ENT - Nose Flashcards
(5 cards)
NOSEBLEEDS
i) where does bleeding usually originate from? which area is this found? what causes the bleeding?
ii) name six things they can be caused by? why may a patient vomit blood? is bleeding usually uni or bilat? what may bilateral bleeding suggest?
iii) name an underlying cause if recurrent? what should be advised to pts (2)
iv) after how long bleeding is the nosebleed classed as severe? name two tx options
v) what cream ccan be given after an acute nosebleed? when is this contra indicated?
i) bleed from kiesselbachs plexus in littles area > exposed to nasal mucosa at front of nasal cavity with lots of BV > mucosa disruptted > bv exposed and prone to bleeding
ii) nose picking, ccolds, sinusitis, nose blowing, traumaa, coag disorders, anti coag meds, cocaine, tumours eg SCC
vomit blood if swallowed
usually unilateral but can be bilat if bleeding is ccoming from posterior nose
iii) recurrent - thrombocytopenia or clotting disorder
advise : sit up and tilt head forwards > squeeze soft part of nose for 10-15mins, spit out blood rather than swallow
iv) bleed for more than 10-15 mins = severe
tx with nasal packing using tampons or inflatable packs
nasal cautery with silver nitrate sticks
v) post acute nosebleed - naseptin nasal cream (chlorhexidine and neomcin) for 10d to reduce inflam and crusting
CI in peanut or soya allergy
SINUSITIS
i) what is it? what is it usually accompanied by - what is this called? what is classed as acute and chronic?
ii) what causes sinusitis structurally? name four causes? patients with which condition are more likely to get it?
iii) what do pts with acute sinusitis often present with? name five assoc symptoms
iv) name three things that may be seen on exam? name two things chronic sinusitis can be associated with?
i) inflammation of paranasaal sinuses
often accomp by inflam of nasal cavity > rhinosinusitis
acute <12 weeks
chronic >12 weeks
ii) paranasal sinuses produce mucus > drain to nasal cav through holes called ostia > blockage of ostia prevents drainage > inflam
causes - infection (following viral URTI), allergies, obstruc eg trauma, polyps
more likely to get if asthma
iii) acute - px with viral URTI
assoc - nasal conges, discharge, facial pain/headache, swelling, loss of smell
iv) tender palpation of affected area, inflam/oedemaa of nasal mucosa, discharge, fever
chronic - assoc with nasal polyps
MX OF SINUSITIS
i) name two investigations that may be done?
ii) up to how many days of symptoms should abx not be offered for? how long do most take to resolve?
iii) what tx should be offered if not resolving? (2)
iv) name three things that can be done for chronic sinusitis
i) nasal endoscopy and CT scan
ii) symp up to 10 days - viral caause should self resolve in 2-3 weeks
iii) offer high dose steroid nasal spray for 14 days eg mometasone
delayed abx prescription if worsening or not improve in 7d - pen V
iv) chronic - saline nasal irrigation
steroid nasal spray/drops eg momet or fluticasone
func endoscopic sinus surgery - endoscope through sinus and remove/correct obstructions
NASAL POLYPS
i) what are they? what are they often assoc with? are they usually uni or bilat? what is a red flag?
ii) name four conditions they may be assoc with? what is samters triad?
iii) name four ways they may px? how can the nose be examined? what specialist exam can be done? how do nasal polyps look?
iv) what does medical mx involve?
v) when is surgical mx offered? name two things that may be done
i) growths of the nasal mucosa thay occur in nasal cavity or sinus
assoc with inflamm (chronic rhinitis) - grow slow and obstruct nasal passage
usually bilat
unilateral is a red flag for tumour
ii) assoc chronic rhinitis and sinusitis, asthma, CF, eosino granulomatosis w polyangitis
samter triad - nasal polyp, asthma, aspirin allergy
iii) px with chronic rhinosinusitis, difficulty breathe through nose, snoring, nasal discharge, loss of smell
examine with nasal speculum
specialist - nasal endoscopy to assess nasal cav
iv) medical - intranasal topical steroid drops or spray
v) sx if medical fails
intranasal polypectomy (when polyps are close to nostrils)
endoscopic nasal polypec (when polyps are further into nose/sinus)
OBSTRUCTIVE SLEEP APNOEA
i) what is it caused by? name four RF?
ii) name four features? name two things that severe cases can cause
iii) what scale is used to assess sleepiness assoc with OSA?
iv) who should they be referred to? what clinic? what is the first step in mx? what is the second step
v) what surgery may be done?
i) caused by collapse of pharyngeal airway charac by episodes of apnoea during sleep
RF - middle age, male, obesity, ETOH, smoking
ii) apnoea during sleep, snoring, morning headacche, waking up unrefreshed, daytime sleepy, conc problems, reduced o2 sats during sleep
severe > HF and increase risk of MI/stroke
iii) epworth sleepiness scale
iv) refer to ENT and specialist sleep clinic
mx - correct reversible RFs eg stop ETOH and lose weight
then use CPAP
v) UPPP - surgical recons of soft palate and jaw
