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ENT > Nose Disease > Flashcards

Nose Disease Flashcards

1
Q

What are the symptoms of allergic rhinitis?

A

sneezing
pruritus
bilateral nasal discharge
bilateral itchy red eyes

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2
Q

What are the characteristics of intermittent allergic rhinitis?

A

symptoms <4 days per week
OR
symptoms <4 weeks duration

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3
Q

What are the characteristics of persistent allergic rhinitis?

A

symptoms >4 days per week
AND
symptoms >4 weeks duration

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4
Q

What causes intermittent allergic rhinitis?

A

grass pollen
tree pollen
fungal spores

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5
Q

What causes persistent allergic rhinitis?

A

house dust mite
cat
dog

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6
Q

What makes allergic rhinitis moderate-severe?

A 
one or more of:
abnormal sleep 
impairment of daily activities , sport or leisure 
missing work or school 
troublesome symptoms
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7
Q

What is the treatment of allergic rhinitis?

A

allergen avoidance
1 - antihistamines e.g. loratadine
2 - intranasal corticosteroid spray e.g. mometasone, fluticasone
3 - intranasal corticosteroid spray + antihistamines
4 - short course of prednisolone can help reduce severe symptoms
5 - immunotherapy for selected patients with IgE mediated disease, surgery for specific indications for relief of obstruction

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8
Q

What is the treatment for nasal polyps?

A

1 - oral steroids
2 - topical steroids
3 - surgery
small + bilateral = can be managed in primary care
causing significant obstruction = routine ENT referral
bilateral = urgent ENT referral - possible malignancy

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9
Q

What are the symptoms of acute infective rhinosinusitis?

A

facial pain - typically frontal pressure which is worse on bending forward
nasal discharge - usually thick and purulent
nasal blockage - mouth breathing
post-nasal drip - may produce a chronic cough

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10
Q

What is the main cause of acute infective rhinosinusitis?

A

viruses

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11
Q

What is the treatment for acute infective rhinosinusitis?

A

1 - analgesics and decongestants or nasal saline

2 - if persisting or worsening add antibiotic

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12
Q

What complication can arise from acute infective rhinosinusitis?

A

orbital cellulitis - emergency ENT referral

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13
Q

What can cause a unilateral nasal discharge in a young child?

A

foreign body in nose

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14
Q

What can cause a unilateral nasal discharge in an adult?

A

nasal or paranasal tumour

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15
Q

What is the management of a unilateral nasal discharge?

A

urgent ENT referral

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16
Q

What indicates bacterial acute sinusitis?

A

severe pain and tenderness with purulent nasal discharge

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17
Q

When should antibiotics be prescribed for acute sinusitis?

A

severe/deteriorating cases

significant co-morbidities that pre-dispose them to complications e.g. COPD

18
Q

What are the antibiotics used in acute sinusitis?

A

1st line - phenomethylpenicillin

2nd line - doxycycline (not in children)

19
Q

What can cause nasal polyps?

A 
allergy 
infection 
non-allergic asthma 
aspirin sensitivity 
nickel exposure
20
Q

What should be considered if a child has nasal polyps?

A

cystic fibrosis

21
Q

What is granulomatosis with polyangiitis/Wegnerer’s granulomatosis?

A

autoimmune disorder of unknown aetiology characterised by a small vessel vasculitis and necrosis

22
Q

What systems is granulomatosis with polyangiitis/Wegnerer’s granulomatosis usually limited to?

A

respiratory tract

kidneys

23
Q

What is the age of onset of granulomatosis with polyangiitis/Wegnerer’s granulomatosis?

A

> 40

24
Q

How does granulomatosis with polyangiitis/Wegnerer’s granulomatosis present?

A

pulmonary disease
renal disease
nasal symptoms of perforation (septal perforation etc)

25
Q

What disease is characterised by high levels of anti-neutrophil cytoplasm antibodies (ANCA)?

A

granulomatosis with polyangiitis/Wegnerer’s granulomatotis

26
Q

How is granulomatosis with polyangiitis/Wegnerer;s granulomatosis diagnosed?

A

cANCA +Ve

cytoplasmic-staining anti-neutrophil cytoplasm antibodies

27
Q

What is a Schneiderian papilloma?

A

benign tumour of the nose

28
Q

What is the aetiology of a Schneiderian papilloma?

A

HPV (low risk)
smoking
organic solvents
welding

29
Q

What are the symptoms of a Schneiderian papilloma?

A

blocked nose

30
Q

What is the pathology of a Schneiderian papilloma?

A

inverted and oncocytic on lateral walls and paranasal sinuses
exophytic on nasal septum

31
Q

What does oncocytic mean?

A

epithelial cell characterised by an excessive number of mitochondria, resulting in acidophilic, granular cytoplasm

32
Q

What does exophytic mean?

A

grow outward beyond the surface epithelium from which it originates

33
Q

What is rhinitis medicamentosa?

A

rebound nasal congestion brought on by extended use of topical decongestants

34
Q

Why should topical nasal decongestants not be used long term?

A

increasing doses required to achieve the same effect - tachyphylaxis
rebound hypertrophy of nasal mucosa may occur upon withdrawal

35
Q

What are the clinical features of nasal polyps?

A

nasal obstruction
rhinorrhoea
sneezing
poor sense of taste and smell

36
Q

What is Samter’s triad?

A

asthma + aspirin sensitivity + nasal polyposis

37
Q

Why drugs should be avoided in asthma and why?

A

aspirin and other NSAIDs

precipitate an asthma exacerbation

38
Q

What is sinusitis?

A

inflammation of the mucous membranes of the paranasal sinuses
sinuses are usually sterile - most common infectious agents are Strep. pneumonia, Haemophilus influenzae and rhinoviruses

39
Q

What are the predisposing factors for sinusitis?

A

nasal obstruction - e.g. septal deviation, nasal polyps
recent local infection e.g. rhinitis, dental extraction
swimming
diving
smoking

40
Q

What is the management of a patient that presents with unilateral nasal symptoms?

A

referral to ENT

41
Q

When should sinusitis be treated with intra-nasal corticosteroids?

A

severe symptoms

lasted for 10 days or more

ENT (21 decks)

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