Session 9 B

Question 1

Functions of nose and nasal cavity

Answer 1

Olfaction
Filtering
Humidifying and warming inspired air
Drainage of secretions from paranasal sinuses and nasolacrimal ducts

Question 2

External nose is predominantly

Answer 2

Cartilaginous, however frontal processes of maxillae and 2 nasal bones form root

Question 3

Complications of nose injuries

Answer 3

Septal haematoma, septal deviations and nasal bone fractures

Question 4

Describe Nasal cavity

Answer 4

Extends from nostrils anteriorly (anterior nasal apertures)

To posterior nasal apertures (choanae)

Has a roof, floor and 2 walls

Opens into most superior part of pharynx, Nasopharynx

Question 5

Medial wall of nasal cavity is formed by

Answer 5

Nasal septum - perpendicular plate of ethmoid bone, septal cartilage and vomer

Question 6

Cartilaginous portion of septum relies on

Answer 6

Overlying perichondrium for blood supply

Question 7

Clinical implications of injuries involving nasal septum

Answer 7

-Septal haematoma
-blood collects in space between cartilagenous septum and perichondrium
-Lifts perichondrium off cartilage, stripping away blood supply
- Pressure of accumulating blood causes ischeamia of cartilage

Question 8

Outcomes of septal haematoma

Answer 8

Must be recognised and drained in timely fashion, irreversible necrosis occurs if not

Saddle deformity- cosmetic distortion of the nose

hence important to inspect nasal septum after any sort of nasal trauma

Question 9

What are these

Answer 9

Question 10

Describe the paranasal cavities or sinuses

Answer 10

4 major ones

Maxillary, frontal, ethmoidal and sphenoid

All paired except sphenoid, maxillary is largest

Question 11

Ethmoidal sinuses collectively consist of the

Answer 11

Anterior, middle and posterior air cells

Question 12

Describe paranasal sinuses anatomy

Answer 12

Air-filled spaces

Lined with respiratory mucosa (ciliated Pseudostratified columnar with goblet cells)

Communicate with nasal cavity via openings e.g. middle meatus

Question 13

Obstruction to drainage from a paranasal sinus can lead to

Answer 13

An accumulation of mucosal secretions, development of acute sinusitis

Pain and tenderness over sinus involved, nasal discharge, general systemic upset (fever, feeling unwell)

Question 14

Causes of sinusitis

Answer 14

Infections of nose (infective rhinitis)

Dental infections (roots of some of the upper teeth lie on floor of maxillary sinus)

Question 15

4 paranasal air sinuses

Answer 15

Question 16

What is sinusitis

Answer 16

Inflammation of the lining of the sinuses and can occur following a viral infection of the nasal mucosae

Spreads to involve sinuses

Question 17

Paranasal sinus infection causes

Answer 17

Mucosal oedema, impedance of ciliary function and increasing mucosal secretions

Question 18

What can happen if drainage from sinuses become obstructed

Answer 18

Oedema involves openings into nasal cavity

Obstruction combined with increased mucosal secretions leads to a stagnant pool collecting within sinus

Secondarily infected by bacteria

Question 19

Which sinus is prone to infection

Answer 19

Maxillary sinus- antrum

Location of its opening high on the wall of the nasal cavity

Question 20

Diagnosis and treatment of sinusitis

Answer 20

History and clinical examination

Self-limiting, treated with simple analgesics, improve within 1-2 weeks

Antibiotics needed if secondary bacterial infection suspected (prolonged, severe symptoms)

Question 21

Complications from sinusitis

Answer 21

Rare

Ethmoidal sinuses= break through thin medial wall of orbit

Infection spreads to orbit = orbital cellulitis

Potentially sight threatening as may involve optic nerve, track back further to involve intracranial structures

Question 22

Answer 22

Question 23

Answer 23

Question 24

Answer 24

Question 25

Role of concha and meatuses

Answer 25

Question 26

Lateral wall of nasal cavity

Answer 26

Question 27

Medial wall of nasal cavity

Answer 27

Question 28

What is this

Answer 28

Septal haematoma

Question 29

Answer 29

Question 30

Features of nasal bone fracture

Answer 30

Question 31

Features of blood supply to nasal cavity

Answer 31

rich Allows humidification and warming Anastomoses on medial wall is a site of bleeding (Epistaxis)

Question 32

Answer 32

Question 33

What are nasal polyps

Answer 33

Question 34

Features of rhinitis

Answer 34

Question 35

What are Ostia

Answer 35

Small channels that drain from paranasal cavity into nasal cavity into meatus

Question 36

Anterior and posterior ethmoid arteries arise from the

Answer 36

Opthalmic artery

Question 37

Opthalmic artery is a branch of the

Answer 37

Internal carotid artery

Question 38

Sphenopalatine artery and greater palatine arteries are branches of the

Answer 38

Maxillary artery

Question 39

Maxillary artery is a branch of the

Answer 39

External carotid

Question 40

Branches of external carotid artery

Answer 40

Some anatomists like freaking out poor medical students

Question 41

Nervous supply to nasal cavity

Answer 41

Trigeminal nerve- Opthalmic branch and maxillary branch

Question 42

Paranasal air sinus innervation

Answer 42

Question 43

Clinical diagnosis of acute sinusitis

Answer 43

recent URTI Blocked nose and rhinorrhoea +/- green yellow discharge Pyrexia Headache/facial pain worse on leaning forwards

Question 44

Acute bacterial sinusitis more likely if

Answer 44

Symptoms particularly severe at onset Symptoms more than 10 days without improvement but less than 4 weeks Worsen after initial improvement

Question 45

Most common bacteria for acute bacterial sinusitis

Answer 45

Streptococcus pneumonia, haemophilia influenzae, moraxella catarrhalis

Question 46

Answer 46

Question 47

Arteries that are important to know for nose bleeds

Answer 47

Question 48

Minor treatment of nose bleeds

Answer 48

Pinch in front of the bony bridge of nose and hold for 15-20 mins

Question 49

Arterial supply to the nasal cavity is mainly from

Answer 49

Branches of the maxillary artery

Question 50

Origin for most nosebleeds

Answer 50

Little’s area (90%) 10% arise from sphenopalatine artery (can be very problematic as at higher pressure, and posteriorly located, harder to reach)

Question 51

Causes of nose bleeds

Answer 51

Spontaneously, very minor trauma, underlying systemic causes (abnormal coagulation and connective tissue disorders)

Question 52

Management of epistaxis includes

Answer 52

Applying simple compression, cauterisation or anterior packing using nasal tampons Posterior packing or surgical intervention e.g. embolisation, ligation of blood vessels ABCs closely monitored in severe epistaxis

Question 53

Steps to confirm correct placement of nasogastric tube

Answer 53

Aspirate to confirm pH is acidic, CXR

Question 54

NG tube use (not feeding)

Answer 54

Bowel obstruction Act to drain or empty stomach of excess gas and fluid that is accumulating whilst bowel is obstructed