sinusitis (quiz 1, exam 1)

Question 1

inflammation of the sinuses leads to blackade of the normal sinus drainage pathways (__), which in turn leads to __(4)

Answer 1

• sinus ostia
• mucus retention
• hypoxia
• decreased mucocilliary clearance
• predisposition to bacteiral growth

Question 2

acute sinusitis symtpom duration

Answer 2

<4 weeks

Question 3

subacute sinusitis symtpom duration

Answer 3

4-8 weeks

Question 4

chronic sinusitis symptom duration

Answer 4

>8 weeks

Question 5

recurrent acute sinusitis: __ epidsodes per year, with each episode lasting __ weeks

Answer 5

• 3 or more
• <2 weeks

Question 6

acute rhinosinusitis (aka sinusitis) is inflammation of the __ and __

Answer 6

paranasal sinuses

nasopharynx

Question 7

mos people with non-speicif URI have some component of sinus inflammation, with __% of pts with URI having abnormalities in the __ sinus (regardless of whether symtpoms localize to the sinuses)

Answer 7

• 87%
• maxillary sinus

Question 8

sphenoidal sinusitis is __, has a different presentation, and has a greater risk of complications including __ and __; symptoms are non specific and usually include __ and __, making diagnosis difficult

Answer 8

• rare
• meningitis
• cavernous sinus thrombosis
• headache
• retro-orbital pain

Question 9

most cases are caused by __; 10-20% of pts seeing a clnician with complaints consistent with sinusitis have a __ infection

Answer 9

• viral
• bacterial

Question 10

bacterial rhinosinusitis complicates only __% of all cases of URI

Answer 10

0.5-2% (but 85-95% receive a prescription for antibiotics)

Question 11

Answer 11

pathophysiology of acute sinusitis

Question 12

Answer 12

pathophysiology of acute sinusitis

Question 13

T or F: antibiotics reduce symptoms in most cases of sinusitis and paly a role in preventing complications

Answer 13

false

Question 14

the main serious complicatinos of bacterial sinusitis are these 3 things

Answer 14

1. local extension (e.g. osteitis, infection of the intracranial cavity, orbital cellulitis)
2. spread of bacteria to the central nervous system
3. infection of the intracranial venous sinuses

(these complications are rare, estimated to occur in 1 per 10,000 cases of sinusitis)

Question 15

classis cymptoms of acute rhinosinustits

Answer 15

1. nasal congestion
2. purulent nasal discharge
3. headache
4. maxillary tooth pain
5. hyposmia or anosmia (decreased or absent sense of smell)
6. facial pain that is worsened by bending forward
7. malaise

Question 16

T or F: no symptom or cluster of symptoms effectively diferentiates viral from bacterial rhinosinusitis

Answer 16

true

Question 17

clinical features that are sugestive of bacterial sinusitis

Answer 17

1. presence of symptoms greater than 7-20 days
2. MAXILLARY TOOTH PAIN
3. unilateral facial pain
4. unilateral sinus tenderness
5. FEVER (MOST CONSISTENTLY CORRELATED WITH BACTERIAL SINUSITIS)
6. PURULENT NASAL DISCHARGE
7. symptoms worsening after initial improvement

Question 18

Answer 18

normal sinuses

Question 19

Answer 19

acute maxillary sinusitis; note the fluid levels in the maxillary sinuses (arrows)

Question 20

common viral causes of acute sinusitis

Answer 20

1. rhinovirus
2. coronavirus
3. adenovivrus
4. parainfluenza virus

Question 21

common bacterial causes of acute sinusitis

Answer 21

1. Streptococcus pneumoniae
2. Haemophilus influenzae
3. Moraxella catarrhalis
4. Staphylococcus aureus

Question 22

fungal sinusitis occurs in populations with __

Answer 22

underlying immune disorders (poorly controlled diabetes, hematologic malignancies, and chronic renal failure)

Question 23

pts with fungal sinusitis may present with symptoms similar to acute rhinosinusitis, but imaging may reveal

Answer 23

a mass in the sinus and erosion into contiguous bone

Question 24

fungal sinusitis: rapid management including __ and __ is essential

Answer 24

1. surgical debridement
2. antifungal therapy

Question 25

most common causes of fungal acute sinusitis

Answer 25

1. Asppergillus 2. Mucorales (e.g. mucormycosis): classically occur during episodes of diabetic ketoacidosis, and are uncommon in the normal host

Question 26

symptomatic therapy: maximizing __ is the goal

Answer 26

isnus drainage

Question 27

symptomatic therapy: __ can help decrease discomfort and inflammation

Answer 27

non-steroidal anti-inflammatory drugs (NSAIDs)

Question 28

symptomatic therapy: __ may decrease mucus production

Answer 28

first generation antihistamines

Question 29

symptomatic therapy: corticosteroid nasal spary had __ results in studies; studies of decongestants reveal __ evidence for clinical benefit

Answer 29

* conflicting * little (but decongestants may relieve symptoms in some pts)

Question 30

symptomatic therapy: saline, either as a spray or a lavage, is promoted as helping to \_\_

Answer 30

1. clear mucus 2. maintain mucosal moisture 3. clear viral antigens there is a lack of evidence from clinical trials but some pts may perceive some relief

Question 31

its appropriate to treat acute sinusitis with antibiotics when pts have

Answer 31

moderate to severe symptoms that localize to the sinuses, which significantly interfere with routine activiteis, and are consistent with bacterial infection

Question 32

antibiotics against __ are appropriate; it is recommended that \_\_, __ or __ be used

Answer 32

* S. pneumoniae * amoxicillin * doxycycline * trimethoprim-sulfamethoxazole

Question 33

pts who have received recent antibiotics (within the past __ weeks) are at higher risk for harboring drug resistant organisms; __ or __ or __ are reasonable choices for pts with recent antibiotic exposure

Answer 33

* 6 weeks * amoxicillin/clavulanic acid (augmentin) * moxifloxacin * levofloxacin

Question 34

failure to respond to antibiotics within __ hours suggests with incorrect diagnosis or inactive agents; switching antibiotics to either a __ or __ is appropriate in this situation

Answer 34

* 72 hours * fluoroquinolone * amoxicilin/clavulanate

Question 35

standard treatment duration for acute bacterial sinusitis is __ days

Answer 35

10-14 days

Question 36

sinus radiography __ recommended for the diagnosis of uncomoplicated sinusitis

Answer 36

is not

Question 37

acute bacterial sinusitis __ requrie antibitoic treatment

Answer 37

does not (esp. if the symptoms are mild or moderate)

Question 38

pts with __ should be treated with an antibiotic; __ antibiotics are reasonable first line agents

Answer 38

* severe or persistent moderate symptoms and specific findings of bacterial sinusitis * narrow-spectrum