RED part 2

Question 1

What is sinusitis

Answer 1

Sinusitis is inflammation of the paranasal sinuses.

Acute sinusitis can last up to four weeks, subacute sinusitis lasts between 1 to 3 months, and chronic sinusitis lasts more than 3 months.

Question 2

What are most cases of sinusitis?

Answer 2

acute- result of a viral infection.

Question 3

Pathophysiology of sinusitis

Answer 3

invading pathogen often causes an inflammatory response > causes goblet cells to over secrete mucus + leads to congestion >

At same time immune cells try to fight off these pathogens which creates pus

Question 4

What is pus

Answer 4

mixture of pathogens, immune cells, and dead tissue.

Question 5

Viral pathogens of sinusitis

Answer 5

• rhinovirus
• parainfluenza virus
• influenza virus

Question 6

Bacterial pathogens of sinusitis

Answer 6

• streptococcus pneumoniae
• haemophilus influenzae
• moraxella catarrhalis
• staphylococcus aureus

Question 7

What is chronic hyperplastic sinusitis caused by?

Answer 7

Allergies leading to hyperplasia of the connective tissues of the sinuses. This can give rise to nasal polyps.

Question 8

Clinical manifestations of sinusitis

Answer 8

• Facial pain
• Headache
• Fever
• Voice changes
• Change in smell and taste

Question 9

Investigations for sinusitis

Answer 9

• Diagnosis is mainly based on clinical presentation
• Rhinoscopy
• Sinus culture
• MRI sinuses

Question 10

Management of sinusitis

Answer 10

• Sinusitis usually last 2-3 weeks and resolves without treatment
• High dose steroid nasal spray: if no improvement

Question 11

Antibiotics for sinusitis if bacterial cause

Answer 11

• First line: penicillin V (phenoxymethylpenicillin) for a 5 day course
• Second line: co-amoxiclav
• If penicillin allergy: clarithromycin, erythromycin (pregnancy), doxycycline

Question 12

What is epiglottitis

Answer 12

Epiglottitis refers to inflammation and localised oedema of the epiglottis, which can result in potentially life-threatening airway obstruction

Question 13

Epidemiology of epiglottitis

Answer 13

• More commonly occurs in children
• M>F

Question 14

RFs for epiglottitis

Answer 14

• Male gender
• Unvaccinated
• Immunocompromised
• Age - 6-23

Question 15

What does the epiglottis do?

Answer 15

Epiglottis prevents food from entering trachea, when eating. Other times, it remains open to allow air flow to trachea.

Question 16

What is epiglottis caused by

Answer 16

Epiglottis bacterially infecteed by Haemophilus influenzae B in children - since vaccine incidence decreased

Strep pneumoniae and Strep pygones more common now

Question 17

Pathophysiology of epiglottitis

Answer 17

Immune cells detect invading bacteria in epiglottis tissue > release cytokines TNF-A> Cause BVs to be more permeable to fluid results in local inflammation and swelling

epiglottis can swell to the point of completely obscuring the airway within hours of symptoms developing

Question 18

Signs of epiglottis

Answer 18

• Stridor
• Muffled voice:
• Respiratory distres
• Pyrexial

Question 19

Symptoms of epiglottitis

Answer 19

• Fever
• Sore throat
• Dysphagia

Question 20

Primary investigations of epiglottitis

Answer 20

• Laryngoscopy
• Lateral neck radiograph

Question 21

1st line management of epiglottitis

Answer 21

Secure the airway:
- Airway compromise
- Airway maintained
- Nebulised adrenaline:may be used in an emergency to minimise laryngeal oedema prior to intubation
- Intravenous antibiotics:typically a broad-spectrum antibiotic, such as ceftriaxone
2nd line - dexamethasone

Question 22

Complications of epiglottitis

Answer 22

• Airway obstruction: occurs secondary to significant upper airway inflammation and oedema
• Respiratory failure can lead to a respiratory acidosis
• Mediastinitis:infection can track along the retropharyngeal space and involve the mediastinum, which is associated with a poor prognosis
• Soft tissue involvement: