Allergic Disorders

Question 1

nasal turbinates: swollen (boggy), pale, bluish-gray
itchy eyes, itchy nose, nasal congestion, rhinorrhea (thin, watery) sneezing
no LAD
present most days, worse in fall + spring

Answer 1

allergic rhinitis

Question 2

treatment of allergic rhinitis

Answer 2

can be used in combo:
avoid allergen (DOC, most successful tx)
antihistamines (if nasal + conjunctivitis)
decongestants (cold sx, if topical - can cause rebound congestion if excessive use)
intranasal steroids (if only nasal sx, most consistent symptomatic relief)
oral (systemic) CS if severe
immunotherapy

Question 3

inflammation of nasal membranes (rhinitis) +/- eyes, eustachian tube, middle ear, sinuses, pharynx
sneezing, nasal congestion, nasal + eye + ears itchy, rhinorrhea, postnasal drip
tearing, red eyes
anosmia (lack of smell), HA, earache, drowsy

Answer 3

allergic rhinitis

Question 4

rapidly progressing, life-threatening allergic reaction, mediated by IgE immediate HSR
urticaria or angioedema, SOB, visceral edema, hypotension + shock (widespread vasodilation, respiratory distress from bronchospasm or laryngeal edema, GI and uterine muscle ctx)

Answer 4

anaphylaxis

Question 5

most common cause of rhinitis

Answer 5

allergic rhinitis

Question 6

allergic sensitization: foreign protein exposure → IgE against protein coats mast cells in nasal mucosa
2nd exposure: allergen binds to IgE on mast cells → release of mediators
immediate release: histamine, tryptase, chymase, kinase
mast cells synthesize some immediately: LK, PGD2
immediate symptoms: ↑ mucous secretions, vasodilation → congestion, sensory nerves: sneeze, itch, conjunctivitis, postnasal drip, ear pressure
next 4-8 hrs: mediators recruit PMN, eosinophils, lymphs, macrophages to mucosa
symptoms for hrs-days: increase congestion, mucous, fatigue, sleepy, malaise

Answer 6

allergic rhinitis

Question 7

allergic rhinitis consistent level throughout the year

Answer 7

perennial rhinitis

Question 8

allergic rhinitis only during specific seasons (pollens, outdoor molds)

Answer 8

seasonal rhinitis (can have perennial with seasonal exacerbations)

Question 9

allergic rhinitis during job

Answer 9

occupational rhinitis

Question 10

response to antihistamines supports diagnosis of:

Answer 10

allergic rhinitis

Question 11

spores, animals, cleaning, pollen

smoke, pollution, strong smells

Answer 11

allergic rhinitis triggers

Question 12

dark circles around eyes due to vasodilation and/or nasal congestion

Answer 12

allergic shiners

Question 13

horizontal crease across bridge of nose - rubbing tip of nose by palm of hand

Answer 13

allergic salute

nasal crease

Question 14

thick, purulent nasal secretions

Answer 14

sinusitis (can also occur in allergic rhinitis)

Question 15

thin, watery nasal secretions

Answer 15

allergic rhinitis

Question 16

firm, gray masses attached by a stalk (may not be visible)

does NOT shrink after spraying topical decongestant (surrounding nasal mucosa does shrink)

Answer 16

nasal polyp

Question 17

septal deviation or perforation caused by

Answer 17

chronic rhinitis
granulomatous disease
cocaine abuse
prior surgery
topical decongestant abuse
topical steroid overuse

Question 18

tympanic membranes:
TM retraction
air-fluid levels
bubbles
altered mobility with pneumatic otoscopy

Answer 18

allergic rhinitis with eustachian tube dysfunction or secondary otitis media

Question 19

injection + swelling of palpebral conjunctivae
excessive tear production
creases below inferior eyelid (Dennie-Morgan lines)

Answer 19

allergic rhinitis

Question 20

cobblestoning of posterior pharynx: streaks of lymphoid tissue on posterior pharynx
tonsilar hypertrophy

Answer 20

allergic rhinitis

Question 21

wheezing, ↑ RR, prolonged expiratory phase of respiration

Answer 21

asthma

Question 22

tree pollens: worse in spring (some in fall)
grass pollens: most are cross-reactive, worse in late spring to fall
weeds: ragweed (worse in late summer to fall)

Answer 22

seasonal allergic rhinitis

Question 23

home allergens: dust mite (clean to remove), indoor pets (also cockroaches)
year-round outdoor allergens (warmer climate: grass) or trees/grass in summer, mold/weed in winter

Answer 23

perennial allergic rhinitis

Question 24

SE of first gen antihistamine: diphenhydramine, chlorpheniramine, hydroxyzine

Answer 24

sedation, anticholinergic (dry mouth + eyes, blurred vision, urinary retention) - caution if elderly

Question 25

SE of second gen antihistamines: loratadine, desloratadine, fexofenadine, cetirizine

Answer 25

less sedation (except cetirizine)
less anticholinergic SE (good if BPH - urinary retention)
as effective as first-gen antihistamines
more expensive
available OTC

Question 26

mild, intermittent symptoms of allergic rhinitis

med takes effect within 15-30 minutes after ingestion

Answer 26

antihistamines PO

Question 27

med for nasal congestion

constrict blood vessels of nasal mucosa

Answer 27

decongestant PO or intranasal (risk of rebound congestion)

Question 28

SE of pseudoephedrine: α receptor agonist (decongestant)

Answer 28

↑ HR, tremor, insomnia

rebound hyperemia, worsening congestion with chronic use or discontinuation of nasal decongestant

Question 29

DOC for long-term management of mild-mod persistent allergic rhinitis
max effect after 2-4 wks of use
↓ mediator production and recruitment of ICs

Answer 29

nasal corticosteroid

Question 30

SE of nasal corticosteroids

Answer 30

nosebleeds
pharyngitis
URIs

Question 31

use: allergic rhinitis, persistent asthma maintenance therapy, if ASTHMA + allergies, allergens trigger asthma

Answer 31

leukotriene inhibitors: zafirlukast, montelukast, zileuton

Question 32

inhibitor of cell-mediated immunity

use: severe allergies

Answer 32

oral corticosteroids

Question 33

SE of oral corticosteroids

Answer 33

suppression of HPA
hyperglycemia
long-term use: peptic ulcer, susceptibility to infection, poor wound healing, reduction of bone density

Question 34

treatment if remain symptomatic despite maximal medical therapy
test for antigens that patient is allergic
inject patient with diluted concentration of antigen
gradually increase concentration to reduce inflammatory response to antigen (given weekly)

Answer 34

desensitization therapy

Question 35

irregular, pruritic, erythematous wheals

Answer 35

urticaria

Question 36

painless, deep, subq swelling that involves periorbital, circumoral, and facial regions

Answer 36

angioedema

Question 37

treatment of anaphylaxis

Answer 37

first suspicion: subq or IM epinephrine (repeat q 15-30 min PRN)
IV fluids (saline, lactated ringer solution, plasma, or plasma expanders) to replace loss of intravascular plasma into tissues
endotracheal intubation if airway obstruction
subq epinephrine or terbutaline: bronchospasm
antihistamine: urticaria, angioedema, pruritus
monitor for 24 hrs

Question 38

infection of palpebral (eyelid) or bulbar (eye) conjuntiva
most commonly caused by virus or bacteria
less common: allergy, chemical
transmission: direct contact via finger, towel, handkerchief

Answer 38

conjunctivitis

Question 39

cause of bacterial conjuncitvitis

Answer 39

staph
strep
H. influenzae
moraxella
pseudomonas

Question 40

eye itching, tearing, redness, stringy clear discharge +/- photophobia

Answer 40

allergic conjunctivitus

Question 41

tx of allergic conjunctivitis

Answer 41

oral antihistamine
topical antihistamine
anti-inflammatory eye drops

Question 42

mild eye discomfort
no blurry vision
lasts 10-14 days if untreated, 2-3 days if use sulfonamide

Answer 42

bacterial conjuncitivitus

Question 43

caused by adenovirus
very contagious: direct contact or fomites
red palpebral conjunctiva
lots of watery discharge
associated with: pharyngitis, fever, malaise, preauricular LAD

Answer 43

epidemic keratoconjunctivitis (pink eye)