Diseases of nose and paranasal sinuses

Question 1

Folliculitis of nasal vestibule

Answer 1

presence of inflammation (staphylococcal infection) within the wall and ostia of the hair follicle, creating a follicular-based pustule.

Question 2

Clinical features of Folliculitis and furunculitis of nasal vestibule

Answer 2

pain and sensitivity to pressure, followed by redness and swelling of the tip of the nose and/or nasal ala and the upper lip.

Question 3

treatment of Folliculitis and furunculitis of nasal vestibule

Answer 3

local antibiotic creams if a furuncle is forming — oral or i.v. antibiotics are administered.

Question 4

rhinosinusitis

Answer 4

inflammation of the paranasal sinuses and nasal cavity

Question 5

Rhinosinusitis s characterised by two or more symptoms name them

Answer 5

 One of them should be either nasal blockage (obstruction, congestion) or nasal discharge in adults (anterior or posterior nasal drip), respectively, or a cough in children.

 Another symptom is facial pain (pressure) and/or reduction (loss) of smell

Question 6

Endoscopic signs of rhinosinusitis

Answer 6

polyps or mucopurulent discharge primarily from the middle meatus

and/or oedema (mucosal obstruction) primarily in the middle meatus must be present

Question 7

Acute vs chronic rhinosinusitis

Answer 7

acute, lasting more than 10 days and less than 12 weeks with complete resolution of the symptoms. Chronic rhinosinusitis lasts more than 12 weeks without complete resolution of the symptoms.

Question 8

Acute rhinosinusitis can be divided into several subgroup name them

Answer 8

subgroups: Common cold/acute rhinosinusitis

Acute post-viral rhinosinusitis

Acute bacterial rhinosinusitis

Question 9

Acute post-viral rhinosinusitis

Answer 9

defined as an increase of symptoms after 10 days with less than 12 weeks of duration

Question 10

Onee must have at least one of these features of Acute bacterial rhinosinusitis

Answer 10

 Discoloured discharge and purulent exudate in the nasal cavity

 Severe local pain (with unilateral predominance)

 Fever (38°C or higher)

 Elevated erythrocyte sedimentation rate/CRP

 “Double sickening” – deterioration after an initial milder phase of illness

Question 11

Aetilogy of Acute bacterial rhinosinusitis

Answer 11

after a course of viral sinusitis.

Typical pathogens include Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus

Question 12

Treatment in adult patients. Supportive therapy for acute rhinosinusitis

Answer 12

analgesics/ antipyretics for pain and fever,

intranasal saline irrigation,

short-term use of intranasal steroids,

especially in patients with allergic rhinitis, and topical nasal decongestant

Question 13

The following risk factors for antibiotic resistance should be considered for an appropriate choice of antibiotics

Answer 13

age older than 65 years, antibiotic use within the past 1 month, immunocompromised host, and presence of medical comorbidities.

Question 14

Treatment in children Acute bacterial rhinosinusitis

Answer 14

. Intranasal steroids

antibiotics in the empiric treatment

Question 15

Allergic rhinitis

Answer 15

nasal inflammation caused by allergic reaction to airborne allergens and is an extremely common condition

Question 16

Clinical features of Allergic rhinitis

Answer 16

rhinorrhoea,

sneezing,

pruritus,

and conjunctivitis.

The mucosa of the nasal turbinates may be swollen and have a pale, bluish-grey colour.

Some patients may have predominant erythema of the mucosa.

Thin, watery secretions are frequently associated with allergic rhinitis,

Question 17

Possible complications of Allergic rhinitis

Answer 17

otitis media, Eustachian tube dysfunction, acute sinusitis, and chronic sinusitis

Question 18

Allergic rhinitis can be associated with a number of comorbid conditions

Answer 18

asthma,

atopic dermatitis,

and nasal polyps

Question 19

DX of Allergic rhinitis

Answer 19

clinically on the basis of a history and rhinoscopic examination and/or skin testing

Question 20

Treatment of allergi rhinitis

Answer 20

three major categories of treatment: environmental control measures and allergen avoidance,

pharmacological management (antihistamines, decongestants,

intranasal steroids and cromolyns),

and immunotherapy

Question 21

Pseudoephedrine: function and SEs

Answer 21

(oral or intranasal) is used to relieve congestion. If overused, it causes severe rebound congestion, leading to rhinitis medicamentosa

Question 22

Chronic sinusitis is almost always accompanied by

Answer 22

Chronic sinusitis is almost always accompanied by concurrent nasal airway inflammation and is often preceded by rhinitis symptom

Question 23

CRS is associated with

Answer 23

asthma and allergic rhinitis.

Question 24

Clinical features of CRS

Answer 24

nasal obstruction,

discharge,

hyposmia,

cough,

congestion

and postnasal drip

Question 25

functional endoscopic sinus surgery (FESS

Answer 25

This involves visualisation of the nasal cavity and sinuses using rigid endoscopy. The surgeon removes any tissues that are blocking the drainage of the affected sinus. This can improve sinus drainage and ventilation and help to restore normal function to the sinuses

Question 26

Nasal polyps Definition

Answer 26

an end result of varying disease processes in the nasal cavity.

benign, semi-transparent nasal lesions

arise from the mucosa of the nasal cavity or from one or more of the paranasal sinuses, often at the outflow tract of the sinuses

Question 27

Polyp development has been linked to

Answer 27

chronic inflammation, autonomic nervous system dysfunction, allergy, and genetic predisposition

Question 28

Clinical features of polyps

Answer 28

nasal airway obstruction, postnasal drainage, dull headaches noring, hyposmia and rhinorrhoea obstructive sleep symptoms and chronic mouth breathing

Question 29

treatment of polyps

Answer 29

Corticosteroids are the treatment of choice, either topically or systemically. Surgical intervention (FESS) is required for patients with multiple polyposis or chronic rhinosinusitis who fail maximum medical therapy

Question 30

Osteomyelitis (“Pott’s puffy tumour”)

Answer 30

frontal rhinosinusitis resulting in a subperiostal abscess.

Question 31

Clinical features of osteomyelitis

Answer 31

prominent frontal swelling

Question 32

Osteomyelitis treatment

Answer 32

drain the abscess and responsible paranasal sinuses,

remove the infected bone, and

direct a six-week regimen of intravenous antibiotics

Question 33

Aetiology of Orbital complications in children

Answer 33

Streptococcus and Staphylococcus

Question 34

Aetiology of Orbital complications in adults

Answer 34

Streptococcus pneumoniae,

Haemophilus influenzae,

and Moraxella catarrhalis usually affect adult patients

Question 35

A classification scheme that categorises the various forms of orbital complications of rhinosinusitis and triages them in increasing severity

Answer 35

preseptal cellulitis,

orbital cellulitis,

subperiosteal abscess,

orbital abscess, and

cavernous sinus thrombosis

Question 36

Nasal papilloma may be caused by

Answer 36

tissue injury

Question 37

Inverted papillomas are

Answer 37

nasal tumours that originate in the mucous membrane of the nasal cavity and paranasal sinuses. They tend to invert into the underlying connective tissue stroma, which differs from other types of papillomas

Question 38

most common presenting symptom of patients with inverted papillomas + other symptoms

Answer 38

Unilateral nasal obstruction

epistaxis, nasal discharge, epiphora, and facial pain.

Question 39

Physical examination in Dx of inverted papilloma

Answer 39

unilateral polypoidal mass filling the nasal cavity and causing nasal obstruction

Question 40

Morphology of inverted papillomas

Answer 40

Papillomas have an irregular, friable appearance, and they often bleed when touched.

Question 41

Septal haematoma is

Answer 41

The accumulation of blood between the perichondrium and septal cartilage.

Question 42

Aetiology of Septal haematoma

Answer 42

It is caused by trauma to the external nose or septum. Blunt nasal trauma can lead to elevation of the mucoperichondrium/mucoperiosteum from the underlying cartilage/bone.

A haematoma forms in the newly created perichondrial/periosteal space on one or both sides

Question 43

Aetiology of septal abscess

Answer 43

. Infection of the haematoma

After septal surgery

Question 44

Sx of Septal haematoma and septal abscess

Answer 44

Increasing nasal obstruction,

tenderness, and pain.

If an abscess forms, pain increases, and the patient complains of

headache, fever, and redness of the bridge of the nose

Question 45

Tx of Septal haematoma and septal abscess

Answer 45

Urgent drainage is indicated for all nasal septal haematomas.

Needle aspiration under topical anaesthesia can be performed and systemic antibiotics should then be administered.

To drain the haematoma or abscess, incise the mucosa over the area of greatest fluctuance without incising cartilage. D

Question 46

Local causes of epistaxis

Answer 46

Environmental influences

Foreign body

Idiopathic

Infection

Trauma

Tumour

Question 47

Systemic causes of epistaxis

Answer 47

Anticoagulants

Endocrine

Haematological diseases

Hereditary haemorrhagic telangiectasia (Osler`s disease)

Hypertension

Question 48

Types of epistxis

Answer 48

Anterior

Posterior

Question 49

The most common site of bleeding in epistaxis

Answer 49

anterior nasal septum (90% of cases) due to its rich blood suppl

Question 50

an anastomotic network of vessels located on the anterior cartilaginous septum

Answer 50

Kiesselbach plexus, or Little’s area

Question 51

Kiesselbach plexus, or Little’s area blood supply origins

Answer 51

internal carotid artery and the external carotid artery

Question 52

Complications of posterior epistaxis

Answer 52

present a greater risk of airway compromise, aspiration of blood, and greater difficulty controlling bleeding.

Question 53

Treatemnt of epistaxis

Answer 53

Cauterisation

anaesthetic-vasoconstrictor solution

chemical cauterisation using a silver nitrate stick

Thermal cauterisation is reserved for more aggressive bleeding

Question 54

Anterior nasal packing

Answer 54

to stop anterior bleeding, the nasal cavity should be packed with ribbon gauze impregnated with petroleum jelly/Vaseline

Question 55

Posterior nasal packing

Answer 55

passing a catheter through one nostril, through the nasopharynx, and out the mouth

double balloon devices that have separate anterior and posterior balloons.

Question 56

Surgical epistaxis intervention

Answer 56

Endonasal ligation of the sphenopalatine artery or the internal maxillary artery usually controls the bleeding

Question 57

Clinical features of choanal atresia

Answer 57

Unilateral choanal atresia t presents as a unilateral nasal discharge until later childhood or even adulthood.

Bilateral atresia, on the other hand, almost always presents as a respiratory emergency and is apparent at birth

Question 58

Dx. of choanal atresia

Answer 58

inability to pass a feeding catheter at least 3 cm through the nose into the nasopharynx.

In addition, direct observation with nasal endoscopy and

CT scanning are essential to determine the type of obstruction

Question 59

Treatment of choanal atresia

Answer 59

Immediate management of bilateral atresia involves training the infant to breathe through the mouth with the aid of an indwelling oral appliance; a plastic oropharyngeal airway may be placed temporarily

Question 60

A nasal foreign body should be suspected in all cases of

Answer 60

unilateral childhood rhinorrhoea.

Question 61

The most common signs and symptoms of foreign bodies

Answer 61

nasal obstruction,

foetor,

unilateral rhinorrhoea

and bleeding