Theme №5. Theme : acute and chronic disease of the nose icon

Theme №5. Theme : acute and chronic disease of the nose




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Theme5.


Theme : ACUTE AND CHRONIC DISEASE OF THE NOSE


Topicality of theme: Inflammatory diseases of the nose are the most pressing problems of Otorhinolaryngology, because this type of pathology, is the commonest in their practice of clinical physician otolaryngologist.

In recent decades, the literature systematically published the results of numerous studies examining individual aspects of etiology, pathogenesis, and conservative and operative treatment of rhinitis and sinuses, but the trend towards a decrease in the number of patienst suffering from this disease is not observed, the frequency of dissemination of inflammatory diseases of paranasal sinuses firmly occupy a leading position in the structure of diseases of upper respiratory tract.

Allergic rhinitis during the exacerbation of the patient exhausts sneezing, itchy nose and eyes, nasal obstruction of hole damping, an abundance of secretions from the nose leads to a decrease in working.

Injuries of the nose, often occurring in the home and at work entail deformation and curvature of the external nose, or hematoma, nasal septum, which violates the nasal breathing, affects the air in the lungs and causes hypoxia of the brain - a condition causing considerable suffering,reduces his or her physical and mental performance.

Epistaxis (significance can lead to a lethal use-go because of blood loss and shock) refers to the urgent conditions, urgent assistance which should be able to provide competently any physician-fighting profession.

Anatomical features of venous outflow make furuncle nose in a serious pathology, threatening the development of intracranial complications: brain abscess, meningitis

septic thrombosis of cerebral sinuses - a disease characterized by high mortality. It is therefore right a preliminary diagnosis and the right to determine further care of the patient to a doctor for any profile.


^ The purpose (general): to know to estimate the typical clinical picture of acute and chronic diseases of the nose, determine fundamental tactics of treatment. To know to diagnose and provided fist medical help.




^ Specific goals






Goals of initial level

To know how

1.To collect the medical history and select information related to inflammation disorders of the nose.




1.To Collect and evaluate data history and systematize them

(Dept. of Propedevutique therapy)

2.To draw up a plan of survey of patients with acute and chronic disorders of the nose




2. To indicate the scope and sequence of basic and advanced methods of examination: examination and palpation, x-ray and laboratory examinations (Dept. of Propedevutique therapy, Radiology). 

3.To evaluate data of study and to provide the most informative for the inflammatory disorders of the nose.





3.To define inflammatory changes from the side of mucous membrane (department of pathoanatomy) and X-ray signs of inflammatory pathology (department of Radiology)

4.To put the preliminary diagnosis of epistaxis, fractures, Rhinitis, Sinusitis





4.To formulate a diagnosis taking into account description of character and localization of pathological process (department of Propedevutique therapy).

5. To define tactic of conducting a concrete patient.




5. To choose facilities of symptomatic therapy (department of pharmacology).



Assessment and support of initial level of knowledge skills form


Test for checking of initial level


Test № 1.

Patient complains of difficulty nasal breathing, profuse serous secretion from the nose, a feeling of itchiness in the nose and eyes, watery eyes, sneezing fits. He is sick during the year. It is noted the gradual increase in symptoms.

Rhinoscopy: mucosa pale and edematous. Nasal passages are significant but narrowed, an abundance of serous discharge.

Allergic rhinitis is suspected.

Which examination will determine the diagnosis?


a) Hemoglobin and hematocrit

b) Allergy testing

c) Adrenal test


Test №2

Patient Z, 34 years old, snores during sleeping. Examination - warping of the septum.

Which function of the nose is impaired?


a) Airway Resistance

b) Air Conditioning

c) Olfaction


Test №3

Patient Z., 46 year old is work at the manufacture of woodworking. He complains of sneezing, nasal congestion and profuse, watery rhinorrhea.

Suspected Allergic rhinitis is suspected

What drug do you prefer?


а) Antibiotic

b) Efedrin

c) Topical steroid


^ Answers to tests

Test №1 B, Test №2 A , Test №3 B


Literature:

1. Human Anatomy. In three volumes. Valume 3/ editd by V.G. Koveshnikov. – Lugansk: LTD “Virtualnaya realnost”, 2009 – 384 p.

2.O.V. Sinyachenko, G.A. Ignatenko. Propaedeutics of the inner diseases: Learner’s guide. – Donetsk, Donetchina, 1999, pages 10-50, 160-170.

3.K.I. Kulchytsky, I.I. Bobrik. Operational surgery and topographical anatomy. Kiev, “Vyscha shkola”, 2000, pages 265-278.

4. A.D. Lindenbraten, I.P. Korolyuk. Medical radiology, Moscow, “Medicine”, 2000, pages 273-276.


^ ACADEMIC CONTENT ACCODING TO THE GOALS


Control questions

  1. Acute and chronic rhinitis, ozena

  2. Epistaxis. History. First aid. Methods the stop of nose-bleedings. Posterior packing and anterior nasal pack

  3. Hematoma and abscess of nasal septum. Clinic, diagnostics, treatment

  4. Warping of the septum

  5. Furuncle of nose: clinic, diagnostics, treatment.

^ GRAPH OF LOGICAL STRUCTURE OF THE THEME: “ACUTE AND CHRONIC DISEASE OF THE NOSE(suppl. 11)


Literature:

1.Оториноларингологія. - Otorhinolaryngology: підручник/Ю.В. Мітін, Ю.В. Дєєва, Я.Ю. Гомза та ін - К.:Медицина, 2009. - 232 с.

2. Lecture


^ ORIENTED BASES FOR ACTIVITIES


DIAGNOSTIC ALGORITHM DISEASE OF THE NOSE(suppl. 12)


to cheсk knowledge of the given material do the following tasks.


CLINICAL TASKS FOR LESSON:

Test № 1.

Patient complains nasal congestion. He is ill for a few years. Regularly uses vasoconstrictor drops in a nose, but their effect lasts the 1-2 hours.

Direct rhinoscopy: nasal septum in middle position. Mucous membrane of nasal cavity is soft-tissue swelling . The inferior nasal conchas are hypertrophic. The nasal breathing is labouredly on either side.

Which is your diagnosis?

  1. Chronic hypertrophic rhinitis

  2. Chronic catarrhal rhinitis

  3. Allergic rhinitis

  4. Atrophic rhinitis

  5. Chronic sinusitis



Test № 2

The patient is disturbed with purulent rhinitis. He is sick for about a week. Rhinoscopy: mucous membrane is hyperemic, hydropic. In the middle nasal meatuses there is purulent secret. Pharyngoscopy: purulent secret flows down on back wall of the pharynx. X-ray: pneumatization of the ethmoidal cells is lowered.

What is the initial diagnosis?

A) Chronic purulent ethmoiditis

B) Malignant tumour

C) Allergic rhinitis

D) Polipous ethmoiditis

E) Benign tumour


Test №3

Feeling of pressure in the projection of the left maxillary sinuses and purulent rhinitis of the left half of the nose have appeared in the patient in 5 days after extraction of the 4 top teeth at the left. Secret has an unpleasant smell. X-ray film: intensive opacity of the left maxillary sinus with a horizontal level is determined.

What is the basic medical tactics?

A) Antibiotics, vasoconstrictive drops, punctions of the left maxillary sinus

B) Antibiotics, vasoconstrictive drops, alkaline inhalations

C) Operation - maxillary sinusotomy at the left

D) Antibiotics, alkaline inhalations, UHF-therapy on the left maxillary sinus

E) Antibiotics, alkaline inhalations, diastolisation of the paranasal sinuses


Test № 4

Patient complains of sense of dryness in a nose and rough crusts. He is ill a few years. He was not treated earlier.

Direct rhinoscopy: a mucous membrane is pinky, dry, thinned, crusts.

What is the initial diagnosis?

  1. Chronic atrophic rhinitis

  2. Chronic catarrhal rhinitis

  3. Allergic rhinitis

  4. Benign tumour

  5. Malignant tumour


Answers to tests

Test №1. А, Test №2. А, Test №3.С, Test №4.A


^ CONCISE METHODICAL RECOMMENDATIONS FOR A LESSON


Each student does situation tasks describing conditions and organization of schooling at one of classes of the comprehensive school according to the algorithm of assessment a consequent analysis where situation is carried out, deductions and conclusions containing minimal information about the school are made by studenes, recommendations on optimization of school medium and organization of schooling are worked out.


Supplement 11.


^ GRAPH OF LOGICAL STRUCTURE OF THE THEME

ACUTE AND CHRONIC DISEASE OF THE NOSE”






Complaints and Patient’s History













Complains




Patient’s History

- Discharge




- One side or both sides are involved?

Duration? Continual or intermittent, and why so? Age and onset?

- Headache or other pain




- Is the discharge watery or thick? Purulent or bloody?

- Obstruction




- Duration? Continual or intermittent, and why so? Age and onset?

- Sneezing attacks

- Loss or Change of Smell

- Bleeding




-Does it occur with environmental or seasonal changes?

-Does the patient use nasal sprays or medications?


























Objective information













^ Examination of the nose




Palpation















may reveal mucosal edema




Nasal and Septal Fractures

Bleeding




sickliness of points of output of branches of trigeminal nerve , pathological mobility of bones of nose

























Additional researches
















Laboratory




Histological




X-ray













preliminary diagnosis













Treatment
















Surgical Therapy




Medical Therapy






Supplement 12.


^ DIAGNOSTIC ALGORITHM DISEASE OF THE NOSE


Continual

ß

Obstruction



intermittent

â




â




duration




depends on






















from birth

â

anomalities of development




during days, weeks, months в

â

trauma, disorders, inflammation




blood pressure

â

Hypertension

â

Examination by theraputist




primarily pollens

â

Allergic rhinitis

â

examination by allergist




body position â

vazomotor rhinitis










yes

ß

nose injury

à

no










Nasal and Septal Fractures





Rhinitis, Sinusitis, tumor




















Mirror rhinoscopy






















yes

ß

availability of additional education













â




â







tumor




no







â




â







biopsy




Rhinitis, Sinusitis






















Mucosa






















Hypertrophic turbinate, swollen

â

^ Hypertrophic rhinitis




Pus or secretion, swelling

â

inflammation




The turbinates appear swollen

â

^ Allergic rhinitis



















X-ray










â







yes

ß

air-fluid level

à

no




â




â

Sinusitis




rhinitis

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