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A. MLA Map ENT > Rhinosinusitis > Flashcards

Rhinosinusitis Flashcards

1
Q

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

A

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

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2
Q

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

A

3 - 40-50

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3
Q

Is Rhinosinusitis more common in men or women?

A
  • equal in both
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4
Q

How long does acute Rhinosinusitis typically last for?

1 - 24h
2 - 7 days
3 - 2 weeks
4 - 4 weeks

A

4 - 4 weeks

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5
Q

How long does sub-acute Rhinosinusitis typically last for?

1 - 7 days
2 - 2 weeks
3 - 1 month
4 - 1-3 months

A

4 - 1-3 months

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6
Q

How long does chronic Rhinosinusitis typically last for?

1 - >4 weeks
2 - >2 months
3 - >4 months
4 - >6 months

A

3 - >4 months

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7
Q

What is the time frame for Rhinosinusitis to be defined as acute?

1 - <2 weeks
2 - <4 weeks
3 - <8 weeks
4 - <12 weeks

A

4 - <12 weeks

Chronic is >12 weeks

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8
Q

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

A

1 - frontal sinuses

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9
Q

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

A

4 - maxillary sinuses

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10
Q

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

A

2 - ethmoidal sinuses

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11
Q

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

A

3 - sphenoidal sinuses

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12
Q

Are paranasal sinuses typically sterile or non-sterile?

A
  • sterile
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13
Q

Which 2 of the following sinuses are most commonly affected in rhinosinusitis?

1 - ethmoid
2 - frontal
3 -sphenoidal
4 - maxillary

A

1 - ethmoid
4 - maxillary

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14
Q

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

A

4 - macrophage containing

  • lysozyme are enzymes able to degrade pathogens
  • mucus collects dust, pollen and pathogens
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15
Q

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

A

5 - all of the above

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16
Q

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

A

5 - all of the above
all are viral

  • Rhinoviruses = common cold
  • Parainfluenza virus = common cold
  • Haemophilus influenza = flu
17
Q

Which bacteria commonly lead to Rhinosinusitis?

1 - Streptococcus pneumoniae
2 - Haemophilus influenzae
3 - Moraxella catarrhalis
4 - all of the above

A

4 - all of the above

18
Q

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

A

4 - COPD

19
Q

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

A

3 - blood

20
Q

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

A

1 - connective tissue in paranasal sinuses proliferate quicker than usual forming polyps

21
Q

Are the polyps that can form in chronic hyperplastic Rhinosinusitis cancerous or benign?

A
  • benign

Unilateral polyps are a red flag though and need urgent ENT referral

22
Q

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

A

2 - blurred vision

All are typically caused by excessive mucus

23
Q

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

A

1 - head CT
3 - rhinoscopy

Contrast is used in the CT scan as this is good at identifying any abscesses

24
Q

Do the majority of cases of Rhinosinusitis always need treatment?

A
  • No

The majority resolve spontaneously

25
Q

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

A

3 - oral antivirals

Oral antibiotics can be used in high risk populations

Surgery to open airways and sinuses may also be useful

26
Q

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

A

3 - >10 days

Co-amoxiclav = 1st line
Doxicicline = if patient has a penicillin allergy

27
Q

Are unilateral or bilateral symptoms more likely to be malignant?

A
  • unilateral
28
Q

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

A

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

29
Q

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)
A
30
Q

Which 2 of the following are extracranial complications of Rhinosinusitis?

1 - Periorbital cellulitis/abscess
2 - Meningitis
3 - Frontal osteomyelitis (“Potts puffy tumour”)
4 - Tinnitus

A

1 - Periorbital cellulitis/abscess

3 - Frontal osteomyelitis (“Potts puffy tumour”)

31
Q

Which of the following is NOT an intracranial complications of Rhinosinusitis?

1 - Meningitis
2 - Abscesses
3 - Stroke
4 - Venous sinus thrombosis (cavernous)

A

3 - Stroke

32
Q

Chronic rhinosinusitis can have all of the following:

  • CT scan
  • Regular sinus saline irrigation
  • Intranasal corticosteroids
  • Oral antibiotics
  • Surgery (Endoscopic sinus surgery)
A

Each patient is judged on a case to case basis though

A. MLA Map ENT (27 decks)

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