Anatomy
Name the nasal concha.
What is the superior, middle, and inferior nasal concha
persistent rhinorrhea, congestion, nasal itching, pale/bluish, swollen turbinates
What is allergic rhinitis
What is the 1st line treatment for allergic rhinitis?
What is intranasal corticosteroids (fluticasone, triamcinolone)
Posterior nose bleeds usually arise from which artery or arteries?
What is the sphenopalatine artery
A 58 y/o female presents with a 2 day hx of congestion, rhinorrhea, fatigue, sore throat, PND, frontal headache, sinus pressure and ear pressure. Exam shows erythema/edema of nasal mucosa, dull TMs with decreased mobility, mild erythema of OP, heart-RRR, lungs-CTAB. What is the best treatment for this patient?
What is symptomatic treatment (nasal saline, NSAIDs, decongestants etc)
What is the name of the site where most nose bleeds occur?
What is Kiesselbach's plexus
Usually a unilateral, fluctuant widening/swelling of the anterior nasal septum noted after trauma
What is a septal hematoma
What is the definitive treatment of a septal hematoma?
What is drainage
What must you r/o with nasal trauma?
What is a septal hematoma
36 y/o male with significant congestion and rhinorrhea, itchy eyes and nose x 2 wks. The symptoms seem to wax and wane. He states he gets this every year around this time. He denies hx of allergies, sinus pain, or fever. On exam you note pale, bluish, edematous nasal turbinates. What is the most likely diagnosis?
What is allergic rhinitis
What is the frontal sinus located in the frontal bone just medial to the brows, the ethmoid sinus in the ethmoid bone, the sphenoid sinus within the body of the sphenoid, and maxillary sinus in the maxilla inferior to the orbit.
Nasal congestion, PND, cough, sinus pressure, erythema/edema of the nasal turbinates with watery discharge x 2 days
What is viral rhinosinusitis
What is the treatment of viral rhinosinusitis?
What is symptomatic treatment (nasal saline, NSAIDs, decongestants, etc.)
What is Samter's triad?
What is asthma, aspirin sensitivity, and nasal polyposis
A 19 y/o male c/o getting punched in the nose during a basketball game. States the nose bled for a couple minutes at first but stopped with applied pressure for 10 min. He now is c/o pain and nasal stuffiness. On exam the nose is midline without major deformity. there is some swelling and ecchymosis over the bridge of the nose. No ttp over the orbital rim. The septum is midline and without swelling. No active bleeding. What is the best initial management of this patient?
What is observation, ice, analgesics if needed.
What is the middle meatus.
congestion, purulent nasal discharge, sinus pain/pressure, cough, PND >10 days
What is bacterial rhinosinusitis
What is the 1st line treatment of bacterial rhinosinusitis in adults <65 y/o?
What is Amoxicillin or Augmentin
Name 3 signs of allergies not pertaining to the nasal cavity
What is allergic shiners, allergic conjunctivitis, dennie morgan lines, allergic salute, or cobblestoning in the posterior pharynx
52 y/o male presents with a 4 wk hx of congestion. Pt states symptoms started out like a cold which he has been using OTC meds for since. He saw his PCP 2 wks ago and was put on 10 days of Augmentin. Pt states all his symptoms have resolved and he doesn't feel sick anymore but the congestion just won't go away. Through questioning the patient tells you he has been using oxymetazoline nasal spray multiple times/day the past 4 weeks which worked great at first. What has this pt most likely developed?
What is rhinitis medicamentosa
What is the cribriform plate
Significant epistaxis unresolved by multiple conservative measures including bilateral nare packing. What area is the bleed most likely coming from?
What is a posterior bleed
What is the 1st line treatment for nasal polyps?
What is intranasal corticosteroids
How do we determine when to treat rhinosinusitis with antibiotics?
A 12 y/o female presents with a left sided epistaxis x 10 min occurring shortly after picking her nose. With the amount of bleeding you know you won't be able to see much on exam at this time unless you can stop the bleeding. What is the best initial management option for this patient?
What is apply direct pressure on the anterior 1/3rd of the nose for 15 min in a sitting, slightly leaned forward position.