Bailey And Johnson - Chapter 88

Front 1

What is the DDx of diseases compatible with pediatric chronic sinusistis?

Back 1

Chronic sinusitis, adenoid hypertrophy, Recurrent URI's, Allergies, Immune deficiencies, Ciliary dyskinesias

Front 2

What are the signs/symptoms of chronic sinusitis?

Back 2

Purulent nasal discharge, day and night cough, nasal airway obstruction, headache, irritability, facial pain, fever, postnasal drip

Front 3

In children what do nasal polyps usually signal?

Back 3

cystic fibrosis or allergic fungal sinusitis

Front 4

Which sinuses are drained by the infundibulum?

Back 4

Frontal, anterior ethmoid and maxillary sinuses

Front 5

What are the anterior and posterior borders of the infundibulum?

Back 5

Uncinate process anteriorly, posteriorly by the ethmoid bulla

Front 6

What are the viruses most frequently seen in acute sinusitis?

Back 6

rhinovirus, parainfluenza, influenza, and adenovirus

Front 7

Does anatomical variablity cause a higher incidence of chronic sinusitis?

Back 7

NO! - unclear why

Front 8

Most common bacteria in acute sinusitis?

Back 8

Strep pneumoniae (30%), Moraxella catarrhalis and Haemophilus influenzae (20%)

Front 9

Bacteria invovlved in subacute sinusitis (infections lasting 10-21 days)

Back 9

Same as acute sinusitis

Front 10

Bacteria of chronic sinusitis

Back 10

Similar to acute, but higher anaerobes (peptococci, peptostreptococci, bacteroides), alpha hemolytic strep, staph aureus, m catarrhalis, strep pneumoniae, h. influenzae, Pseudomonas aeruginosa

Front 11

Common dosage of antibiotics for pediatric sinusitis?

Back 11

1. Amoxicillin, 40 mg/kg/d in three divided doses;
2. Amoxicillin-potassium clavulanate (Augmentin), 40/10 mg/kg/d in three divided doses;
3. Erythromycin-sulfisoxazole (Pediazole), 50/150 mg/kg/d in four divided doses;
4. Sulfamethoxazole–trimethoprim (Sulfa or Bactrim), 40/8 mg/kg/d in divided doses;
5. Cefuroxime axetil (Ceftin), 30 mg/kg/d in two divided doses; 6. Cefprozil (Cefzil), 30 mg/kg/d in two divided doses;
7. Cefpodoxime proxetil (Vantin), 10 mg/kg/d in two divided doses;
8. Clindamycin (Cleocin), 30 mg/kg/d in four divided doses;
9. Clarithromycin (Biaxin), 15 mg/kg/d in two divided doses;
10. Azithromycin (Zithromax), 10 mg/kg/d in one loaded dose

Front 12

Antibiotic choice for pediatric patients with mild disease who have not received antibiotics in the previous month?

Back 12

high dose augmentin, high dose amoxicillin, cefpodoxime, proxetil, cefuroxime or cefdinir

Front 13

Pedi patient with hx of immediate type I hypersensitivity to Beta lactams - what is the antibiotic choice for acute sinusitis?

Back 13

bactim, azithromycin, clarithromycin or erythromycin

Front 14

What is a reasonable first step in surgically managing pediatric chronic rhinosinusitis?

Back 14

adenoidectomy

Front 15

What are 6 orbital complications of persistent sinus disease?

Back 15

Preseptal orbital inflammatio, orbital cellulitis, subperiosteal abscess, orbital abscess, cavernous sinus thrombosis, blindness

Front 16

What are 4 intracranial complications of persistent sinus disease?

Back 16

meningitis, epidural abscess, subdural abscess, acute and chronic brain abscess

Front 17

What is the Chandler classification of orbital complications of sinus disease?

Back 17

Group 1: Inflammatory edema of the eyelids without tenderness; obstruction of venous drainage; no associated visual loss or limitation of ocular movements.

Group 2: Orbital cellulitis with diffuse edema of the adipose tissue in the orbital contents secondary to inflammation and bacterial infections; no abscess formation.

Group 3: Subperiosteal abscess; abscess between the orbital periosteum and the bony wall. Mass displaces the globe in the opposite direction; the proptosis may be severe with decreased ocular mobility and visual acuity. The abscess may rupture into the orbit through the orbital septum.

Group 4: Orbital abscess; a discrete abscess within the orbit. Proptosis is usually severe but is symmetrical and not displaced, as in the subperiosteal abscess. Complete ophthalmoplegia results, and visual loss occurs in 13%.

Group 5: Cavernous sinus thrombosis; progression of the phlebitis into the cavernous sinus and to the opposite side, resulting in bilateral symptoms.

Front 18

CT findings of cavernous sinus thrombosis?

Back 18

CT scan will show a lack of contrast enhancement in one or both cavernous sinuses.