Rhinosinusitis Flashcards
Rhinosinusitis (Rhino refers to the nose), also referred to as sinusitis is inflammation of the paranasal sinuses. What is the estimated incidence of acute Rhinosinusitis?
1 - 2.5 cases per 100,000
2 - 25 cases per 100,000
3 - 250 cases per 100,000
4 - 2500 cases per 100,000
4 - 2500 cases per 100,000
Rhinitis = inflammation of the lining of the nose (allergic vs non-allergic)
Rhinosinusitis: Inflammation of the lining of the nose and paranasal sinuses
Rhinosinusitis, also referred to as sinusitis is inflammation of the paranasal sinuses. What age does acute Rhinosinusitis peak at?
1 - 10-20
2 - 20-30
3 - 40-50
4 - >75
3 - 40-50
Is Rhinosinusitis more common in men or women?
- equal in both
How long does acute Rhinosinusitis typically last for?
1 - 24h
2 - 7 days
3 - 2 weeks
4 - 4 weeks
4 - 4 weeks
How long does sub-acute Rhinosinusitis typically last for?
1 - 7 days
2 - 2 weeks
3 - 1 month
4 - 1-3 months
4 - 1-3 months
How long does chronic Rhinosinusitis typically last for?
1 - >4 weeks
2 - >2 months
3 - >4 months
4 - >6 months
3 - >4 months
What is the time frame for Rhinosinusitis to be defined as acute?
1 - <2 weeks
2 - <4 weeks
3 - <8 weeks
4 - <12 weeks
4 - <12 weeks
Chronic is >12 weeks
All of the following are paranasal sinuses that help amplify your voice, if blocked your voice sound changes. Which of the following are above the eyes?
1 - frontal sinuses
2 - ethmoidal sinuses
3 - sphenoidal sinuses
4 - maxillary sinuses
1 - frontal sinuses
All of the following are paranasal sinuses that help amplify your voice, if blocked your voice sound changes. Which of the following are below the eyes?
1 - frontal sinuses
2 - ethmoidal sinuses
3 - sphenoidal sinuses
4 - maxillary sinuses
4 - maxillary sinuses
All of the following are paranasal sinuses that help amplify your voice, if blocked your voice sound changes. Which of the following are behind the eyes?
1 - frontal sinuses
2 - ethmoidal sinuses
3 - sphenoidal sinuses
4 - maxillary sinuses
2 - ethmoidal sinuses
All of the following are paranasal sinuses that help amplify your voice, if blocked your voice sound changes.Which of the following are above the pharynx and infront of the ears?
1 - frontal sinuses
2 - ethmoidal sinuses
3 - sphenoidal sinuses
4 - maxillary sinuses
3 - sphenoidal sinuses
Are paranasal sinuses typically sterile or non-sterile?
- sterile
Which 2 of the following sinuses are most commonly affected in rhinosinusitis?
1 - ethmoid
2 - frontal
3 -sphenoidal
4 - maxillary
1 - ethmoid
4 - maxillary
The nasal cavity is lined by hairs that are lined by mucus. Which of the following is not a characteristic of mucus?
1 - salty
2 - sticky
3 - lysozyme containing
4 - macrophage containing
4 - macrophage containing
- lysozyme are enzymes able to degrade pathogens
- mucus collects dust, pollen and pathogens
Which of the following is a function of the paranasal sinuses?
1 - echo our voice
2 - goblet cells that produce mucus to trap pathogens and foreign particles
3 - circulate, moisten and warm air
4 - columnar cells with cilia that can move mucus and foreign bodies
5 - all of the above
5 - all of the above
The most common cause of Rhinosinusitis is an infection. Which of the following viruses can cause Rhinosinusitis?
1 - Influenzae virus
2 - Rhinoviruses
3 - Parainfluenza virus
4 - Coronavirus
5 - all of the above
5 - all of the above
all are viral
- Rhinoviruses = common cold
- Parainfluenza virus = common cold
- Haemophilus influenza = flu
Which bacteria commonly lead to Rhinosinusitis?
1 - Streptococcus pneumoniae
2 - Haemophilus influenzae
3 - Moraxella catarrhalis
4 - all of the above
4 - all of the above
2 most common are:
- Streptococcus pneumoniae
- Haemophilus influenzae
Typically following an URTI and can occur in asthma
Which of the following is NOT a predisposing factors to Rhinosinusitis?
1 - nasal obstruction (septal deviation or nasal polyps)
2 - recent local infection (rhinitis or dental extraction)
3 - swimming/diving
4 - COPD
5 - smoking
6 - asthma
4 - COPD
In acute Rhinosinusitis there is a foreign body that causes an inflammatory response. Goblet cells increase mucus production leading to congestion and immune cells attack foreign body forming pus. Which of the following is NOT a component of this pus?
1 - immune cells
2 - dead tissue
3 - blood
4 - foreign body
3 - blood
In some patients with Rhinosinusitis, this can become chronic and progress into chronic hyperplastic Rhinosinusitis, which leads to what?
1 - connective tissue in paranasal sinuses proliferate quicker than usual forming polyps
2 - connective tissue proliferates and becomes malignant
3 - paranasal sinuses collapse on themselves
4 - connective tissue proliferates leading to increased sign of paranasal sinuses
1 - connective tissue in paranasal sinuses proliferate quicker than usual forming polyps
Are the polyps that can form in chronic hyperplastic Rhinosinusitis cancerous or benign?
- benign
Unilateral polyps are a red flag though and need urgent ENT referral
Which of the following is NOT a clinical symptom of Rhinosinusitis?
1 - facial pain, typically frontal and worse when leaning forward
2 - blurred vision
3 - pressure in the face
4 - headaches
5 - change in voice, smell and taste
6 - cough when lying down
2 - blurred vision
All are typically caused by excessive mucus
Diagnosis of Rhinosinusitis is typically clinical, but which 2 of the following can be useful for diagnosis?
1 - head CT
2 - raised ESR and CRP
3 - rhinoscopy
4 - X-ray
1 - head CT
3 - rhinoscopy
Contrast is used in the CT scan as this is good at identifying any abscesses
Do the majority of cases of Rhinosinusitis always need treatment?
- No
The majority resolve spontaneously
When treating Rhinosinusitis, all of the following should be used EXCEPT which one?
1 - analgesia
2 - intranasal decongestants or nasal douching
3 - oral antivirals
4 - corticosteroids if symptoms >10 days (given nasally or orally)
5 - oral antibiotics
6 - avoid allergens where possible
3 - oral antivirals
Oral antibiotics can be used in high risk populations
Surgery to open airways and sinuses may also be useful
If there is not improvement in patients symptoms following initial treatment, how long should it be before antibiotics are considered?
1 - >3 days
2 - >5 days
3 - >10 days
4 - >21 days
3 - >10 days
Co-amoxiclav = 1st line
Doxicicline = if patient has a penicillin allergy
Are unilateral or bilateral symptoms more likely to be malignant?
- unilateral
Rhinitis = inflammation of the lining of the nose (allergic vs non-allergic)
Rhinosinusitis: Inflammation of the lining of the nose and paranasal sinuses
Does rhinitis or Rhinosinusitis causes the following symptoms?
1 - nasal obstruction
2 - rhinorrhoea/post-nasal drip
3 - hyposmia/anosmia
4 - sneezing, itching
5 - watery eyes/swelling
Rhinitis = inflammation of the lining of the nose (allergic vs non-allergic)
This is typically the cause can be allergic in nature, causing sneezing and itching
Rhinosinusitis is inflammation of nose and paranasal sinuses. Patients must have >2 of the following symptoms:
- nasal obstruction/congestion/discharge
- facial pain/pressure
- reduction or loss of smell
AND AT LEAST A POSITIVE SIGN IN ONE OF THE FOLLOWING:
- nasal polyps
- mucopurulent discharge
- inflammation of the paranasal sinuses (confirmed on CT)
Which 2 of the following are extracranial complications of Rhinosinusitis?
1 - Periorbital cellulitis/abscess
2 - Meningitis
3 - Frontal osteomyelitis (“Potts puffy tumour”)
4 - Tinnitus
1 - Periorbital cellulitis/abscess
3 - Frontal osteomyelitis (“Potts puffy tumour”)
Which of the following is NOT an intracranial complications of Rhinosinusitis?
1 - Meningitis
2 - Abscesses
3 - Stroke
4 - Venous sinus thrombosis (cavernous)
3 - Stroke
Chronic rhinosinusitis can have all of the following:
- CT scan
- Regular sinus saline irrigation
- Intranasal corticosteroids
- Oral antibiotics
- Surgery (Endoscopic sinus surgery)
Each patient is judged on a case to case basis though
