Diseases Of The Nose And Paranasal Sinuses

Front 1

Nasal septum is made of what four bones?

Back 1

ethmoid, vomer, maxilla, palatine
and cartilage

Front 2

T/F: The septum helps give the exterior nose its shape.

Back 2

False. We can remove most of it and have no effect on external shape.

Front 3

Turbinates are located on ____ wall.

Back 3

lateral

Front 4

The nasal lacrimal duct drains underneat the ____ turbinate.

Back 4

inferior

Front 5

The ethmoid, maxillary, and frontal sinuses drain underneath the _____ turbinate.

Back 5

middle

Front 6

Orbit is in close proximity to ____sinuses.

Back 6

ethmoid

Front 7

Four fxns of paranasal sinuses.

Back 7

humidifying and warming air
lightening skull
absorbing shock
generate mucous

Front 8

ICA leads to _____ artery which leads to ___ and ____ ___ arteries.

Back 8

ophthalmic, anterior, posterior, ethmoid

Front 9

ECA leads to ____ artery and ____ artery.

Back 9

facial, sphenopalatine

Front 10

Innervation of nasal cavity is predominately ___ with some ____.

Back 10

V2-maxillary nerve, V1-opthalmic nerve

Front 11

Viral rhinitis is characterized by ?

Back 11

inflammation of mucous membranes of the nose

Front 12

Symptoms of viral rhinitis.

Back 12

runny nose, congestion, post nasal drip, cough, low grade fever

Front 13

Diagnosis of viral rhinitis is usually done w/ ?

Back 13

history

Front 14

Inflammation and swelling in nose can lead to other problems like?

Back 14

blockage of Eustachian tubes or sinuses that can lead to otitis media or sinusitis

Front 15

Treatment of viral rhinitis:

Back 15

keep swelling and inflammation down to avoid secondary infections like otitis media or sinusitis

Front 16

Criteria for diagnosis of sinusitis

Back 16

2 major symptoms or 1 major and 2 minor

Front 17

Major symptoms of sinusitis

Back 17

facial pain or pressure
congestion
nasal obstruciton
purulent post nasal drip
altered smell
fever (acute)

Front 18

Minor symptoms of sinusitis

Back 18

headache
fever
halitosis
fatigue
dental pain
cough
ear pain or pressure

Front 19

Acute sinusitis is typically less than ____ and generally follows a ______.

Back 19

4 weeks
upper-respiratory infection

Front 20

Typically w/ sinusitis you'll be sick for ____ days then you'll get ____.

Back 20

3-5
worse

Front 21

____ coming out of a sinus or in the nose is diagnostic for sinusitis.

Back 21

Pus

Front 22

Chronic Rhinosinusitis - duration of greater than or equal to ___ .

Back 22

12 weeks

Front 23

With chronic infection, the tissue in the nose _____.

Back 23

undergoes changes

Front 24

Distinguishing feature of chronic sinusitis.

Back 24

Tissue in nose undergoes changes

Front 25

What is often used to diagnose chronic sinusitis

Back 25

CT to see mucosa changes

Front 26

Typical bugs w/ acute rhinosinusitis and otitis media?

Back 26

Pneumococcus, Moraxella, Haemophilus

Front 27

Typical bugs w/ chronic Rhinosinusitis

Back 27

Staph, pseudomonas

Front 28

Management of Sinusitis.

Back 28

eliminate infection and restore ventilation

Front 29

Recurrent episodes of sinusitis, give?

Back 29

nasal steroids to get inflammation down (Nasonex or Flonase)

Front 30

NATURAL draining pathways are opened up so that sinuses can drain

Back 30

Functional Endoscopic Sinus Surgery

Front 31

What are some complications that you would operate on acute sinusitis?

Back 31

ethmoid sinusitis where infection spreads to globe

epidural abscesses
intracranial sinusitis

Front 32

When do you operate on chronic sinusitis?

Back 32

when it is refractory to treatment

Front 33

___ is often helpful in patients w/ recurring infections but don't necessarily have changes seen w/ chronic sinusitis. This is called?

Back 33

Surgery

Recurrent Acute Rhinosinusitis (RARS)

Front 34

In surgery for RARS the ___ is taken down, and behind it is the opening for the ostium of the maxillary sinus

Back 34

uncinate process

Front 35

Get CT scan w/ patient wearing a headset and instruments can be tracked INTRAOPERATIVELY.

Back 35

Computerized Assisted Surgery (CAS)

Front 36

CAS is helpful when?

Back 36

when there is a lot of bleeding
anatomy is funky
Helpful for avoiding ethmoids and intracranial cavity.

Front 37

Nose bleeds

Back 37

epistaxis

Front 38

What does the large amount of vascularization in the nose help with?

Back 38

humidification of air

Front 39

Vasculature of nose is ___ protected.

Back 39

poorly

Front 40

Vasculature in nose lack ___ therefore they are direct _____. Why is this important in epistaxis?

Back 40

capillaries
aterial-venous anastomoses

Not typical regulatory mechanism.

Front 41

Majority of bleeds in nose occur in ?

Back 41

Kiesselbach's plexus

Front 42

Anterior vasculature of nasal cavity on septum. Confluence of ____ and ___ arteries

Back 42

Kiesselbach's plexus

ethmoid and facial

Front 43

Posterior vasculature of nasal cavity on septum. Where ___ and ____ arteries are located.

Back 43

Woodruff's plexus

sphenopalatine and posterior nasal

Front 44

Bleeds of Woodruff's plexus are usually _____ and seen in ____ patients.

Back 44

more serious

older

Front 45

Local factors that lead to epistaxis.

Back 45

infections
trauma
digital trauma (stop picking Salar)
iatrogenic
foreign bodies
cocaine (uhhhh um...Safa?)

Front 46

Systemic factors that can lead to epistaxis.

Back 46

Severe infections
sepsis
total body inflammatory responses
coagulopathies (von Willebrand)

Front 47

Non surgical treatments of epistaxis.

Back 47

control BP
correction of coagulopathy
pressure/expulsion of clot
topical decongestant/vasoconstrictors
cauterize w/ silver nitrate
nasal packing
greater palatine foramen block

Front 48

Non surgical preventative measures for epistaxis.

Back 48

keep things moist (saline, ointment)
avoid trauma
avoid straining
humidity/emolients

Front 49

Used when bleeding is more severe. Sits in the choana o nasal pharynx. Supposed to block ____ artery.

Back 49

Posterior nasal pack

sphenopalatine

Front 50

Indications for surgery/embolization

Back 50

continuous bleed despite packing and treatments
Hct<38%

Front 51

Radiologist IDs bleeds w/ contrast and then puts material in to thrombose those vessels.

Back 51

Selective Angiography/Embolization

Front 52

Selective Angiography/Embolization can only be done for ___ and its branches.

Back 52

ECA

Front 53

Why is thrombosing ethmoidal arteries dangerous?

Back 53

have to go through ophthalmic artery which could cause blindness

Front 54

Main problem w/ cancers in nose is? Why?

Back 54

delay in diagnosis

Symptoms are not specific

Front 55

Benign Nasal Neoplasms

Back 55

Nasal Polyps
Nasal Papillomas

Front 56

Malignant Nasal Neoplasms

Back 56

SqCC and salivary gland tumors

Front 57

Nasal polyps are caused by ___ of the nose.

Back 57

chronic inflammation

Front 58

Nasal polyps seen w/ ?

Back 58

asthma, allergic rhinitis, CF

Front 59

Treatment for nasal polyp?

Back 59

systemic of topical steroids then surgery

Front 60

Nasal polyps are ___ and arise from ____.

Back 60

semitransparent
nasal mucosa

Front 61

____ papillomas refer to those that arise from nasal mucosa.

Back 61

Schneiderian

Front 62

Two most common papillomas

Back 62

fungiform and inverted

Front 63

____ papillomas have a 10% chance of progression to malignancy.

Back 63

Inverted

Front 64

Inverted papillomas are _____.

Back 64

removed

Front 65

Fungiform papillomas are usually found on ?

Back 65

nasal septum

Front 66

Inverted papillomas are usually found ?

Back 66

lateral wall

Front 67

Cylindrical papillomas are found?

Back 67

on the lateral wall and the septum

Front 68

Inverted papillomas are locally ____

Back 68

destructive

Front 69

Benign slow growing tumors typically seen in frontal sinuses

Back 69

osteomas

Front 70

Problems seen w/ osteomas?

Back 70

obstruct sinus drainage, producing mucoceles

Front 71

Seen in juvenile males, benign but aggressive, originates in post. lateral nasal wall

Back 71

Juvenile Nasopharyngeal Angiofibroma

Front 72

JNA are usually based off ___ artery.

Back 72

sphenopalatine

Front 73

Surgery to remove JNA tumors are often ____ pre-op.

Back 73

embolized to prevent blood loss

Front 74

Malignant lesions are typically seen in?

Back 74

older males w/ exposures

Front 75

Malignant lesions are associated w/ ____ and ____ use.

Back 75

tobacco
alcohol

Front 76

Most malignant lesions are seen in ____.

Back 76

maxillary sinus

Front 77

Malignant lesions present w/

Back 77

pain
trismus - difficulty opening mouth
obstruction
bleeding
runny nose

ocular findings - epiphora (exc. tearing), proctosis (bulging eye)
facial signs-facial or trigeminal nerve affected

Front 78

Most common carcinoma in sinuses

Back 78

SqCC

Front 79

Second most common carcinoma in sinuses

Back 79

Adenocarcinoma

Front 80

Adenocarcinoma has strong association w/?

Back 80

occupation (wood workers)

Front 81

Common manifestation of Adenoid Cystic Carcinoma

Back 81

perineural spread along V2 to skull base

Front 82

Melanoma occurs along ____

Back 82

septum (bad when it involves mucous membranes)

Front 83

Most common malignant sinus tumor in children

Back 83

rhabdomyosarcoma

Front 84

See rhabdomyosarcoma in ___ ___ and ___

Back 84

sinuses, neck, and orbit

SON of a gun, i've got rhabdomyosarcoma

Front 85

Most common metastatic carcinoma to metastasize to sinuses.

Back 85

Renal cell carcinoma

Front 86

Prognosis for metastatic carcinoma in sinuses.

Back 86

bad, palliative treatment

Front 87

Unresectable tumors

Back 87

it gets to frontal love and involves cavernous sinus

involves optic nerve
involves prevetrebral fascia

Front 88

Closure can produce almost no scarring b/c scars are hidden in natural creases of the face.

Back 88

lateral rhinotomy

Front 89

Go in underneath lip and get into nasal cavity

Back 89

midfacial degloving

Front 90

Bicoronal incision gives good access to frontal and ethmoid sinuses and the orbits.

Back 90

Craniofacial approach

Front 91

Most lesions in nose and sinuses present in ____ stages.

Back 91

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