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A - MSRA ENT [6] > [8] Acute Rhinosinusitis > Flashcards

[8] Acute Rhinosinusitis Flashcards

1
Q

What is acute rhinosinusitis also known as?

A

Acute sinusitis

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2
Q

What is acute rhinosinusitis?

A

A symptomatic inflammation of the mucosal lining of the nasal cavity and paranasal sinuses?

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3
Q

What is the time span of acute rhinosinusitis?

A

4 weeks or less

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4
Q

How many pairs of paranasal sinuses are there?

A

4

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5
Q

What are the names of the paranasal sinuses?

A
  • Frontal
  • Ethmoidal
  • Maxillary
  • Sphenoidal
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6
Q

Where does acute rhinosinusitis of the frontal sinuses cause pain?

A

The forehead

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7
Q

Where can acute rhinosinusitis of the ethmoidal sinuses cause pain?

A
  • Between/behind the eyes

- Sides of the upper nose

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8
Q

What can ethmoidal acute rhinosinusitis be subdivided into?

A

Anterior and posterior

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9
Q

What separates anterior and posterior acute rhinosinusitis of the ethmoid sinus?

A

The basal lamella of the middle nasal concha

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10
Q

Where can acute rhinosinusitis of the maxillary sinuses cause pain?

A

Cheeks

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11
Q

Where can acute rhinosinusitis of the sphenoidal sinuses cause pain?

A
  • Behind the eyes
  • On top of head
  • Over mastoid
  • Back of head
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12
Q

What is acute rhinosinusitis typically precipitated by?

A

A recent URTI

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13
Q

What type of URTI typically preceeds acute rhinosinusitis?

A

Viral

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14
Q

What viruses can lead to acute rhinosinusitis?

A
  • Rhinovirus
  • Coronavirus
  • Influenza
  • Adenovirus
  • RSV
  • Metapneumovirus
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15
Q

What are the most common bacterial causes of acute rhinosinusitis?

A
  • Strep pneumoniae
  • Haemophilus influenzae
  • Moraxella catarrhalis
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16
Q

What are some less common causes of acute rhinosinusitis?

A
  • Fungal invasion
  • Chemical irritation
  • Tooth infection
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17
Q

Who is more prone to fungal acute rhinosinusitis?

A

Immunocompromised patients

18
Q

What can cause immunocompromisation?

A
  • Diabetes
  • AIDS
  • Transplant patients
19
Q

What chemicals can cause acute rhinosinusitis?

A
  • Cigarette smoke

- Chlorine fumes

20
Q

What are the risk factors for acute rhinosinusitis?

A
  • Asthma
  • CF
  • Poor immune function
  • GORD
21
Q

How do most patients present with acute rhinosinusitis?

A

Non-resolving cold which may have a biphasic character

22
Q

What is meant by the biphasic character of acute rhinosinusitis presentation?

A

The initial URTI settles and is then followed by further malaise due to sinusitis

23
Q

What is meant by a non-resolving cold?

A

> 1 week of persistent symptoms or worsening symptoms over 4-5 days

24
Q

What are the most common symptoms of acute rhinosinusitis?

A
  • Pain over affected sinuses
  • Pyrexia
  • Purulent nasal discharge
25
How is acute rhinosinusitis pain described?
- Constant dull headache/facial pain
26
What can make the pain of acute rhinosinusitis worse?
Bending over or lying down
27
What are some other symptoms of acute rhinosinusitis?
- Ear pressure - Aching in jaw and teeth - Reduced sense of smell/taste - Cough - Halitosis - Fatigue - Fever
28
What can often indicate a bacterial cause of acute rhinosinusitis?
Symptoms beyond 10 days
29
What is the most common sign on examination?
Painful sinuses
30
How is acute rhinosinusitis typically diagnosed?
Clinically
31
What further investigations may sometimes be indicated in acute rhinosinusitis?
- ESR - CRP - X-ray - USS - Nasendoscopy - CT - MRI - Sinus puncture
32
What are the differentials for acute rhinosinusitis?
- Allergic rhinitis - Non-allergic rhinitis - Common cold - Migraine - Adenoiditis
33
What is the typical treatment for acute rhinosinusitis?
Nothing - it's typically self-limiting
34
What type of therapy is offered to patients with acute rhinosinusitis?
Symptomatic relief
35
Where are most cases of acute rhinosinusitis managed?
Primary care
36
What measures can be used to reduce symptoms?
- Analgesics e.g. paracetamol/ibuprofen - Intranasal decongestants - Nasal douching with warm saline - Warm face packs - Adequate fluids and rest
37
What are antibiotics preserved for in acute rhinosinusitis?
Severe or prolonged infections
38
When is hospital referral indicated for acute rhinosinusitis?
- Severe systemic infections - Complications of sinusitis - High risk patients e.g. immunocompromised
39
What are the potential complications of acute rhinosinusitis?
- Intracranial spread - Orbital spread - Osteomyelitis - Cavernous sinus thrombosis - Conversion to chronic sinusitis
40
What are the symptoms of intracranial spread?
- Severe frontal headache - Frontal swelling - Symptoms or signs of meningitis - Focal neurological signs
41
What can orbital spread lead to?
Orbital cellulitis

A - MSRA ENT [6] (22 decks)

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