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Clin Med Exam 2 (Lauren) > Allergic Rhinitis, Tinnitus, Urticaria > Flashcards

Allergic Rhinitis, Tinnitus, Urticaria Flashcards

1
Q

What is barotrauma

A

Damage to the ear due to pressure differences between the middle ear and outside world

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2
Q

What is the treatment for barotrauma?

A

Time/patience
Swallowing, valsalva, chew gum
Decongestants
Avoiding flying/diving

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3
Q

What is the other name for acoustic neuroma?

A

Vestibular schwannoma

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4
Q

What is acoustic neuroma?

A

Schwann cell tumors that arise from the vesitibular portion of CN VIII.
Slow growing

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5
Q

What is the classic presentation of acoustic neuroma?

A

Unilateral sensorineural hearing loss
Unilateral tinnitus
+/- gait disturbance or other CN involvement

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6
Q

What is the best initial screening test for an acoustic neuroma?

A

Audiometry (hearing test)

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7
Q

What is the treatment for acoustic neuroma?

A

Surgery

Radiation

Observation- grows slow

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8
Q

What percentage of people with tinnitus report interference with daily activities?

A

25%

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9
Q

What is tinnitus?

A

Perception of sound in one or both ears

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10
Q

What is the common etiology for pulsatile tinnitus?

A

Vascular (could be an aneurysm)

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11
Q

When does tinnitus need to be referred to ENT?

A

If it’s pulsatile

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12
Q

Should you auscultation for bruits in patients with possible vascular tinnitus/.

A

Yes

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13
Q

What is the goal of tinnitus treatment?

A

Lessen awareness and impact on quality of life

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14
Q

What are some of the treatments for tinnitus?

A

Behavioral therapy
Benzos
Masking devices “white noise” machines

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15
Q

Is tinnitus associated with anxiety and depression?

A

Yes

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16
Q

What are the 3 types of rhinitis?

A

Allergic rhinitis

Vasomotor rhinitis

Infection rhinitis

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17
Q

What is the key characteristic of allergic rhinitis?

A

Attacks of sneezing, rhinorrhea, and nasal obstruction

Often accompanies by itchy eyes/nose/mouth

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18
Q

When is the peak incidence of allergic rhinitis?

A

Childhood/adolescence

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19
Q

What is the pathophysiology of allergic rhinitis?

A

IgE antibodies sensitize mast cells who are then primed, and freak out on the SECOND exposure to the allergen

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20
Q

What would you see in the periorbital area of a pt with allergic rhinitis?

A

Allergic shiners

Denie-Morgan lines:skin folds under eyes consistent with allergic conjunctivitis

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21
Q

What would you see in the eyes of a pt with allergic rhinitis?

A

Palpebral conjunctiva may be pale and swollen

May see conjunctival injection (red eyes)

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22
Q

What would you see in the nose of someone with allergic rhinitis?

A

Pale, boggy, bluish mucosa**

clear discharge

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23
Q

What would you see in the throat of someone with allergic rhinitis?

A

Post nasal drainage

“Cobblestoning”

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24
Q

Can systemic medications cause rhinorrhea?

A

Yes

Meds like alpha-adrenergic blockers, viagra, etc

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25
Q

Can pregnancy cause rhinitis?

A

Yes, hormone induced

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26
Q

How do you diagnose allergic rhinitis?

A

Clinically**

Allergy testing helpful but not necessary

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27
Q

What are the two types of allergy testing?

A
  1. ) Skin testing-scratch/prick

2. )Serum testing- “ImmunoCAP”

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28
Q

What are the pros and cons of Skin testing for allergies?

A

PROS:
“Wheal and flare” reactions happen quickly 15-20 min
Cheap

CONS:
Could cause anaphylactic reaction

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29
Q

What are the pros and cons of serum testing for allergies?

A

PROS:
Detects allergen-specific IgE antibodies
Less risk for anaphylaxis

CONS:
Expensive
Less sensitive

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30
Q

What is a positive “wheal and flare” reaction in a skin allergy test?

A

The wheal is the same size or bigger than the histamine control, OR it is 3mm

31
Q

What is the treatment for allergic rhinitis?

A

Avoidance of allergens

Pharmacotherapy

Immunotherapy (allergy shots)

32
Q

What is the best way to avoid allergens from cats/dogs/etc

A

Removing the animal from the home. May take 3-6 months for all the animal particles to clear

33
Q

What part of the animal are people usually allergic to?

A

Dander, saliva and urine

Not usually hair

34
Q

If a patient can not part with their pet that they’re allergic to, what should they do?

A

Keep it outdoors

Wash it

35
Q

What are the pharmacotherapy options for allergic rhinitis in children under 2

A

Cromolyn sodium nasal spray

2nd gen antihistamines- cetrizine and fexofenadine approved for childern over 6 months

36
Q

What pharmacotherapy is recommended for Mild symptoms of allergic rhinitis or episodic symptoms related to a predictable exposure?

A

2nd gen oral antihistamines

Antihistamine nasal sprays

Glucocorticoid nasal sprays-start 2-3 days prior to exposure

Cromolyn nasal spray

37
Q

What are some antihistamine nasal sprays?

A

Azelastine (Astelin) >5 yrs old

Olopatadine (Patanase) >12 yrs old

38
Q

What are some 2nd gen oral antihistamines?

A

Loratadine (Claritin)

Cetirizine (Zyrtec)

Fexofenadine (Allegra)

39
Q

What is the 1st line treatment for patients with moderate-severe allergic rhinitis?***

A

Glucocorticoid nasal sprays

Most effective single agent, few side effects

40
Q

What are some glucocorticoid nasal sprays?

A 
1st gen:
Beclomethasone (Beconase)
Flunisolide (Nasolide)
Triamcinolone (Nasocort)
Budesonide (Rhinocort)
2nd gen:
Fluticasone proprionate (Flonase)
Fluticasone furoate (Veramyst)
Mometasone (Nasonex)
Ciclesonide (Omnaris)
41
Q

What is the benefit of 2nd gen glucocorticoid nasal sprays over 1st gen?

A

Less risk of systemic side effects

42
Q

If a patient has allergic rhinitis AND asthma, what else should they add to their treatment regimen?

A

Montelukast (Singulair)

43
Q

If a patient has allergic rhinitis AND allergic conjunctivitis,what else should they take with their glucocorticoid nasal spray?

A

Ophthalmic antihistamine drops

44
Q

Can patients with glaucoma or cataracts use nasal steroid sprays?

A

No, can worsen these conditions

45
Q

What should be done if a patient with mod-sever allergic rhinitis does not respond to steroid nasal sprays?

A 
Add a second agent:
Antihistamine nasal spray
Oral antihistamine
Cromolyn
Montelukast (Singulair)
Oral antihistamine/decongestant combo (allegra-d, sudafed-d, etc)
46
Q

What are some first generation antihistamines?

A

Chlorpheniramine

Diphenhydramine

47
Q

Do antihistamines relieve nasal congestion?

A

NO

Help w sneezing, rhinorrhea and itching only

48
Q

What are the side effects of 1st gen antihistamines?

A

Dry mouth

Constipation

Sedation

49
Q

What is the benefit of 2nd generation antihistamines?

A

Less sedating

No more effective than 1st gen

50
Q

Who should get sympathomimetics (decongestants)?

A

Patients with marked nasal congestion despite antihistamine use.
Vasoconstriction will decrease edema and secretions

51
Q

What is a sympathomimetic you can give for patients with nasal congestion despite using antihistamine?

A

Pseudoephedrine (sudafed) 30-60mg q6-8h or 120mg BID for sustained release

52
Q

Who should you be careful about recommending a sympathomimetic for nasal congestion?

A

Patients with hypertension or cardiac disease

53
Q

How do allergy shots (immunotherapy) work?

A

Administration of gradually increasing amounts of allergen

Multiple, regularly scheduled visits over 3-5 years

54
Q

WHat is another name for non-allergic rhinitis?

A

Vasomotor rhinitis

55
Q

What is non-allergic rhinitis?

A

Abnormal autonomic response triggered by stress, sexual arousal, PERFUMES, cigarette smoke, temperature changes

56
Q

If a patient is always bitching about perfume making their nose run (not sneezing or itching though) what do you think they have

A

Non-allergic rhinitis

57
Q

What are the symptoms of non-allergic rhinitis?

A

Nasal congestion

Rhinorrhea

Post-nasal drainage

NO eye or nose itching

NO sneezing

58
Q

What are the treatments for vasomotor/non-allergic rhinitis?

A

Avoidance of triggers
Nasal glucocorticoids
Antihistamine nasal sprays (anticholinergic effect)
Apratropium nasal spray-if rhinorrhea is the prominent symptom

Also can use oral decongestants and FIRST generation oral antihistamines

59
Q

What is Samter’s triad?

A
  1. Allergic rhinitis
  2. Vasomotor rhinitis
  3. Chronic sinusitis
  4. Asthma

COnditions associated with nasal polyps

60
Q

What are nasal polyps?

A

Pedunculated, painless, gray soft tissue growths

61
Q

What is the treatment for nasal polyps?

A

Nasal glucocorticoids **

Refer to ENT if obstructive

62
Q

What is rhinitis medicamentosa?

A

Swollen and erythematous mucous membranes causing rebound congestion due to >3 days of OTC decongestant nasal spray (Afrin)

63
Q

What is the treatment for rhinitis medicamentosa?

A

Discontinue Afrin

Start nasal steroid spray

64
Q

When would you use ipratropium spray for non-allergic/vasomotor rhinitis?

A

If rhinorrhea is the predominant symptom

65
Q

What is urticaria?

A

“Hives”

Circumscribed, raised wheals, pale to bright red, intensely pruritic, transient lesions

66
Q

What is the difference between acute and chronic urticaria?

A

Acute: present less than 6 wks

Chronic: s/s recurring most days for more than 6 weeks

67
Q

WHat is the hallmark trait of urticaria lesions?

A

Individual lesions are transient and will disappear within 24 hours

68
Q

What kind of cells mediate urticaria?

A

Cutaneous mast cells releasing histamine in superficial epidermis**

69
Q

WHat else may accompany urticaria?

A

Angioedema (swelling deeper in the skin, usually the face, lips, extremities, or genitals)

70
Q

How do morphine, codeine, and radiocontrast agents cause urticaria?s

A

Direct mast cell activation

71
Q

What should you do if your pt comes to you saying they had urticaria but the lesions are now gone?

A

Show them pictures of hives and ask them if it looked like that

72
Q

What is urticarial vasculitis?

A

Fixed red plaques that are PAINFUL, have BLANCHING HALOS, and last LONGER than 24 hours.
Leave residual hyperpigmentation and are linked with lupus.

*may be confused with regular urticaria

73
Q

What is the treatment for urticaria?

A

H1 histamine blockers- 2nd generation antihistamines Gold standard

H2 histamine blockers in combo with above- Zantac, Pepcid, etc . Even though they don’t have heartburn, they block both histamine receptors

Oral steroids if angioedema is present or they have persistent symptoms

74
Q

Which 2nd generation antihistamines are most effective for urticaria?**

A

Cetrizine (Zyrtec) and levocetirizine (Xyzal) due to mast-cell stabilizing properties. More effective for skin stuff

Clin Med Exam 2 (Lauren) (6 decks)

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