The nose

Question 1

What 3 arteries make up Kiesselbach’s area?

Answer 1

Anterior ethmoidal
Posterior ethmoidal
Sphenopalatine.

Question 2

What genetic syndrome is the inability to smell with low GnRH

Answer 2

Kallman’s

Question 3

Allergic rhinosinusitis mediated by what antibody?

Answer 3

IgE

Question 4

Management of rhinosinusitis?

Answer 4

1) Inhaled/steroids. (Avamys). Contains fluticasone.

2) Decongestants (pseudoephedrine). Only use short term tho as can cause rebound congestion and necrosis of the septum.

Question 5

Management of allergic rhinosinusitis?

Answer 5

1) antihistamines.
2) Steroids.
3) antihistamines + steroids.

Question 6

Rhinosinusitis presents with 2 of the following?

Answer 6

Nasal congestion 
Nasal discharge 
Nasal crusting 
Facial pain or fullness
Reduced sense of smell 
Sneezing, itch, fever, 

Nasal discharge can be ant or post with posterior being post nasal drip which causes bad tase.

Typically, facial pain is worse on leaning forward.

Question 7

Infective sinusitis?

Answer 7

Can occur 2* to viral infection or after surgery.

Question 8

Management of infective sinusitis?

Answer 8

Most will resolve within 2 weeks.

ABx should only be used if worsening symptoms after7 10 days.

Question 9

What ABx for infective sinusitis if not cleared up after 7 -10days?

Answer 9

1) Penicllin V

2) Doxycyline.

Question 10

Alarm symptom for nasal polyps?

Answer 10

Nasal polyps should always be BILATEAL = unilateral is worrying

Question 11

If a child less that 10 present with nasal polyps what should u consider?

Answer 11

Cystic fibrosis or malignancy.

Question 12

Presentation of nasal polyps?

Answer 12

Bilateral nasal congestion. 
Watery anterior rhinorrhoea. 
Purulent post nasal drip,.
Taste disturbance
Mouth breather and snoring 

Typically a woman in her 40s.m

Question 13

1st and 2nd line Rx of nasal polyps?

Answer 13

1) topical steroid +/- montelukast

2) Endoscopic polypectomy

Question 14

treatment algorith for nose bleed?

Answer 14

1) Cautery
2) Anterior nasal pack
3) Posterior nasal pack
4) Endoscopic ligation of sphenopalatine artery
5) Ligation of external carotid
6) Embolisation.

Question 15

How long do anterior nasal packs stay in for?

Answer 15

24 hours

Question 16

How long do posterior nasal packs stay in for?

Answer 16

48 hours.

Question 17

What is choanal atresia?

Answer 17

Congenital abnormality in which there is blockage of the posterior nasal cavity. If it is bilateral then it usually presents with difficulty breathing following birth.

Question 18

CSF rhinorrhoea (2 signs)

Answer 18

Assoc with trauma but also tumours.

Positive glucose

Question 19

What protein positive in CSF rhinorrhoea?

Answer 19

Positive B2 Tau protein.

Question 20

Nystagmus is observed in what type of pathology?

Answer 20

In vestibular pathologies.

Question 21

How do you differentiate BPPV from verterobasillar insufficiency?

Answer 21

Vertebrobasillar insufficiency has visual disturbance weakness and numbness too (impaired posterior circulation)

Question 22

What exercises can you teach a. Patient to do who has BPPV?

Answer 22

Brandt Daron exercises.

Question 23

What antibiotic can be Helpful for Menieres?

Answer 23

Intratympanic gentamicin.