Week 1 'Nose and throat'

Question 1

CN1 and CN2 names?

Answer 1

CN1 -olfactory N.

CN2 -Optic N.

Question 2

If anosmia is unilateral and accompanied by visual problems, you should suspect…

Answer 2

CN I abnormality

Question 3

If anosmia is bilateral with concomitant nasal symptoms, you should consider…

Answer 3

local problem is causing it

Question 4

ANterior Epistaxis vs. Posterior epistaxis

Answer 4

Ant. epistaxis: (kiesselbach plexus) children and young adults, caused by dry air, low temps, irritants, following URI (nose blowing), nose-picking

Post. epistaxis: (Woodruff’s plexus) more likely in older adults, more prolonged bleeding and difficult to control

Question 5

Rhinitis

Answer 5

Inflammation of mucus membranes of nose with stuffy, obstructed, runny nose

Question 6

List the different types of Bilateral rhinitis and their common causes:

Answer 6

Acute rhinitis: rhinovirus
Allergic rhinitis: allergies (antigen triggers IgE on mast cells, release hist)
Atrophic rhinitis: Nasal mucous membrane atrophied to stratified squamous epithelium, etiology unknown but bacterial infx often plays a role)
Vasomotor rhinitis: caused by parasympathetic dominance leading to vasodilation and edema of nasal vasculature
Cocaine use: septal perforations common

Question 7

List the types of unilateral Rhinitis:

Answer 7

Trauma: ominous sign for possible skull fracture if trauma involved b/c may be CS fluid that is blood tinged
Choanal Atresia: congenital defect
Foreign body: discharge, malodorous
Neoplasm: bloody discharge, may not be painful

Question 8

Polyps; what are they?
M:F ratio?
common age of onset?

Answer 8

Soft, pedunculated lesions that emanate from any portion of the nasal mucosa or paranasal sinuses
M:F =4:1 male predominance
onset >40

Question 9

List some nasal septum problems:

Answer 9

Deviation (from trauma)
Perforation from chronic infx, crusting, nasal surgery, TB, syphilis, cocaine
Abscess-rare, dangerous, may lead to cavernous sinus thrombosis

Question 10

Rhinophyma

Answer 10

Enlarged, bulbous, reddened nose; may obstruct breathing or vision
Granulomatous infiltration/hypertrophy of sebaceous glands
Associated with untreated acne rosacea, worsened by (but not caused by) alcoholism
More common in men >50; significant psychological toll

Big bumpy red nose

Question 11

Rhinosinusitis

What are the most common organisms that cause it?

Answer 11

> 30 million in US have sinus dz

Most common causes: Viral (common, less severe); Bacterial (Staph, Strep, H. flu, more severe than viral); Fungal (Mucor, Aspergillis)

Usu no fever if viral (if fever is present => bacterial)

Question 12

List the 3 types of Rhinosinusitis: (what causes each)

Answer 12

1. Acute suppurative rhinosinusitis: (last 1-3wks, rhinoviral 7-10 days, rhinobacterial 1-3wks w/ fever)
2. Chronic suppurative rhinosinusitus: (Strep pnue, H. influ, Moraxella catarrhalis, subtle sinusitus sx)
3. Upper Airway Cough Syndrome (common sequallae to rhinosinusitus “post nasal drip”)

Question 13

Anosmia

Answer 13

loss of sense of smell

Question 14

FYI SSxs, PEs, Labs, Etiology all left out for Rhinitis

Answer 14

They’re what you’d expect for the most part

Question 15

Polyps

Signs and Sxs:

Answer 15

(depends on size of polyp) no sx to nasal obstruction ,postnasal drainage, dull HA’s, snoring, rhinorrhea, epistaxis, hyposmia, anosmia
(often surgically removed)

Question 16

What are typical PE findings for someone with acute suppurative rhinosinusitis?

How do these differ from chronic suppurative rhinosinusitis?

Answer 16

Purulent secretions in the middle meatus (highly predicitve of maxillary sinusitis)
fever is rare unless bacterial cause (usu no fever if viral)
Facial tenderness to palpation or percussion (esp over sinuses)
complete opacification of sinus on transillumination

Chronic suppurative rhinosinusitis signs and sxs: same just more subtly than acute symptoms

Question 17

WHat are some seious complications of rhinosinusitis? (there are two of them)

Answer 17

i) orbital or periorbital cellulitis-edema, pain moving the eye, chemosis (conj. edema), very sick pt.
ii) cavernous sinus thrombosis - very dangerous, mortality 50%, high fever, chills, prostrated, comatose, change in mental status (early signs= deep eye pain, ocular palsy, diplopia; late signs= both eyes involved, edema, death in 2-3 days)

Question 18

Upper Airway Cough syndrome
common sequellae to ….
SSX:
PE:

Answer 18

common sequellae to rhinosinusitis “post-nasal drip”

SSX: cough, rhinorrhea, frequent swallowing, halitosis, frequent spitting, tickling in throat, constant cleaning of throat, chronic sore throat
PE: may see tonsilloliths, cobblestoning of oropharyngeal mucosa, tenderness of sinuses

Question 19

what does it mean if a patient is prostrated?

Answer 19

Due to distress, exhaustion, or illness, patient is reduced to extreme physical weakness, lying down (face down technically).

Question 20

Study the little graph at the end of notes comparing URI, allergies, Influenza

Answer 20

Week 1 head, nose and throat