Rhinosinusitis

Question 1

Rhinosinusitis (Rhino refers to the nose), also referred to as sinusitis is inflammation of the paranasal sinuses. What is the estimated incidence of acute Rhinosinusitis?

1 - 2.5 cases per 100,000
2 - 25 cases per 100,000
3 - 250 cases per 100,000
4 - 2500 cases per 100,000

Answer 1

4 - 2500 cases per 100,000

Rhinitis = inflammation of the lining of the nose (allergic vs non-allergic)

Rhinosinusitis: Inflammation of the lining of the nose and paranasal sinuses

Question 2

Rhinosinusitis, also referred to as sinusitis is inflammation of the paranasal sinuses. What age does acute Rhinosinusitis peak at?

1 - 10-20
2 - 20-30
3 - 40-50
4 - >75

Answer 2

3 - 40-50

Question 3

Is Rhinosinusitis more common in men or women?

Answer 3

• equal in both

Question 4

How long does acute Rhinosinusitis typically last for?

1 - 24h
2 - 7 days
3 - 2 weeks
4 - 4 weeks

Answer 4

4 - 4 weeks

Question 5

How long does sub-acute Rhinosinusitis typically last for?

1 - 7 days
2 - 2 weeks
3 - 1 month
4 - 1-3 months

Answer 5

4 - 1-3 months

Question 6

How long does chronic Rhinosinusitis typically last for?

1 - >4 weeks
2 - >2 months
3 - >4 months
4 - >6 months

Answer 6

3 - >4 months

Question 7

What is the time frame for Rhinosinusitis to be defined as acute?

1 - <2 weeks
2 - <4 weeks
3 - <8 weeks
4 - <12 weeks

Answer 7

4 - <12 weeks

Chronic is >12 weeks

Question 8

All of the following are paranasal sinuses that help amplify your voice, if blocked your voice sound changes. Which of the following are above the eyes?

1 - frontal sinuses
2 - ethmoidal sinuses
3 - sphenoidal sinuses
4 - maxillary sinuses

Answer 8

1 - frontal sinuses

Question 9

All of the following are paranasal sinuses that help amplify your voice, if blocked your voice sound changes. Which of the following are below the eyes?

1 - frontal sinuses
2 - ethmoidal sinuses
3 - sphenoidal sinuses
4 - maxillary sinuses

Answer 9

4 - maxillary sinuses

Question 10

All of the following are paranasal sinuses that help amplify your voice, if blocked your voice sound changes. Which of the following are behind the eyes?

1 - frontal sinuses
2 - ethmoidal sinuses
3 - sphenoidal sinuses
4 - maxillary sinuses

Answer 10

2 - ethmoidal sinuses

Question 11

All of the following are paranasal sinuses that help amplify your voice, if blocked your voice sound changes.Which of the following are above the pharynx and infront of the ears?

1 - frontal sinuses
2 - ethmoidal sinuses
3 - sphenoidal sinuses
4 - maxillary sinuses

Answer 11

3 - sphenoidal sinuses

Question 12

Are paranasal sinuses typically sterile or non-sterile?

Answer 12

• sterile

Question 13

Which 2 of the following sinuses are most commonly affected in rhinosinusitis?

1 - ethmoid
2 - frontal
3 -sphenoidal
4 - maxillary

Answer 13

1 - ethmoid
4 - maxillary

Question 14

The nasal cavity is lined by hairs that are lined by mucus. Which of the following is not a characteristic of mucus?

1 - salty
2 - sticky
3 - lysozyme containing
4 - macrophage containing

Answer 14

4 - macrophage containing

• lysozyme are enzymes able to degrade pathogens
• mucus collects dust, pollen and pathogens

Question 15

Which of the following is a function of the paranasal sinuses?

1 - echo our voice
2 - goblet cells that produce mucus to trap pathogens and foreign particles
3 - circulate, moisten and warm air
4 - columnar cells with cilia that can move mucus and foreign bodies
5 - all of the above

Answer 15

5 - all of the above

Question 16

The most common cause of Rhinosinusitis is an infection. Which of the following viruses can cause Rhinosinusitis?

1 - Influenzae virus
2 - Rhinoviruses
3 - Parainfluenza virus
4 - Coronavirus
5 - all of the above

Answer 16

5 - all of the above
all are viral

• Rhinoviruses = common cold
• Parainfluenza virus = common cold
• Haemophilus influenza = flu

Question 17

Which bacteria commonly lead to Rhinosinusitis?

1 - Streptococcus pneumoniae
2 - Haemophilus influenzae
3 - Moraxella catarrhalis
4 - all of the above

Answer 17

4 - all of the above

2 most common are:
- Streptococcus pneumoniae
- Haemophilus influenzae

Typically following an URTI and can occur in asthma

Question 18

Which of the following is NOT a predisposing factors to Rhinosinusitis?

1 - nasal obstruction (septal deviation or nasal polyps)
2 - recent local infection (rhinitis or dental extraction)
3 - swimming/diving
4 - COPD
5 - smoking
6 - asthma

Answer 18

4 - COPD

Question 19

In acute Rhinosinusitis there is a foreign body that causes an inflammatory response. Goblet cells increase mucus production leading to congestion and immune cells attack foreign body forming pus. Which of the following is NOT a component of this pus?

1 - immune cells
2 - dead tissue
3 - blood
4 - foreign body

Answer 19

3 - blood

Question 20

In some patients with Rhinosinusitis, this can become chronic and progress into chronic hyperplastic Rhinosinusitis, which leads to what?

1 - connective tissue in paranasal sinuses proliferate quicker than usual forming polyps
2 - connective tissue proliferates and becomes malignant
3 - paranasal sinuses collapse on themselves
4 - connective tissue proliferates leading to increased sign of paranasal sinuses

Answer 20

1 - connective tissue in paranasal sinuses proliferate quicker than usual forming polyps

Question 21

Are the polyps that can form in chronic hyperplastic Rhinosinusitis cancerous or benign?

Answer 21

• benign

Unilateral polyps are a red flag though and need urgent ENT referral

Question 22

Which of the following is NOT a clinical symptom of Rhinosinusitis?

1 - facial pain, typically frontal and worse when leaning forward
2 - blurred vision
3 - pressure in the face
4 - headaches
5 - change in voice, smell and taste
6 - cough when lying down

Answer 22

2 - blurred vision

All are typically caused by excessive mucus

Question 23

Diagnosis of Rhinosinusitis is typically clinical, but which 2 of the following can be useful for diagnosis?

1 - head CT
2 - raised ESR and CRP
3 - rhinoscopy
4 - X-ray

Answer 23

1 - head CT
3 - rhinoscopy

Contrast is used in the CT scan as this is good at identifying any abscesses

Question 24

Do the majority of cases of Rhinosinusitis always need treatment?

Answer 24

• No

The majority resolve spontaneously

Question 25

When treating Rhinosinusitis, all of the following should be used EXCEPT which one? 1 - analgesia 2 - intranasal decongestants or nasal douching 3 - oral antivirals 4 - corticosteroids if symptoms >10 days (given nasally or orally) 5 - oral antibiotics 6 - avoid allergens where possible

Answer 25

3 - oral antivirals Oral antibiotics can be used in high risk populations Surgery to open airways and sinuses may also be useful

Question 26

If there is not improvement in patients symptoms following initial treatment, how long should it be before antibiotics are considered? 1 - >3 days 2 - >5 days 3 - >10 days 4 - >21 days

Answer 26

3 - >10 days Co-amoxiclav = 1st line Doxicicline = if patient has a penicillin allergy

Question 27

Are unilateral or bilateral symptoms more likely to be malignant?

Answer 27

- unilateral

Question 28

Rhinitis = inflammation of the lining of the nose (allergic vs non-allergic) Rhinosinusitis: Inflammation of the lining of the nose and paranasal sinuses Does rhinitis or Rhinosinusitis causes the following symptoms? 1 - nasal obstruction 2 - rhinorrhoea/post-nasal drip 3 - hyposmia/anosmia 4 - sneezing, itching 5 - watery eyes/swelling

Answer 28

Rhinitis = inflammation of the lining of the nose (allergic vs non-allergic) This is typically the cause can be allergic in nature, causing sneezing and itching

Question 29

Rhinosinusitis is inflammation of nose and paranasal sinuses. Patients must have >2 of the following symptoms: - nasal obstruction/congestion/discharge - facial pain/pressure - reduction or loss of smell AND AT LEAST A POSITIVE SIGN IN ONE OF THE FOLLOWING: - nasal polyps - mucopurulent discharge - inflammation of the paranasal sinuses (confirmed on CT)

Question 30

Which 2 of the following are extracranial complications of Rhinosinusitis? 1 - Periorbital cellulitis/abscess 2 - Meningitis 3 - Frontal osteomyelitis (“Potts puffy tumour”) 4 - Tinnitus

Answer 30

1 - Periorbital cellulitis/abscess 3 - Frontal osteomyelitis (“Potts puffy tumour”)

Question 31

Which of the following is NOT an intracranial complications of Rhinosinusitis? 1 - Meningitis 2 - Abscesses 3 - Stroke 4 - Venous sinus thrombosis (cavernous)

Answer 31

3 - Stroke

Question 32

Chronic rhinosinusitis can have all of the following: - CT scan - Regular sinus saline irrigation - Intranasal corticosteroids - Oral antibiotics - Surgery (Endoscopic sinus surgery)

Answer 32

Each patient is judged on a case to case basis though