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MD2 Surgery and Anaesthesia > Common Conditions of the Nose > Flashcards

Common Conditions of the Nose Flashcards

1
Q

How does the nose warm and humidify the air?

A

Turbinates direct air flow

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2
Q

Which sinuses drain to the middle meatus?

A

Maxillary
Frontal
Anterior ethmoids

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3
Q

Which sinuses drain to the superior meatus?

A

Sphenoid

Posterior ethmoids

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4
Q

What are common nasal symptoms?

A 
Blockage
Congestion
Rhinorrhoea
Sneezing
Irritation
Post-nasal drip
Loss of olfaction
Epistaxis
Facial pressure/pain
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5
Q

What symptoms arise from pathology affecting the orbits and lacrimal system?

A

Blockage of nasolacrimal apparatus > epiphora
Diplopia
- Due to displacement of axis of globe
- Ophthalmoplegia due to mechanical restrction of extra-ocular muscles

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6
Q

When can you get a raccoon eye?

A

Base of skull fracture

Procedures around nose

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7
Q

What symptoms arise from pathology affecting the base of the skull?

A

CSF rhinorrhoea
Mechanial restriction of airflow to olfactory region/neurological deficit > change in smell
Frontal lobe lesion > change in cerebral function

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8
Q

How can you detect CSF rhinorrhoea?

A

Doulbe ring sign on blotting paper
Measure
- Glucose
- Beta-2 transferrin = gold standard

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9
Q

What symptoms arise from pathology affecting the oral cavity and teeth?

A

Dental pain

Discharge through oro-antral fistula

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10
Q

What can cause the formation of an oro-antral fistula?

A

Traumatic tooth extraction

Chronic infections

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11
Q

What symptoms arise from pathology affecting the post-nasal space and auditory tube?

A

Nasal obstruction

Middle ear effusion

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12
Q

Why do persisting unilateral middle ear effusions need further investigation?

A

Rule out post-nasal tumours

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13
Q

What is Horner’s syndrome?

A

Miosis
Anhydrosis
Ptosis

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14
Q

What can Horner’s syndrome be a sign for?

A

Gastric tumours, and others

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15
Q

What is the significance of aspirin intolerance in nasal pathology?

A

Samter’s triad

  • Aspirin intolerance
  • Asthma
  • Nasal polyps
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16
Q

What features of history are important in nasal pathology?

A 
Smoking
Drug Hx
Aspirin intolerance
Asthma
Allergic Hx
Age
FHx
- ENT cancers
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17
Q

In which lung condition are polyps common?

A

Cystic fibrosis

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18
Q

What is rhinitis?

A

Inflammation of nasal mucosa

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19
Q

What are the causative groups of rhinitis?

A 
Allergic
Infectious
Occupational
Drug induced
Hormonal
Idiopathic
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20
Q

What is intermittent allergic rhinitis?

A

Less than 4 days/week or <4 weeks

21
Q

What is persistent allergic rhinits?

A

More than 4 days/week for >4 weeks

22
Q

What are the symptoms of allergic rhinitis?

A

Clear rhinorrhoea
Nasal blockage
+/- itching of nose
Sneezing

23
Q

What is the management for mild intermittent allergic rhinitis?

A

Oral/local non-sedative H1 blocker
Intra-nasal/oral decongestant
Allergen and irritant avoidance

24
Q

What is the management for moderate-severe intermittent allergic rhinitis?

A 
Oral/local non-sedative H1 blocker
Intra-nasal/oral decongestant
Allergen and irritant avoidance
Intra-nasal steroid
Local cromone
25
Q

What is the management for persistent allergic rhinitis?

A 
Oral/local non-sedative H1 blocker
Intra-nasal/oral decongestant
Allergen and irritant avoidance
Intra-nasal steroid
Local cromone
Consider immunotherapy
26
Q

What is rhinitis medicamentosa?

A

Inflammation of nasal mucosa secondary to prolonged alpha agonist topical medications

27
Q

What are the symptoms of rhinitis medicamentosa?

A

Clear rhinorrhoea

Marked nasal congestion > obstruction > progressively less well controlled by topical medication

28
Q

What is infectious rhinitis called?

A

Rhinosinusitis

29
Q

What are the symptoms of viral rhinosinusitis?

A

Less than 10 days
Rhinorrhoea
Blockage
Itching

30
Q

What are the common causes of viral rhinosinusitis?

A

Rhinovirus

31
Q

What is the duration of symptoms for acute non-viral rhinosinusitis?

A

Symptoms increase after 5 days
Last >10 days
Less than 12 weeks

32
Q

What is the usual duration of rhinosinusitis?

A

Less than 2 weeks

33
Q

What are the common symptoms of rhinosinusitis?

A 
Clear/purulent rhinorrhoea
Nasal congestion/obstruction
Sneezing
Nasal irritation
Epiphora
34
Q

What is the most common site of anterior epistaxis?

A

Anterior septum - confluence of multiple vessels

35
Q

How is anterior epistaxis controlled?

A

Direct pressure

36
Q

Where is posterior epistaxis most commonly felt?

A

Dripping down back of throat

37
Q

What is the common artery that bleeds in posterior epistaxis?

A

Sphenopalatine

38
Q

How is posterior epistaxis controlled?

A

Nasal packing - usually kept in for 1-2 days

39
Q

How is a nasal fracture confirmed?

A

No indication for imaging unless suspecting

  • Other facial fractures
  • Skull base disruption
  • Central signs
40
Q

What raises your suspicion of a skull base fracture?

A 
Mechanism of injury
CSF rhinorrhoea/othorrhoea
Raccoon eyes
Battles sign
Haemotympanum
Subconjunctival haemorrhage with no posterior margin
41
Q

If left untreated, what can a septal haematoma progress to?

A

Septal abscess > cartilage destruction > saddle nose deformity

42
Q

What is the management of a septal haematoma?

A

Immediate ENT referral for

  • Drainage of haematoma
  • Possible nasal bone manipulation
43
Q

What are the likely bacterial organisms that cause acute rhinosinusitis?

A

Upper respiratory tract pathogens

  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Moraxella catarrhalis
44
Q

What are symptoms of orbital spread of the infection from the paranasal sinuses?

A

Eye pain and swelling
Double vision
Ophthalmoplegia

45
Q

What is an initial sign of increased intra-orbital pressure?

A

Red-green colour vision disturbance

46
Q

What is the management for chronic rhinosinusitis?

A

Nasal steroid spray
- Mainstay of therapy
Saline nasal douche
Abx if purulent

47
Q

What bacteria cause chronic rhinosinusitis?

A

Similar to acute rhinosinusitis
Staphylococcus aureus
Anaerobes

48
Q

What is FESS?

A

Functional Endoscopic Sinus Surgery

49
Q

What is the aim of FESS?

A

To open sinuses and return them to premorbid functioning state
Allows medical therapy to enter

MD2 Surgery and Anaesthesia (31 decks)

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