Trans 54 and 55 Paranasal and Nose

Question 1

in the nose, Upper 1/3 consists of bones which are (3)

while lower 1/3 is composed of?

Answer 1

 2 nasal bones
 Frontal process of maxilla
 Nasal notch of frontal bone

Cartilage

Question 2

lower lateral cartilage + nasal septal cartilage =

Answer 2

ALA

Question 3

superior and middle turbinates are part of _________ bone

 inferior turbinate is __________ bone

Answer 3

Ethmoid bone;

separate bone

Question 4

lining epithelium of Upper 1/3 of the nasal cavity?

Answer 4

• Upper 1/3 – olfactory epithelium
 Specialized sensory epithelium. Same epithelium with respiratory but without goblet cells. It starts from the superior turbinate.

Question 5

lining epithelium of lower 2/3 of nasal cavity

Answer 5

Lower 2/3 pseudostratified columnar ciliated epithelium

 With goblet cells also with respiratory epithelium

Question 6

lining epithelium of the vestibule

Answer 6

Vestibule – stratified squamous keratinizing epithelium

Question 7

lining epithelium of the sinuses?

Answer 7

cuboidal ciliated

Question 8

located at the antero-inferior part of the septum which is a confluence of arteries.

Answer 8

Kiesselbach’s plexus or Little’s area

Question 9

 No opening
• Usually located at the bony-cartilaginous junction of the nasal dorsum
• Contain all elements of skin: hair, sweat glands, sebaceous glands, connective tissue
• Non-compressible, non-pulsatile
• Diagnosis:
o CT Scan
• Treatment:
o Surgical excision

Answer 9

NASAL DERMOID CYST

Question 10

• Connected to the CNS
• Frequently associated with other midline fusion defects (cleft lip, cleft palate)
• Extracranial herniation of meninges and brain
• Bluish, compressible, pulsatile
(+) Furstenberg’s sign
Diagnosis:
o CT Scan “for confirmation – connection with the brain
• Treatment:
o Surgery

Answer 10

Nasal encephalocele

Question 11

enlargement on compression of the jugular

Answer 11

(+) Furstenberg’s sign

Question 12

• Solid
• Non-compressible, non-pulsatile gray or purple mass
• (-) Furstenberg’s sign
• Diagnosis:
o CT Scan

Answer 12

Nasal Glioma

Question 13

acute vs chronic rhinosinusitis?

Question 14

acute vs chronic rhinosinusitis?

Answer 14

• Acute rhinosinusitis:
o >10 days, <12 weeks with complete resolution of symptoms
• Chronic rhinosinusitis:
o >12 weeks without complete resolution of symptoms

Question 15

Etiology: most of the time, bacterial sinusitis follows after a course of viral sinusitis. Typical pathogens include

Answer 15

o Streptococcus pneumonia
o Haemophilus influenza
o Moraxella catarrhalis
o Staphylococcus aureus

Question 16

o PE
▪ Anterior Rhinoscopy/Nasal endoscopy:
• pale, bluish-grey,
• boggy turbinates
• minimal to profuse, watery to mucoid nasal discharge

what disease entity?

Answer 16

ALLERGIC RHINITIS

Question 17

Pharmacotherapy for Allergic Rhinitis

Answer 17

▪ Antihistamines: for early phase reaction
 E.g. loratadine, cetirizine
 Blocks histamine receptors
▪ Pseudoephedrine: for decongestion
▪ Intranasal corticosteroids: for early and late phase reaction.

Question 18

What type of non allergic rhinitis?

• Patient usually have no history of allergens, and there are no signs of infection
• Symptoms may be exacerbated by temperature changes, strong odors, stress, and exposure to variety of irritants.

Answer 18

Vasomotor rhinitis

Question 19

• Usually caused by Upper Respiratory viral infection
• Tends to resolve after infection run its course
• Nasal discharge is clear or mucopurulent, rather than watery

what form of non allergic rhinitis?

Answer 19

Infectious rhinitis

Question 20

• Experienced only in workplace
• Thought to result from exposure irritants
• May present with concomitant occupational asthma

What form of non allergic rhinitis?

Answer 20

Occupational rhinitis

Question 21

• Associated with hormonal imbalance and hypothyroidism
• Most common during puberty, menstruation, pregnancy and with use of hormonal therapies

what type of non allergic rhinitis?

Answer 21

Hormonal rhinitis

Question 22

• Many drug types have been implicated
• A subtype, rhinitis medicamentosa, is caused by prolonged use of topical decongestants

what type of non allergic rhinitis?

Answer 22

Drug-induced rhinitis

Question 23

Usually occurs after ingesting hot or spicy foods or alcohol
• Characterized by profuse watery rhinorrhea

what type of non allergic rhinitis?

Answer 23

Gustatory rhinitis

Question 24

NARES vs BENARES? (non allergic rhinitis with esonophilia syndrome; blood eosinophilia nares)

Answer 24

• NARES: nasal smears show >5% to >20% eosinophils;
• BENARES: No nasal eosinophilia but elevated serum eosinophil levels
• NARES: estimated to account for 20% of rhinitis diagnoses
• NARES/BENARES: Patients at high risk of developing aspirin sensitivity, nasal polyps, sinusitis, and asthma

Question 25

▪ Presence of two or more of the following symptoms:
• Nasal blockage/ Obstriction/ Congestion
• Nasal discharge (anterior/posterior nasal drip)
• Facial pain/ pressure
• Reduction or loss of smell
▪ Duration of greater than or equal 12 weeks
▪ Presence of any of the following objective findings:
• Mucopurulent discharge from the middle meatus
• Nasal polyps
• Edema/ mucosal obstruction in the middle meatus
• Radiographic imaging showing mucosal changes
within the ostiomeatal complex and/or sinuses.

these are criteria of?

Answer 25

CHRONIC RHINOSINUSITIS

Question 26

postulates that when gases or fluids pass through a constricted area, a negative pressure may develop in the vicinity of constriction. The lowered pressure leads to an increased formation of tissue fluid and subsequent Polyp formation.

Answer 26

Bernoulli phenomenon

Question 27

Nasal polyp score

Answer 27

0 - no polyps
1 - small polyps in the middle meatus
2 - reaching below the lower border of middle turbinate
3 - large polyp reaching the lower border of inf turbinate
4 - large polyp causing complete obstruction of the inferior nasal cavity

Question 28

Grade 1 and grade 2 nasal polyp treatment?

Answer 28

corticosteroids (mometasone and Avamys)

Question 29

grade 3 and grade 4 nasal polyp treatment?

Answer 29

advise functional endoscopic sinus surgery