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Family Medicine Clerkship- Case files > Allergic disorders > Flashcards

Allergic disorders Flashcards

1
Q

What is the treatment for allergic rhinitis (seasonal allergies)?

A
  • Antihistamines
  • Decongestants
  • Intranasal corticosteroids (most consistent relief)
    (or any combination thereof)
  • In severe cases, systemic corticosteroids
  • Avoidance of the trigger is always indicated (if possible_
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2
Q

How long should topical decongestants (nasal sprays, like Afrin) be used?

A
  • Topical decongestants should be used for only 5-7 days and can cause rebound congestion (ie “nasal spray addiction” as you need more spray or continued use to get the same effect)
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3
Q

What physical exam signs are consistent with allergic rhinitis?

A
  • Swollen/boggy nasal turbinates that are pale and blue-gray in color
  • Thin and watery secretions
  • Itchy eyes
  • Nasal congestion/discharge
  • Seasonal in nature
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4
Q

What mediators are released in allergic rhinitis?

A
  • Histamine, tryptase, chymase, kinase, leukotrienes, and prostaglandin D2
    • Leads to mucus gland stimulation (increased secretion), vasodilation (congestion), sensory nerve stimulation ( sneezing and itching)
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5
Q

What symptoms are associated with allergic rhinitis?

A
  • sneezing
  • itching (of nose, eyes, or ears)
  • rhinorrhea
  • post nasal drip
  • congestion
  • anosmia
  • headache/earache
  • tearing
  • red eyes
  • drowsiness
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6
Q

What are causes of a deviated septum?

A
  • Chronic rhinitis
  • Granulomatous disease
  • Cocaine abuse (snorting)
  • Prior surgery
  • Topical decongestant abuse
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7
Q

What is perennial allergic rhinitis typically caused by?

A
  • Typically caused by allergens in the home (ie dust mites and animal dander)
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8
Q

What is the role of antihistamines in treating allergic rhinitis?

A
  • Antihistamines competitively antagonize the receptors for histamine, which is released from mast cells
    • reduces symptoms
    • Diphendyramine, chlorpheniramine, hydroxyzine (all otc)
    • More expensive, less CNS penetration: loratadine, fexofenadine, cetirizine
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9
Q

What are side effects of antihistamines?

A
  • dry mouth/eyes, blurred vision, urinary retension
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10
Q

What is the mechanism of action of nasal decongestants?

A
  • Constrict blood vessels in the nasal mucosa and reduce the overall volume of the mucosa
    • Most common is pseudoephedrine, an alpha adrenoreceptor agonist
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11
Q

What are the side effects of oral decongestants?

A
  • Tachycardia, tremors, and insomnia

- Rebound hyperemia and worsening of symptoms can occur with chronic use

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12
Q

What treatment is most effective in the long term management of allergic rhinitis?

A
  • Corticosteroid nasal sprays => reduce production of inflammatory mediators and the recruitment of inflammatory cells
  • Systemic absorption is relatively low (reduces side effects)
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13
Q

What side effects are associated with corticosteroid nasal sprays?

A
  • Nosebleeds, pharyngitis, and URIs
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14
Q

What treatment is effective for both allergic rhinitis and as maintenance therapy for persistent asthma?

A
  • Leukotriene inhibitors (montelukast, zafirlukast, and zileuton)
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15
Q

What is the danger of long term oral corticosteroid use for severe rhinitis?

A
  • Suppression of the hypothalamic-pituitary-adrenal axis
  • Hyperglycemia
  • Peptic ulcer formation
  • Increased susceptibility to infection, poor wound healing, and reduction of bone density
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16
Q

What therapy is used in patients who remain symptomatic despite maximal medical therapy?

A

desensitization therapy

17
Q

What is angioedema?

A
  • Painless, deep, subcutaneous swelling that often involves the periorbital, circumoral, and facial regions
18
Q

At the first suspicion of anaphylaxis, what should be given?

A
  • Aqueous epinephrine 1:1,000 in a dose of 0.2-0.5ml (or mg) injected subcutaneously or IM, can be given every 15 minutes
  • IV fluid to replace loss of intravascular plasma into tissues
  • Endotracheal intubation may be required if airway obstruction
  • Bronchospasm responds to subcutaneous epinephrine or terbutaline
19
Q

Where does asthma result in airflow obstruction?

A
  • IN the tracheobronchial tree
20
Q

What are the major childhood triggers of asthma?

A

-Viral infections and allergens

21
Q

What may the physical exam of an asthmatic reveal?

A
  • Wheezing, SOB, dyspnea, cough, increased sputum production and chest tightness
  • Increased expiratory phase, tachypnea, cyanosis, tachycardia, use of accessory respiratory muscles
22
Q

What are the treatments for asthma?

A
  • Beta2 adrenergic agonists
  • INhaled corticosteroids
  • Leukotriene modifiers
  • Mast cell stabilizers
  • Systemic corticosteroids
23
Q

What is the mainstay to acute symptomatic relief of asthma?

A
  • Beta 2 adrenergic agonist (albuterol) => works rapidly to relax bronchial smooth muscle and reduces release of mast cell mediators and increases mucociliary clearance
24
Q

What is the use of long acting beta2 adrenergic agonists in the treatment of asthma?

A

-Long acting beta 2 adrenergic agonists are effective at reducing the frequency of exacerbation in persistent asthma

25
Q

What is the primary treatment of persistent asthma?

A
  • Daily use of inhaled corticosteroids or leukotriene inhibitors are the tx for persistent asthma
  • Reduces the production of inflammatory mediators and reduce vascular permeability

*NOT used for acute attacks

26
Q

What organisms commonly cause conjunctivitis?

A
  • Staphylococcus, Streptococcus, Haemophilus, Moraxella, and Pseudomonas
27
Q

How long does conjunctivitis generally last?

A
  • Self limiting 10-14 days
28
Q

What abx is generally indicated in conjunctivitis?

A
  • Sulfonamide will clear conjunctivitis in 2-3 days
29
Q

What type of eye infection is highly contagious and spread by person to person and fomites?

A
  • Keratoconjunctivitis (pink eye)
30
Q

What is the most common cause of keratoconjunctivitis?

A
  • Adenovirus => associated with pharyngitis, fever, malaise, and preauricular lymphadenopathy
  • Usually lasts 2 weeks
31
Q

What is the treatment for keratoconjunctivitis?

A
  • Local sulfonamide therapy may prevent secondary bacterial infection
  • Hot compress
  • Weak topical steroids treat corneal infiltrates

Family Medicine Clerkship- Case files (13 decks)

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