose
  • Head forward
  • Spit out (not swallow) any blood in mouth
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4
Q

Describe the conservative management of epistaxis.

A
  • Cautery: silver nitrate or bipolar diathermy
  • Nasal packing if cautery fails to control bleeding

NOTE: Topical adrenaline may help control bleeding before cautery

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5
Q

Describe the surgical management of epistaxis.

A

The following vessels can either
be ligated surgically or embolised radiologically:

  • Sphenopalatine
  • Anterior ethmoid (can not be embolised because comes from
    internal carotid artery)
  • External carotid (last resort)
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6
Q

Define rhinosinusitis.

A

Inflammation of the nose and the paranasal sinuses characterised by two or more symptoms, one of which should be:

  • Either nasal blockage/obstruction/congestion or nasal discharge
  • Facial pain/pressure
  • Reduction or loss of smell

AND

  • Endoscopic signs of Polyps, mucopurulent discharge, or oedema in middle
    meatus
  • CT changes- Mucosal changes within the osteomeatal complex, or sinuses.
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7
Q

What is acute rhinosinusitis?

A

Inflammation of the nose and the paranasal sinuses lasting <12 weeks.

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8
Q

How can acute rhinosinusitis be divided?

A

Viral (common cold) and non-viral

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9
Q

How can chronic rhinosinusitis be divided?

A

With or without nasal polyps

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10
Q

Name 2 causative organisms of viral ARS.

A

The common cold.

  1. Rhinovirus
  2. Influenza
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11
Q

Name 3 causative organisms of non-viral ARS.

A

Bacterial infections such as:

  1. Streptococcus pneumoniae
  2. Haemophilus influenzae
  3. Moraxella catarrhalis
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12
Q

How long does it take for viral ARS to resolve of symptoms?

A

5 days

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13
Q

How long does it take for non-viral ARS to resolve of symptoms?

A

Persist after 5 days

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14
Q

Describe how to manage patients with ARS.

A
  • Analgesia
  • Nasal decongestants
  • Topical nasal steroids
  • Oral antibiotics
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15
Q

Name some factors that predispose patients to CRS.

A
  • Allergy
  • Infections
  • Ciliary impairment: cystic fibrosis (present in 40% of patients)
  • Anatomical abnormalities: septal deviation and abnormal uncinate
  • Immunocompromised host
  • Aspirin hypersensitivity
  • Atmospheric irritants: smoking, dusts, fumes.
  • Hormonal: pregnancy and hypothyroidism
  • Trauma
  • Foreign body
  • Swimming and diving
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16
Q

Do nasal polyps require biopsy for histological diagnosis?

A

Not as long as there are no worrying signs from the history and examination

17
Q

Describe how you would investigate a patient with CRS.

A
  • Skin prick tests if allergy suspected

- CT Sinuses

18
Q

Describe how you would conservatively manage a patient with CRS.

A
  • Avoidance of possible allergens

- Nasal douching

19
Q

Describe how you would medically manage a patient with CRS.

A
  • Antihistamines
  • Topical nasal steroids
  • Oral steroids (1 week course) in severe cases
  • Oral antibiotics
20
Q

Describe how you would surgically manage a patient with CRS.

A
  • Nasal polypectomy: very high rate of recurrence
  • Functional Endoscopic Sinus Surgery to improve ventilation/drainage of
    sinuses
21
Q

What type of hypersensitivity reaction is allergic rhinitis?

A

IgE-mediated, type 1

22
Q

What percentage of the western population is affected by allergic rhinitis?

A

Approx 30%

23
Q

What atopic condition is associated with allergic rhinitis?

A

Asthma

24
Q

What is meant by perennial allergic rhinitis?

A

Sometimes with seasonal exacerbations

25
Q

Name some commonly reported allergens from patients with allergic rhinitis.

A
  • Pollens
  • Moulds
  • House dust mites
  • Animal epithelia.
26
Q

Describe the class-action system used by Allergic Rhinitis according to its Impact on Asthma (ARIA).

A

This is based on the duration, and severity of symptoms:

Duration:

  • Intermittent: symptoms < 4 days per week, and less than 4 weeks
  • Persistent: symptoms > 4 days per week, and more than 4 weeks

Severity:

  • Mild: normal daily activities, and sleep. No troublesome symptoms
  • Moderate to severe: Impairment of daily activities and sleep.
27
Q

Describe the pathophysiology behind allergic rhinitis.

A

Allergic reaction leads to synthesis and release of arachidonic acid metabolites (prostaglandin D & leukotrienes) and mast cell degranulation to release histamine.

The effect is to increase capillary permeability which leads to congestion, oedema, rhinorrhoea, sneezing and irritation.

28
Q

Describe how you would investigate a patient with allergic rhinitis.

A
  • Skin prick tests (SPT) for specific allergens

- RAST (adioallergosorbent) blood tests if SPT not possible

29
Q

Describe how you would conservatively manage a patient with allergic rhinitis.

A
  • Allergen avoidance

- Nasal douching

30
Q

Describe how you would medically manage a patient with allergic rhinitis.

A
  • Antihistamines

- Topical nasal steroids

Year 4: Special Senses (6 decks)

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