15 Nose and Paranasal Sinuses

Question 1

What is stertor

Answer 1

Inspiratory low-pitched sound resulting from turbulent airflow through the nasal cavity and NP

Question 2

What study confirms dx of primary ciliary dyskinesia

Answer 2

Electron microscopic study of cilia from nasal respiratory mucosa

Question 3

What do the 3 valleys on acoustic rhinometry represent?

Answer 3

1st valley - nasal valve
2nd valley - anterior portion of MT
3rd valley - middle portion of MT

Question 4

Topical decongestants have a statistically significant different response between normal and allergic subjects are given a topical decongestant. For which valley on acoustic rhinometry will a statistically different response be seen?

Answer 4

1st valley (nasal valve)

Question 5

Acoustic rhinometry showing decreased cross-sectional area and nasal volume that does not improve with topical decongestant suggests what d/o

Answer 5

septal deviation

Question 6

What effect do nasal dilator strips have on nasal airflow as measured by spirometry

Answer 6

Increased peak inspiratory flow rates

Question 7

What are the m/c sx of CRS

Answer 7

Nasal congestion and obstruction

Question 8

What is the m/c sx of isolated sphenoid dz

Answer 8

HA

Question 9

What is Sluder’s syndrome

Answer 9

Sinonasal HA 2/2 irriation of the sphenopalatine ganglion

Question 10

What are the dx criteria for sarcoidosis of the sinuses

Answer 10

• Radiographic evidence of sinusitis
• Histopath confirmation of noncaseating granulomas in sinus tissue
• Negative serologic test for syphilis and c-ANCA
• Negative stains for fungus and AFB

Question 11

When is LP indicated in pts with preseptal cellulitis

Answer 11

Age < 2 months, meningeal or focal neuro signs, clinical toxicity

Question 12

30-year-old man presents with chronic sneezing, pruritus, rhinorrhea, and nasal congestion. His past medical history is significant for asthma. Comprehensive allergy testing and serum IgE are normal. What is the most likely diagnosis and what test should be ordered to confirm this?

Answer 12

NARES (nonallergic rhinitis with eosinophilia syndrome); nasal smear will show marked eosinophilia (>25%).

Question 13

What PE signs are suggestive of CSF leak

Answer 13

Halo sign and reservoir sign (rush of clear rhinorrhea with sudden upright position)

Question 14

What is the m/c presenting sx of sinonasal neoplasms

Answer 14

Nasal obstruction (50%)

Question 15

What percent of pts with sinonasal tumors are asx at presentation

Answer 15

10%

Question 16

What 3 signs are classically present in pts with sinonasal neoplasms

Answer 16

Facial asymmetry, tumor bulge in OC and nasal mass; all 3 in 50% (= advanced dz)

Question 17

What percent of pts with NP CA will have a nl scope at initial eval

Answer 17

6%