Sinusitis

Question 1

What are the bacterial causes of acute sinusitis?

Answer 1

strep pneumo, H. flu, s. aureus, m. cat

Question 2

What are risk factors for acute sinusitis?

Answer 2

smoking, trauma, foreign body

Question 3

What is the alternative term for acute sinusitis?

Answer 3

rhinosinusitis

Question 4

What do you see on exam of rhinosinusitis?

Answer 4

purulent nasal discharge, facial pain over sinuses, acute onset

Question 5

What will suggest sinusitis?

Answer 5

no response to decongestants

Question 6

What does rhinosinusitis usually follow?

Answer 6

URI infection

Question 7

How can you distinguish bacterial vs viral rhinosinusitis?

Answer 7

suspect bacterial after >10 days after onset or worse within 10 days

Question 8

What will maxillary sinusitis cause?

Answer 8

pain in the teeth

Question 9

What will ethmoid sinusitis cause?

Answer 9

pain up by eyes, radiates to orbit

Question 10

What will sphenoid sinusitis cause?

Answer 10

headache in middle of head

Question 11

What will frontal sinusitis cause?

Answer 11

pain of forehead, orbit roof below eyebrow

Question 12

How do you diagnosis rhinosinusitis?

Answer 12

clinically, radiographs not cost effective (only if pt does not respond to tx - then get CT)

Question 13

What is the criteria for ABX in rhinosinusitis?

Answer 13

sxs last longer than 10 days or severe sxs

Question 14

What is the first line tx of rhinosinusitis?

Answer 14

amoxicillin 1000mg 7-10 d PO

Question 15

What is the preferred treatment to those with peniciilin allergies with rhinosinusitis?

Answer 15

TMP-SMX - 7-10 d PO

Doxycycline 200 mg d x 1 day then 100 mg BID 7-10 days

Question 16

What is the tx for rhinosinusitis if no improvement after 3 days of ABX?

Answer 16

augmentin

Question 17

What is the timeline for acute rhinits and sinusitis?

Question 18

What is timeline for chronic rhinitis and sinusitis?

Answer 18

persists for more than 3 months despite treatment

Question 19

What is recurrent acute rhinitis and sinusitis?

Answer 19

4 or more times per year and last 7-10 days per episode

Question 20

What is subacute rhinitis and sinusitis?

Answer 20

btw 4-12 wks and resolves w/o treatment

Question 21

What are major symptoms of sinusitis?

Answer 21

facial pain or pressure, facial fullness, nasal obstruction, nasal discharge or purulence, fever

Question 22

What are minor symptoms of sinusitis?

Answer 22

headache, halitosis, fatigue, dental pain, fever, cough, ear pressure

Question 23

What do you need for dx sinusitis?

Answer 23

2 major and 1 minor symptom

Question 24

What do you look at on PE for sinusitis?

Answer 24

purulent drainage?, endoscopic exam of nose

Question 25

What is the gold standord for evaluating rhinitis and sinusitis?

Answer 25

endoscopic examination

Question 26

What is the emperic tx for acute sinusitis?

Answer 26

amoxicillin-clavulante 875 mg/125mg PO BID

Question 27

What do you use for penicillin allergy?

Answer 27

doxy and fluoroquinolones (levofloxacin)

Question 28

How long is the tx for acute sinusitis?

Answer 28

5-7 days

Question 29

What is not recommended of acute sinusitis?

Answer 29

Z pack, macrolides, cephalosporins due to resistance

Question 30

What are some adjunctive therapy for acute sinusitis?

Answer 30

Intranasal saline irrigations
Humidification/vaporizer 
Warm compresses 
Adequate hydration 
Smoking cessation 
Balanced nutrition 
Nonnarcotic analgesia
Neither topical decongestants nor antihistamines are useful

Question 31

When do you refer acute sinusitis for specialists?

Answer 31

Temperature >39°C (>102° F); orbital edema; severe headache, visual disturbance, altered mental status, meningeal signs
Failure to respond to more than two courses of antimicrobial therapy
Nosocomial infection, anatomic abnormalities
Immunocompromised or multiple comorbidities
Unusual or resistant pathogens
Fungal sinusitis or granulomatous disease
Recurrent episodes suggesting chronic sinusitis

Question 32

What can cause chronic sinusitis?

Answer 32

viral infection, bacterial or fungal or allergy

Question 33

What is the length of chronic sinusitis?

Answer 33

12 wks or longer of 2+ of
drainage, nasal obstruction, facial pain/pressure or decreased sense of smell
ANDDDDDDD
one of the below
purulent mucous and edema in middle meatus, polyps, radiograph imaging showing inflammation

Question 34

What pathogens cause chronic bacterial sinusitis?

Answer 34

polymicro
Coagulase‐negative staphylococcus
Alpha‐hemolytic streptococci
Staph aureus
H. flu
Strep pneumoniae
Moraxella
Pseudomonas aeruginosa
Anaerobes ( Peptostreptococcus, Prevotella, Porphyromonas, Bacteroides, Fusobacterium species

Question 35

What are complications of sinusitis?

Answer 35

orbital cellulitis/abscess, meningitis, epidural abscess, subdural abscess, intracerebral abscess, thromboembolism

Question 36

What are the findings on CT with sinusitis?

Answer 36

air fluid levels, mucosal thickening, complete opacification

Question 37

What is the preferred imaging for rhinosinusitis?

Answer 37

CT, don’t use x ray

Question 38

What is the goal of medical therapy for chronic rhinosinusitis?

Answer 38

reduce mucosal edema, promote sinus drainage, eradicate infection

Question 39

What do you have to do before surgery is considered in chronic rhinosinusitis?

Answer 39

MAX THERAPY
steroids, ABX, saline irrigation
steroids - 6 wks
culture guided ABX - 3-6 wks