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2 ENT > The Stuffy Nose > Flashcards

The Stuffy Nose Flashcards

1
Q

what are the two mediators of inflammation released by mast cells

A

histamine (causes blocked noses by causing vasodilation of vessels)

leukotrienes (attract other inflammatory cells)

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2
Q

what drugs are used to treat allergy related stuffy nose

A

topical corticosteroids (beclomethasone)
anti-histamines -cetirizine
decongestants - pseudoephedrine
anticholinergics - ipratropium (relaxes muscles in airway)

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3
Q

what key symptoms should you ask about with a stuffy nose

A

blockage
loss of smell
discharge
facial pain

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4
Q

what is unilateral clear discharge from the nose suggestive of

A

CFS leak

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5
Q

what are some symptoms of allergy related stuffy nose

A

sneezing
itching
crusting
epitaxis

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6
Q

what are some secondary symptoms caused by nasal problems

A

dry mouth
sore throat (can be caused by breathing through mouth all night)
snoring
halitosis (from dry mouth leading to bacterial growth)
loss of taste (from dry mouth)

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7
Q

key things to do in a nasal exam

A

check airway potency
(by covering 1 nostril at a time of looking for vapour spots on mirror)
check external nose (alignment)
rhinoscopy (look inside nose)

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8
Q

what is rhinitis

A

inflammation of the nose

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9
Q

what are infective causes of rhinitis

A

viral URTI

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10
Q

What are non-infective causes of rhinitis

A

allergic

non-allergic

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11
Q

what is the classification for intermittent rhinitis

A

symptoms <4 days per week

symptoms <4 week duration

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12
Q

what is the classification for persistent rhinitis

A

symptoms >4 days per week

symptoms >4 week duration

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13
Q

causes of intermittent allergic rhinitis

A 
grass pollen (summer) 
tree pollen (spring) 
fungal spores (autumn)
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14
Q

what are causes of persistent allergic rhinitis

A

house dust mites
cat
dog

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15
Q

classification of mild rhinitis

A

normal sleep
no impairment of daily activities
normal work and school
no troublesome symptoms

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16
Q

classification of moderate-severe rhinitis

A

one or more or:

abnormal sleep
impairment of daily activities
missing work or school
troublesome symptoms

17
Q

what is step 1 of allergic rhinitis management

A

allergen avoidance

antihistamine

18
Q

what is step 2 of allergic rhinitis management

A

allergen avoidance

topical steroids

19
Q

what is step 3 of allergic rhinitis management

A

allergen avoidance
topical steroids
antihistamines

20
Q

when do you give immunotherapy

A

for selected patents with severe IgE related disease

21
Q

when is the best time to start treatment for allergic rhinitis

A

before the month they get problems

22
Q

what are nasal polyps

A

growths within the nose with have a high association with non-allergic asthma AND adult onset asthma

23
Q

how do you treat nasal polyps

A

oral then topical steroids

if no improvement - surgery

24
Q

how do polyps cause a stuffy nose

A

grow to fill the whole nasal cavity

25
Q

how to differentiate between a polyp and a turbinate

A

polyps have no sensation but turbinates do

26
Q

signs of acute infective rhino sinusitis

A

facial pain
discharge
nasal blockage

27
Q

most common cause of infective rhino sinusitis and treatments

A

98% are viral

analgesics and decongestants
if persisting/worsening add antibiotic

28
Q

what investigations would you do if allergy is suspected

A

skin prick tests
RAST (IgE level check)
Screening tests for different allergens

29
Q

what allergens would you screen for in suspected allergic rhinitis

A

cat
dog
dust mites
grass pollen

30
Q

what is the management for non-infective (allergic/drug related) rhinitis

A 
allergen/ irritant avoidance 
House dust mite specific IgE 
Change drug therapy 
decrease alcohol 
topical steroid +/- antihistamine 
topical anticholinergic
31
Q

management for infective rhinitis

A

nasal decongestant
analgesia
broad spectrum antibiotic

32
Q

steps for nasal trauma

A

check airways and deal with immediate issues

send home for week

then reassess and decide if surgery is needed (needs to be done <3 weeks after injury)

33
Q

what is a septal haematoma

A

blood in the septum underneath the lining (perichondrium)

34
Q

management of septal haematoma

A

drain it out and suture the perichondrium back together

35
Q

how should you suspect in a child with unilateral nasal discharge

A

foreign body in the nose

refer urgently

36
Q

what would you suspect in an adult with unilateral nasal discharge

A

nasal or paranasal tumour

refer urgently

37
Q

what is an important complication of acute sinusitis

A

orbital cellulitis

emergency referral needed

2 ENT (15 decks)

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