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Clinical Medicine II > sinusitis (quiz 1, exam 1) > Flashcards

sinusitis (quiz 1, exam 1) Flashcards

1
Q

inflammation of the sinuses leads to blackade of the normal sinus drainage pathways (__), which in turn leads to __(4)

A
  • sinus ostia
  • mucus retention
  • hypoxia
  • decreased mucocilliary clearance
  • predisposition to bacteiral growth
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2
Q

acute sinusitis symtpom duration

A

<4 weeks

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3
Q

subacute sinusitis symtpom duration

A

4-8 weeks

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4
Q

chronic sinusitis symptom duration

A

>8 weeks

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5
Q

recurrent acute sinusitis: __ epidsodes per year, with each episode lasting __ weeks

A
  • 3 or more
  • <2 weeks
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6
Q

acute rhinosinusitis (aka sinusitis) is inflammation of the __ and __

A

paranasal sinuses

nasopharynx

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7
Q

mos people with non-speicif URI have some component of sinus inflammation, with __% of pts with URI having abnormalities in the __ sinus (regardless of whether symtpoms localize to the sinuses)

A
  • 87%
  • maxillary sinus
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8
Q

sphenoidal sinusitis is __, has a different presentation, and has a greater risk of complications including __ and __; symptoms are non specific and usually include __ and __, making diagnosis difficult

A
  • rare
  • meningitis
  • cavernous sinus thrombosis
  • headache
  • retro-orbital pain
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9
Q

most cases are caused by __; 10-20% of pts seeing a clnician with complaints consistent with sinusitis have a __ infection

A
  • viral
  • bacterial
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10
Q

bacterial rhinosinusitis complicates only __% of all cases of URI

A

0.5-2% (but 85-95% receive a prescription for antibiotics)

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11
Q
A

pathophysiology of acute sinusitis

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12
Q
A

pathophysiology of acute sinusitis

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13
Q

T or F: antibiotics reduce symptoms in most cases of sinusitis and paly a role in preventing complications

A

false

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14
Q

the main serious complicatinos of bacterial sinusitis are these 3 things

A
  1. local extension (e.g. osteitis, infection of the intracranial cavity, orbital cellulitis)
  2. spread of bacteria to the central nervous system
  3. infection of the intracranial venous sinuses

(these complications are rare, estimated to occur in 1 per 10,000 cases of sinusitis)

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15
Q

classis cymptoms of acute rhinosinustits

A
  1. nasal congestion
  2. purulent nasal discharge
  3. headache
  4. maxillary tooth pain
  5. hyposmia or anosmia (decreased or absent sense of smell)
  6. facial pain that is worsened by bending forward
  7. malaise
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16
Q

T or F: no symptom or cluster of symptoms effectively diferentiates viral from bacterial rhinosinusitis

A

true

17
Q

clinical features that are sugestive of bacterial sinusitis

A
  1. presence of symptoms greater than 7-20 days
  2. MAXILLARY TOOTH PAIN
  3. unilateral facial pain
  4. unilateral sinus tenderness
  5. FEVER (MOST CONSISTENTLY CORRELATED WITH BACTERIAL SINUSITIS)
  6. PURULENT NASAL DISCHARGE
  7. symptoms worsening after initial improvement
18
Q
A

normal sinuses

19
Q
A

acute maxillary sinusitis; note the fluid levels in the maxillary sinuses (arrows)

20
Q

common viral causes of acute sinusitis

A
  1. rhinovirus
  2. coronavirus
  3. adenovivrus
  4. parainfluenza virus
21
Q

common bacterial causes of acute sinusitis

A
  1. Streptococcus pneumoniae
  2. Haemophilus influenzae
  3. Moraxella catarrhalis
  4. Staphylococcus aureus
22
Q

fungal sinusitis occurs in populations with __

A

underlying immune disorders (poorly controlled diabetes, hematologic malignancies, and chronic renal failure)

23
Q

pts with fungal sinusitis may present with symptoms similar to acute rhinosinusitis, but imaging may reveal

A

a mass in the sinus and erosion into contiguous bone

24
Q

fungal sinusitis: rapid management including __ and __ is essential

A
  1. surgical debridement
  2. antifungal therapy
25
Q

most common causes of fungal acute sinusitis

A
  1. Asppergillus
  2. Mucorales (e.g. mucormycosis): classically occur during episodes of diabetic ketoacidosis, and are uncommon in the normal host
26
Q

symptomatic therapy: maximizing __ is the goal

A

isnus drainage

27
Q

symptomatic therapy: __ can help decrease discomfort and inflammation

A

non-steroidal anti-inflammatory drugs (NSAIDs)

28
Q

symptomatic therapy: __ may decrease mucus production

A

first generation antihistamines

29
Q

symptomatic therapy: corticosteroid nasal spary had __ results in studies; studies of decongestants reveal __ evidence for clinical benefit

A
  • conflicting
  • little (but decongestants may relieve symptoms in some pts)
30
Q

symptomatic therapy: saline, either as a spray or a lavage, is promoted as helping to __

A
  1. clear mucus
  2. maintain mucosal moisture
  3. clear viral antigens

there is a lack of evidence from clinical trials but some pts may perceive some relief

31
Q

its appropriate to treat acute sinusitis with antibiotics when pts have

A

moderate to severe symptoms that localize to the sinuses, which significantly interfere with routine activiteis, and are consistent with bacterial infection

32
Q

antibiotics against __ are appropriate; it is recommended that __, __ or __ be used

A
  • S. pneumoniae
  • amoxicillin
  • doxycycline
  • trimethoprim-sulfamethoxazole
33
Q

pts who have received recent antibiotics (within the past __ weeks) are at higher risk for harboring drug resistant organisms; __ or __ or __ are reasonable choices for pts with recent antibiotic exposure

A
  • 6 weeks
  • amoxicillin/clavulanic acid (augmentin)
  • moxifloxacin
  • levofloxacin
34
Q

failure to respond to antibiotics within __ hours suggests with incorrect diagnosis or inactive agents; switching antibiotics to either a __ or __ is appropriate in this situation

A
  • 72 hours
  • fluoroquinolone
  • amoxicilin/clavulanate
35
Q

standard treatment duration for acute bacterial sinusitis is __ days

A

10-14 days

36
Q

sinus radiography __ recommended for the diagnosis of uncomoplicated sinusitis

A

is not

37
Q

acute bacterial sinusitis __ requrie antibitoic treatment

A

does not (esp. if the symptoms are mild or moderate)

38
Q

pts with __ should be treated with an antibiotic; __ antibiotics are reasonable first line agents

A
  • severe or persistent moderate symptoms and specific findings of bacterial sinusitis
  • narrow-spectrum

Clinical Medicine II (11 decks)

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