Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ENT > Rhinosinusitis > Flashcards

Rhinosinusitis Flashcards

1
Q

the 4 sinuses and function

A

Maxillary
Ethmoid
Frontal
sphenoid

Lighten skulls
Resonate voice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

layers of sinus

A
  • Lines by ciliated stratified or pseudostratified columnar epithelium
  • Mucous layer trapping particles
  • Mucous layer is wafted into nose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

rhino sinusitis definition, symptoms & signs

A

Inflammation of the nose and paranasal sinuses.

It is characterised by two or more symptoms, one of which should be
- nasal blockage/obstruction/congestion
or
- nasal discharge (anterior/posterior nasal drip)

+- facial pain/pressure (Rhinorrhoea)
+- reduction or loss of smell

and either endoscopic signs of:

  • nasal polyps and/or
  • mucopurulent discharge primarily from middle meatus and/or
  • oedema/mucosal obstruction primarily in middle meatus

and/or CT changes:
- mucosal changes within the ostiomeatal complex and/or sinuses

RED FLAG - unilateral obstruction and bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

classification of rhino sinusitis: acute, chronic, recurrent acute

A

Acute:

  • <12 weeks
  • Complete resolution of Sx
  • Increase in Sx after 5 days or persistent sx after 10 days with <12 weeks duration

Chronic:

  • > 12 weeks
  • Without complete - resolution of Sx
  • May also be subject to exacerbations

Recurrent acute:
- >4 or more episodes ARS/year with interim symptom resolution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Acute Rhinosinusitis (ARS): aetiology

A

Commonest causes are nasal

Any condition that blocks the natural drainage of the sinuses may lead to secretion retention and poor ventilation

Usually viral URTI  secondary bacterial infection

Viral: rhinovirus, influenza, RSV
Bacterial: pneumococcus, streptococcus,
H Influenza

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Acute Rhinosinusitis (ARS): clinical diagnosis, examination, imaging

A

Clinical diagnosis – sx based, no need for imaging (plain x-ray not recommended)

Examination:
Anterior rhinoscopy: swelling, redness, pus

Imaging: CT-scan in very severe disease, immunocompromised patients & signs of complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

examples of nasal decongestants

A

pseudoephedrine, otrivine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

examples of topical steroids

A

mometasone furoate, fluticasone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

acute complications of ARS

A 
Sepsis (toxic shock) 
Orbital
- Orbital Cellulitis
- Orbital Abscess
- Vision loss (colour blindness=loss of vision)

Intracranial

  • Meningitis
  • Extradural abscess
  • Subdural abscess
  • Cavernous sinus thrombosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

chronic rhinosinusitis + aetiology

A

> 12 weeks
Often preceded by acute episode

Causes:

  • Chronic infection: Streptococcus
  • Allergic = sneezing, better in warm climate
  • Non-Allergic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

CRS – Clinically + examination

A 
Similar to ARS 
Nasal obstruction/congestion
Rhinorrhoea
Post nasal drip
hyposmia/anosmia
?facial discomfort
Examination: 
inflamed nasal mucosa, 
oedematous middle turbinate, 
pus, 
nasal polyps
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

CRS - Investigations

A

Nasoendoscopy

Allergy screen (skin prick/RAST blood test)

X rays of sinuses are USELESS.

CT Scanning excellent but do not help you make a diagnosis. Used to plan surgery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

CRS - Management

A

Management should be stepwise depending on how blocked the nose is:

  1. topical steroid spray
    • topical steroid drops
  3. +oral steroids
  4. Surgery (FESS/Polypectomy)
    - Some benefit for sinusitis without polyps
    - Evidence of improvement in disease with polyps – improvement in symptoms and polyp size
    - Drops more effective than sprays
    - Minimal systemic effects due to small dose delivery

NB antihistamines & antibiotics
- low dose macrocodes to be used if topical steroids fail

anti-leukotrienes

aspirin desensitisation
- If associated with nasal polyps and aspirin intolerance showed benefit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

chronic rhonosinusitis complication

A

Mucocoele/pyocoele

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Intracranial Complications

A

Usually from frontal/ethmoid/sphenoid

  • Meningitis
  • Extradural abscess
  • Subdural abscess
  • Cavernous sinus thrombosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

aetiology of rhinosinusitis: local and system factors

A

local factors:

  • URTI
  • Pre-existing rhinitis – allergic, vasomotor
  • Nasal polyps
  • Foreign body
  • Nasal tumour
  • Swimming and diving
  • Dental extraction or infection

systemic factors:

  • Immunocompromise
  • Mucociliary disorders – Kartageners syndrome, primary ciliary dyskinesia
  • Cystic Fibrosis
  • Samters Triad – Aspirin hypersensitivity, nasal polyps, asthma
17
Q

pathophysiology of rhino sinusitis

A
  • triggers of inflammation (acute bacterial, viral, fungi)
  • anatomical factors
  • stasis of flow within sinuses - further inflammation
  • controversial: many believe osteomeatal complex is key
  • polyps: evagination of normal mucosa vs separate entity
18
Q

rhino sinusitis investigations

A

History
Nasal endoscopy
CT Paranasal sinuses (pre-op planning)

Microbiology
Allergy testing

19
Q

acute rhino sinusitis - management

A

Topical steroids

  • mometasone furoate, fluticasone
  • 200micrograms BD mometasone significantly superior to amoxicillin and placebo, no strong evidence when given antibiotics

Nasal decongestants

  • pseudoephedrine, otrivine
  • one week

oral abx

  • e.g: amoxicillin
  • benefit for 7-14 day course for acute maxillary sinusitis

antihistamine: loratidine

irrigation

20
Q

aims of endoscopic sinus surgery

A
  1. open blocked ostia to restore ventilation and normal sinus function
    - allow drainage and reversal of mucosal disease
  2. preserve as much normal anatomy and nasal mucosa as possible
    - promotes faster healing
    - reduces inflammatory response
    - improves surgical outcomes
21
Q

Orbital Complications of Rhinosinusitis

A

Peri-orbital cellulitis (Chandlers Classification)

  • Grade I – Pre-septal cellulitis
  • Grade II – Orbital cellulitis
  • Grade III - Sub-periosteal abscess
  • Grade IV - Orbital abscess
  • Grade V - Cavernous sinus thrombosis

ENT (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions