BAILEY

CH 2
25-44
25. MRI is most appropriate in evaluating:
A. Extent of sinus disease in chronic
sinusitis
B. Determining normal anatomic structures
in cases of extensive nasal polyposis
C. Suspected orbital or intracranial
extension of tumor
D. Location of the anterior ethmoidal artery
 Answer: C. MR imaging is not
appropriate for most rhinosinusitis,
and is not as helpful as CT for
defining sino nasal anatomy.
However, MR imaging is superior
for the evaluation of soft tissue
processes in the anatomic
compartments adjacent to the
paranasal sinuses. PAGES 422-425
 26. Which of these is an intracranial
complication with the most
favorable outcome?
A. Epidural abscess
B. Meningitis
C. Subdural abscess
D. Intracerebral abscess
 Answer: A.
 Of all the intracranial complications
listed here, epidural abscess has the
best prognosis. PAGES 580-581
27. A patient undergoing endoscopic sinus
surgery has proptosis, chemosis, and a
firm globe despite attempts to treat with
medical therapy. Which one of the
following is the next best treatment at this
time?
A. Stat CT scan
B. Lateral canthotomy and orbital
decompression
C. Re-treat with a higher dose of mannitol
and dexamethasone
D. Transfer to ophthalmology service for
ocular paracentesis
 Answer: B.
 This patient has signs of an orbital hematoma.
Failed medical management should prompt
immediate decompression, which can be
accomplished endoscopically and via lateral
canthotomy/inferior cantholysis. PAGE 651
28. Which of the following is not an
indication for computer-image-guided
surgery according to the American
Academy of Otolaryngology-Head and
Neck Surgery consensus statement
guidelines?
A. Revision sinus surgery
B. Extensive nasal polyposis
C. Cases involving cerebrospinal fluid
(CSF) leak repair
D. Cases involving concha bullosa
takedown
 Answer: D.
 Image guidance is neither appropriate
nor required for simple nasal surgeries
such as a concha bullosa resection.
Image guidance is indicated for sinus
surgery in the setting of neoplasm, CSF
leak, nasal polyp disease, or revision
surgery. PAGE 601
29. Which of the following irrigations has
proven to be effective at breaking up
biofilm while at the same time
preserving greater than 90% ciliary
function in clinical trials?
A. Manuka honey
B. Baby shampoo
C. Citric acid zwitterionic surfactant
D. None of the above
 Answer: D.
 Although a variety of substances have the
ability to disrupt bacterial biofilms, these often
have damaging effects on the nasal mucosa
and can disrupt mucociliary clearance. PAGE
546
30. Which of the following is the most
common complication of endoscopic
sinus surgery (ESS)?
A. Synechia formation
B. Cerebrospinal fluid leak
C. Orbital violation
D. Epistaxis
 Answer: A.
 Synechia formation is the most common
complication of ESS. Often these synechiae
do not have functional significance. On the
other hand, they may impair endoscopic
access to the sinuses, cause mucus
recirculation, limit access for topical therapy,
or cause sinus obstruction. PAGE 657
31. What is the purpose of preserving the
"keystone area" during septoplasty?
A. To maintain appropriate support of the
nasal dorsum to prevent postoperative
saddle nose deformity
B. To keep cartilage available for future
rhinoplastic procedures
C. To support the lower lateral cartilages
D. To prevent postoperative epistaxis
 Answer: A.
 The perpendicular plate and
quadrangular cartilages just underneath
the upper lateral cartilages should be
preserved to avoid external nasal
deformity. PAGE 614
32. For which reason is Fel d 1 a "major
allergen" from cats?
A. More than 50% individuals sensitized to
cat are sensitized to Fel d 1.
B. Fel d 1 sensitization is associated with
more symptoms than other cat
allergens.
C. Fel d 1 is the most common protein
found in cat dander.
D. Fel d 1 is the only cat allergen with
which slgE can bind.
 Answer: A.
 A major allergen is defined as an
antigen to which >50% of allergic
individuals are sensitive. Most
"allergens," such as dust mites,
contain multiple potentially
allergenic proteins. PAGE 413
33. Which of the following bacteria is not
commonly seen in chronic sinusitis?
A. Pseudomonas aeruginosa
B. Staphylococcus aureus
C. Chlamydia trachomatis
D. Coagulase-negative Staphylococcus
 Answer: C.
 Culture studies of patients with chronic
sinusitis have shown Pseudomonas and
Staphylococcus to be common bacteria
in chronic sinusitis. C. trachoma tis is a
sexually transmitted pathogen that
affects the urogenital tract. PAGE 589
34. What is the recommended first-line
antibiotic in a patient with acute
sinusitis and no medication allergies?
A. Penicillin
B. Azithromycin C
C. Amoxicillin
D. Levafloxacin
E. Amoxicillin-clavulanate
 Answer: C.
 Despite high rates of antibiotic resistance in
the current era, amoxicillin is still considered
to be first-line therapy for acute bacterial
sinusitis. In uncomplicated cases there is little
additional benefit to be gained from the use of
more expensive broaderspectrum antibiotics.
PAGE 518
35. What postoperative complication
may occur as a result of resection of
the inferior turbinate or injury to the
inferior turbinate mucosa?
A. Sinusitis
B. Nasal septal perforation
C. Empty nose syndrome
D. Samter's triad
 Answer: C.
 Overaggressive surgery on the inferior
turbinates may result in excessive nasal
drying or phantom (paradoxical) nasal
obstruction. PAGE 618
36. Which of the following laboratory
studies is most specific for suspected
cerebrospinal fluid (CSF) rhinorrhea?
A. Glucose strip test
B. Protein analysis of fluid
C. Albumin level of fluid
D. ß2-transferrin analysis
 Answer: D.
 The most specific laboratory test to
detect CSF is the ß-transferrin assay. ß-
Transferrin is not present in sinonasal
secretions. PAGES 665-666
37. What is the most common
attachment site for the uncinate
process?
A. Lamina papyracea
B. Skull base
C. Bulla ethmoidalis
D. Middle turbinate
 Answer: A.
 In the most common variation, the anterosuperior
portion of the uncinate process inserts onto the
lamina papyracea so that the uncinate process
separates the ethmoidal infundibulum from the frontal
recess. In this setting, the frontal recess opens into
the middle meatus medial to the ethmoidal
infundibulum, between the uncinate process and the
middle turbinate. When the uncinate process inserts
onto the ethmoid roof or the middle turbinate, the
frontal recess opens directly into the ethmoidal
infundibulum. The frontal sinus opens into the middle
meatus medial to the uncinate process in 88% of
patients and lateral to the uncinate in the remaining
12% of patients. PAGE 360
38. Which of the following drugs is not
recommended for the treatment of
methicillinresistant Staphylococcus
aureus (MRSA) in monotherapy?
A. Rifampin
B. Linezolid
C. Tetracycline
D. Clindamycin
 Answer: A.
 MRSA may rapidly develop resistance to
rifampin if it is used as monotherapy.
PAGE 589
39. In patients with cerebrospinal fluid
(CSF) rhinorrhea after skull base
fracture, the use of prophylactic
antibiotics is associated with:
A. Decrease in frequency of meningitis
B. Reduction in meningitis-related
mortality
C. Less need for surgical repair of CSF
leakage
D. No apparent therapeutic benefit
 Answer: D.
 The use of prophylactic antibiotics in
traumatic CSF leaks is controversial.
Studies have not shown a clear
therapeutic benefit, and antibiotics may
select out resistant organisms. PAGE
668
40. All of the following are advantages of
MR imaging for sino nasal disease,
except:
A. Lack of radiation exposure
B. Excellent bony anatomy definition
C. Multiplanar reconstruction
D. Detailed soft tissue definition
E. Differentiation between secretions
and soft tissue
 Answer: B.
 MR imaging is superior to CT
imaging for soft tissue pathology
and characterization of opacified
sinuses. However, CT provides
superior definition of sinonasal bony
anatomy. PAGE 449
41. Which of these are the most common
pathogens associated with acute bacterial
rhinosinusitis?
A. Streptococcus pneumoniae, Haemophilus
infiuenzae, Staphylococcus aureus, and
Moraxella catarrhalis
B. Streptococcus pneumoniae, H. infiuenzae,
Enterobacteriaceae, and M. catarrhalis
C. Streptococcus pneumoniae, H. infiuenzae,
Staphylococcus aureus, and
Enterobacteriaceae
D. Enterobacteriaceae, H. infiuenzae,
Staphylococcus aureus, and M. catarrhalis
 Answer: A.
 Enterobacteriaceae are uncommon
pathogens in acute bacterial sinusitis.
PAGES 535, 536
42. In cases of acute invasive fungal
rhinosinusitis in which Pseudoallescheria
boydii is identified, which of the following
management steps is recommended?
A. Medical therapy with voriconazole.
B. Limit surgical resection outside the
paranasal sinuses.
C. Repeat the fungal culture in diabetic
patients.
D. Amphotericin use should be limited to
topical nasal irrigations.
 Answer: A.
 P. boydii is resistant to amphotericin B;
however, this fungus is susceptible to
voriconazole. PAGE 562
43. What is the most characteristic skin
lesion of sarcoidosis?
A. Erythema nodosum
B. Lupus pernio
C. Subcutaneous nodules
D. Ulcerative lesions
 Answer: B.
 A variety of skin lesions may develop in
sarcoidosis, but lupus pernio is the most
characteristic of the disease. It occurs more
commonly in sarcoidosis with sino nasal
fibrosis. PAGE 491
44. Which of these is the main IgG
subclass that is increased during
maintenance immunotherapy?
A. IgGl
B. IgG2
C. IgG3
D. IgG4
 Answer: D.
 During immunotherapy, antigen-specific IgG4
levels increase in the serum. Induction of this
antibody may be one immunologic
mechanism by which immunotherapy exerts
its beneficial effects in allergic disease.
PAGES 386, 403
TERIMA KASIH