ENT - Sinusitis

Question 1

Differentiate acute, chronic, and recurrent acute rhinosinusitis?

Answer 1

Acute - <4 weeks
Chronic - >6 weeks
Recurrent acute - 4+ episodes per year, with symptom resolution between attacks

Question 2

What is the gold standard imaging for Rhinosinusitis? Which is a waste? Which is used for complicated cases?

Answer 2

CT w/ coronal cuts - GOLD standard
Plain XR - waste
MRI - for complicated - malignancy or fungal extension

Question 3

What are three ways to treat the etiology of rhinosinusitis?

Answer 3

Avoid allergens
Antibiotics
Surgery

Question 4

What type of saline irrigation leads to thinning of mucous? Thickening of mucous?

Answer 4

Alkaline medium - thins mucous

Acidic medium - creates more viscous mucous

Question 5

Are mucolytics and 1st gen-antihistamines useful in relieving symptoms of rhinosinusitis? 2nd gen?

Answer 5

No
Would take super high dose for mucolytics
antihistamines - ineffective
2nd gen - slightly better - no anticholinergic effect

Question 6

What class of drugs is highly effective for chronic rhinosinusitis?

Answer 6

Corticosteroids - short course

Leukotrienes - helpful in allergic/chronic also

Question 7

Do decongestants provide therapeutic efficacy for treatment of sinusitis?

Answer 7

No

Question 8

What are the first line antibiotics for chronic RS?

Answer 8

Amoxicillin - clavulanate or 2nd/3rd gen cephlasporin

Question 9

What symptom of a chronic RS patient would make you lean toward GERD/LPR?

Answer 9

History of heartburn

Question 10

What protein is mutated in CF?

Answer 10

CFTR

Question 11

What is Kartagener’s Syndrome? What are 4 key features?

Answer 11

Primary ciliary diskinesia
Sinusitis
Situs inversus
Bronchiectasis
Male infertility

Question 12

How is KAragener’s syndrome diagnosed?

Answer 12

Biopsy of one of the following:
Inferior turbinate
Middle turbinate
Tracheal biopsy

Question 13

What is the most common cause of chronic rhinosinusitis?

Answer 13

Fungal!

Question 14

What is the Chandler’s Classification of Complications of Sinusitis?

Answer 14

1. Periorbital cellulitis - anteiror, unilateral
   2 Orbital cellulitis - posterior to the septum, vision changes
2. Subperiosteal abscess - collection of pus between bone and periosteum
3. Orbital abscess - collection of pus in orbital soft tissue
4. Cavernous Sinus Thrombosis

Question 15

What are symptoms of cavernous sinus thrombophlebitis?

Answer 15

Picket fence fevers
Toxemia
Papilledema
EOM paralysis
Proptosis
Chemosis