Nasal foreign body and button-battery injury — formative SAQs

SAQ 1 — The two-year-old with a missing button battery (10 marks, 15 minutes)

A two-year-old boy is brought to the emergency department after his parents found the back of a remote control open and a button battery missing. He is well and afebrile, but on anterior rhinoscopy a shiny metallic disc is wedged firmly against the right side of the nasal septum. He last ate 30 minutes ago. [3]

a) State the immediate management decision and explain why the fasting status does not change it. (2 marks) [3] [5]

b) Explain the mechanism by which a button battery injures the nasal septum, naming the pole at which the key reaction occurs and the type of necrosis that results. (3 marks) [5] [6]

c) Describe how you would distinguish a button battery from a coin if the object were uncertain, naming the imaging sign. (2 marks) [9]

d) State what you would do immediately after the battery is removed, including two complications that can continue to evolve, and the role of a topical neutralising agent. (3 marks) [3] [7]

SAQ 2 — The four-year-old with unilateral foul discharge and a bead (10 marks, 15 minutes)

A four-year-old girl presents with a one-week history of a foul-smelling, blood-stained discharge from the left nostril. She is otherwise well and denies putting anything in her nose. Anterior rhinoscopy shows a smooth round bead resting on the floor of the left nasal cavity. [11]

a) What is the diagnostic maxim for a unilateral foul-smelling nasal discharge in this age group, and why does the child's wellbeing not exclude it? (2 marks) [1] [11]

b) Give the first-line removal technique for an anterior inert object, including how it is performed and one preparation that improves its success. (3 marks) [10] [1]

c) The bead is smooth and round. Name the instrument you would use if forceps fail, and explain why forceps are unsuitable. (2 marks) [1] [6]

d) Name the manoeuvre that is contraindicated in removal and explain why, and state one feature that would convert this routine case into an emergency. (3 marks) [1] [5]