module 3 sinusitis, tumors, and polyps of the nose

Question 1

rhinosinusitis

Answer 1

symptomatic inflammation of the mucosal surface of the paranasal sinuses

Question 2

subclassifications of rhinosinusitis

Answer 2

acute: resolves in less than 4 weeks
subacute: resolves within 4-12 weeks
chronic: continues beyond 12 weeks

Question 3

Acute rhinosinusitis

Answer 3

inflammatory process of the paranasal sinuses caused by:
- viral
- bacterial
- fungal
- allergic
Usually proceeded by an acute viral respiratory infection which extends into the paranasal sinus cavities

Question 4

Acute Bacterial rhinosinusitis usually caused by

Answer 4

streptococcus pneumoniae
HIB
moraxella catrrhalis
S. pneumonia

Question 5

Acute rhinosinusitis s/s

Answer 5

Abrupt onset:
nasal congestion
purulent nasal discharge
dental pain
post-nasal drip
halitosis
ear fullness/otalgia
dec. smell
headache
fever
fatigue

Question 6

chronic sinusitis

Answer 6

prolonged sinus infection that resist tx or recurrent acute infections
- anatomic abnormality
- immunocompromised
- continued irritant/allergen exposure
- incompletely treated bacterial or fungal infection

Question 7

medical devices that can cause sinusitis

Answer 7

NG tube
intubated through nare

Question 8

largest paranasal sinus

Answer 8

maxillary

Question 9

maxillary anatomy and infections

Answer 9

ostium into nose is superiorly placed
- no gravity advantage
- infected secretions are forced into sinus cavity

Question 10

bacterial sinusitis

Answer 10

• most often a complication of viral rhinosinusitis OR
• allergies
• dental infection
• fluid introduced into sinuses: diving, swimming

Question 11

sinusitis r/t anatomic abnormalities

Answer 11

deviated septum
adenoidal hypertrophy
neoplasms
foreign body
ciliary dysfunction: CF

Question 12

acute bacterial rhinosinusitis s/s

Answer 12

mucopurulent discharge
nasal obstruction
facial pain or pressure
- ARS s/s > 10 days or initial improvement followed by worsening of s/s

Question 13

Chronic rhinosinusitis s/s

Answer 13

purulent nasal drainage
nasal obstruction: bilateral
facial pain or pressure
dec. or loss of smell
- > 12 weeks
frequent throat clearing
cough
INC. in:
- allergy s/s
- asthma
- eczema

Question 14

rhinosinusitis physical exam

Answer 14

General inspection for facial:
- asymmetry
- periorbital edema
- cellulitis
Speech: hyponasal quality
Nasal turbinate:
- edema
- erythema
- discharge
- patency of nares
- septal deviation
- polyps
Transillumination
- inability to transilluminate indicates fluid in sinuses
Palpation and Percussion:
- frontal and maxillary sinuses
Pharynx:
- postnasal drip
- erythema
- lymphoid hypertrophy
Otic exam
- otitis media

Question 15

Rx management of rhinosinusitis

Answer 15

antibiotic tx if s/s > 7 days
NSAIds
nasal saline
oral or topical decongestants
nasal steroids

Question 16

complications of rhinosinusitis

Answer 16

quality of life
osteomyelitis
orbital infection
vision loss: pressure on optic nerve
invasive fungal sinusitis

Question 17

osteomyelitis of frontal bone

Answer 17

fever
pain
edema over bone: Pott’s puffy tumor

Question 18

primary sites for malignant tumors

Answer 18

nose
nasopharynx
paranasal sinuses

Question 19

malignant lesions include

Answer 19

carcinomas
lymphomas
sarcomas
melanomas
squamous cell carcinoma: most common

Question 20

most common type of benign tumor

Answer 20

inverted papilloma
- arises from the common wall between the nose and maxillary sinuses

Question 21

juvenile angiofibroma

Answer 21

highly vascular benign tumor
- common in adolescent boys
- bleeds easily
- can cause nasal obstruction

Question 22

nasal polyps

Answer 22

inflammatory disorder of the nose and paranasal sinuses
-> chronic nasal obstruction
-> diminished sense of smell

Question 23

nasal polyps on exam

Answer 23

pale
edematous
developing: teardrop shape
Mature: resembles a peeled seedless grape

Question 24

nasal polyps assoc. with

Answer 24

allergic rhinitis
asthma
acute or chronic infections
cystic fibrosis

Question 25

squamous cell carcinomas arise from

Answer 25

keratinocytes of the epithelium - more common in male Associated with: - smoking - ETOH - sunlight exposure

Question 26

inverted papillomas develop from

Answer 26

squamous cells in which the epithelium is invaginated into the vascular connective tissue

Question 27

complications of inverted papillomas

Answer 27

invasion of the orbit or cranial vault

Question 28

nasopharyngeal angiofibromas may be assoc. with

Answer 28

familial adenomatous paolyps - almost exclusively occur in adolescent males who have red hair and fair skin

Question 29

nasal polyps originate

Answer 29

from the mucous membrane linings of the maxillary sinuses and prolapse into the nasal cavity

Question 30

4 types of polyps

Answer 30

antrochoanal idiopathic eosinophilic polyps with underlying systemic disease

Question 31

antrochoanal polyp

Answer 31

non-eosinophilic unilateral

Question 32

idiopathic polyp

Answer 32

unilateral or bilateral eosinophilic without lower airway involvement

Question 33

eosinophilic polyps

Answer 33

assoc. with asthma or aspirin sensitivity

Question 34

polyps with underlying systemic disease

Answer 34

CF Churg-Strauss syndrome Kartagener syndrome

Question 35

s/s that suggest presence of cancer

Answer 35

unilateral nasal obstruction discharge w/ pain recurrent hemorrhage headache visual or olfactory changes

Question 36

Benign nasal tumors s/s

Answer 36

nasal obstruction discharge facial swelling bleed easily: recurrent epistaxis

Question 37

nasal polyps s/s

Answer 37

nasal obstruction hyposmia or anosmia recurrent sinusitis headache post-nasal drip

Question 38

Granulomatosis with polyangiitis (GPA)

Answer 38

systemic vasculitis of unknown causes characterized by glomerulonephritis plus granulomas of the nose and lung - without tx survival rate less than a year

Question 39

GPA s/s

Answer 39

nasal congestion nasal ulcerations rhinitis sinusitis otitis media otorrhea hearing loss gingival hypertrophy cough dyspnea hemoptysis fever weakness malaise wt loss conjunctivitis rash or skin lesions polyarthralgias

Question 40

GPA physical exam

Answer 40

nasal congestion and crusting rhinorrhea ulceration of nasal septum epistaxis destruction of nasal septum -> saddle nose deformity erosion through skin that cover the nose and sinuses rales rhonchi wheezing unilateral proptosis red eye otitis media symmetric polyarticular arthritis purpura