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Holy Grail Docs > Nose > Flashcards

Nose Flashcards

1
Q

what type of epithelium lines the nasal cavity?

A

roof = olfactory epithelium (allows receptor cells from the olfactory bulb to send information about smell
rest is lined by respiratory epithelium

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2
Q

what bones form the nasal septum?

A

perpendicular plate of the ethmoid bone

vomer

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3
Q

what nerve supplies the upper half of the nasal cavity?

A

CN V1

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4
Q

what nerve supplies the lower half of the nasal cavity?

A

CN V2

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5
Q

describe arterial supply to the lateral wall of the nasal cavity

A

superior :
- anterior ethmoidal arteries
- posterior ethmoidal arteries
posterior = sphenopalatine artery (traverses sphenopalatine foramen)
inferior = greater palatine artery
anterior = lateral nasal branches of facial artery

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6
Q

what is kieselbachs area?

A

area on nasal septum which is rich an anastomosing arteries
common site of bleeding
- anterior and posterior ethmoidal arteries
- septal branch of labial artery
- greater palatine artery
- branch of sphenopalatine artery

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7
Q

where is the sphenoethmoidal recess and what drains here?

A

above the superior nasal concha

drains the sphenoidal sinus

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8
Q

where is the superior meatus and what drains here?

A

below the superior nasal concha

drains posterior ethmoidal air cells

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9
Q

where is the middle meatus and what are the 2 parts of it?

A

below the middle meatus
2 parts
- semilunar hiatus
- ethmoidal bulla

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10
Q

what drains into each part of the middle meatus?

A 
semilunar hiatus
- frontal sinus
- maxillary sinus
- anterior ethmoidal cells
ethmoidal bulla
- middle ethmoidal air cells
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11
Q

where is the inferior meatus and what drains here?

A

below the inferior nasal concha

drains nasolacrimal duct

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12
Q

how may a nasal fracture present and how is it managed?

A

bruising, swelling, tenderness, deviation, epistaxis

review after 2-3 weeks once swelling has reduced and manipulate under anaesthetic

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13
Q

4 risks which accompany nasal fracture?

A

recurrent epistaxis
CSF leak/meningitis
anosmia
septal haematoma

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14
Q

what are the dangers of a septal haematoma?

A

can lead to perichondrium separation, de vascularisation of the cartilage, necrosis and infection

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15
Q

where does epistaxis usually occur from?

A

kiesselbachs area (anastomising arteries on the septal wall)

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16
Q

how is mild epistaxis managed?

A

lean forward
external compression
ice

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17
Q

how is moderate epistaxis managed?

A

silver nitrate vessel cautery or electrocautery

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18
Q

how is severe epistaxis managed?

A 
nasal packing
post nasal packing
topical vasoconstriction 
rhino packs
consider arterial ligation in severe bleeds
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19
Q

viral vs bacterial vs secondary bacterial sinusitis?

A

viral = lasts less than 10 days
bacterial = lasts over 10 days, but less than 4 weeks
secondary bacterial = viral infection which seems to get better then worsens a few days later

20
Q

symptoms of sinusitis?

A

purulent nasal discharge
nasal obstruction
facial pain/pressure over sinuses

21
Q

how is acute viral sinusitis managed?

A 
analgesia
decongestants
intranasal corticosteroids
ipratropium
mucolytics
22
Q

how is acute bacterial sinusitis managed?

A

watchful waiting for >10 days and then commence antibiotics
- 1st line = penicillin for 7 days
- 2nd line = doxycycline for 7 days
plus same management as viral

23
Q

how is sinusitis managed in immunosuppressed?

A

immediate antibiotic treatment and ENT specialist referral

24
Q

what is chronic sinusitis?

A

lasting more than 12 weeks

25
Q

how is chronic sinusitis investigated?

A 
anterior rhinoscopy
flexible nasoendoscopy 
imaging
- sinus CT (for pre surgical staging)
sinus MRI (shows intracranial spread, fungal infections etc)
26
Q

how is chronic sinusitis managed medically?

A

antibiotics
decongestants
intranasal corticosteroids
oral corticosteroids (if oedema or polyps present)
anti-histamines/anti-leukotrienes if complicated with allergic rhinitis

27
Q

how is chronic sinusitis managed surgically?

A

FESS (functional endoscopic sinus surgery)

- increases diameter of sinus opening to allow drainage of sinuses

28
Q

what are the 2 groups of rhinitis?

A

allergic

non-allergic

29
Q

what is allergic rhinitis?

A

inflammation of the nasal cavity due to a type 1, IgE associated response to indoor and/or outdoor environmental allergens
e.g - pollens, mould spores, animals, feathers, dust mites

30
Q

how is allergic rhinitis investigated?

A

skin prick allergy test

RAST testing

31
Q

how is allergic rhinitis managed?

A 
oral anti-histamines (cetirizine)
intranasal antihistamines (azelastine)
intranasal corticosteroid (beclomethasone)
2nd line = leukotriene receptor antagonists (e.g montelukast) - helpful in patients with persistent asthma
32
Q

what are the 2 types of non-allergic rhinitis?

A

vasomotor

NAR eosinophilic syndrome

33
Q

how does non-allergic rhinitis occur?

A

regulated by autonomic innervation of the nasal cavity

reacts to changes in temperature, humidity, stress, hormonal changes

34
Q

how is non allergic rhinitis diagnosed?

A

negative findings in skin prick testing and serological IgE testing

35
Q

how is non allergic rhinitis managed?

A

iptrtropium for vasomotor
nasal saline irrigation, intranasal antihistamines + intranasal corticosteroids + oral decongestant
surgical = CO2 laser turbinectomy

36
Q

what are nasal polys and where do they usually come from?

A

swellings in the nasal cavity formed of oedematous mucosa
usually occurs from the ethmoidal sinuses - presenting bilaterally in the middle meatus causing obstruction
can sometimes occur from maxillary sinuses (antrochoanal polyps)

37
Q

what causes nasal polyps?

A

samter’s triad (aspirin intolerance, asthma, nasal polyps)

EGPA

38
Q

what presentation of nasal polyps required further investigation?

A

if occurring in children

if unilateral

39
Q

how are nasal polyps managed?

A

intranasal corticosteroids (beclomethasone)
oral corticosteroids if severe
surgical polypectomy

40
Q

what are inverting papillomas?

A

wart like unilateral projections into the nasal cavity or paranasal sinuses
benign but can become malignant in 5-15% of cases

41
Q

symptoms of inverting papillomas?

A

anosmia
bleeding
irritation
occlusion

42
Q

what causes inverting papillomas?

A

unknown
can be virus (HPV)
industrial contaminants
pollution

43
Q

how are inverting papillomas managed?

A

all papillomas are removed

radiotherapy may be required for malignant inverting papillomas

44
Q

what is the most common cancer of the nasal cavity?

A

SCC

2nd = adenocarcinoma

45
Q

risk factors for nasal cancers?

A 
work exposure
hard woods (saw dust) - adenocarcinoma risk
glues
dyes
chemicals
HPV infection
smoking
46
Q

how are nasal cancers managed?

A

complete surgical resection and adjuvant radiotherapy

Holy Grail Docs (39 decks)

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