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MC > Nasal DO > Flashcards

Nasal DO Flashcards

1
Q

Unilateral discharge, unilateral

blockage

A

Foreign body

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2
Q

Facial pain, toothache, nasal

discharge, postnasal drip

A

Acute sinusitis

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3
Q

Sneezing, rhinorrhoea, itch,

eye irritation

A

Allergic rhinitis

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4
Q

Blockage, purulent discharge,

postnasal drip

A

Infective rhinitis

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5
Q

Blockage, postnasal drip

A

Deviated septum

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6
Q

Blockage, reduced sense of smell

A

Nasal polyps

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7
Q

Blockage, unilateral discharge,

epistaxis

A

Nasal tumour

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8
Q

Bilateral blockage, snoring,

halitosis

A

Adenoidal hypertrophy

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9
Q

Local pain, crusting, malodour

A

Nasal vestibulitis

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10
Q

Nature of d/c

Bloody

A

Neoplasia, trauma, bleeding disorder,

rhinitis, infection, hypertension

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11
Q

Nature of d/c

Mucopurulent

A

Bacterial rhinitis, foreign body

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12
Q

Nature of d/c

Neoplasia, foreign body

A

Serosanguineous

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13
Q

Nature of d/c

Watery/mucoid

A

Viral rhinitis, allergic rhinitis,

vasomotor rhinitis, CSF

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14
Q

red flags for nasal DO

A 
• Unilateral nasal ‘polyp’
• Unilateral blood-stained discharge
• Toddler with offensive nasal discharge esp.
unilateral
• Post-traumatic periseptal swelling
• Rhinitis medicamentosa
• Chronic sinusitis + LRTI = ? Wegener
granulomatosis
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15
Q

Disorders of smell can be caused by ______ or _________ disturbances or considered as idiopathic

A

conductive or

sensorineural

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16
Q

Most cases of idiopathic anosmia are considered to be __________ and may last from a few days to several
months.

A

viral neuropathies

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17
Q

Head trauma, which can cause conductive
or sensorineural disturbances, is considered to be caused either from a fracture of the skull involving the _______ or, more commonly, by posterior head
trauma.

A

cribriform plate

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18
Q

Causes of conductive defect

A

Head trauma
Nasal polyps
Septal deviation
Rhinitis and sinusitis

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19
Q

Examples of central defects

A

Ageing
Chemicals (e.g. benzene, chlorine, formaldehyde, cement dust)
Cigarette and other smoking/inhalation
Drugs
Endocrine disorders (e.g. diabetes, hypothyroidism)
Frontal lobe tumour
Parkinson disease
Head trauma
Kallmann syndrome (anosmia + hypogonadism)
Nutritional deficiencies
Viral infections

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20
Q

_________ is inflammation of the nose causing sneezing, nasal discharge or blockage for more than an hour
during the day

A

Rhinitis

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21
Q

Classification of rhinitis accdg to season

A

— seasonal rhinitis: occurs only during a limited period, usually springtime
— perennial rhinitis: present throughout the
year

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22
Q

Classification of rhinitis accdg to pathophysiology

A

— allergic rhinitis: an IgE-mediated atopic
disorder
— vasomotor rhinitis: due to parasympathetic
overactivity

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23
Q

Both allergic and vasomotor rhinitis have a strong association with ______

A

asthm a

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24
Q

Allergic rhinitis—nasal allergy:
• detection of ________(not specific)
• _______or skin testing for specific allergens (can get false negatives)

A

allergen-specific IgE antibodies

RAST test

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25
Q

_________—following overuse of

OTC decongestant nasal drops or oxymetazoline sprays

A

Rhinitis medicamentosa

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26
Q

Drug-induced rhinitis

A 
— various antihypertensives
— aspirin
— phenothiazines
— oral contraceptives
— cocaine, marijuana
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27
Q

Factors aggravating rhinitis (vasomotor)

A
  • Emotional upsets
  • Fatigue
  • Alcohol
  • Chilly damp weather
  • Air-conditioning
  • Sudden changes in temperature and humidity
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28
Q

_________is acute inflammation in the mucous membranes of the paranasal sinuses

A

Acute sinusitis

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29
Q

About ________ of URTIs are complicated by an acute sinusitis

A

5%

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30
Q

In __________ the symptoms
and signs of inflammation persist for more than 8–12 weeks and are more likely to be associated with factors that impair drainage via the osteomeatal complex, including nasal polyps

A

chronic sinusitis

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31
Q

Abx for chronic sinusitis

A

Amoxycillin 500 mg (o) 8 hourly for 10–14 days, possibly for longer periods of 3–6 weeks

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32
Q

How to use decongestant?

A

Consider decongestant spray (e.g.
xylometazoline) for maximum of 5 days and
intranasal steroid

33
Q

Indications for surgery of chronic rhinosinusitis

A
  • for surgical drainage if there is no response to the above regimen
  • those with orbital or facial cellulitis
34
Q

_______ are round, soft, pale, pedunculated

outgrowths arising from the nasal or sinus mucosa

A

Nasal polyps

35
Q

Nasal polyps are basically prolapsed, congested, oedematous

mucosa, described by some as ______

A

‘bags of water

36
Q

Nasal polyps may be associated with _____ and _____

A

asthma and aspirin sensitivity

37
Q

_______should be considered in any child with nasal polyps

A

Cystic fibrosis

38
Q

_______ should be considered in any child with nasal polyps

A

Cystic fibrosis

39
Q

A polyp that does not have the typical smooth pale appearance may be _______

A

malignant

40
Q

How to Tx polyp medically

A

A medical ‘polypectomy’ can be achieved with oral steroids, for example, prednisolone 50 mg daily for 7 days

41
Q

What is the aim of surgical removal of polyps

A

to remove the polyp with the mucosa of the sinuses (often ethmoidal cells) from which it arises

42
Q

Cause of epistaxis

The common situation is intermittent anterior bleeding from_______, seen in children and the young adult (90% of episodes), while posterior epistaxis (10%) is more common in the ________

A

Little area

older hypertensive patient

43
Q

Mx of Persistent anterior bleed

A

Merocel (surgical sponge) nasal tampon or Kaltostat pack

44
Q

Mx ‘Trick of the trade’ for intermittent minor anterior epistaxis

A 
topical antibiotic (e.g. Aureomycin ointment) bd
or tds for 10 days
or (better option)
Nasalate nasal cream tds for 7–10 days
or
Rectinol ointment or Vaseline
45
Q

Tx of nasal folliculitis

A

Treatment is with bacitracin or preferably mupirocin (intranasal) ointment topically
for 5–7 days.

46
Q

Furunculosis of the nasal vestibule is usually due to ________. It starts as a small superficial abscess in the skin or the mucous membrane and may develop into a spreading cellulitis of the tip
of the nose

A

Staphylococcus aureus

47
Q

Painful fissures often develop at the

_________. They may become crusted and chronic

A

mucocutaneous junction

48
Q

Fissures can be treated by :

A

keeping the
area moist with petroleum jelly (Vaseline) or saline gel, using hot compresses and the use of an antibiotic or antiseptic ointment if necessary.

49
Q

This disfiguring swelling of the nose is due to

hypertrophy of the nasal sebaceous glands

A

Rhinophyma

50
Q

Association of Rhinophyma

A

There is no specific association with alcohol. It is almost exclusive to men over the age of 40 years.

Rhinophyma may be associated with rosacea.

51
Q

Mild septal deviation tends to cause _______ while severe deviation causes ________on one side.

A

alternating blockage

persistent blockage

52
Q

The septum can be divided into anterior and
posterior segments. The anterior portion is necessary to support the _________of the nose whereas the posterior portion has_________

A

cartilaginous pyramid

no supporting role and can be removed without disturbing the support

53
Q

The ________operation

is therefore suitable for posterior septal deviations

A

classic submucous resection

54
Q

A hole in the nasal septum is caused commonly by
1
2
3

A

chronic infection including tuberculosis, repeated trauma such as vigorous nose ‘picking’ or following nasal
surgery

55
Q

If a deformity is present in pts with nasal fx, refer the patient within
________

A

7 days, ideally from days 3–5.

56
Q

Skin lacerations, i.e. __________, usually require early repair

A

compound fracture

57
Q

The optimal time to reduce a fractured nose is about 10 days after injury. There is a window period of ______weeks before the fracture unites

A

2–3

58
Q

________ is more suitable for bilateral
fractures with significant septal deviation,
bilateral fractures with major dislocations or
fractures of the cartilaginous pyramid

A

Open reduction

59
Q

It is easily diagnosed as

a marked swelling on both sides of the septum when inspected through the nose

A

Haematoma of nasal septum

60
Q

There is a________in which there is nasal congestion and decongestion that alternates from side to side and leads to rhinorrhoea.

A

‘nasal cycle’

61
Q

This is a common, distressing problem in the elderly, caused by failure of the vasomotor control of the mucosa. It may be associated with a deviated septum
and dryness of the mucosa.

A

Senile rhinorrhoea

62
Q

Senile rhinorrhoea TX

A

The treatment is to keep the nasal passages lubricated with an oily based preparation, for example, insufflation with an oily
mixture (a sesame oil based preparation, e.g. Nozoil, is suitable) or petroleum jelly

63
Q

Following head injury, clear dripping fluid ( + ve for glucose) may indicate a fracture of the __________

A

roof of the ethmoid

64
Q

_________which is uncommon, may cause nasal discharge which may be clear at first, becoming thick and offensive

A

Malignant nasal disease,

65
Q

_________ occur exclusively in males between the ages of 9 and 24. Patients present with unilateral nasal obstruction and recurrent epistaxis

A

Fibroangiomas

66
Q

Malignant tumours include nasopharyngeal
carcinoma, with the ______ being the
most common site

A

maxillary sinus

67
Q

MC cause of NPCA

A

Squamous cell carcinoma is
the most common, followed by adenocarcinoma
melanoma and lymphoma

68
Q

Malignant or non-healing granuloma, sometimes called ________ is
a slowly progressing ulceration of the face starting in the region of the nose

A

‘midline granuloma’,

69
Q

_______ is uncommon in children under

the age of 10 and allergic nasal polyps are relatively rare.

A

Sinusitis

70
Q

If a child presents with polyps, consider the

possibility of ____ or _______

A

cystic fibrosis or neoplasia

71
Q

Acute bilateral nasal obstruction may occur in

newborns with ______

A

congenital bilateral choanal atresia

72
Q

Red flags for sinusitis requiring consideration include ____

A

a sick child, pyrexia, rapid onset, unilateral and deteriorating airway obstruction.

73
Q 
If a fracture is undisplaced the
treatment is 
1
2
3
A

pain relief, ice compresses and res

74
Q

If Fx is displaced, what is the tx?

A

refer for closed reduction under general

anaesthetic within 1–2 weeks (ideally at 10 days).

75
Q

In normal children these problems are almost always due to adenotonsillar hypertrophy and most cases are relieved by surgery

A

Snoring and obstructive

sleep apnoea

76
Q

T or F

‘a child with unilateral nasal discharge has a foreign body (FB) until proved
otherwise’.

A

T

77
Q

A_______may develop in time on the foreign

body

A

rhinolith

78
Q

Removal of FBs from the nose in children is a relatively urgent procedure because of the risks of _______

A

aspiration

MC (90 decks)

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