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H and N > Rhinology > Flashcards

Rhinology Flashcards

1
Q

Common presenting symptoms in rhinology cases (9)

A 
Nasal obstruction
Rhinorrhoea (nasal discharge)
Epistaxis
Facial pain
Post nasal drip - excess mucous drips down back of nose into nasopharynx (upper throat)
Nasal deformity
Anosmia - loss of smell
Hyposmia - impaired/reduced smell
Sneezing
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2
Q

Name some nasal examination techniques (2)

A

Auriscope

Nasal speculum - tool used to widen nostril to see into it more clearly

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3
Q

Investigations of rhinology cases

  • blood tests (4)
  • imaging (3)
  • other (2)
A

Rigid/flexible nasal endoscopy
Skin test - to test for allergy

Blood tests

  • FBC
  • RAST (radioallergosorbent test)
  • antineutrophil cytoplasmic antibodies (are autoantibodies)
  • ACE (angiotensin converting enzyme) test

Imaging

  • CT sinuses
  • MRI

Rhinomanometry

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4
Q

What does rhinomanometry measure

A

Nasal airway resistance and airflow, so measuring degree of nasal obstruction

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5
Q

Name some disorders of the nose (7)

A 
Nasal trauma, e.g. septal haematoma
Epistaxis
Rhinitis
Rhinosinusitis
Nasal polyps
Nasal tumour
Choanal atresia
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6
Q

Rhinosinusitis is just referred to as

A

Sinusitis

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7
Q

What is samter’s triad (consists of 3 things)

A

Chronic condition that consists of asthma, sinus inflammation with recurrent nasal polyps, and a sensitivity to aspirin and other NSAIDs

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8
Q

What is samter’s triad also referred to as

A

Aspirin exacerbated resp disease or aspirin sensitive asthma

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9
Q

Symptoms/signs of samter’s triad (7)

A 
Increased nasal congestion/stuffiness
Eye watering/redness
Cough, 
wheezing
chest tightness
Frontal headache
Sinus pain
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10
Q

Rhinosinusitis =

A

inflammation of the nasal cavity and the paranasal air sinuses

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11
Q

How long do symptoms last in acute rhinosinusitis

A

<12 weeks

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12
Q

Rhinosinusitis usually caused by bacteria or viruses + name some causative bacterial/viral organisms

A

Viruses - usually
- rhinoviruses

Bacteria

  • strep pneumoniae
  • H. influenza
  • staph. aureus
  • M. catarrhalis
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13
Q

Symptoms of rhinosinusitis (6)

A 
Rhinorrhoea
Nasal congestion/obstruction
Facial pain/pressure
Hyposmia/ anosmia
Post nasal drip
Cough
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14
Q

Define recurrent acute rhinosinusitis

A

> 1 but <4 episodes of acute rhinosinusitis per year

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15
Q

How long do symptoms last in chronic rhinosinusitis

A

> 12 weeks

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16
Q

Main radiological investigation of rhinosinusitis

A

CT sinuses

17
Q

Treatment of rhinosinusitis

A

If bacterial

  • b lactase (penicillins, cephalosporins)
  • macrolides (Erythromycin, clarithromycin) - better penetration of sinuses
18
Q

What antibiotics have better penetration of sinuses

A

MacROlides, e.g. erythromycin

19
Q

Complications of rhinosinusitis

A

Periorbital cellulitis
-needs oral or IV antibiotics

Pott’s puffy tumour (RARE)

20
Q

What is a pott’s puffy tumour + treatment (2)

A

RARE complication of frontal sinusitis
Not actually a tumour, is an abscess

Surgical drainage of abscess
Endoscopic sinus surgery - to explore and drain frontal sinus

21
Q

Treatment of a nasal fracture (2)

A

Digital manipulation - moving the bones back into placebo hand ASAP

Rhinoplasty - plastic surgery to reshape nose if left uncorrected for months

22
Q

Causes of nasal polyps (4)

A

Idiopathic
Chronic inflammation - asthma, recurring infection, allergies etc
Genetic predisposition
Autonomic nervous system dysfunction

23
Q

What are nasal polyps

A

prolapsed swellings of the mucosal lining of the paranasal air sinuses

24
Q

Name some allergic conditions associated with nasal polyps

A

Asthma

Allergic rhinitis

25
Q

Name some non- allergic conditions associated with nasal polyps

A

CF

Allergic fungal sinusitis

26
Q

Nasal polyps can be associated with sensitivity to what drug

A

Aspirin

27
Q

Investigations of nasal polyps (6)

A

RAST (Radioallergosorbent test)
Skin test
Nasal smear

CT of sinuses
Nasendoscopy

28
Q

If CF suspected in someone with nasal polyps, what test can you do

A

Sweat test

29
Q

Treatment of nasal polyps (4)

A

Oral/nasal steroids

Immunotherapy - can treat aspirin sensitivity by giving a bit of aspirin; increasing every day

Polypectomy

Endoscopic sinus surgery - microdebrider may be used to remove any polyps to enlarge sinuses

30
Q

What enhances the surgical effect of polypectomy (for nasal polyps)

A

Steroids

31
Q

What is a mucocele

A

Benign, mucous-containing lesion

32
Q

Mucoceles (benign, mucous-containing lesion ) can occur in the paranasal sinuses due to what things (3)

A

Obstruction of the ostium (opening) of a sinus due to inflammation, trauma, mass lesion

33
Q

Mucoceles commonly occur in what sinus

A

Frontal

34
Q

When sinus mucoceles cannot naturally drain through the nose. Instead, they grow and slowly invade adjacent tissues leading to what…

A

Orbital mucocele which can displace the eye

35
Q

Treatment of sinus mucoceles

A

Drainage and marsupialisation - cutting a slit into the abscess/cyst and suturing the edges of the slit to form a continuous surface from the exterior surface to the interior surface of the cyst or abscess so it remains open drains freely

36
Q

Causes of epistaxis (5)

A 
Idiopathic - commonest
Infection
Trauma
Allergy
Hereditary haemorrhage telangiectasia (HHT) - malformation of blood vessels
37
Q

Initial management of epistaxis (1) + further management (3)

A

Pinch soft part of nose

Cauterise artery - with silver nitrate
Nasal packing
Endoscopic sphenopalatine artery ligation/ ligation in general

38
Q

Treatment of hereditary haemorrhagic telangiectasia (HHT) (3)

A

Laser coagulation
Septodermoplasty - graft stratified squamous epithelium and dermis to replace the mucous membrane of the nasal septum
Young’s procedure (closure of nostrils)

39
Q

What is the young’s procedure

A

Closure of nostrils - used in HEREDITARY HAEMORRHAGIC TELANGIECTASIA

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