Allergy & Immunology

Question 1

Acute sinusitis

Key Diagnostic Factors

Answer 1

_{symptoms <10 days (acute viral sinusitis)}

_{symptoms >10 days but <4 weeks (acute bacterial sinusitis)}

_{severe symptoms at onset (acute bacterial sinusitis)}

_{symptoms that worsen after an initial improvement (acute bacterial sinusitis)}

_{purulent nasal discharge}

_{nasal obstruction}

_{facial pain/pressure}

Question 2

Acute sinusitis

Differential Diagnosis

Answer 2

Allergic rhinitis

Nonallergic rhinitis

Migraine

Question 3

Acute sinusitis​

Treatment Options

suspected acute viral sinusitis

Answer 3

1st line: supportive therapy

+/- analgesic/antipyretic

+/- decongestant

+/- intranasal corticosteroid

+/- intranasal anticholinergic

+/- intranasal saline

+/- mucolytic

Question 4

Acute sinusitis​

Treatment Options

suspected acute bacterial sinusitis

Answer 4

_{1st line: watchful waiting up to 10 days, or immediate commencement of abx, and supportive therapy}

_{+/- antibiotic therapy}

_{+/- analgesic/antipyretic}

_{+/- decongestant}

_{+/- intranasal corticosteroid}

_{+/- intranasal anticholinergic}

_{+/- intranasal saline}

_{+/- mucolytic}

Question 5

Acute sinusitis

supportive therapy

Answer 5

Adequate rest and hydration, warm facial packs, and steam inhalation may be useful

Question 6

Acute sinusitis​

analgesics/antipyretics

Answer 6

Primary Options

acetaminophen : children: 10-15 mg/kg orally every 4-6 hours when required, maximum 90 mg/kg/day; adults: 325-1000 mg orally every 4-6 hours when required, maximum 4000 mg/day

ibuprofen : children: 5-10 mg/kg orally every 6-8 hours when required, maximum 40 mg/kg/day; adults: 200-400 mg orally every 4-6 hours when required, maximum 2400 mg/day

Question 7

Acute sinusitis​

decongestants

Answer 7

Primary Options

oxymetazoline nasal : children 2-5 years of age: (0.025%) 2-3 sprays/drops into each nostril twice daily when required; children >5 years of age and adults: (0.05%) 1-2 sprays/drops into each nostril twice daily when required [max 3-5 days]

Secondary Options

pseudoephedrine : adults: 30-60 mg orally every 4-6 hours when required, maximum 240 mg/day

Question 8

Acute sinusitis

intranasal corticosteroids

Answer 8

Primary Options

mometasone nasal : children 2-11 years of age: 50 micrograms (1 spray) in each nostril once daily; children ≥12 years of age and adults: 100 micrograms (2 sprays) in each nostril once daily [at least 1 month of therapy]

Question 9

Acute sinusitis​

intranasal anticholinergics

Answer 9

Primary Options

ipratropium bromide nasal : children ≥6 years of age: (0.03%) 42 micrograms (2 sprays) in each nostril two or three times daily; adults: (0.06%) 84 micrograms (2 sprays) in each nostril three times daily

Question 10

Acute sinusitis​

mucolytics

Answer 10

Primary Options

guaifenesin : children 6 months to 2 years of age: 25-50 mg orally every 4 hours when required, maximum 300 mg/day; children 2-5 years of age: 50-100 mg orally every 4 hours when required, maximum 600 mg/day; children 6-11 years of age: 100-200 mg orally every 4 hours when required, maximum 1200 mg/day; children >11 years of age and adults: 200-400 mg orally every 4 hours when required, maximum 2400 mg/day