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ENT > Rhinology - the nose / Epistaxis / Trauma > Flashcards

Rhinology - the nose / Epistaxis / Trauma Flashcards

1
Q

What does types of discharge suggest

A

Watery = allergic rhnitis

Green / pus = rhino sinusitis

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2
Q

How can you examine the nose

A

Rhinoscope
Otoscope in children
Flexible endoscopy

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3
Q

What bloods can be done when investigating nasal issues

A

FBC, ESR
ANCA
Serum ace
RAST

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4
Q

What is CT used for

A

Gold standard nasal surgery
Chonal atresia
Rarely diagnostic

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5
Q

Are X-ray’s useful

A

Not in viewing sinuses

May show adenoidal hypertrophy

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6
Q

What do you biopsy

A

Unilateral single polyp to rule out malignancy

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7
Q

What is Rhinitis and what causes non-allergic

A

Inflammation of lining of nose
Can be allergic vs non-allergic
Normal to have 8 a year
Children more prone

Non-allergic

  • Irritant
  • Gustatory - spicy food
  • Rebound nasal congestion due to prolonged topical decongestant
  • Infection
  • Sarcoid / macroscopic vasculitis
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8
Q

What are symptoms of non-allergic rhinitis

A 
Blocked nose / congestion 
Anosmia as blocked 
Runny nose
Sneezing
Itch 
Post nasal drip 
May have pain
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9
Q

What is important to ask

A

Any risk of FB
Feeding - breast or bottle
Snoring
QOL

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10
Q

How do you examine and manage

A

Otoscope
Look for foreign body
Can do allergy testing to exclude allergic

Management
Avoid trigger e.g. smoking
Intra-nasal steroid
Ipatroopium / Decongestant = short term only

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11
Q

What are causes of nasal obstruction

A 
Rhinitis 
Foreign body
Adenoidal hypertrophy
Nasal polyps
Rhinosinusitis
Choanal atresia
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12
Q

How do you RX

A

Decongestations
Nasal hygiene - saline spray
Nasal steroid sprray - reduce obstruction
Anti-histamine
Surgery - reduce turbinate / adenoidectomy
Correct choanal atresia

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13
Q

If adenoidal hypertrophy what do you check for

A

OSA

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14
Q

How does foreign body present

A

Unilateral nasal discharge

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15
Q

What does it need

A 
EUA
Battery = emergency as corrodes
Posterive pressure through mouth
Forceps
Removal under GA and refer ENT
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16
Q

What is choanal atresia

A

Membrane in nose persists resulting in blockage

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17
Q

How does it present

A

Recurrent infection
Obstruction if both blocked
Sinus issues

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18
Q

How do you Rx

A

Surgery if both blocked

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19
Q

What causes nasal polyps

A 
Unknown
Chronic inflammation
Infectious sinusitis
Rhinosinusitis
CF
Churg Strauss / Kartagener syndrome
Autonomic dysfunction
Genetic predisposition
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20
Q

What can polyps be

A

Allergic vs non-allergic

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21
Q

What allergic conditions are polyps associated with

A

Asthma = strong association
Allergic rhinitis = small
Aspirin intolerance
Alcohol intolerance

Santer’s triad

  • Asthma
  • Atopy
  • Aspirin allergy
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22
Q

What is rare association in children

A

Angiofibroma

- Refer if polyp <10 as unlikely

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23
Q

What are the features of polyps

A 
Nasal obstruction
Rhinorrhoea
Sneezing 
Poor sense of taste and smell
Associated eosinophilia 
Post-nasal drip
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24
Q

What requires further investigation urgently

A

If unilateral or bleeding

Sign of nasopharyngeal cancer - SCC

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25
Q

How do you investigate

A 
Refer ENT routine 
Sweat test CF
RAST / skin test 
Nasal smear
Coronal CT
MRI
Naso-endoscopy
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26
Q

What does nasal smear show

A

Eosinophils suggest allergic

Neutrophils suggest chronic sinusitis

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27
Q

When is coronal CT useful

A

CF patient

Can’t see sinus as filled with mucous and polyps

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28
Q

How do you Rx

A

Refer ENT for full examination routinely
Oral and nasal steroids to shrink
Immunotherapy
Surgery - endoscopic sinus or polypectomy

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29
Q

What epithelium lines the nose

A

Respiratory ciliated columnar epithelium with goblet cells

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30
Q

Function of nose

A 
Airway in respiration = primary 
Warm inspired air 
Humidification
Filtration of large matter
Mucous production 
Cilary clearance
Immune protection
Olfaction
Drainage of middle ear via Eustacian tube 
Drainage of sinuses and nasolacrimal duct
Voice modification
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31
Q

What are sinuses and role

A 
Ethmoid and maxillary develop at 4 months 
Air cavity in nasal bones
Decrease weight of skull
Help vocal resonance
Buffer for trauma
32
Q

What is external nose made up of

A

1/3 bone
- Nasal bone
- Frontal process of maxilla
2/3 cartilage

33
Q

What causes deformity

A

Congenital

Trauma= most common

34
Q

When can turbinates block nasal passage

A

Infection or inflammation i.e. allergic rhinitis

35
Q

How do you deal

A

Topical steroid spray

Turbinate reduction

36
Q

What is anterior nasal supply

A

Branch of ICA

Opthalmic - anterior / posterior ethmoid

37
Q

Where does blood supply enter

A

Naval cavity at cribriform plate

38
Q

What is posterior nasal supply

A

Branch of ECA
Splenopalantine
All anastomose at front of nose

39
Q

Where do most nose bleeds come from an causes

A

Little area’s at front of nose
- Where anterior ethmoid, facial and splenopalatine anatomise

Splenopalantine = idioapthic
Anterior ethmoid = trauma

40
Q

What is visible

A

Anterior bleeds

Usually easier to treat

41
Q

Who are posterior bleeds more common in

42
Q

What are they at higher risk of

A

Aspiration and airway compromise

43
Q

What should you ask in Hx of nose bleed

A 
When did it begin 
How much blood 
If unilateral or bilateral 
If it coming out of nose only or trickling down back (posterior bleed) 
Frequency 
Drug use if septum looks atrophied
Comorbid - HTN / cardiac disease 
Trauma? 
Any anti-coagulant ?
RF - smoker / occupation
44
Q

What is uni

A

More likely malignancy

45
Q

What are causes of nose bleeds

A 
Idiopathic = most 
Trauma - nose picking / blowing / FB 
Infection - Rhinitis / sinusitis 
Allergy
Iatrogenic - surgery
Drugs - anti-coagulant / cocaine 
Haematological abnormality
Malignancy
HTN 
Jevenile Angiofibroma 
Vasculitits 
HHT in elderly
46
Q

What haematological

A

Thrombocytopenia / ITP
Leukaemia
Haemophilia

47
Q

What will make nose bleeds more difficult to manage

A

Anti-coag

HTN

48
Q

What is HHT

A

Haemorrhagic hereditary telangiectasia

AV malformation so patient’s tend to bleed and don’t respond to Rx

49
Q

How does it present

A

Regular nose bleed
Visible red spots over body
Anaemia
From childhood

50
Q

How do you Rx

A

Laser coagulation
Iron if anaemic
Septodermoplasty or Young’s

51
Q

What is an angiofibroma

A

Rare benign vascular tumour that only affects men

52
Q

How does it present

A

Nasal obstruction
Epistaxis
Headache and facial swelling

53
Q

What do you never do

A

Biopsy as highly vascular

54
Q

How do you Rx

A

Pre-op embolisation

Surgery

55
Q

When do you admit to ED

A

If unstable
If unknown source
If posterior source
If nasal packing

56
Q

How do you manage unstable

A 
ABCDE 
See in resus room if active bleeding
First aid - head forward and squeeze top of nose for 15 minutes
Manage as per ATLS
Give O2 
Suction any visible clot 
IV access + bloods
IV fluid 
Nasal packing
57
Q

What do you do if stable

A 
ABCDE 
History 
Examination - rhinoscopy to look inside the nose 
Medication Hx
First aid
58
Q

What can you do for recurrent

A

Ax ointment - najsoseptin / bactroban to reduce crusting or vaseline
Chemical nasal cautery if can see bleeding point

59
Q

If bleeding does not stop after 10-15 minutes what do you do

A

Cautery with silver nitrate or diathermy
Nasal packing if can’t do cautery
Surgical ablation

60
Q

Complications of packing

A

Septal perforation

61
Q

What are complications of epistaxis

A

Aspiration
Airway compromise
Infection into cranial cavity due to drainage of veins into sinus of brain
Septal haematoma which can lead to necrosis

62
Q

Nerve innervation

A

Olfactory nerves which travel through cribriform plate

63
Q

What can cause dysfunction

A

Rhinosinusitis
Post viral anosmia
Trauma

64
Q

Do you X-ray broken nose

65
Q

What must you exclude in nasal trauma

A

Significant head or C-spine injury

66
Q

Most common cause of nasal fracture

67
Q

How does it present

A

Defomrity

Black eye + bruising

68
Q

What should you always look for and how does it present

A

Septal hameatoma

  • Boggy swelling
  • Usually bilateral
  • Obstruction
  • Pain
  • Poor breathing
69
Q

How do you treat haematoma

A

Iv Ax and drainage

70
Q

What causes septal perforation

A 
Septal surgery = most common
Too much packing 
Trauma - FB / nose picking 
Septal haematoma as necrosis 
Inhalation - steroid / Spray / cocaine 
Infection 
Churg Strauss 
Malignant
71
Q

How do you tret

A

Irrigation

Surgical closure

72
Q

Complication of nasal trauma

A 
Haematoma
Leakage of CSF if meninges perforated 
Meningitis
Brain abscess
Olfactory nerve damage
73
Q

When would you send nasal fracture home

A

No epistaxis
No haematoma
No deformity
No obstruction

74
Q

When do you refer ENT

A

5-7 days after swelling down for discussion of Rx

75
Q

What Rx for fracture

A

Usually 6-12 months after injury as elective
Septalplasty
Rhinplasty

76
Q

Why is FB dangerous in the nose

A

Can inhale and block airway

ENT (14 decks)

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