Practice Paper 5: Answers
Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar in Get ahead! Medicine, 2016
Acute sinusitis is inflammation of the paranasal sinuses, which usually occurs following a bacterial upper respiratory tract infection. The pain of acute sinusitis is worse on bending and coughing, and may be accompanied by headache. The site of the pain depends on which sinus is affected. Acute maxillary sinusitis causes pain over the cheek, which may be referred to the teeth. Acute frontal sinusitis causes pain above the eyes. Acute ethmoid and sphenoid sinusitis can result in pain between or behind the eyes. In reality, however, the site of sinusitis may be very difficult to distinguish. In maxillary sinusitis, a skull X-ray may show a fluid level on the affected side. Treatment is with antibiotics (amoxicillin) and analgesia. Vasoconstricting nose drops (1% ephedrine) aid drainage of the sinus.
Head and neck
David A Lisle in Imaging for Students, 2012
Acute sinusitis is usually viral or bacterial and presents clinically with facial pain and headache, nasal discharge and fever. Diagnosis is usually made on clinical grounds and may be confirmed with nasal cultures or minimally invasive procedures such as endoscopic paranasal sinus aspiration. Imaging usually is not required for acute sinusitis. Indications for imaging in suspected acute paranasal sinusitis include:Lack of response to antibiotic therapyImmunocompromised patientsSuspected complications, such as meningitis, subdural empyema or cerebral abscess.
Otolaryngology
Philip Stather, Helen Cheshire in Cases for Surgical Finals, 2012
A 37-year-old female presents to her GP, complaining of a frontal headache, which is made worse on leaning forwards. A diagnosis of sinusitis is suspected. State four functions of the paranasal sinuses. (4 marks)Describe three clinical features of sinusitis, other than pain and headache. (3 marks)On viewing her medical records, you realise that this patient has previously presented with episodes of sinusitis in the past and you wish to investigate further in view of her recurrence. State two ways you could do this. (2 marks)Further investigation reveals no structural abnormality.Name two treatment options for this patient. (2 marks)
An updated patent review on P-glycoprotein inhibitors (2011-2018)
Published in Expert Opinion on Therapeutic Patents, 2019
Marcello Leopoldo, Patrizia Nardulli, Marialessandra Contino, Francesco Leonetti, Gert Luurtsema, Nicola Antonio Colabufo
Sinusitis is an inflammation of the mucous membrane lining one or more paranasal sinuses. Rhinitis is an inflammation of the mucous membrane lining the nasal passage. Rhinitis and sinusitis coexist and the expert in this field adopts the term rhinosinusitis. The symptoms of rhinosinusitis include nasal congestion and obstruction, colored nasal discharge, anterior or posterior nasal drip. Recently, Belier and Nocera in WO2017/123933A1 (Table 1) [32] reported that P-gp is secreted into nasal mucus under physiological condition whereas high concentration of pump is present in chronic rhinosinusitis. Therefore, the first innovative step is to evaluate P-gp in the nasal secretion of Chronic Rhinosinusitis. After this important innovative step, Bleier in the same patent and in another specific patent, US2017/0348384 [33], reported the innovative treatment of rhinosinusitis with P-glycoprotein inhibitor alone or in association with antibiotic, and or corticosteroids. P-glycoprotein inhibitor could be administered systematically or locally to the subject’s nasal passage and sinuses by inhalation device, by flushing, spraying, and nebulization.
Current healthcare pathways in the treatment of rhinosinusitis in Germany
Published in Acta Oto-Laryngologica, 2018
Jonas Jae-Hyun Park, Claus Bachert, Stefan Dazert, Karel Kostev, David Ulrich Seidel
The rates of referrals to radiologists are relatively similar in general and ENT practices (both about 13%), but these referrals are not fully understandable (Figure 4). For a simple diagnosis of sinusitis, radiologic imaging as a primary diagnostic tool is obsolete and is only required for the indication of surgery or in case of suspected complications [2]. It is possible that the referral rates to radiologists indicate an inadequate diagnostic approach by some physicians, which needs to be addressed and questioned. On the other hand, it is important to keep in mind that the database does not indicate whether the referrals were made due to sinusitis. Instead, it provides merely a chronologic association between the diagnosis and the referral. In other words, the referrals have probably mostly been made due to the sinusitis diagnosis, but not in all of the cases.
Chronic rhinosinusitis: pathogenesis, therapy options, and more
Published in Expert Opinion on Pharmacotherapy, 2018
Umut Can Kucuksezer, Cevdet Ozdemir, Mubeccel Akdis, Cezmi A. Akdis
Rhinosinusitis (RS) is defined as the inflammation of the nasal cavity and paranasal sinuses and is associated with symptoms such as nasal blockage and congestion, nasal discharge, facial pain and pressure, and a dysregulated sense of smell [1,2]. Fever, foul taste, odor, ear fullness, sense of fatigue, and disturbance of sleep may also present in several cases. Physical examinations usually reveal changes in the mucosa, like mucosal edema and pus formation. In general, viral sinusitis, which has a course of less than 10 days, may be followed by acute bacterial sinusitis. Bacteria including Streptococcus pneumonia, Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pyogenes generally induce mucosal infection and inflammation in RS, contributing to the development and propagation of symptoms [3]. After 4 weeks, sub-acute RS develops. If inflammation and symptoms persist for over 12 weeks, the presence of CRS is confirmed; in CRS, Staphylococcus aureus and anaerobic organisms are predominant [4]. A non-infectious etiology, as well as chronic fungal infections, may also be involved in CRS, while viral, bacterial or acute fungal infections may be associated with RS [5,6]. The diagnosis of CRS should be validated with endoscopic or radiological investigations [7]. CRS reportedly affects around 10% of the population, with geographical variations [7]. The Global Allergy and Asthma European Network performed a study in 19 centers across 12 European countries and estimated the overall prevalence of CRS to be 10.9% [8]. In the United States, 12.5% of the population has experienced CRS [9].
Related Knowledge Centers
- Fever
- Hyposmia
- Inflammation
- Nasal Mucosa
- Orofacial Pain
- Paranasal Sinuses
- Sore Throat
- Headache
- Nasal Congestion
- Phlegm