Chronic Rhinosinusitis Quiz
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Questions and Answers

What is the minimum duration of symptoms required to diagnose chronic rhinosinusitis (CRS)?

  • 8 weeks
  • 6 weeks
  • 4 weeks
  • 12 weeks (correct)

    • Which of the following findings would support a diagnosis of chronic rhinosinusitis?

  • Detection of laryngopharyngeal reflux
  • Presence of dental caries
  • Confirmation of edema in the anterior ethmoid region (correct)
  • Evidence of acute tonsillitis

    • In addition to edema, what other type of nasal discharge supports a diagnosis of chronic rhinosinusitis?

  • Mucoid
  • Purulent (correct)
  • Serous
  • Serosanguinous

    • Where should edema or purulent mucous discharge be located to aid in the diagnosis of chronic rhinosinusitis?

    <p>Anterior ethmoid region or middle meatus (A)</p> Signup and view all the answers

    What type of process is chronic rhinosinusitis (CRS)?

    <p>Inflammatory (D)</p> Signup and view all the answers

    What is the primary characteristic defining chronic rhinosinusitis?

    <p>Persistent inflammation of the nasal and paranasal sinus mucosa (A)</p> Signup and view all the answers

    Which duration of symptoms is most consistent with chronic rhinosinusitis (CRS)?

    <p>Symptoms persisting for more than 12 weeks (A)</p> Signup and view all the answers

    Where might a clinician look for the presence of edema or purulent mucous discharge when diagnosing chronic rhinosinusitis?

    <p>Anterior ethmoid region or middle meatus (A)</p> Signup and view all the answers

    Confirmation of which of the following findings is required for the diagnosis of chronic rhinosinusitis?

    <p>Confirmation of the presence of edema or purulent mucous discharge (C)</p> Signup and view all the answers

    A patient presents with 14 weeks of facial pain, nasal congestion, and thick nasal discharge. Endoscopy reveals mucosal edema in the middle meatus. What is the most likely diagnosis?

    <p>Chronic rhinosinusitis (A)</p> Signup and view all the answers

    Which diagnostic criterion is essential for confirming chronic rhinosinusitis (CRS)?

    <p>Radiographic documentation of paranasal sinus inflammation (D)</p> Signup and view all the answers

    A patient is suspected of having chronic rhinosinusitis (CRS). Besides radiographic evidence, what is the minimum number of symptoms from the defined list that must be present to support the diagnosis?

    <p>Two (C)</p> Signup and view all the answers

    What are the two distinguished types of Chronic Rhinosinusitis?

    <p>With nasal polyps and without nasal polyps (D)</p> Signup and view all the answers

    A patient presents with radiographic evidence of sinus inflammation and reports diminished sense of smell and nasal congestion. Which other symptom would meet the diagnostic criteria for chronic rhinosinusitis?

    <p>Facial pain (D)</p> Signup and view all the answers

    Which of the following symptoms is NOT explicitly listed as one of the diagnostic criteria for chronic rhinosinusitis (CRS)?

    <p>Headache (A)</p> Signup and view all the answers

    What is the significance of radiographic documentation in diagnosing Chronic Rhinosinusitis (CRS)?

    <p>It confirms the presence of inflammation in the paranasal sinuses. (D)</p> Signup and view all the answers

    Which of the following signs or symptoms, when combined with radiographic evidence of sinus inflammation, would be MOST indicative of chronic rhinosinusitis with nasal polyps (CRSwNPs)?

    <p>Visible growths in the nasal passages (D)</p> Signup and view all the answers

    A patient with suspected chronic rhinosinusitis presents with nasal congestion, facial pain, and radiographic evidence of sinus inflammation, but reports a normal sense of smell. What other symptom MUST be present to meet the diagnostic criteria for CRS?

    <p>Mucopurulent drainage (B)</p> Signup and view all the answers

    Which of the following factors differentiates between the two main subtypes of chronic rhinosinusitis (CRS)?

    <p>The presence or absence of nasal polyps (D)</p> Signup and view all the answers

    What is the primary role of radiographic imaging in the diagnostic process for chronic rhinosinusitis (CRS)?

    <p>To visualize and document the inflammation in the paranasal sinuses (B)</p> Signup and view all the answers

    Which diagnostic method is specifically performed by an otolaryngology specialist?

    <p>Nasal endoscopy (B)</p> Signup and view all the answers

    Which of the following is NOT typically part of the diagnostic evaluation for chronic nasal congestion and discharge?

    <p>Blood pressure measurement (D)</p> Signup and view all the answers

    What type of scan is commonly utilized to assess sinus conditions in patients with chronic nasal congestion?

    <p>Sinus CT scan (B)</p> Signup and view all the answers

    Laboratory tests in the diagnosis of chronic nasal congestion are primarily used to evaluate which of the following?

    <p>Allergies and immune deficiencies (D)</p> Signup and view all the answers

    Which of the following procedures provides a direct view of nasal passages?

    <p>Nasal endoscopy (B)</p> Signup and view all the answers

    Which diagnostic method assesses both the nasal passages and the sinuses but is less invasive than nasal endoscopy?

    <p>Anterior rhinoscopy (A)</p> Signup and view all the answers

    What is the primary goal of inspecting the nasal and turbinate structures during diagnostics?

    <p>To assess the presence of anatomical anomalies (B)</p> Signup and view all the answers

    Which examination is specifically utilized to visualize the internal nasal structures and identify potential blockages?

    <p>Nasal endoscopy (B)</p> Signup and view all the answers

    What is the primary treatment strategy for managing chronic nasal congestion and discharge?

    <p>Intranasal corticosteroids. (A)</p> Signup and view all the answers

    Which of the following symptoms necessitates an immediate referral to an otolaryngologist for chronic nasal congestion and discharge?

    <p>Periorbital edema. (D)</p> Signup and view all the answers

    What should be considered as a method for addressing chronic nasal congestion?

    <p>Saline lavage of the sinus cavities. (D)</p> Signup and view all the answers

    In the context of chronic nasal congestion and discharge, under what circumstance should antibiotics be considered?

    <p>When there is evidence of a bacterial infection. (A)</p> Signup and view all the answers

    A patient with chronic nasal congestion reports double vision. Which course of action is most appropriate?

    <p>Immediate referral to an otolaryngologist. (D)</p> Signup and view all the answers

    Which of the following is the LEAST relevant symptom to consider for immediate otolaryngologist referral in a patient with chronic nasal congestion?

    <p>Mild nasal dryness.. (D)</p> Signup and view all the answers

    Besides topical treatments, what is another treatment option for inflammation control?

    <p>Oral decongestants. (D)</p> Signup and view all the answers

    Which of the following symptoms related to chronic nasal congestion suggests potential orbital involvement requiring urgent evaluation?

    <p>Displaced globe. (D)</p> Signup and view all the answers

    What is the overall approach to managing chronic nasal congestion and discharge?

    <p>Symptom control of inflammation and reduction of infectious exacerbations (C)</p> Signup and view all the answers

    : A patient experiencing which of the following visual disturbances alongside chronic nasal congestion should be immediately referred to a specialist?

    <p>Diplopia. (D)</p> Signup and view all the answers

    Which of the following is considered the first-line treatment for chronic nasal congestion and discharge?

    <p>Intranasal corticosteroids (C)</p> Signup and view all the answers

    What is the primary goal of treatment for chronic nasal congestion and discharge?

    <p>Symptom control of inflammation and reduction of infectious exacerbations (D)</p> Signup and view all the answers

    In addition to other treatments, what adjunctive therapy is recommended for chronic nasal congestion and discharge?

    <p>Saline lavage of the sinus cavities (A)</p> Signup and view all the answers

    When should antibiotics be considered as a treatment for chronic nasal congestion and discharge?

    <p>Only when there is a confirmed bacterial infection (A)</p> Signup and view all the answers

    Which of the following symptoms, when occurring with nasal congestion and discharge, warrants immediate referral to an otolaryngologist?

    <p>Periorbital edema (A)</p> Signup and view all the answers

    The presence of which symptom alongside chronic nasal congestion should raise concern for a more serious underlying condition requiring immediate referral?

    <p>Diplopia (C)</p> Signup and view all the answers

    What physical finding, in conjunction with chronic nasal congestion, would be most concerning for orbital cellulitis?

    <p>Proptosis (A)</p> Signup and view all the answers

    A patient with chronic nasal congestion and discharge also reports a severe headache. When should this patient be referred to an otolaryngologist?

    <p>Immediately (B)</p> Signup and view all the answers

    A patient with chronic nasal congestion reports progressively worsening vision. What is the most appropriate action?

    <p>Refer to an otolaryngologist immediately (B)</p> Signup and view all the answers

    Which of the following symptoms indicates a potential complication of chronic nasal congestion requiring immediate specialist referral?

    <p>Displaced globe (B)</p> Signup and view all the answers

    When is a plain X-ray considered acceptable for diagnosing nasal trauma?

    <p>Only for isolated nasal bone injuries. (A)</p> Signup and view all the answers

    Which diagnostic method is considered the most comprehensive for assessing nasal trauma?

    <p>CT Scan. (C)</p> Signup and view all the answers

    What is the recommended timeframe for otolaryngology follow-up after a nasal injury?

    <p>Within the first week of injury, once swelling has subsided. (C)</p> Signup and view all the answers

    Under what condition is manual reduction of a displaced nasal fracture ideally performed?

    <p>In the initial post-injury hours by a trained provider. (B)</p> Signup and view all the answers

    In which scenario is antibiotic prescription typically indicated in nasal trauma management?

    <p>For open fractures and injuries involving nasal cartilage. (B)</p> Signup and view all the answers

    Besides antibiotics, what additional preventative measure is recommended in the management of nasal trauma?

    <p>Tetanus booster. (A)</p> Signup and view all the answers

    What is the primary reason for delaying re-evaluation by otolaryngology until the swelling has subsided after a nasal injury?

    <p>To obtain a more accurate assessment of the nasal structure. (C)</p> Signup and view all the answers

    What type of anesthesia may be utilized during the manual reduction of a displaced fracture?

    <p>General or local anesthesia (C)</p> Signup and view all the answers

    When are broad spectrum antibiotics most appropriately prescribed in the context of nasal trauma?

    <p>In open fractures, injuries with contaminated wounds or nasal packing needs. (D)</p> Signup and view all the answers

    In which of the following scenarios is antibiotic prescription most appropriate for nasal trauma?

    <p>Injuries involving nasal cartilage. (D)</p> Signup and view all the answers

    When is a plain X-ray the most suitable diagnostic tool for nasal trauma?

    <p>For isolated nasal bone injuries. (D)</p> Signup and view all the answers

    What is the recommended timeframe for otolaryngology follow-up after nasal trauma?

    <p>In the first week of injury, once swelling has subsided. (D)</p> Signup and view all the answers

    Under which circumstance should manual reduction of a displaced nasal fracture be performed?

    <p>In the initial postinjury hours by a trained provider. (A)</p> Signup and view all the answers

    What is the primary purpose of a Tetanus booster in the context of nasal trauma management?

    <p>To prevent tetanus infection, especially with open wounds. (B)</p> Signup and view all the answers

    When is a CT scan most indicated in cases of nasal trauma, according to the provided information?

    <p>In all cases of nasal trauma. (B)</p> Signup and view all the answers

    A patient has sustained a nasal injury. Which assessment would be MOST appropriate for confirming significant soft tissue damage?

    <p>High-resolution ultrasound (if available). (C)</p> Signup and view all the answers

    Which of the following factors is MOST important in determining the need for antibiotics following nasal trauma?

    <p>The presence of contaminated wound.. (B)</p> Signup and view all the answers

    In cases of nasal trauma, why is a CT scan generally preferred over a plain X-ray?

    <p>CT scans can reveal soft tissue injuries better than radiographs. (C)</p> Signup and view all the answers

    Under which circumstance, related directly to the injury itself, is antibiotic prescription most clearly advised in the context of nasal trauma?

    <p>When the injury involves a grossly contaminated wound. (D)</p> Signup and view all the answers

    Why is otolaryngology follow-up recommended within the first week post-nasal trauma?

    <p>To reassess the injury after initial swelling has subsided. (C)</p> Signup and view all the answers

    What is the recommended timeframe for manual reduction of a displaced nasal fracture?

    <p>In the initial postinjury hours. (B)</p> Signup and view all the answers

    Besides contaminated wounds and open fractures, which of the following scenarios necessitates antibiotic use after nasal trauma?

    <p>Injuries involving nasal cartilage. (B)</p> Signup and view all the answers

    What is the primary reason for administering a tetanus booster in the context of nasal trauma?

    <p>To prevent infection from <em>Clostridium tetani</em>. (C)</p> Signup and view all the answers

    In what specific instance would a plain X-ray be considered as a diagnostic tool for injuries involving nasal trauma?

    <p>Only for isolated nasal bone injuries. (B)</p> Signup and view all the answers

    Who is qualified to perform manual reduction of a displaced nasal fracture?

    <p>A trained provider or otolaryngologist. (C)</p> Signup and view all the answers

    When is a CT scan indicated for nasal trauma diagnostics?

    <p>As a primary diagnostic tool, except in cases of isolated nasal bone injuries. (C)</p> Signup and view all the answers

    After initial management of nasal trauma, when should a patient typically follow up with otolaryngology?

    <p>After the initial swelling has subsided, usually within the first week post-injury. (A)</p> Signup and view all the answers

    In which scenario following nasal trauma would antibiotics be most appropriate?

    <p>For injuries involving cartilage, or other injuries that require nasal packing. (C)</p> Signup and view all the answers

    What is the suggested course of action for a displaced nasal fracture?

    <p>Manual reduction under anesthesia in the initial post-injury hours by a trained provider. (B)</p> Signup and view all the answers

    When assessing nasal trauma, in what specific instance might a plain X-ray be considered?

    <p>Only for isolated nasal bone injuries. (B)</p> Signup and view all the answers

    Within what timeframe should manual reduction of a displaced nasal fracture ideally occur?

    <p>In the initial post-injury hours. (C)</p> Signup and view all the answers

    Aside from open fractures, what other type of wound might necessitate antibiotic use in nasal trauma?

    <p>Grossly contaminated wounds. (D)</p> Signup and view all the answers

    What is the role of high-resolution ultrasound in nasal trauma diagnostics?

    <p>It can be used if available. (D)</p> Signup and view all the answers

    What is an important consideration regarding tetanus prophylaxis in the management of nasal trauma?

    <p>Tetanus status should be assessed and a booster given if needed. (B)</p> Signup and view all the answers

    A patient with nasal trauma should be immediately referred to the emergency department (ED) if they exhibit:

    <p>Evidence of intracranial injury. (B)</p> Signup and view all the answers

    Which of the following signs or symptoms in the context of nasal trauma would warrant immediate referral to the ED?

    <p>Clear rhinorrhea suggestive of cerebrospinal fluid (CSF) leak. (D)</p> Signup and view all the answers

    In cases of nasal trauma, which condition necessitates an immediate emergency department referral due to potential systemic complications?

    <p>Airway compromise. (D)</p> Signup and view all the answers

    When should suspicion for cervical spine injury from nasal trauma lead to immediate referral?

    <p>Any suspicion of cervical spine injury, regardless of other symptoms. (A)</p> Signup and view all the answers

    Which scenario following nasal trauma requires immediate referral due to the risk of significant neurological sequelae?

    <p>Suspected cervical spine injury (C)</p> Signup and view all the answers

    What is the most common type of malignant nasal tumor?

    <p>Squamous cell carcinoma (C)</p> Signup and view all the answers

    Which of the following is a potential early symptom of malignant nasal tumors?

    <p>Nonspecific symptoms similar to rhinitis (B)</p> Signup and view all the answers

    Which symptom, if present alongside nasal obstruction and discharge, would most strongly suggest the possibility of a malignant nasal tumor?

    <p>Recurrent nasal hemorrhage (A)</p> Signup and view all the answers

    Which of the following is a type of malignant lesion that can occur in the nasal cavity?

    <p>Sarcoma (D)</p> Signup and view all the answers

    What is a characteristic feature of malignant nasal tumors regarding their presentation?

    <p>Late presentation due to asymptomatic initial course (B)</p> Signup and view all the answers

    A patient presents with unilateral nasal obstruction, discharge, and changes in their sense of smell. Which condition should be suspected?

    <p>Malignant nasal tumor (C)</p> Signup and view all the answers

    Which of the following symptoms associated with a potential nasal tumor would warrant further investigation to rule out malignancy?

    <p>Persistent headache (D)</p> Signup and view all the answers

    Besides carcinomas, lymphomas, sarcomas and melanomas, which of the following lesions can be found in the nasal cavity?

    <p>Squamous cell cancers (C)</p> Signup and view all the answers

    Which symptom is LEAST likely to be associated with early-stage malignant nasal tumors?

    <p>Severe facial swelling (D)</p> Signup and view all the answers

    Which of the following is the most common type of malignant nasal tumor?

    <p>Squamous cell carcinoma (C)</p> Signup and view all the answers

    What is a common characteristic of malignant nasal tumors in their early stages?

    <p>Asymptomatic presentation that remains late in their course (D)</p> Signup and view all the answers

    Which of the following symptoms, if occurring unilaterally, should raise suspicion for a malignant nasal tumor?

    <p>Unilateral nasal obstruction and discharge with pain (D)</p> Signup and view all the answers

    Besides carcinomas, which class of malignant lesions can be found in the nose, nasopharynx and paranasal sinuses?

    <p>Lymphomas (D)</p> Signup and view all the answers

    Which symptom associated with nasal tumors may indicate involvement of the nervous system?

    <p>Visual or olfactory changes (A)</p> Signup and view all the answers

    What characteristic distinguishes symptoms of malignant nasal tumors from those of rhinitis?

    <p>The persistence of symptoms despite treatment (D)</p> Signup and view all the answers

    A patient presents with recurrent nosebleeds and persistent facial pain, localized unilaterally. What other symptom should raise suspicion of a possible nasal malignancy?

    <p>Decreased sense of smell (C)</p> Signup and view all the answers

    A patient is experiencing visual changes alongside nasal symptoms. which of the following symptoms is most concerning for a nasal malignancy?

    <p>New-onset double vision or visual field deficits (C)</p> Signup and view all the answers

    Which factor contributes to the typically late presentation of malignant nasal tumors?

    <p>Nonspecific early symptoms that mimic common conditions (C)</p> Signup and view all the answers

    Which type of malignant lesion is the most common in the nose, nasopharynx, and paranasal sinuses?

    <p>Squamous cell carcinoma (A)</p> Signup and view all the answers

    What characteristic is typical of malignant nasal tumors regarding their presentation?

    <p>They are typically asymptomatic until their course is advanced. (A)</p> Signup and view all the answers

    A patient presents with unilateral nasal obstruction and discharge. Which additional symptom should raise suspicion for a malignant nasal tumor?

    <p>Recurrent hemorrhage (D)</p> Signup and view all the answers

    Besides carcinomas, which of the following is a type of malignant lesion that can occur in the nasal and paranasal areas?

    <p>Lymphomas (C)</p> Signup and view all the answers

    What is a common characteristic of the early symptoms related to malignant nasal tumors?

    <p>Nonspecific and similar to rhinitis (A)</p> Signup and view all the answers

    Which symptom, combined with nasal obstruction and discharge, is a strong indicator of a potential malignant nasal tumor requiring further investigation?

    <p>Headache (B)</p> Signup and view all the answers

    A patient reports changes in their sense of smell along with persistent unilateral nasal symptoms. What should this raise suspicion for?

    <p>Malignant nasal tumor (B)</p> Signup and view all the answers

    Which of the following visual or olfactory changes, alongside nasal symptoms, most strongly suggests a malignant nasal tumor?

    <p>Sudden onset of double vision (C)</p> Signup and view all the answers

    Why are malignant nasal tumors often diagnosed late in their development?

    <p>Early symptoms are nonspecific and easily overlooked (A)</p> Signup and view all the answers

    What is the most common type of benign tumor in the nasal region?

    <p>Inverted papilloma (B)</p> Signup and view all the answers

    Which of the following symptoms is NOT typically associated with benign nasal tumors?

    <p>Headaches (A)</p> Signup and view all the answers

    What is a potential complication of benign nasal tumors due to their vascular nature?

    <p>Epistaxis (A)</p> Signup and view all the answers

    Which benign tumor in the nasal area is most frequently seen in adolescent males?

    <p>Juvenile angiofibroma (A)</p> Signup and view all the answers

    What is a primary characteristic of benign tumors in the nasal cavity?

    <p>Commonly cause nasal obstruction (C)</p> Signup and view all the answers

    In addition to nasal obstruction, what other symptoms are commonly experienced with nasal benign tumors?

    <p>Recurrent epistaxis and discharge (D)</p> Signup and view all the answers

    What is a typical presentation of an inverted papilloma?

    <p>Nasal congestion and facial pressure (C)</p> Signup and view all the answers

    Which type of benign nasal tumor is generally known for a significant vascular component?

    <p>Juvenile angiofibroma (B)</p> Signup and view all the answers

    What is a common risk factor for developing benign tumors in the nasal cavity?

    <p>Age during adolescence (B)</p> Signup and view all the answers

    What is the most common type of benign tumor mentioned?

    <p>Inverted papilloma (A)</p> Signup and view all the answers

    Which of the following symptoms is NOT typically associated with benign tumors in the nasal region?

    <p>Chronic fever (D)</p> Signup and view all the answers

    What complication may arise due to the propensity of benign tumors to bleed?

    <p>Recurrent epistaxis (C)</p> Signup and view all the answers

    Which characteristic symptom could indicate the presence of a benign nasal tumor?

    <p>Nasal obstruction (B)</p> Signup and view all the answers

    The recurrence of which symptom is often associated with benign nasal tumors?

    <p>Nasal obstruction (C)</p> Signup and view all the answers

    Which benign tumor is specifically associated with adolescent males?

    <p>Juvenile angiofibroma (B)</p> Signup and view all the answers

    In the context of benign nasal tumors, what phenomenon is commonly observed regarding bleeding?

    <p>Easy bleeding (A)</p> Signup and view all the answers

    What is a common consequence of nasal tumors in individuals with recurrent nasal bleeding?

    <p>Facial swelling (B)</p> Signup and view all the answers

    What potential symptom might indicate an exacerbation of a benign nasal tumor?

    <p>Nasal discharge (B)</p> Signup and view all the answers

    What is considered the 'gold standard' for evaluating nasal polyps?

    <p>Complete HEENT and nasopharynx exam, Endoscopic evaluation and biopsy (D)</p> Signup and view all the answers

    Which of the following is a management strategy for nasal polyps?

    <p>Nasal topical steroids (A)</p> Signup and view all the answers

    What topical treatment other than steroids may be effective for nasal polyps

    <p>Topical intranasal capsaicin (D)</p> Signup and view all the answers

    When is surgical excision typically considered in the management of nasal polyps?

    <p>When topical treatments are ineffective or symptoms are severe (B)</p> Signup and view all the answers

    Which of the following is a key component of the initial examination for suspected nasal polyps?

    <p>Complete HEENT and nasopharynx exam (C)</p> Signup and view all the answers

    What is the role of endoscopic evaluation in the diagnosis of nasal polyps?

    <p>To directly visualize the nasal passages and sinuses (A)</p> Signup and view all the answers

    What is the primary purpose of performing a biopsy during the evaluation of nasal polyps?

    <p>To rule out malignancy or other atypical conditions (D)</p> Signup and view all the answers

    Why is a complete HEENT (Head, Eyes, Ears, Nose, and Throat) examination necessary when evaluating nasal polyps?

    <p>To evaluate the extent of polyp involvement and rule out other contributing factors (C)</p> Signup and view all the answers

    Which treatment is the MOST appropriate for shrinking nasal polyps?

    <p>Nasal topical steroids (D)</p> Signup and view all the answers

    Which of the following is considered the 'gold standard' for evaluating and diagnosing nasal and nasopharynx issues?

    <p>Endoscopic evaluation and biopsy. (B)</p> Signup and view all the answers

    What is a primary treatment option for managing nasal polyps?

    <p>Nasal topical steroids (B)</p> Signup and view all the answers

    Which non-surgical treatment may be effective in treating nasal polyps?

    <p>Topical intranasal capsaicin (C)</p> Signup and view all the answers

    Prior to initiating treatment for nasal polyps, which diagnostic step is MOST critical?

    <p>Complete HEENT and nasopharynx exam (B)</p> Signup and view all the answers

    What is the purpose of obtaining a biopsy during the endoscopic evaluation of the nasopharynx?

    <p>To identify and rule out malignancies or other pathological conditions at a cellular level. (A)</p> Signup and view all the answers

    Which of the following is least likely to be part of the initial management for nasal polyps?

    <p>Surgical excision (B)</p> Signup and view all the answers

    The effectiveness of topical intranasal capsaicin in treating nasal polyps is believed to be related to its effect on:

    <p>Modulating the inflammatory response (A)</p> Signup and view all the answers

    Following a complete HEENT exam and endoscopic evaluation, a patient is diagnosed with nasal polyps that are unresponsive to topical steroids. What is the next most appropriate step in management?

    <p>Considering surgical excision (A)</p> Signup and view all the answers

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    Study Notes

    Chronic Rhinosinusitis (CRS)

    • CRS is a clinical syndrome of persistent inflammation in nasal and paranasal sinus membranes.
    • Symptoms must last longer than 12 weeks.
    • Diagnosis requires radiographic documentation of paranasal sinuses inflammation.
    • Diagnosis requires two of the following: diminished sense of smell, facial pain, nasal congestion, and mucopurulent drainage.
    • Diagnosis requires evidence of swelling (edema) or pus (purulent mucus) in the anterior ethmoid region or middle meatus.
    • Two types:
      • Chronic rhinosinusitis without nasal polyps (CRSsNPs)
      • Chronic rhinosinusitis with nasal polyps (CRSwNPs)
    • Diagnostics for suspected CRS often include:
      • Nasal and turbinate inspection
      • Nasal endoscopy by an otolaryngology specialist
      • Anterior rhinoscopy
      • Sinus CT scan
      • Labs to evaluate for allergies, autoimmune, and immune deficiency
    • Treatment:
      • Intranasal corticosteroids are the primary treatment.
      • Oral decongestants may be used.
      • Antibiotics are used when necessary.
      • Saline lavage of the sinus cavities may be helpful.
    • Symptom Management:
      • Controlling inflammation and reducing infectious exacerbations are key.
    • Important Considerations and Referral:
      • Immediate otolaryngologist referral is necessary for periorbital edema, diplopia, displaced globe, reduced visual acuity, proptosis, and severe headache.
      • Immediate referral to emergency department (ED) is necessary for nasal trauma with airway compromise, evidence of intracranial injury, leaking CSF, or suspicion of cervical spine injury.

    Nasal Trauma

    • Diagnostics:
      • CT scan is used for diagnosis.
      • Plain X-rays are only used for isolated nasal bone injuries, and not recommended unless there is reason to suspect more extensive injuries than a simple fracture.
      • High-resolution ultrasound may be used as well.
    • Management:
      • Otolaryngology follow-up within a week of injury, to re-evaluate once swelling has subsided.
      • Displaced fractures may require manual reduction under general or local anesthesia, within hours of injury, by a trained provider/otolaryngologist.
      • Antibiotics may be prescribed for open fractures, grossly contaminated wounds, wounds involving nasal cartilage, or injuries requiring nasal packing.
      • Tetanus booster may be needed.
      • Immediate ED referral is necessary for nasal trauma with airway compromise, evidence of intracranial injury, leaking CSF, or suspicion of cervical spine injury.

    Benign Nasal Tumors

    • Benign nasal tumors include inverted papilloma, juvenile angiofibroma, and nasal polyps.
    • Inverted papilloma is the most common benign nasal tumor.
    • Presentation:
      • Symptoms of benign tumors may include nasal obstruction, discharge, or facial swelling.
      • Benign tumors can bleed easily, causing recurrent epistaxis (nosebleeds).

    Malignant Nasal Tumors

    • Malignant tumors can develop in the nose, nasopharynx, and paranasal sinuses.
    • Malignant lesions include carcinomas, lymphomas, sarcomas, and melanomas; squamous cell carcinoma is the most common.
    • Presentation:
      • Tumors often remain asymptomatic until later stages.
      • Early symptoms are often non-specific, similar to rhinitis.
      • Unilateral nasal obstruction, discharge with pain, recurrent hemorrhage, headache, or changes in vision or smell may suggest cancer.

    Nasal Polyps

    • Diagnosis: Complete HEENT and nasopharynx exam, endoscopic evaluation, and biopsy are considered the gold standard.
    • Management:
      • Nasal topical steroids
      • Topical intranasal capsaicin may be effective
      • Surgical excision

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    Description

    Test your knowledge about Chronic Rhinosinusitis (CRS), a condition characterized by ongoing inflammation in the nasal and paranasal sinuses. This quiz covers its symptoms, diagnosis, and key characteristics that differentiate CRS from other conditions. Challenge yourself and enhance your understanding of CRS today!

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