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25 Cards in this Set

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What time period of infection is categorized as acute rhinosinusitis?
less than 4 weeks
What are the common viral causes for colds (4)?
rhinovirus
parainfluenza virus
respiratory syncytial virus
influenza virus
Which viral pathogen for colds is most common and when does its incidence peak?
rhinovirus, peaks in fall
RSV and influenza virus are more destructive of respiratory cilia. True or False.
True
When do RSV and influenza virus peak?
winter and early spring, respectively
Radiographs are helpful in distinguising a cold from a bacterial infection. T or F?
False
What are the most common causes of acute bacterial rhinosinusitis?
s. penumoniae
h. influenzae
Purulent nasal discharge can distinguish a viral infection from a bacterial infection. T or F?
False
Even with purulent discharge for at least 7 days, only 60% of maxillary taps show bacterial in high concentration.
What symptoms suggest that an actue RS is bacterial?
1) symptoms suddenly worsen after several days instead of slowly improving
2) persistent severe symptoms extend beyond 7 days
Is there a difference between endoscopic vs maxillary puncture cultures in children vs adults?
Inchildren, the same pathogens that cause ABRS are normally found in the nasal cavity in children, so endoscopic cultures are not a surrogate for maxillary taps.
In adults, however, there is good correlation between aspirates of purulence from the middle meatus and maxillary taps.
In chronic rhinosinusitis, does extent of disease on CT correlate with severity of symptoms?
No.
What are extrinsic causes of CRS (3)?
1) Infectious (viral, bacterial, fungal, parisitic)
2) Noninfectious/inflammatory (allergic, Non IgE-mediated hypersensitivies, pharmacologic, irritants)
3) Disruption of normal ventilation or mucociliary drainage by (surgery, infectious, trauma)
What are intrinsic causes of CRS (9)?
1)Genetic:
a)mucociliary abnormality (CF, PCD)
b) structural
c) immunodeficiency
2) Acquired:
a)aspirin hypersensitivity
b)autonomic dysregulation
c)hormonal (pregnancy, hypothyroidism)
d)structural (neoplasms, osteoneogenesis and outflow obstruction, retention cysts and antral choanal polyps)
e)autoimmune or idiopathic (Sarcoid, Wegener's, SLE, Churg Strauss, Pemphigoid)
f)immunodeficiency
When do frontal sinuses develop in children?
6-8 years
What percentage of the time does aspiration yield pus in sinuses that are completely opaque on CT? what about thickened mucous membranes with central aeration?
80-88%
50%
If a child develops nasal polyps before age 10, what dx must be considered rather than allergies?
CF
What are the five manifestations of fungal sinusitis?
1)invasive
2)chronic invasive
3)fungal ball
4)saprophytic
5)allergic fungal sinusitis
What are the five criteria for diagnosing allergic fungal sinusitis?
1) allergic mucin
2) positive cultures
3) hyphae on path
4) radiographic findings
5) nasal polyposis
What fungus demonstrates narrow hyphae and regular septations with 45-degree branching?
Aspergillus
Which is more commonly found in invasive fungal sinusitis: aspergillus flavus or fumigatus?
Aspergillus fumigatus - aspergillus flavus is commonly associated with indolent chronic invasive fungal disease seen in Sudan
Serum of patients with DKA may enhance fungal growth. T or F?
True - may be attributable to altered transferrin binding in diabetic patients. Renal dialysis and des-ferrioxamine are risk factors for mucormycosis.
What are the dematiaceous fungi involved in AFS?
Alternaria, Bipolaris, Curvularia.
What are some differences in patients with AFS vs. esinophilic mucin rhinosinusitis that suggests they may be different?
1) EMRS are nearly all asthmatic (93% vs 41%)
2) EMRS patients are older (48yrs vs 30.7yrs)
3) EMRS patients have bilateral disease (100% vs 45%)
4) EMRS patients have lower total IgE (1000 mg/dL vs 12000 mg/dL)
What are the Chandler classifications of orbital involvement from ethmoid sinusitis?
1) Preseptal cellulitis
2) Orbital cellulitis
3) Subperiosteal abscess
4) Orbital abscess
5) Cavernous sinus thrombosis
What are indications for surgical intervention?
1) orbital cellultitis progresses despite IV ABX
2) physical sings regress slightly for 2-3 days, then stabilize or exacerbate
3) Definite abscess on U/S or CT.
4) Loss of visual acuity