Nose part 1

Question 1

Functions of the nose

Answer 1

Breathing
Smell 
Humidifying + filtering air 
85% taste 
Defence against pathogens 
Equalisation + ventilation of middle ear 
Drainage of paranasal sinuses + NLD

Question 2

Where are the nasal vestibular bodies

Answer 2

Inferior to the inf nasal turbinates

Question 3

What is the upper 1/3 of the external nose made of?

Answer 3

Bone

Question 4

What is the lower 2/3 of the external nose made of

Answer 4

Cartilage

Question 5

What is the vestibule?

Answer 5

The nasal entrance

Question 6

What is the nasal vestibule enclosed by?

Answer 6

Ala

Question 7

What important pathologies are common at the vestibule

Answer 7

BCC/SCC

Question 8

What bones form the nasal septum posteriorly (2)

Answer 8

Ethmoid

Vomer

Question 9

What important structure does the nasal septum contain?

Answer 9

Little’s area

Question 10

What structures drain into the middle meatus?

Answer 10

NLD

Sinuses

Question 11

Why is the inferior turbinate blocked by autonomic control?

Answer 11

To prevent drying and allow regeneration

Question 12

What structures do the nasal cavities end in?

Answer 12

Choanae

Question 13

What is the line between the nasopharynx and oropharynx called?

Answer 13

Soft palate

Question 14

Key features to ask about in a nose Hx (6)

Answer 14

Obstruction 
Bleeding 
Pain 
Discharge 
Smell 
Snoring/OSA

Question 15

Red flags nasal Hx

Answer 15

Nasal bleeding 
Polyps
Neck lumps 
Numb face 
Eye Sx - unilateral , proptosis, Diplopia, eye displacement

Question 16

Causes of nasal obstruction

Answer 16

Infectious 
Allergy 
Developmental (septal deviation) 
Traumatic
Iatrogenic 
Drugs 
Neoplastics 
Inflamm/systemic disease

Question 17

What is Rhinitis

Answer 17

Inflammation nasal lining

Question 18

Common Sx rhinitis (4)

Answer 18

Nasal congestion
Rhinorrhoea
Post-nasal drip
Sneezing + irritation

Question 19

Diagnosis of rhinorrhoea made by?

Answer 19

Nasal Hx features + allergy test. 2+ of:: 
Blockage/congestion
Facial pain/P 
Decr smell 
Presence endoscopic features

Question 20

What type of reaction is allergic rhinitis?

Answer 20

T1HS

Question 21

causes of allergic rhinitis

Answer 21

Int - grass/pollen
Persistent - house dust mite, mould, cat/dog
Food allergen rhinitis

Question 22

Signs allergic rhinitis (3)

Answer 22

Inflamed nasal turbinates + mucosa
Watery discharge
Gross turbinate hypertrophy

Question 23

Mx allergic rhinitis

Answer 23

Avoid allergy

Dx (PO/TO anti H, Na cromoglycate spray)

Question 24

Secondary effects of infective rhinitis (2)

Answer 24

OM

Long standing rhinosinusitis

Question 25

Acute Sx infective rhinitis (4)

Answer 25

Systemic upset Pyrexia Rhinorrhoea Pus

Question 26

Chronic Sx infective rhinitis

Answer 26

PN drip Decr concentration Facial pain

Question 27

Which non-allergic rhinitis is a diagnosis of exclusion?

Answer 27

Vasomotor

Question 28

What is medicamentosa due to?

Answer 28

Overuse of meds

Question 29

Mx medicamentosa

Answer 29

Stop decongestant Steroids Surgery

Question 30

What is atrophic rhintiis

Answer 30

Thickened secretions dry --> large crust + unpleasant odor | Req bleeding

Question 31

Mx atrophic rhinitis

Answer 31

Soften crust w/ steam inhal + glycerine | Surgically close

Question 32

Def acute rhinosinusitis

Answer 32

<4 w

Question 33

Def subacute rhinosinusitis

Answer 33

4-12w

Question 34

Def chronic rhinosinusitis

Answer 34

>12w

Question 35

Where does the posterior ethmoid sinuses drain

Answer 35

superior meatus

Question 36

Which sinuses drain into the middle meatus

Answer 36

Ethmoid Frontal Maxillary

Question 37

Which sinus is most commonly affected by acute rhinosinusitis?

Answer 37

Maxillary

Question 38

Features acute rhinosinusitis

Answer 38

Severe unilateral pain over infected sinus Malaise Pyrexia

Question 39

Tx acute rhinosinusitis

Answer 39

Simple analgesia Steam inhalation >10days - nasal CCS TO xylometolazine - 5 days max

Question 40

Who to Rx for surgery - rhinosinusitis (3)

Answer 40

Progressive pain Headache Focal neurology

Question 41

Chronic sinusitis

Answer 41

Longstanding mucosal inflammation leading to cystic polypoid changes Swollen mucosa narrows ostia --> cycle

Question 42

Features of chronic sinusitis (4)

Answer 42

Usually painless Hx sinogenic pain - exaccerbated during URTI Purulent secretions

Question 43

DDx chronic sinusitis (3)

Answer 43

Midfacial segment pain Migraine Cluster headaches

Question 44

Tx chronic sinusitis

Answer 44

Beclomethasone 2m (take lying down) BS Abx Nasal douching Surgery?

Question 45

Which sinusitis is life threatening?

Answer 45

Frontal

Question 46

PS frontal sinusitis

Answer 46

Tender forehead especially when percussed | Worse on bending over

Question 47

How can frontal sinusitis progress

Answer 47

into orbit --> blindness | Into cranial cavity --> abscess

Question 48

Tx frontal sinusitis

Answer 48

BS Abx | Decongestants

Question 49

Complications of rhinosinusitis (7)

Answer 49

``` Pre-orbital cellulitis Mucoceles Meningitis Cavernous sinus thrombosis Brain abscess Extradural abscess Subdural abscess ```

Question 50

Which sinus does pre-orbital cellulitis come from

Answer 50

Ethmoidal

Question 51

Which is the most ocmmon rhinosinusitis complication?

Answer 51

pre-orbital cellulitis

Question 52

Tx pre-orbital cellulitis

Answer 52

High dose Abx | Obseve

Question 53

PS mucocoele (2)

Answer 53

Facial swelling | Changes to eye orientation

Question 54

Tx mucocele

Answer 54

Surgical drainage

Question 55

PS cavernous sinus thrombosis (6)

Answer 55

``` Orbit swells Fever Rigors Headache Change in consciousness CN III, IV, VI palsies ```

Question 56

Tx cavernous sinus thrombosis

Answer 56

High dose Abx