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91 Cards in this Set

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Nasal septum is made of what four bones?
ethmoid, vomer, maxilla, palatine
and cartilage
T/F: The septum helps give the exterior nose its shape.
False. We can remove most of it and have no effect on external shape.
Turbinates are located on ____ wall.
lateral
The nasal lacrimal duct drains underneat the ____ turbinate.
inferior
The ethmoid, maxillary, and frontal sinuses drain underneath the _____ turbinate.
middle
Orbit is in close proximity to ____sinuses.
ethmoid
Four fxns of paranasal sinuses.
humidifying and warming air
lightening skull
absorbing shock
generate mucous
ICA leads to _____ artery which leads to ___ and ____ ___ arteries.
ophthalmic, anterior, posterior, ethmoid
ECA leads to ____ artery and ____ artery.
facial, sphenopalatine
Innervation of nasal cavity is predominately ___ with some ____.
V2-maxillary nerve, V1-opthalmic nerve
Viral rhinitis is characterized by ?
inflammation of mucous membranes of the nose
Symptoms of viral rhinitis.
runny nose, congestion, post nasal drip, cough, low grade fever
Diagnosis of viral rhinitis is usually done w/ ?
history
Inflammation and swelling in nose can lead to other problems like?
blockage of Eustachian tubes or sinuses that can lead to otitis media or sinusitis
Treatment of viral rhinitis:
keep swelling and inflammation down to avoid secondary infections like otitis media or sinusitis
Criteria for diagnosis of sinusitis
2 major symptoms or 1 major and 2 minor
Major symptoms of sinusitis
facial pain or pressure
congestion
nasal obstruciton
purulent post nasal drip
altered smell
fever (acute)
Minor symptoms of sinusitis
headache
fever
halitosis
fatigue
dental pain
cough
ear pain or pressure
Acute sinusitis is typically less than ____ and generally follows a ______.
4 weeks
upper-respiratory infection
Typically w/ sinusitis you'll be sick for ____ days then you'll get ____.
3-5
worse
____ coming out of a sinus or in the nose is diagnostic for sinusitis.
Pus
Chronic Rhinosinusitis - duration of greater than or equal to ___ .
12 weeks
With chronic infection, the tissue in the nose _____.
undergoes changes
Distinguishing feature of chronic sinusitis.
Tissue in nose undergoes changes
What is often used to diagnose chronic sinusitis
CT to see mucosa changes
Typical bugs w/ acute rhinosinusitis and otitis media?
Pneumococcus, Moraxella, Haemophilus
Typical bugs w/ chronic Rhinosinusitis
Staph, pseudomonas
Management of Sinusitis.
eliminate infection and restore ventilation
Recurrent episodes of sinusitis, give?
nasal steroids to get inflammation down (Nasonex or Flonase)
NATURAL draining pathways are opened up so that sinuses can drain
Functional Endoscopic Sinus Surgery
What are some complications that you would operate on acute sinusitis?
ethmoid sinusitis where infection spreads to globe

epidural abscesses
intracranial sinusitis
When do you operate on chronic sinusitis?
when it is refractory to treatment
___ is often helpful in patients w/ recurring infections but don't necessarily have changes seen w/ chronic sinusitis. This is called?
Surgery

Recurrent Acute Rhinosinusitis (RARS)
In surgery for RARS the ___ is taken down, and behind it is the opening for the ostium of the maxillary sinus
uncinate process
Get CT scan w/ patient wearing a headset and instruments can be tracked INTRAOPERATIVELY.
Computerized Assisted Surgery (CAS)
CAS is helpful when?
when there is a lot of bleeding
anatomy is funky
Helpful for avoiding ethmoids and intracranial cavity.
Nose bleeds
epistaxis
What does the large amount of vascularization in the nose help with?
humidification of air
Vasculature of nose is ___ protected.
poorly
Vasculature in nose lack ___ therefore they are direct _____. Why is this important in epistaxis?
capillaries
aterial-venous anastomoses

Not typical regulatory mechanism.
Majority of bleeds in nose occur in ?
Kiesselbach's plexus
Anterior vasculature of nasal cavity on septum. Confluence of ____ and ___ arteries
Kiesselbach's plexus

ethmoid and facial
Posterior vasculature of nasal cavity on septum. Where ___ and ____ arteries are located.
Woodruff's plexus

sphenopalatine and posterior nasal
Bleeds of Woodruff's plexus are usually _____ and seen in ____ patients.
more serious

older
Local factors that lead to epistaxis.
infections
trauma
digital trauma (stop picking Salar)
iatrogenic
foreign bodies
cocaine (uhhhh um...Safa?)
Systemic factors that can lead to epistaxis.
Severe infections
sepsis
total body inflammatory responses
coagulopathies (von Willebrand)
Non surgical treatments of epistaxis.
control BP
correction of coagulopathy
pressure/expulsion of clot
topical decongestant/vasoconstrictors
cauterize w/ silver nitrate
nasal packing
greater palatine foramen block
Non surgical preventative measures for epistaxis.
keep things moist (saline, ointment)
avoid trauma
avoid straining
humidity/emolients
Used when bleeding is more severe. Sits in the choana o nasal pharynx. Supposed to block ____ artery.
Posterior nasal pack

sphenopalatine
Indications for surgery/embolization
continuous bleed despite packing and treatments
Hct<38%
Radiologist IDs bleeds w/ contrast and then puts material in to thrombose those vessels.
Selective Angiography/Embolization
Selective Angiography/Embolization can only be done for ___ and its branches.
ECA
Why is thrombosing ethmoidal arteries dangerous?
have to go through ophthalmic artery which could cause blindness
Main problem w/ cancers in nose is? Why?
delay in diagnosis

Symptoms are not specific
Benign Nasal Neoplasms
Nasal Polyps
Nasal Papillomas
Malignant Nasal Neoplasms
SqCC and salivary gland tumors
Nasal polyps are caused by ___ of the nose.
chronic inflammation
Nasal polyps seen w/ ?
asthma, allergic rhinitis, CF
Treatment for nasal polyp?
systemic of topical steroids then surgery
Nasal polyps are ___ and arise from ____.
semitransparent
nasal mucosa
____ papillomas refer to those that arise from nasal mucosa.
Schneiderian
Two most common papillomas
fungiform and inverted
____ papillomas have a 10% chance of progression to malignancy.
Inverted
Inverted papillomas are _____.
removed
Fungiform papillomas are usually found on ?
nasal septum
Inverted papillomas are usually found ?
lateral wall
Cylindrical papillomas are found?
on the lateral wall and the septum
Inverted papillomas are locally ____
destructive
Benign slow growing tumors typically seen in frontal sinuses
osteomas
Problems seen w/ osteomas?
obstruct sinus drainage, producing mucoceles
Seen in juvenile males, benign but aggressive, originates in post. lateral nasal wall
Juvenile Nasopharyngeal Angiofibroma
JNA are usually based off ___ artery.
sphenopalatine
Surgery to remove JNA tumors are often ____ pre-op.
embolized to prevent blood loss
Malignant lesions are typically seen in?
older males w/ exposures
Malignant lesions are associated w/ ____ and ____ use.
tobacco
alcohol
Most malignant lesions are seen in ____.
maxillary sinus
Malignant lesions present w/
pain
trismus - difficulty opening mouth
obstruction
bleeding
runny nose

ocular findings - epiphora (exc. tearing), proctosis (bulging eye)
facial signs-facial or trigeminal nerve affected
Most common carcinoma in sinuses
SqCC
Second most common carcinoma in sinuses
Adenocarcinoma
Adenocarcinoma has strong association w/?
occupation (wood workers)
Common manifestation of Adenoid Cystic Carcinoma
perineural spread along V2 to skull base
Melanoma occurs along ____
septum (bad when it involves mucous membranes)
Most common malignant sinus tumor in children
rhabdomyosarcoma
See rhabdomyosarcoma in ___ ___ and ___
sinuses, neck, and orbit

SON of a gun, i've got rhabdomyosarcoma
Most common metastatic carcinoma to metastasize to sinuses.
Renal cell carcinoma
Prognosis for metastatic carcinoma in sinuses.
bad, palliative treatment
Unresectable tumors
it gets to frontal love and involves cavernous sinus

involves optic nerve
involves prevetrebral fascia
Closure can produce almost no scarring b/c scars are hidden in natural creases of the face.
lateral rhinotomy
Go in underneath lip and get into nasal cavity
midfacial degloving
Bicoronal incision gives good access to frontal and ethmoid sinuses and the orbits.
Craniofacial approach
Most lesions in nose and sinuses present in ____ stages.
advanced