Rhinology

Question 1

what may you look for in a past medical history?

Answer 1

> nasal surgery
nasal trauma
asthma
aspirin sensitivity

Question 2

what is important in the social history?

Answer 2

> alcohol
smoking
cocaine abuse

Question 3

when examining the nose with a nasal endoscope what three areas can be examined?

Answer 3

> Eustachian tube
middle meatus
superior meatus

Question 4

what can be used to examine the nose?

Answer 4

> otoscope
torch
nasal endoscopy

Question 5

what investigations may you carry out (depending on the problem)?

Answer 5

> blood tests
> CT scan
> MRI scan
> skin tests
> rhinomanometry

Question 6

what blood test would be relevant?

Answer 6

> FBC
> ANCA
> ESR
> ACE
> RAST

Question 7

what can cause a septal haematoma?

Answer 7

trauma

Question 8

why must a septal haematoma be drained early on?

Answer 8

to prevent deformity and septal perforation

Question 9

what may a patient with a constant blocked nose, PN drip and hyposmia with asthma and aspirin sensitivity have?

Answer 9

nasal polyps

Question 10

what are nasal polyps?

Answer 10

chronic inflammation due to autonomic nervous system dysfunction. can be allergic or non-allergic.

Question 11

what percentage of people with nasal polyps have alcohol intolerance?

Answer 11

50%

Question 12

what allergic conditions are associated with nasal polyps?

Answer 12

> asthma
allergic rhinitis
aspirin intolerance
alcohol intolerance

Question 13

what non-allergic conditions are associated with nasal polyps?

Answer 13

> cystic fibrosis
AFS
churg-strauss syndrome

Question 14

what investigations would you carry out for nasal polyps?

Answer 14

> sweat test
> RAST/skin testing
> nasal smear: microbiology, eosinophils, neutrophils
> coronal CT scan
> MRI scan
> Flexible nasendoscopy
> rigid nasendoscopy

Question 15

what is the treatment fro nasal polyps?

Answer 15

> oral and nasal steroids
immunotherapy
surgery

Question 16

what is the surgical treatment for nasal polyps?

Answer 16

> traditional polypectomy
microdebrider
endoscopic sinus surgery

Question 17

what sort of recurrence of polyps post surgery is common?

Answer 17

multiple small polyps

Question 18

what are the cons of a sinus radiograph in the di\gnosis of rhinosinusitis?

Answer 18

> high false positive finding rate

> less accurate compared to other imaging techniques

Question 19

describe acute adult sinusitis

Answer 19

> acute onset of symptoms
duration <12weeks
complete resolution of symptoms

Question 20

describe recurrent acute adult sinusitis

Answer 20

> 1 to <4 episodes of acute rhinosinusitis per year with complete recovery between episodes and a symptoms free period of >weeks between acute attacks with absence of medical treatment

Question 21

describe the classification of chronic adult sinusitis

Answer 21

symptoms last >12 weeks with persistent inflammatory changes on imaging >4 weeks

Question 22

describe an acute exacerbation of chronic adult sinusitis

Answer 22

there is worsening of existing symptoms or appearance of new symptoms with resolution of the acute symptoms between episodes.

Question 23

what is the most common microbial aetiology of acute rhinosinusitis?

Answer 23

> s. pneumonia

> h. influenza

Question 24

what are the main factors in the symptoms for rhinosinusitis?

Answer 24

> facial pain and pressure
> hyposmia/anosmia
> nasal congestion/obstruction
> purulent postnasal drainage
> olfactory disturbance
> cough

Question 25

what are the minor factors in the rhinosinusitis symptom complex?

Answer 25

``` > headache > fever > fatigue > halitosis > dental pain ```

Question 26

what are the antimicrobial choices for rhinosinusitis?

Answer 26

> beta lactams (penicillins and cephalosporins) | > macrolides (erythromycin and clarithromycin)

Question 27

what is the treatment plan for a young boy with acute periorbital swelling and a history of acute URI?

Answer 27

> emergency referral with ophthal opinion > urgent CT > IV antibiotics > emergency surgery

Question 28

how would you treat frontal sinusitis?

Answer 28

emergency referral and frontal sinus surgery

Question 29

what can cause epistaxis?

Answer 29

``` > infection > trauma > allergy > hypertension > hereditary haemorrhagic telangiectasia > blood dyscrasias > atrophic rhinitis > tumour > congenital nasal defects ```

Question 30

what are nasal packs used for?

Answer 30

to stop nasal bleeding if you cannot find the source and to stabilise the patient

Question 31

what surgical treatment is there for epistaxis?

Answer 31

``` > endoscopic sphenopalatine artery ligation > transmaxillary IMA ligation > anterior/posterior ethmoidal ligation > external carotid artery ligation > intraoral IMA ligation ```

Question 32

what treatment can be offered to a young man with profuse right sided epistaxis and an angiofibroma?

Answer 32

preoperative embolization and surgery