Nose Pathologies

Question 1

What class of medications can be used as topical nasal decongestants for short periods of time? Give an example?

Answer 1

Sympathomimetics e.g. pseudoephedrine

Question 2

Anti-histamine drugs most commonly act on which receptors?

Answer 2

H1 receptors

Question 3

What are some examples of non-sedating anti-histamines?

Answer 3

Cetirizine, loratidine

Question 4

What is a potential side effect of the use of nasal steroids?

Answer 4

Epistaxis

Question 5

What medication can be used in individuals with seasonal allergic rhinitis who have not responded to steroids and anti-histamines?

Answer 5

LTRAs

Question 6

What is the first line investigation for allergic rhinitis?

Answer 6

Skin prick testing

Question 7

What is the second line investigation for allergic rhinitis?

Answer 7

RAST (IgE levels)

Question 8

What are the first line treatments to try when treating allergic rhinitis, along with allergen avoidance?

Answer 8

Oral anti-histamines and topical steroids

Question 9

Oral steroids should only be used for allergic rhinitis if all other treatments fail- they should only be used for a maximum of how long?

Answer 9

2 weeks

Question 10

How is infective rhinitis treated?

Answer 10

Topical decongestants and analgesia

Question 11

What is the medical term for a drippy nose in older men, which can be triggered by the cold, smoke, spicy food etc?

Answer 11

Vasomotor rhinitis

Question 12

What is the first line treatment for nasal polyps?

Answer 12

Oral and then topical steroids

Question 13

If steroids are not effective in the treatment of nasal polyps, what can be done?

Answer 13

Surgical removal

Question 14

If a young person has nasal polyps, a diagnosis of what condition should be considered?

Answer 14

CF

Question 15

What are some common causative organisms of infective sinusitis?

Answer 15

Strep pneumoniae, haemophilus influenzae, strep pyogenes

Question 16

Antibiotics are reserved for cases of sinusitis which have persisted for how long and continue to deteriorate?

Answer 16

> 10 days

Question 17

What is the first line antibiotic for sinusitis and how long should it be given for?

Answer 17

Oral penicillin V for 5 days

Question 18

What is the second line antibiotic for sinusitis and how long should it be given for?

Answer 18

Oral doxycycline for 5 days

Question 19

Chronic sinusitis is defined as symptoms lasting for how long?

Answer 19

> 4 weeks

Question 20

If symptoms of sinusitis are recurrent or complications arise, an ENT opinion should be sought and what investigation should be performed?

Answer 20

Sinus CT scan

Question 21

What autoantibody will be present in cases of GPA?

Answer 21

cANCA

Question 22

Unilateral nasal symptoms in a child should raise suspicion of what diagnosis?

Answer 22

Foreign body

Question 23

Unilateral nasal symptoms in an adult should raise suspicion of what diagnosis?

Answer 23

Nasal tumours

Question 24

What is the most important pathology to exclude in an individual with nasal trauma?

Answer 24

Septal haematoma

Question 25

What is the treatment for a septal haematoma?

Answer 25

IV antibiotics and surgical drainage

Question 26

Providing there is no immediate problem with breathing, patients with a nasal fracture should be reviewed when?

Answer 26

5-7 days post-injury

Question 27

Physical straightening of the nose after nasal trauma can only be performed within what timeframe?

Answer 27

The first 2 weeks following injury

Question 28

Epistaxis from what artery is a recognised complication of nasal trauma?

Answer 28

Anterior ethmoid artery

Question 29

Anosmia can occur as a result of what type of nasal fracture?

Answer 29

Cribriform plate fracture

Question 30

Which area of the nose is most likely to be affected by epistaxis?

Answer 30

Keisselbach's plexus

Question 31

Which arteries of Keisselbach's plexus are branches of the internal carotid artery?

Answer 31

Anterior and posterior ethmoidal arteries

Question 32

What is a condition that can cause nosebleeds in boys at puberty?

Answer 32

Juvenile nasal angiofibroma

Question 33

What are some first aid measures for the management of epistaxis?

Answer 33

Pinch nose, ice packs, lean forwards

Question 34

Following first aid measures, what is the first line management of epistaxis if a bleeding vessel can be identified?

Answer 34

Cautery

Question 35

What is the next line treatment for epistaxis if cautery isn't possible or hasn't worked?

Answer 35

Nasal packing

Question 36

Following nasal packing, what are some potential treatment options for epistaxis?

Answer 36

Endoscopic ligation of the sphenopalatine artery or external carotid artery or embolisation

Question 37

CSF leak from the nose may occur as a result of what injury?

Answer 37

Fracture of the cribriform plate

Question 38

CSF leaks from the nose will often settle spontaneously, but repair may be needed if it hasn't settled in how long?

Answer 38

10 days

Question 39

Should prophylactic antibiotics be given in association with a CSF leak from the nose?

Answer 39

No

Question 40

What is the investigation of choice for a suspected inhaled or ingested opaque foreign body?

Answer 40

Plain radiographs

Question 41

What is the most common malignant lesion of the nose?

Answer 41

Squamous cell carcinoma

Question 42

Nasopharyngeal carcinoma is very common in individuals from where?

Answer 42

The middle east

Question 43

Nasopharyngeal carcinoma has a strong association with what infection?

Answer 43

EBV