INESSS Acute rhinosinusitis

Question 1

Name the 3 clinical situations that would indicate acute Bacterial rhinosinusitis. (Children)

Answer 1

1- Persisting symptoms for 10-14 days without improvement: Purulent rhinorrhea OR Daytime cough that may increase at night,
2- Symptoms worsening after 5 to 7 days following initial improvement (Biphasic infection: Purulent rhinorrhea OR persistent daytime cough OR temperature >38C
3- Severe symptoms for at least 3 days in a row: Temps >39 and Purulent rhinorrhea.

Question 2

Red flags for acute rhinosinusitis (3) Children

Answer 2

1-Impairment of general condition
2-Edema/peri-orbital redness
3- Impairment of CNS

Would indicate complications and hospital consulation.

Question 3

2 clinical situations that would indicate acute bacterial rhinosinusitis in adults.

Answer 3

1- Symptoms persist for 10 to 14 days without improvement.
2- Symptoms worsen 5 to 7 days after initial improvement (Biphasic infection)

Question 4

Symptoms for acute rhinosinusitis in adults. (6)

Answer 4

1- Unilateral dental or facial pain
2- Nasal obstruction or congestion
3- Coloured anterior or posterior rhinorrhea
4- Headache
5- Hyposmia/anosmia
6- Cough

Question 5

Physical exam for rhinosinusitis in adults. (3)

Answer 5

1- Examine nose with otoscope for presence of secretions between middle turbinate and middle meatus
2- Examine throat for secretions in back of throat.
3- Palpate or percuss the maxillary or frontal sinuses

Question 6

Ddx for rhinitis. (5)

Answer 6

1- Viral infection
2- Bacterial infection
3- Rhinosinusitis (bact or viral)
4- Allergic rhinitis
5- Rhinitis medicamentosa

Question 7

Red flags adults rhinosinusitis (4)

Answer 7

1- Significant deterioration in patient’s overall condition
2- Severe headache (risk of frontal or sphenoid rhinosinusitis or CNS damage)
3- Measured persistent fever >38C
4- PEiorbital edema/redness

Question 8

Supportive treatment for rhinosinusitis (3)

Answer 8

1- Antipyretic/analgesic
2- Nasal irrigation at least BID
3- Topical decongestant at low concentration when very bothersome. (Adults only)

Question 9

Risk factors in children for Strep resistance (4)

Answer 9

1- daycare attendance.
2- <2 yo
3- Recent hospitalization
4- recent ATB tx (<30days)

Question 10

1st line treatment for acute rhinosinusitis.
1- Peds
2- Adult

Answer 10

1- Amoxicillin 90mg/kg/day PO divided BID 10 to 14 days
2- Amoxicillin 500mg PO TID x 5 days

Question 11

Describe acute rhinosinusitis symptoms for each catergory. (Impact on functional status) And what action to take
1- Mild
2- Moderate
3- Severe

Answer 11

1- Slight discomfort with minor impact on patient’s functional status. Use adjunct therapies only.
2- Discomfort and constant tolerable symptoms with a moderate impact on the patient’s functional status. Use adjunct therapies before considering antibiotics.
3- Major impact on the patient’s functional status and sleep. Consider using antibiotics.

Question 12

When would you go to 2nd line antibiotic therapy in acute rhinosinusitis?
1- adults (2)
2- peds (1)

Answer 12

1- Failure to respond to 1st line tx after 72-96 hours OR 1st line tx causing side effects.
2- If 1st line tx fails after 48-72hrs.

Question 13

Whats the 2nd line tx for acute bacterial rhinosinusitis?
1- Children
2- Adults

Answer 13

1- Amoxicillin/Clavulanate 90mg/kg/day PO divided BID x 10-14 days
2- Amoxicillin/Clavulanate 500/125mg POT TID OR 875/125mg PO BID x 7 days

Question 14

Acute bacterial rhinosinusitis: Refer to ENT if (3)

Answer 14

1- complications supsected
2- Rhinosinusitis reccurent (>3 episodes per year)
3- Symptoms persits more than 8 weeks.