DISORDERS OF THE NOSE & SINUS

Question 1

What are the seasonal allergic triggers ?

Answer 1

– Spring - flowering shrubs and
tree pollens
– Summer - flowering plants and
grasses
– Fall - ragweed and molds
– Perennial - dust mites, air
pollution, pet dander

Question 2

What is the pathophysiology of allergic rhinitis?

Answer 2

It is an IgE mediated type 01 hypersensitivity reaction leading to immune sensitisation, mast cell degranulation increased vascular permeability and leukocyte chemotaxis.

Question 3

What are the signs and symptoms of allergic rhinitis ?

Answer 3

It looks like viral cold and the PE findings are:
– Allergic shiners
– Allergic salute
– Nasal crease
– Boggy turbinates
– Cobblestoning

Question 4

What are the Differential diagnosis of allergic rhinits ?

Answer 4

1. Acute Viral Rhinosinusitis
2. Vasomotor Rhinitis
3. Rhinitis Medicamentosa

Question 5

What is the first line management of allergic rehinits ?

Answer 5

– Intranasal corticosteroid
– Intranasal antihistamine
– Oral non-sedating antihistamine

Question 6

What are the second line management of allergic rehinits ?

Answer 6

– Intranasal corticosteroid + intranasal antihistamine
– Intranasal corticosteroid + oral nonsedating antihistamine
– Intranasal antihistamine + oral nonsedating antihistamine

Question 7

What are the tertiary management of allergic rhinitis ?

Answer 7

– Leukotriene receptor antagonists
– Mast Cell Stabilizer
– Intranasal Decongestant
– Oral Decongestant

Question 8

What is subcutaneous immunotherapy in allergic rhinitis ?

Answer 8

It consist of “High dose allergy shots” every four week and it takes 1 year for symptom reduction and 5 year for Tx success. If allergen is known 80 to 90% success rate. It has a severe allergic reaction as side effect.

Question 9

What is Sublingual Immunotherapy in allergic rhinitis ?

Answer 9

It consist of Sublingual drops or tablets, increasing dose over 4 months, then maintenance exposure.

Question 10

What are the steps to avoid outdoor allergen ?

Answer 10

– Pollen counts
– Close windows
– Use AC and air filters
– Shower after outdoor exposures
– Shower before bed

Question 11

What are the measures to avoid indoor allergens ?

Answer 11

– Wash bed linens frequently in hot water
– Replace carpeting with solid surface flooring
– Frequent vacuuming of carpet, rugs
– Dehumidifiers
– Confine pets to non-carpeted rooms
* Keep out of bedrooms
– HEPA filters for cat hair or bathe cat weekly

Question 12

What is the most common etiology of rhino sinusitis ?

Answer 12

• Viral
  – Rhinovirus
  – Influenza virus
  – Parainfluenza virus

Question 13

What are the bacterial etiologies of rhino sinusitis ?

Answer 13

– S pneumoniae
– H influenzae
– Moraxella catarrhalis

Question 14

What are the risk factors for rhino sinusitis ?

Answer 14

– Older age and Smoking
– Air travel and Swimming
– Change in air pressure (diving)
– Asthma / seasonal allergies
– Dental disease
– Immuodeficiency

Question 15

What is the presentation of rhinosinusitis ?

Answer 15

• Nasal congestion & obstruction
• Purulent nasal discharge
• Maxillary tooth discomfort
• Facial pain or pressure that is worse or localized to the sinuses when
  bending forward

Question 16

What is the presentation difference between viral and bacterial rhino- sinusitis ?

Answer 16

In viral rhino-sinusitis the symptoms peaks in 3 to 6 days and resolves by 10 days with early fever. Whereas in bacterial disease much worse symptoms that lasts > 10 days.

Question 17

What are the PE findings in rhino-sinusitis ?

Answer 17

• Erythema over sinus regions
• Tenderness to percussion over
  upper teeth and sinus cavities
• Boggy, swollen nasal mucosa
• Purulent nasal secretions
• +/- Polyps
• Transillumination discrepancy ??

Question 18

What is the symptomatic management of rhino-sinusitis ?

Answer 18

• Reduce Swelling using intranasal corticosteroids or mast cell stabilizaers or decongestants.
• use mucolytics to thin secretions.
• Anti-histamines to dry the sinuses.
• pain control.
• If bacterial infections that last > 10 days start 5 ot 7 days of high dose augmentin.

Question 19

What are the four cardinal signs of rhino-sinusitis ?

Answer 19

– Anterior and/or posterior nasal
mucopurulent drainage
– Nasal obstruction / congestion.
– Facial pain, pressure, and/or fullness
– hyosmia or anosmia.

Question 20

What are the types of chronic rhinosinusitis ?

Answer 20

1. CRS with Nasal Polyps
2. Allergic Fungal Rhinosinusitis
3. CRS without Nasal Polyps

Question 21

What is the time frame to diagnose chronic rhinosinusitis ?

Answer 21

12 weeks or more

Question 22

What is anterior epitaxis ?

Answer 22

It accounts for 90% of epitaxis from the keisalbach plexus. It is more common in children

Question 23

What is posterior epitaxis ?

Answer 23

It is bleeding from the Woodruff’s plexus and is more profuse and common in adults.