nose stuff

Question 1

nasal polyps triad

Answer 1

Samter’s triad
- asthma
- aspirin sensitivity
- nasal polyposis

Question 2

who are nasal polyps more commonly found in

Answer 2

2-4 times more in men

NOT common in kids + elderly

Question 3

nasal polyp red flag symptom

Answer 3

unilateral symptoms or bleeding

Question 4

nasal polyp assoc condtions

Answer 4

asthma - esp late onset
aspirin sensitivity
infective sinusistis

cystic fibrosis
Kartagener’s
Churg-Strauss

Question 5

nasal polyp presentation

Answer 5

nasal obstruction
rhinorrhoea, sneezing
poor sense of taste + smell

Question 6

management of nasal polyps

Answer 6

all referred to ENT

topical corticosteroids
- shrink polyps in 80%

Question 7

chronic rhinosinusitis definition

Answer 7

inflammatory disorder of paranasal sinuses + linings of the nasal passage that lasts 12 weeks or longer

Question 8

management of recurrent or chronic sinusitis

Answer 8

avoid allergen
intranasal corticosteroids

nasal irrigation with saline solution

Question 9

chronic rhinosinusitis red flags

Answer 9

unilateral sx
persistent sx despite 3months of treatment

epistaxis

Question 10

commonest site of epistaxis

Answer 10

Kiesselbach’s plexus
(littles area)

Question 11

management of epistaxi

Answer 11

1st = pinch cartilaginous area for 20mins

2nd = topical antiseptic - Naseptin (chlorhexidine + neomycin)
- NO if peanut allergy

admit + follow up care if;
- comorbidity - CAD, hypertension, suspected underlying cx
- <2yrs

… if bleed still at 10-15 mins
-> cautery
- use initially if source of bleed visible

cautery not viable/bleeding point not visualised –> packing

Question 12

epistaxis that has failed all emergency management

Answer 12

sphenopalatine ligation in theatre

Question 13

most common infectious agents seen in acute sinusitis

Answer 13

• strep pneumoniae
• haemophilus influenzae
• rhinoviruses

Question 14

predisposing factors to acute sinusitis

Answer 14

nasal obstruction - septal deviation or polyps
recent local infection - rhinitis, dental extraction

swimming/diving
smoking

Question 15

management of acute sinusitis

Answer 15

sx >10days = intranasal corticosteroids

• analgesia
• intranasal decongestant/saline

oral abx only if severe sx - phenoxymethylpenicillin, co-amoxiclax
- NOT normally required

Question 16

what is meant by “double-sickening” in acute sinusitis

Answer 16

where an initial viral sinusitis worsens due to secondary infection

Question 17

sinusitis is inflammation of what …

Answer 17

mucous membranes of paranasal sinuses
(they usually sterile)