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Head and Neck > Rhinology > Flashcards

Rhinology Flashcards

1
Q

What is important to find out in the HPC of problems with nose?

A
  • Nasal obstruction
  • Nasal discharge
  • Epistaxis
  • Facial pain
  • Nasal deformity
  • Anosmia (reduced smell)
  • Sneezing
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2
Q

What do you need to ask about in the PMH of someone present with nose problem?

A
  • Medical treatment
  • Nasal surgery
  • Nasal trauma
  • Asthma/aspirin sensitivity
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3
Q

What do you need to ask in the SH?

A
  • Alcohol
  • Smoking
  • Cocaine abuse
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4
Q

What happens if olfactory epithelium of nasal lining is damaged?

A

Develop hyposmia (reduced smell)

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5
Q

What is a nasal polyp?

A

Prolapse of oedematous nasal lining (filled with fluid) into nasal cavity

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6
Q

What allergic conditions are polyps commonly associated with?

A
  • Asthma
  • Allergic rhinitis
  • Aspirin intolerance
  • Alcohol intolerance
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7
Q

What is the general cause of nasal polyps?

A

Chronic inflammatory process, not due to allergy

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8
Q

What investigations are used for high suspicion of other conditions which would change treatment?

A
  • Blood tests: FBC, ANCA, ESR, ACE, RAST
  • CT scan
  • MRI scan
  • Skin tests
  • Rhinomanometry
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9
Q

What is the purpose of carrying out a CT scan?

A
  • To identify the anatomical relationship of the key structures(optic nerve, orbital contents and carotid artery)
  • Nature and extent of disease
  • Anatomical abnormalities
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10
Q

What is rhinomanometry?

A
  • Shows degree of nasal obstruction

* Measures air flow in each nostrils and compares with normative data to determine degree nasal obstruction

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11
Q

Name seven nasal disorders

A
  • Nasal trauma
  • Epistaxis
  • Rhinosinusitis
  • Nasal polyps
  • Nasal Deformity
  • Nasal tumors
  • Choanal atresia
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12
Q

What are the two management options for nasal trauma?

A
  • Digital manipulation - for day of or up to 7 days after (bone not fixed)
  • Rhinoplasty - if longer and bones have fused the wrong way
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13
Q

What can nasal trauma cause?

A

Nasal blockage or septal haematoma

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14
Q

Where does cartilage relieve its blood from?

A

Overlying skin

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15
Q

What can prolonged cocaine use cause?

A

Septal perforation

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16
Q

What is aspirin hypersensitivity?

A

Huge inflammatory process in nose after use of aspirin which can cause polyps

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17
Q

What are causes of nasal polyps?

A
  • Unknown cause
  • Chronic inflammatory process
  • Autonomic nervous system dysfunction
  • Genetic predisposition
  • Allergic vs non-allergic condition association
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18
Q

What non-allergic conditions are polyps commonly associated with?

A
  • Cystic fibrosis
  • Churg-Strauss syndrome
  • AFS
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19
Q

What non-invasive investigations would be carried out to determine cause of aspirin hypersensitivity/nasal polyps?

A
  • Sweat test (CF)
  • RAST / skin testing
  • Nasal smear: eosinophils (allergic component) and neutrophils (chronic sinusitis)
20
Q

What invasive investigations are used for aspirin hypersensitivity/nasal polyps?

A
  • Coronal CT scan
  • MRI scan
  • Flexible nasendoscopy
  • Rigid nasendoscopy
21
Q

What two treatments can be used for aspirin hypersensitivity/nasal polyps?

A
  • Oral and nasal steroids - high dose prednisolone for 20 days
  • Immunotherapy
22
Q

How is immunotherapy used for aspirin hypersensitivity?

A

Tiny doeses of aspirin in ITU over 3 days and escalate to develop immune tolerance. After 3 days, patient has to take aspirin for rest of life to be desensitised to prevent allergic reaction

23
Q

What three surgical treatment can be used for nasal polyps?

A
  • Polypectomy
  • Microdebrider
  • Endoscopic sinus surgery
24
Q

What is used to diagnose rhinosinusitis?

A

Sinus radiographs

25
Q

What are the disadvantages of sinus radiographs?

A
  • Poor visualization of the osteomeatal complex and the anterior ethmoid sinuses
  • High rate of false positive findings
26
Q

What are the advantages of sinus radiographs?

A

• Positive findings include air-fluid levels, mucosal thickening, sinus opacification (only have a 50%
sensitivity)
• Less expensive, but not as accurate as newer imaging

27
Q

What are the clinical classifications of adult sinusitis?

A
  • Acute
  • Recurrent acute
  • Chronic
  • Acute on chronic
28
Q

Define acute classification of sinusitis

A
  • Acute onset of symptoms
  • Duration of symptoms <12 weeks
  • Symptoms resolve completely
29
Q

Define recurrent acute classification of sinusitis

A
  • > 1 to <4 episodes of acute rhinosinutitis per year
  • Complete recovery between episodes
  • Symptom-free period of >8 weeks between acute attacks in absence of medical treatment
30
Q

Define chronic classification of sinusitis

A
  • Duration of symptoms >12 weeks

* Persistent inflammatory changes on imaging >4 weeks after starting appropriate therapy

31
Q

Define acute on chronic classification of sinusitis

A

• Worsening of existing symptoms or appearance of new symptoms
• Complete resolution of acute (but not chronic)
symptoms between episodes

32
Q

What are the two main causative bacteria of adult sinusitis?

A
  • Step. pneumoniae

* H. influenza

33
Q

What are six main symptoms of sinusitis?

A
  • Facial pain and pressure
  • Hyposmia/anosmia
  • Nasal congestion/obstruction
  • Purulent post-natal drain
  • Olfactory disturbance
  • Cough
34
Q

What are minor symptoms of sinusitis?

A
  • Headache
  • Fever
  • Fatigue
  • Halitosis
  • Dental pain
35
Q

What antimicrobial medication is used for rhinosinusitis?

A
  • B-lactams - penicillin, cephalosporin

* Macrolides - erythromycin, clarithromycin

36
Q

What is the cause of 10yr old presenting with acute perirbital swelling with a 10 H/O acute URI?

A

Developed infection and spread into orbit - us can erode bone of orbit allowing infection into eye

37
Q

What is the treatment of 10yr old presenting with acute perirbital swelling with a 10 H/O acute URI?

A
  • Emergency referral
  • Ophthal opinion
  • Urgent CT
  • IV Antibiotics
  • Emergency surgery
38
Q

What is the cause of 10yr old presenting with acute onset fever, frontal headache, nasal discharge?

A

Potts puffy tumour - infection spread to frontal sinus

39
Q

What is Potts puffy tumour?

A

Frontal sinus drain into narrow pathway and inflammation causes oedema which blocks the frontal nasal duct

Pus fill up in the frontal sinus so bone expands as children bones are soft - bone can necrose and pus is just under the skin

Emergency – drain abscess (frontal sinus surgery)

40
Q

What is diplopia?

A

Double vision

41
Q

What is a cause of diplopia?

A

Mucoul seal – frontal sinus produce mucous (resp. epithelium) but if front nasal duct is blocked, it fills up and expands which erodes bone aorund that area to push the orbit downwards

Endocope to open up frontal sinus to drain mucous

42
Q

Name nine causes of epistaxis

A
  • Infection
  • Trauma
  • Allergy
  • Hypertension and atherosis
  • Hereditary haemorrhage telangiectasia
  • Blood dycrasias (iatrogenic)
  • Atrophic rhinitis
  • Tumour
  • Congenital or acquired nasal defects
43
Q

What is management of epistaxis?

A
  • ABC
  • Medical history/meds
  • Physical exam (anterior and endoscopic rhinoscopy)
  • Labarotomy exam
  • May need nasal pack
44
Q

What are the different types of nasal packs?

A

Depends on where bleeding occurs:
• Anterior nasal packs
• Posterior nasal packs
• Ant/post nasal packing

45
Q

What different types types of surgical treatment can be used by epistaxis?

A
  • Endoscopic sphenopalatine artery ligation
  • Transmaxillary IMA ligation
  • Intraoral IMA ligation
  • Anterior/posterior ethmoidal ligation
  • External carotid artery ligation
46
Q

What is hereditary haemorrhage telangiectasia?

A

Inherent abnormality in their blood vessels (wekakness) and can cause major bleeding

  • Hereditary – autosomal dominant
  • Only occurs in males
47
Q

What is the management of hereditary haemorrhage telangiectasia?

A
  • Preoperative embolisation

* Surgery

Head and Neck (12 decks)

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