Allergy
Fungus Amongus
AERD
Anatomy
Wild Cards
It's not a Tooma... unless it is
100
Beta blockers are contraindicated with allergy testing because of this.
What is masking of anaphylactic symptoms and resistance to systemic epi
100
This is the most common location and organism for a fungal ball
What is the Maxillary sinus and Aspergillus
100
This is the mechanism of cellular inflammation found in AERD
What is a baseline imbalance in arachadonic acid metabolism with shunting from anti-inflammatory prostaglandins towards pro-inflammatory leukotrienes
100
The distance of the anterior lacrimal crest to the anterior ethmoid artery is ___mm.
The distance of the anterior ethmoid artery to the posterior ethmoid artery is ___mm.
The distance of the patterer ethmoid artery to the optic canal is ___mm.
What is 24, 12, 6mm
Important to keep in mind when dissecting along the medial orbital wall
100
this is the classic ciliary defect in patients with Kartagener's syndrome
What is Reduction in the number of outer dynein arms on ciliary microtubules. Results in abnormal ciliary motion and impaired mucociliary clearance
100
This is a chronic, expansile collection of entrapped mucous in a paranasal sinus
what is a mucocele
200
The dosage of epi in the epi pen is this
What is 0.3mg
Pt may repeat dose after 5-15 min if symptoms persist
200
These are the five major criteria for allergic fungal rhinosinusitis
What are:
type 1 hypersensitivity (IgE mediated)
nasal polyps
characteristics CT findings
EOSINOPHILIC MUCUS
+fungal stain
200
This is the only disease specific intervention recommended for the treatment of AERD
What is aspirin desensitization
200
The opening to this sinus is always anatomically posterior and lateral to the frontal sinus outflow tract
hint- this sinus is not always present
What is the supraorbital ethmoid cell
200
A patient has post-operative CSF leak after clival Chordoma resection. Repair with nasoseptal flap was performed but failed. The surgeon elects to use lateral nasal wall flap. What is the blood supply to this flap?
What is Inferior turbinate artery-
200
This is a Serous or mucinous submucosal collection of fluid secondary to blocked gland
what is a mucous retention cyst?
300
A 35 yo F with allergic rhinitis undergoes allergy testing showing a reaction to ragweed. She elects to undergo intradermal immunotherapy. What interleukin and cell type is upregulated?
What is IL-10 and TReg cells
(so does TGF beta)
300
You are consulted to see a 47 year old female with DKA. The patient has been complaining of a 2 day history of worsening fever, facial pain, and paresthesias. biopsy of middle turbinate is shown. what is the organism responsible? 
What is mucormycosis?
300
Daily Double!
It is estimated that ____ percent of adults with asthma and ____ percent of patients with combined asthma and nasal polyps have AERD.
What is 10% and 40%
300
This structure forms the anterior boundary of the frontal recess
What is the posterior wall of the agger nasi
posterior: anterior edge of ethmoid bulla,
lateral: lam pap and uncinate
medial: middle turbinate
300
A 6 year old female is brought to your clinic with complaint of nasal obstruction, recurrent sinus infections. On endoscopy you notice nasal polyps. this is the next test you should order
What is sweat chloride test?
300
These are the 5 basal or ground lamella of the paranasal sinuses
what are the
1. uncinate process,
2.ethmoid bulla,
3. basal lamella of middle turbinate,
4. superior turbinate and
5. supreme turbinate?
400
A 25 yo F who is 10 weeks pregnant presents with complaints of clear rhinorrhea and nasal congestion. A diagnosis of rhinitis of pregnancy is obtained. She is interested in a topical nasal spray, but is concerned regarding effects to the fetus. Which intranasal corticosteroid is the only class B med and can be offered?
What is Budesonide (not fluticasone or mometasone)
400
what is/are the material(s) responsible for hyperdensities within the sinuses in allergic fungal sinusitis? ie: double density sign?
what is iron, magnesium and manganese?
400
Why are respiratory reactions to certain foods suggestive for undiagnosed AERD?
Name two foods.
What dietary sources of salicylic acid
1. Alcohol, especially dark wine/spirits
2. Tomatoes
3. Dried fruits, spices
400
In a minority of patients, the uncinate attaches to this structure, causing the frontal sinus to drain into this.
What is the skull base; infundibulum
In 20% the uncinate attaches to the skull base which causes the frontal sinus to drain laterally into the infundibulum.
As opposed to 80% of the time when the uncinate attaches to the lam pap, which results in drainage medial to the uncinate
400
A 55 yr old male presents with recurrent epistaxis. physical exam shows hemorrhagic lesions on her nasal and oral mucosa. His father had similar condition. what is the inheritance pattern of this disorder?
autosomal dominant (hereditary hemorrhagic telangiectasia)
400
Daily Double!
A 14 year old male presents with recurrent left epistaxis and imaging shown below. what is the sign that describes anterior bowing of the posterior wall of maxillary sinus from tumor involvement? what is the likely tumor?
what is Holman-Miller sign? what is Juvenile Nasopharyngeal Angiofibroma?
500
These foods should be avoided if you have a latex allergy
what are kiwis, bananas, avocados, and chestnuts?
500
The six month survival of acute invasive rhinosinusitis is this
What is 18%
Mean survival for all patients is 3 months
500
This is the mechanism of action of dupilumab
What is blocking the shared alpha subunit (IL-4Rα) of the interleukin-4 (IL-4) and interleukin-13 (IL-13) receptors?
500
These are the 5 basal or ground lamella of the paranasal sinuses
what are the
1. uncinate process,
2.ethmoid bulla,
3. basal lamella of middle turbinate,
4. superior turbinate and
5. supreme turbinate?
500
Final Jeopardy: What is superior orbital fissure syndrome and which nerves are involved?
Fixed globe (III, IV, VI)
• Dilated pupil (loss of
parasympathetic
input)
• Upper lid Ptosis (CN
III) levator palpebrae
superioris
• Hypesthesia of the upper lid
• Cranial nerve III, IV,
VI, V-1 are involved
500
CT sinus is obtained due to chronic sinus complaints. Multiple lesions similar to the one shown are noted within the paranasal sinuses. This is the likely diagnosis. Name the additional testing this patient should be avised to undergo. 
What is Gardener's syndrome?
what is colonoscopy for evaluation of colon polyps/colon cancer screening?