nose

Question 1

what organism can causes sinusitis

Answer 1

strep pneumo // H. influ // rhinovirus

Question 2

RF developing sinusitis

Answer 2

nasal obstruction eg deviation, polyp // local infection eg rhinits, dental extraction // swimming or diving // smoking

Question 3

symptoms sinusitis

Answer 3

facial pain/ pressure worse bending forward!! // thick nasal discharge // obstruction

Question 4

mx sinusitis

Answer 4

analgesia +/- nasal decongestants or saline

Question 5

mx sinusitis lasting 10+ days

Answer 5

intranasal steroids

Question 6

abx for sinusitis

Answer 6

only if severe/ systemically unwell - may worsen a viral infection // 1 = pen V // 2 = co-amox if v unwell

Question 7

complication sinusitis

Answer 7

brain abscess // orbital abscess

Question 8

what is seasonal allergic rhinits

Answer 8

comes with the seasons secondary to pollen - hayfever

Question 9

what is perennial allergic rhinits

Answer 9

throughout the year

Question 10

what is occupation allergic rhinits

Answer 10

antigens in a work place

Question 11

mx mild-moderate allergic rhinitis

Answer 11

oral/ nasal antihistamine

Question 12

mx moderate-severe allergic rhinitis

Answer 12

intranasal steroids

Question 13

what can be prescribed for allergic rhinitis to control symptoms prophylactically

Answer 13

oral steroids

Question 14

role of nasal decongestants allergic rhinitis

Answer 14

short periods of time // prolonged = require increasing dose + causes rebound hypertrophy on withdrawal

Question 15

what is vasomotor rhinitis

Answer 15

(non-allergic rhinitis) when blood vessels in nose dilate –> runny nose, nose drip

Question 16

triggers vasomotor rhinitis

Answer 16

strong smell, cold air, alcohol, spicy food

Question 17

what is chronic rhino-sinusitis

Answer 17

inflamm disorder of paranasal sinus linings + nasal passage that lasts 12+ weeks

Question 18

RF chronic rhino-sinusitis

Answer 18

atopy // obstruction (deviation or polyp) // local infection // swimming, diving // smoking

Question 19

symptoms chronic rhino-sinusitis

Answer 19

frontal pressure pain worse leaning forward // nasal discharge (clear) // mouth obstruction (from nasal obstruction) // post nasal drip +/- chronic cough

Question 20

mx chronic sinusitis

Answer 20

allergy avoidance // intranasal steroids // nasal irrigation + saline

Question 21

Red flags chronic rhino-sinusitis

Answer 21

unilateral!! // persistant after 3 months // epistaxis

Question 22

what causes nasolacrimal duct obstruction

Answer 22

incomplete membrane lower end of lacrimal duct

Question 23

symptoms + age nasolacrimal duct obstruction

Answer 23

infants + watery eye

Question 24

mx nasolacrimal duct obstruction

Answer 24

massage lacrimal duct // if 1 year refer to ophthalmologist

Question 25

assoc nasal polyps

Answer 25

asthma // aspirin sensitivity // sinusitis // CF // EGPA (Churg-Strauss) // Kartageners

Question 26

what is samters triad

Answer 26

asthma + aspirin sensitivity + nasal polyps

Question 27

features nasal polyps

Answer 27

nasal obstruction // runny nose // sneezing // decreased taste + smell

Question 28

what symptoms require further testing in nasal polyps

Answer 28

unilateral or bleeding

Question 29

mx nasal polyps

Answer 29

refer ENT // topical steroids

Question 30

most common nasopharnygeal cancer

Answer 30

SCC

Question 31

what virus is nasopharnygeal cancer assoc with

Answer 31

EBV

Question 32

symptoms nasopharnygeal

Answer 32

sore ear // unilateral otitis media + effusion // nasal obstruction, discharge, nose bleed // cranial nerve palsy (esp III-VI) // cervical lymph (bad)

Question 33

invx nasopharnygeal cancer

Answer 33

CT + MRI

Question 34

mx nasopharnygeal cancr

Answer 34

radiotherapy

Question 35

source of bleeding anterior nose bleed

Answer 35

kisselbach plexus (esp sphenopalatine)

Question 36

RF assoc with posterior epistaxis

Answer 36

aspiration or airway compromise

Question 37

RF epistaxis

Answer 37

nose picking or blowing // trauma // bleeding disorder // juvenile angiofibroma // cocaine use // E+GPA // hereditary haemorrhagic telangiectasia

Question 38

first aid mx nosebleed

Answer 38

sit forward, mouth open // pinch soft cartilage for 20 mons

Question 39

potential nosebleed mx if first aid successful

Answer 39

topical antiseptic eg naseptin (chlorehexidine + neomycin) // avoid blowing nose, heaving lifting, alcohol

Question 40

cautions naseptin

Answer 40

peanut, soy, neomycin allergy

Question 41

mx nosebleed that does not stop after 15 mins

Answer 41

cautery (usually best) or packing

Question 42

what is nasal cautery

Answer 42

apply topical anaesthetic // use silver nitrate // dab clean and apply naseptin or muciprocin // (not well tolerated in kids)

Question 43

when is nasal packing indicated

Answer 43

bleeding vessel cannot be visualised

Question 44

emergency epistaxis mx

Answer 44

sphenopalatine ligation

Question 45

who needs admitted with epistaxis

Answer 45

severe comorbidity (ACS, hypertension) // under 2 (haemphilia, leukaemia) // haemodynamically unstable // unknown source eg posterior bleed

Question 46

symptoms septal heamatoma

Answer 46

following trauma // obstruction // pain // runny nose // bilateral, red swelling

Question 47

mx nasal septal heamatoma

Answer 47

surgical drainage + IV abx

Question 48

complications septal heamatoma

Answer 48

septal necrosis