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Year 4 - 5. Neurology & Special Senses > Nose (ENT) + sinuses > Flashcards

Nose (ENT) + sinuses Flashcards

1
Q

Outline some functions of the nose

A
  • Smell
  • Breathing
  • Humidify + warms air
  • Protection against pathogens
  • Resonating chamber for speech
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2
Q

List the bones making up the roof, medial wall and floor of the nasal cavity

A

Roof:
- Nasal bone + frontal (anterior aspect)
- Ethmoid
- Sphenoid

Medial wall:
- Ethmoid
- Vomer

Floor:
- Hard palate

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3
Q

Outline the nerves innervating the nasal cavity

A

Anterior (soft) portion = trigeminal ophthalmic branch
Posterior (hard) portion = trigeminal maxillary branch

+ roof of oral cavity = trigeminal mandibular branch

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4
Q

State the ‘region’ from which epistaxis usually begins from

A

Kiesselbach’s plexus (anterior septum)

+ sphenopalatine artery is less common but more difficult to treat at the posterior aspect of the nose

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5
Q

State some features of acute sinusitis which makes it more likely to be a bacterial infection

A
  • Severe symptoms at onset
  • Symptoms last more than 10 days without improvement
  • Symptoms that worsen after initial improvement (suggested secondary bacterial infection)
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6
Q

List some causes of nasal blockage

A
  • Nasal polyps
  • Nasal tumors (malignant)
  • Deviated septum
  • Enlarged adenoids
  • Choanal atresia
  • Foreign body
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7
Q

Outline some signs and symptoms of nasal blockage

A
  • Mouth breathing
  • Snoring / difficulty sleeping
  • Runny nose / postnasal drip
  • Facial pain / pressure
  • Headaches
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8
Q

List some causes of rhinitis

A
  • Allergic (hay fever)
  • UTRI
  • Weather changes e.g. temperature or humidity
  • Alcohol / spicy food
  • Hormonal changes (pregnancy, puberty, HRT)
  • Hypothyroidism
  • Medications e.g. ACEi, beta blockers, aspirin
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9
Q

Outline some signs and symptoms of rhinitis

A
  • Rhinorrhoea
  • Blocked nose
  • Itchy nose
  • Sneezing
  • Reduced sense of smell
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10
Q

List some causes of epistaxis (local vs general)

A

Local:
- Idiopathic / spontaneous
- Trauma incl. picking nose or iatrogenic e.g. post-operatively
- Foreign body
- Inflammatory e.g. rhinitis, polyps
- Tumours

General:
- HTN
- Coagulation defects e.g. haemophilia, thrombocytopenia
- Leukaemia
- Anticoagulation medication e.g. DOACs

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11
Q

Outline the management steps for epistaxis

A

ABC approach

Initial steps:
- Head forward
- Pinch soft part of nose
- Spit out blood (don’t swallow)
- Locate source of bleed

Management - stepwise approach:
- Cautery (silver nitrate sticks or diathermy) +/- topical adrenaline
- Nasal packing (anterior pack first, then posterior pack)
- Surgical intervention (ligate or embolise arteries)

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12
Q

Outline the management steps for nasal fracture

A

ABC approach
If recently broken and no swelling (within minutes) then can attempt to reset but otherwise need to bring them back in 7-10 days to reset

Initial steps:
- Examine for septal haematoma

Management - stepwise approach:
- Manipulation under anaesthetic (LA or GA) within 2 weeks of initial injury

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13
Q

List some causes of facial pain

A
  • Trauma e.g. fracture
  • Sinusitis (acute or chronic)
  • Salivary gland pathology e.g. inflammation, stones
  • Shingles in facial area
  • Malignancy
  • Giant cell arteritis
  • Trigeminal neuralgia
  • Temporomandibular joint dysfunction
  • Dental issues
  • Referred pain e.g. otalgia or tonsillitis
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14
Q

Outline the 3 main categories of rhinitis

A
  1. Infectious
    - Rhinoviruses
    - Coronaviruses
    - Influenza
    - Adenovirus
    - RSV
  2. Non-allergic (multiple causes)
    - Occupational (chemical)
    - Smoking
    - Hormonal
    - Senile (rhinitis of the elderly)
    - Medication-induced
  3. Allergic
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15
Q

Outline rhinitis and how it can present

A

Irritation and inflammation of the mucous membrane, leads to excessive mucus production

Presentation:
- Runny nose
- Blocked nose
- Sneezing
- Post-nasal drip
+ associated symptoms depending on cause e.g. watery eyes if allergic cause

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16
Q

Outline how infective and allergic rhinitis cases are managed

A

Allergic:
- Avoid triggers if possible
- Oral antihistamines
- Regular nasal corticosteroid sprays e.g. Fluticasone and Mometasone
- Nasal antihistamines for rapid onset symptoms in response to a trigger

Consider referral to immunology if symptoms are unmanageable with management above
- Skin prick tests for specific allergens

17
Q

List some examples of non-sedating antihistamines (3) and sedating antihistamines (2)

A

Non-sedating antihistamines:
- Cetirizine
- Fexofenadine
- Loratadine

Sedating antihistamines:
- Chlorphenamine (Piriton)
- Promethazine

18
Q

Acute sinusitis - state the following:
- Pathophysiology
- Presentation
- Investigations
- Management (acute)

A

Pathophysiology:
- Inflammation of the paranasal sinuses (usually also the nasal cavity, also known as rhinosinusitis)
- Caused by blockage of ostea draining the sinuses, therefore accumulation of fluid and subsequent inflammation
- Can be a variety of causes
- Acute (< 3 months) or chronic (> 3 months, +/- nasal polyps)

Presentation - face and nose symptoms:
- Facial pressure worse on leaning forward
- Headache (facial)
- Tenderness to palpation
- Facial swelling over affected area
- Nasal discharge
- Nasal congestion / anosmia
- Nasal oedema on examination
+ fever, tachycardia etc. if bacterial infection

Investigations:
Usually not required unless chronic and unresolving
- Nasal endoscopy
- CT head

Management:
Symptoms < 10 days = nasal decongestants and analgesia, no antibiotics (resolve 2-3 weeks)
Symptoms not improving after 10 days = nasal steroid spray for 10 days e.g. Mometasone
Delayed antibiotic prescription if not improving after a further 7 days of Penicillin V
Admission if evidence of systemic infection / sepsis

19
Q

Outline some of the main causes of sinusitis

A
  • Infection (especially following an URTI)
  • Allergies
  • Smoking
  • Obstruction of drainage e.g. foreign body, trauma or polyps (more associated with chronic sinusitis)

If asthma, more common to develop sinusitis

20
Q

Outline how chronic sinusitis is managed

A

Generally no cure, aimed at symptomatic management

Avoidance of allergens
Nasal douching

Medical:
- Antihistamines
- Topical nasal steroid spray or drops e.g. Mometasone

Surgical:
- Functional endoscopic sinus surgery (FES)
- Polyp removal (although high rate of recurrence)

21
Q

Outline technique for spraying nasal spray

A
  • Tilt head slightly forward
  • Use opposite hand for nostril
  • Don’t sniff during spray, gently inhale after spray
    Shouldn’t taste the spray at the back of your throat

Year 4 - 5. Neurology & Special Senses (6 decks)

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