sinonasal disease (see DM)

Question 1

what is anosmia

Answer 1

no sense of smell

Question 2

what is hyposmia

Answer 2

diminished sense of smell

Question 3

what is rhinits

Answer 3

an inflammatory disorder of the nasal mucosa characterised by 2 or more of:
1. rhinorrhoea
2. blockage
3. itching sneezing

Question 4

what is rhinorrhoea

Answer 4

runny nose

Question 5

3 types of allergic rhinits

Answer 5

1. persistent
2. intermittent
3. oral allergy syndrome

Question 6

5 types of non-allergic rhinits

Answer 6

1. non-allergic rhinits with eosinophilia syndrome (NARES)
2. non-eosinophilis non-allergic rhinits (NENAR) -> aka idiopathic/vasomotor
3. pregnancy rhinitis
4. atrophic rhinitis -> primary or secondary
5. rhinitis medicamentosa

Question 7

what other conditions are allergic rhinitis associated with

Answer 7

asthma + atopic dermatitis -> atopic triad

Question 8

intermittent acute rhinits classification

Answer 8

≤4 days per week or ≤4 weeks

Question 9

persistent acute rhinitis classification

Answer 9

≥ 4 days per week AND ≤4 weeks

Question 10

mild acute rhinitis classification (4)

Answer 10

1. normal sleep
2. no impariment of daily activities, sport etc.
3. normal work and school
4. no troublesome symptoms

Question 11

peristent acute rihinits classification (4)

Answer 11

one or more of:
1. abnormal sleep
2. impairment of dialy activities
3. impairment of school
4. troublesome symptoms

Question 12

what is acute rhinosinitis

Answer 12

10 days - 12 weeks of:
1. nasal blockage
2. hyposmia
3. mucopus dishcarge
4. facial pain or pressure

Question 13

signs of acute bacterial rhinosinusitis (5)

Answer 13

at least 3 of:
1. fever > 38
2. double sickening
3. unilateral disease
4. severe pain
5. raised ESR/CRP

Question 14

4 key organism involved in bacterial rhinosinusitis

Answer 14

1. streptococcus pneumoniae
2. haemophilus influenzae
3. moraxella catarrhalis
4. staphylococcus aureus

Question 15

6 complications of sinusitis

Answer 15

1. mucucole/ pyomucocoele formation
2. osteomyelitis (pott’s puffy tumour)
3. periorbital cellulitis
4. silent sinus syndrome
5. meningitis
6. cranial nerve palsies

Question 16

what is silent sinus syndrome

Answer 16

spontaneous, asymptomatic collapse of an air sinus associated with negative sinus pressures

Question 17

silent sinus syndrome presentation (3)

Answer 17

1. painless facial asymmetry (ptosis, eye retraction etc.)
2. diplopia
3. enophthalmos (secondary to collapse of orbital floor)

Question 18

what are mucocoeles

Answer 18

benign, cystic and slow growing lesions located in the paranasal sinuses, which are believed to form due to obstruction of the sinus ostia

Question 19

what is pott’s puffy tumour

Answer 19

a forehead swelling due to frontal bone osteomyelitis with associated subperiosteal abscess

Question 20

what is periorbital cellulitis

Answer 20

an acute infection of the tissues surrounding the eye, which may progress to orbital cellulitis with protrusion of the eyeball -> meningitis is a complication

Question 21

what is chronic rhinosinusitis

Answer 21

> 12 weeks of:
1. nasal obstruction/congestion
2. rhinorrhoea (mucopurulent)
3. hyposmia and/or facial pressure

+
evidence of mucopus/polyps/middle meatal oedema on endoscopy

Question 22

secondary CRS classification (4)

Answer 22

1. anatomically discrete, local pathology -> odontogenic, fungal ball or tumour
2. diffuse distribution + mechanical -> Primary ciliary dyskinesia, CF
3. diffuse distribution + inflammatory -> eosinophilia angiitis, Granulomatosis with polyangiitis (GPA)
4. diffuse distribution + immunity -> selective IgA deficency

Question 23

what is allergic fungal rhinosinusitis

Answer 23

an intense, localized allergic/eosinophilic inflammatory sinus disease that results in the accumulation of eosinophilic (allergic) mucin (a thick, tenacious eosinophilic secretion that contains fungal hyphae)

Question 24

allergic fungal rhinosinusitis presentation (5)

Answer 24

Anesthesia, cranial nerve palsies, proptosis, headache and facial pain

Question 25

2 causes of bilateral nasal obstruction

Answer 25

1. rhinitis 2. rhinosinusitis

Question 26

5 causes of unilateral nasal obstruction

Answer 26

1. neoplasia 2. antro-choanal polyp 3. deviated nasal septum 4. foreign body

Question 27

what should be avoided in those with nasal septal deviation

Answer 27

decongestants - may result in rhinitis medicamentosa

Question 28

ddx for facial pain (5)

Answer 28

if there is only facial pain sinusitis is unlikely to be the cause 1. trigeminal neuralgia 2. cluster headaches 3. migraine 4. tension headache 5. atypical facial pain

Question 29

red flag symptoms for facial pain (5)

Answer 29

1. unilateral symptoms (e.g. bleeding, crusting, blockage) 2. orbital symptoms 3. neurological signs incl CN palsies 4. severe frontal headaches 5. clear, watery, unilateral rhinorrhoea

Question 30

causes of olfactory disturbance (13)

Answer 30

1. conductive (sino-nasal pathology, nasal obstruction) 2. sensorineural (URTIs, trauma) 3. iatrogenic 4. cerebrovascular disease 5. temporal lobe epilepsy 6. intracranial neoplasia 7. toxic exposure 8. medical co-morbidity 9. chronic alcoholism 10. recreational drug use 11. psyhogenic (schizophrenia0 12. idiopathic 13. Parkinsons

Question 31

7 smell/taste disorders

Answer 31

1. anosmia 2. parosmia (smell doesnt correspond to stimulus) 3. phantosmia (hallucination) 4. troposmia (unpleasant parosmia) 5. cacosmia (unpleasant phantosmia) 6. ageusia (absent taste) 7. dysgeusia (taste distortion)

Question 32

4 iatrogenic causes for gustatory disorders

Answer 32

1. tonsillectomy 2. middle ear surgery 3. microlaryngoscopy 4. salivary gland surgery

Question 33

mgx for post viral smell loss (4)

Answer 33

1. steroids (+ ginko biloba?) 2. theophylline 3. pentoxifylline 4. smell training

Question 34

mgx for post traumatic smell loss

Answer 34

1. early steroids 2. same as post viral