Nose

Question 1

Epistaxis:

• Definition + blood supply
• Causes: local, systemic
• Management

Answer 1

Epistaxis:

• Definition + blood supply : most commonly from keisselbachs plexus which is ant nasal septum. More severe is posterior from sphenopalatine or ant/post ethamoidal arts
• Causes: local, systemic: picking nose, idiopathic, nose blowing, foreign body, inflammatory, neoplastic, coagulopathies, cocaine
• Management: pinch soft part + lean forwards 20 mins, cautery lignocaine ant or post if can see bleed, if not nasal packing. if not surgical ligation under GA

Question 2

Nasal trauma:

• Symptoms (4)
• Signs (3)
• Management

Answer 2

Nasal trauma:

• Symptoms (4): swelling, pain, epistaxis, sob
• Signs (3): septal haematoma (bilat boggy septum), deformity
• Management: if suspect haematoma urgent ent review to drain + abx otherwise avn of cartilage causing saddle nose deformity. if deviated nose MAU within 2 weeks. if none just ent review within 7 days

Question 3

Nose red flags (5)

Answer 3

blood stained mucus
facial pain
orbital symptoms
csf leak
nasal skin cancer

Question 4

Acute sinusitis:

• Definition
• Viral and non viral causes
• Risk factors (2)
• Symptoms (5)
• Signs (2)
• Investigations
• Management

Answer 4

Acute sinusitis:

• Definition : inflamm of mucus mem of paranasal sinuses esp maxillary
• Viral and non viral causes: strep pneum, haem influ, rhinovirus
• Risk factors (2): nasal obst, recent infection, swimming, smoking
• Symptoms (5): facial pain worse forwards, nasal obstruction, nasal discharge, fever
• Management: analgesia, if >10 days nasal steroids, if v unwell then phenoxymethylpenicllin / coamox 7 days

Question 5

Chronic sinusitis:

• Definition
• Causes
• Investigations
• Management

Answer 5

Chronic sinusitis:

• Definition : >12 weeks
• Risk f : atopy/allergy, polyps, septal deviation, recent infection, smoking, swimming
• Management: avoid allergens, intranasal steroids, nasal irrigation w saline . red flag if unilat + epistaxis

Question 6

Nasal polyps

• Definition
• Symptoms
• Signs
• Management

Answer 6

Nasal polyps

• Definition : benign fleshy growths assoc with asthma, aspirin sens, cf, sinusitis
• Symptoms: discharge, sob, rhinorrhoea, snoring, postnasal drips
• Signs : bilat
• Management: ent referral, nasal steroid spray, if fails polypectomy

Question 7

Allergic rhinitis:

• Definition
• Symptoms
• Investigations
• mx

Answer 7

Allergic rhinitis:

• Definition: igE type 1 hypesens inflammatory disorder where nose sensitised to allergens - seasonal, perrennial, occupational
• Symptoms: sneezing, bilat nasal obstruction, clear discharge, post nasal drip, pruritus
• Investigations: otoscope, skin prick, RAST
• Mx: avoid, antihistamines, intranasal corticosteroids - do not use decongestants for long periods as causes tachyphylaxis

Question 8

Nasopharyngeal carcinoma:
- def
- symp
- ix
- mx

Answer 8

• def: scc
• symp: cerv lymphad, otalgia, unilat otit med, nasal obstruction, cranial nerve palsies
• ix: ct/mri
• mx: radiotherapy