Rhinology

Question 1

What are the three classification of rhinosinusitis in terms of acute/chronicity?

Answer 1

acute less than 4wks
sub-acute 4-12wks
Chronic longer than 12 wks

Question 2

What is the cause of chronic rhinosinusitis?

Answer 2

It is multfactorial

Question 3

Which sinuses drain into the middle meatus?

Answer 3

Maxillary

Frontal

Anterior ethmoid

Question 4

Which sinuses drain into the superior meatus?

Answer 4

Posterior ethmoid

Question 5

Where does the sphenoid sinus drain into?

Answer 5

Sphenoethmoidal recess in the posterior nasal cavity

Question 6

Which is the order of sinuses most commonly affected by acute rhinosinusitis?

Answer 6

Maxillary

Ethmoidal

Frontal

Sphenoid

Question 7

What does acute rhinosinusitis commonly follow and what can it lead to?

Answer 7

Viral URTI which causes swelling of mucosa and blockage of sinus drainage predisposing to bacterial infection (e.g. streptococcus)

Question 8

What are the signs of acute rhinosinusitis (ARS)?

Answer 8

An accompanying acute viral URTI

Severe unilateral pain over affected sinus

Malaise and pyrexia

(must have some nasal symptoms or unlikely to be ARS)

Question 9

What are the investigations for ARS?

Answer 9

They are not usually indicated

Question 10

How long should decongestants be given for ARS?

Answer 10

5 days

Question 11

What are the two courses of chronic rhinosinusitis (CRS)?

Answer 11

Following ARS or

it may have had a more insidious onset

Question 12

What is the cause of chronic rhinosinusitis?

Answer 12

It is multfactorial

Question 13

What is the treatment for ARS?

Answer 13

Analgesics

Steam inhalations

Decongestants

(surgical washout or drainage in severe cases)

Question 14

How often do antibiotics alter the course of ARS?

Answer 14

3%

Question 15

What are the types of rhinosinusitis?

Answer 15

Acute rhinosinusitis (ARS)
Sub-acute rhinosinusitis
Chronic rhinosinusitis (CRS)
Allergic rhinosinusitis
Non-allergic rhinosinusitis (a.k.a idiopathic rhinosinusitis)

Question 16

How are sinuses examined in CRS?

Answer 16

Nasoendoscope (X-rays are not specific)

Question 17

What types of CRS have increased and decreased of previous decades?

Answer 17

Infective CRS has decreased due to better health and antibiotics

Allergic CRS has increased

Question 18

How can allergic and non-allergic rhinosinusitis be differentiated?

Answer 18

Non-allergic rhinosinusitis rarely has itching or sneezing

Question 19

What are the signs and symptoms (S/S) of CRS?

Answer 19

Nasal obstruction

Purulent discharge around the clock (not just in the morning)

Anosmia or cacosmia (unpleasant smell)

Usually painless

Question 20

What are key symptoms of sinus pain?

Answer 20

Worse with URTI

Associated with rhinological symptoms

Worse when flying

Question 21

What does bending forward causing increase in facial pain indicate?

Answer 21

Not much it is NOT specific for sinus pain

Question 22

What is required to make a diagnosis of CRS?

Answer 22

Matching history symptoms:

(Nasal obstruction

Purulent discharge around the clock (not just in the morning)

Anosmia or cacosmia (unpleasant smell)

Usually painless)

AND physical findings such as:

Mucosal inflammation

Mucosal discharge

Nasal polyps

Question 23

How are physical findings elicited in CRS?

Answer 23

Via nasoendoscope

Anterior rhinoscopy can be used but less can be seen

Question 24

How can polyps and turbinates be differentiated?

Answer 24

Turbinates - red and sensitive

Polyps - Pale, pendulous, painless

Question 25

What are the S/S of allergic rhinosinusitis?

Answer 25

Nasal onstruction Hyposmia (a reduced ability to smell) Nasal irritation -> Sneezing Slightly yellow mucus (non-infective, due to eosinophils)

Question 26

What is often diagnosed incorrectly as chronic infective rhinosinusitis?

Answer 26

Persistent allergic rhinosinusitis due to perennial (plant) allergens

Question 27

What is non-allergic rhinosinusitis?

Answer 27

Essentially idiopathic rhinosinusitis, not due to infection or allergy.

Question 28

Can different types of rhinosinusitis occur concurrently?

Answer 28

Yes

Question 29

What are the S/S of non-allergic rhinosinusitis?

Answer 29

Nasal obstruction Clear rhinorrhoea

Question 30

How can allergic and non-allergic rhinosinusitis be differentiated?

Answer 30

Non-allergic rhinosinusitis rarely has itching or sneezing

Question 31

What is the main aim of treatment for rhinosinusitis?

Answer 31

Ventilate sinuses Restore mucocilliary clearance

Question 32

What is the treatment of CRS?

Answer 32

At least 3 wks of broad spectrum antibiotics Topical nasal steroids for at least 2 mnths followed by a nasal spray Instructions of how to perform nasal douching

Question 33

Should drops or topical sprays be used before or after douching?

Answer 33

After douching

Question 34

What are the complications of infective sinusitis?

Answer 34

Mucoceles (muscous cyst) CRS Periorbital abscess or cellulitis (most common serious complication)) Facial cellulitis Osteomyelitis Intracranial complications

Question 35

What is the limit for the use of nasal steroids

Answer 35

There isn't one if improvement is being seen clinically

Question 36

What is osteomyelitis?

Answer 36

inflammation of bone or bone marrow

Question 37

How can chronic rhinosinusitis be treated surgically?

Answer 37

Functional endoscopic sinus surgery (FESS) to clear natural pathways of sinuses It is very successful over classical "open" surgery

Question 38

What is a classic sign of chronic infective rhinosinusitis?

Answer 38

Green discharge from nose

Question 39

What is the commonest cause facial pain?

Answer 39

Midfacial segment pain

Question 40

What are the symptoms of midfacial segment pain and how can it be differentiated from rhinosinusitis?

Answer 40

Symmetrical sensation of pressure (sometimes described as a "blockage") NO airway impairment

Question 41

What can midfacial segment pain be likened to?

Answer 41

Tension headache that affects the midface

Question 42

What is the treatment for midfacial segment pain?

Answer 42

Amitriptyline for 6 mnths | takes 6 wks to have an effect

Question 43

What are the ingredients for nasal douching?

Answer 43

1/2 teaspoon of salt 1/2 teaspoon of sugar 1/2 teaspoon of bicarb of soda 2 pints of boiled water leave to cool

Question 44

How is nasal douching performed?

Answer 44

Draw up mixture with syringe Block one nostril Sniff or squeeze liquid into other nostril Leave to run out

Question 45

What are the intracranial complications of infective sinusitis?

Answer 45

Meningitis Cavernous sinus thrombosis Brain/extradural/subdural abscess

Question 46

What is the first sign that a periorbital obscess maybe sight threatening?

Answer 46

Loss of colour vision

Question 47

What are mucoceles?

Answer 47

Collections of sterile mucus occupying an obstructed sinus Late complication of ARS

Question 48

What do mucoceles present as?

Answer 48

Facial swelling Visual distubrances

Question 49

How are mucocele treated?

Answer 49

Surgical drainage usually endoscopically

Question 50

What is the post nasal space also known as?

Answer 50

nasopharynx

Question 51

What is the job of vestibule of the nose?

Answer 51

The stiff hairs block large particles

Question 52

How are smaller particles in the nose removed?

Answer 52

via enzymatic destruction from the nose mucosa

Question 53

If someone is reporting poor taste what maybe the cause?

Answer 53

Nasal pathology as it gives about 85% of taste

Question 54

What is the vestibule of the nose? (what encloses it)

Answer 54

the nasal entrance (it is enclosed by the alar cartilages)

Question 55

What is the nasal septum made up of?

Answer 55

Ethmoid and vomer posteriorly, cartilage anteriorly

Question 56

What makes up the floor of the nose?

Answer 56

The maxilla

Question 57

Which area of the nose is most likely to be the source of nose bleeds and why?

Answer 57

Little's area (part of the septum)as it is an area where four arteries anastomose

Question 58

What is the space between the turbinates called?

Answer 58

Meatus (inferior meatus below inferior turbinate)

Question 59

Which meatus does the nasolacrimal duct and eustachian tube drain into?

Answer 59

The inferior meatus

Question 60

Which meatus do the frontal and maxillary sinuses drain into?

Answer 60

The middle meatus

Question 61

What are the best methods for investigating rhinosinusitis?

Answer 61

History and allergy testing

Question 62

What is infective rhinosinusitis effectively?

Answer 62

The nasal effects of the common cold

Question 63

What is allergic rhinosinusitis colloquially known as?

Answer 63

Hay fever

Question 64

What is more common allergic or infective rhinosinusitis?

Answer 64

Infective rhinitis

Question 65

What immunoglobulin is indicated in the hypersensitivity in allergic rhinosinusitis (and thus what does this cause the release of)?

Answer 65

IgE (histamine)

Question 66

What occurs in long-term allergic rhinosinusitis?

Answer 66

The turbinates undergo permanent hypertrophy

Question 67

What is the pathophysiology of rhinosinusitis medicamentosa?

Answer 67

When the decongestant wears off there is a rebound vasodilation so further decongestant is taken.This causes a cycle and leads to turbinate hypertrophywhich is then unresponsively blocking the nasal cavity

Question 68

What is the treatment for rhinosinusitis medicamentosa?

Answer 68

Stop decongestants Steroids Potentially tubinate surgery

Question 69

Which type of sinusitis can be life and sight threatening?

Answer 69

Frontal sinusitis

Question 70

Which types of sinusitis commonly has periorbital sinusitis as an adverse outcome?

Answer 70

Ethmoidal sinusitis

Question 71

How is periorbital sinusitis sight threatening?

Answer 71

It can compress the optic nerve

Question 72

How is periorbital sinusitis treated?

Answer 72

High dose antibiotics and observation

Question 73

Are mucocoeles an early or late complication of acute sinusitis?

Answer 73

mucocoeles are a late complication of acute sinusitis

Question 74

Which sinuses are mucocoeles most common in?

Answer 74

frontal and ethmoidal sinuses

Question 75

Which sinusitis is most commonly associated with extradural abscesses?

Answer 75

frontal

Question 76

Which sinusitis is most commonly associated with subdural abscesses?

Answer 76

frontal

Question 77

Which type of abscess 2ry to sinusitis has a worse prognosis?

Answer 77

subdural abscess

Question 78

Which part of the septum should NOT be removed when the pt has a deviated septum and why?

Answer 78

The anterior portion as it gives a bad cosmetic result

Question 79

If a pt has a damaged external nasal skeleton within how much time is there for the nose to be re-maniulated?

Answer 79

2 weeks

Question 80

What is epistaxis?

Answer 80

A nose bleed

Question 81

What is the initial first aid for epistaxis?

Answer 81

get the pt to sit forward and pinch the fleshy part of the nose (not the bridge) for 10 minutes The patient should spit out the blood (if swallowed may vomit)and an ice pack on the nasal bridge may be helpful.

Question 82

What should be the treatment for severe epistaxis?

Answer 82

IV access, FBC, coagulation screen and croup + save Spray the bleeding point with 5% cocaine Attempt nasal cautery Pack if very severe (generally in posterior bleeds)

Question 83

How long is the packing in posterior nasal epitaxis generally left for?

Answer 83

24-48 hours

Question 84

What can be given prophylactically with nasal packing?

Answer 84

antibiotic

Question 85

What is a rare cause of severe unilateral epistaxis in adolescent boys?

Answer 85

Angiofibroma