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BMS250 > KEY wk 5 lec 1 > Flashcards

KEY wk 5 lec 1 Flashcards

1
Q
A
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2
Q

rhinitis is what cell inflammation and what Ig_

A

eosinophilic inflammation and IgE

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3
Q

what cytokines are made by activated T cell in allergic rhinitis (after sensitization + re-exposure)

A

IL-4, IL-5, IL-13

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4
Q

early phase response:

IgE –> mast cell degranulation –> release ____ —> allergic rhinitis sx (rhinorrhea, nasal congestion, sneeze)

A

histamine

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5
Q

histamine affects what nerve for sneezing

histamine, leukotrienes, prostaglandin cause secretion of ___ + what via blood vessels

A

trigeminal (V)

mucous (rhinorrhea) + nasal congestion

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6
Q

late phase of allergic rhinitis is ___ hours after

what makes late phase persist

A

4-6 hours after (up to 24hrs)

T cells, basophils, eosinophils releasing histamine, kinins, leukotrienes

mast cells secrete IL4, IL5, IL13

cytokines upregulate vascular cell adhesion molecule 1 (VCAM-1) on endothelial cells for T cells and eosinophils and basophils to enter nasal mucosa

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7
Q

common causes of allergic rhinitis and comorbidities

A

Food allergens such as milk, eggs, soy, and wheat, dust mites, and inhalant allergens such as pet dander (in infancy and childhood)

pollen (in older kids)

comorbidities such as atopic dermatitis, otitis media, and asthma.

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8
Q

dysbiosis causes abnormal allergic reactions by switch immune to Th_ and Ig_

A

Th2 and IgE

(from Th1, Treg, IgA)

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9
Q

changes in microbiome and association with allergic rhinitis

A

Increased Bacteroidetes; S. Shigella, E. coli, Parabacteroides, Lachnoclostridium, Dialister.

decreased Actinobacterium, Proteobacterium, and Escherichia coli. Oxalobacter and Clostridiales.

less diversity

  • More abundant Bacteroidetes; reduced Firmicutes.
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10
Q

sx of allergic rhinitis vs non allergic rhinitis

A

Clear and watery nasal discharge, nasal congestion, postnasal drip, and itching of the nose, throat, and eyes.

nonallergic rhinitis are nasal obstruction and clear rhinorrhea. Sneezing and itchy, watery eyes are not common symptoms.

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11
Q

physical exam findings in allergic rhinitis

A

allergic shiners, transverse supra-tip nasal crease

blue inferior turbinates

cobble stoning of nasal mucosa

Eustachian tube dysfunction

dermatitis + asthma

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12
Q

seasonal vs perennial allergic rhinitis

A

seasonal: pollination

perennial i.e. dust mild, cockroaches, animal dander, food allergens, irritants (tobacco, chemicals, pollution)

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13
Q

intermittent vs persistent allergic rhinitis

A

intermittent (< 4 days/week or < 4 weeks’ duration) or

persistent (> 4 days/week or > 4 weeks’ duration)

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14
Q

complications of allergic rhinitis

A

-adenoid hypertrophy

-Eustachian tube dysfunction

-chronic rhinosinusitis

-nasal polyps

-obstruction of osteomeatal drainage

-sleep disruption (OSA)

-learning disturbances (cognitive, memory, fatigue)

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15
Q

symptoms of neoplasm in nose

A

epistaxis (nose bleed), pain, and unilateral symptoms

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16
Q

types of non allergic rhinitis

A

viral (sx: headaches, malaise, aches, cough)

occupational (i.e. dust, cigarette, garden spray, wood particles)

vasomotor

nonallergic rhinitis with eosinophilia (NARES)

rhinitis medicamentosa

rhinitis during pregnancy

vasculitides, autoimmune and granulomatous diseases

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17
Q

most common nonallergic rhintiis

A

vasomotor or idiopathic

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18
Q
A
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18
Q

vasomotor rhinitis cause

A

PNS and SNS and nociceptive nerve dysregulation

PNS: mucous secretion and rhinorrhea via acetylcholine

SNS: vascular tone of nasal mucosa via norepinephrine and neuropeptide Y

mast cell degranulation –> sneezing reflux via neuropeptides and noccipeptive type C fibers of trigeminal nerve

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19
Q

what exacerbates vasomotor rhinitis

A

seasonal changes in barometric pressure, temperature, or humidity

strong odors, cold air exposure, alcohol consumption, and spicy foods.

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20
Q

Nonallergic Rhinitis with Eosinophilia (NARES)

A

nasal obstruction and cogngestion with sinusitis and polyposis

> 25% eosinophilia ut not allergic to inhalant allergens

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21
Q

rhinitis medicamentosa

A

from overuse of topical nasal decongestants (oxymetazoline, phenylephrine)

“rebound congestion”

22
Q

rhinitis during pregnancy pathophysiology

A

increase estrogen –> increase hyaluronic acid in nose –> congestion and edema

decerase nasal cilia and increase mucous glands

2nd and 3rd trimester

23
Q

Vasculitides, Autoimmune, and Granulomatous Diseases (non allergic rhinitis)

A

systemic diseases with inflammation –> turbinates, rhinorrhea, polyposis ??

24
chronic rhinosinusitis timeline sx
> 12 weeks nasal obstruction, facial congestion, pressure + fullness, discolored nasal discharge, hyposmia, fatigue, myalgia
25
pathophysiology in chronic rhinosinusisits
inflame, reduce oxygen, bacteria grow, ciliary dysfunction, hyperplasia of mucus glands, lymphocyte infiltrate
26
2 factors causing chronic rhinosinusitis
biofilms (from bacteria and toxins) bacterial superantigens (nasal polyps causes by exotoxins from s. aureus)
27
pathophysiology of chronic rhinosinusitis
osteitis (inflamed bone) allergy barrier and innate immune dysregulation; impaired tight junctions, dysbiosis, less AMPs genetics and systemic diseases; granulomatosis with polyangitis, aspirin exacerbated respiratory disease, cystitis fibrosis dysfunctional mucocillairy clearance
28
features of chronic rhinosinusitis
-purulent discharge (yellow or green) facial/dental pain nasal obstruction hyposmia (smell), headaches, ear pain, halitosis (bad breath), fatigue, fever nasal endoscopy: 1+ of purulent drainage, polyps, polypoid changes in the mucosa, and edema or erythema.
29
nasal polyps develop from ____ and contain ______-
sinonasal mucosa plasma cells, lymphocytes, eosinohpils
30
nassal polyps from Th_ driven eosinophilia, Ig_ and high IL_
Th2, IgE, IL5
31
clinical presentation of nasal septal deviation
headaches, rhinosinusitis, high blood pressure, obstructive sleep apnea, and breathing sounds
32
pharyngotonsillitis
viral (~80% - mostly acute) or bacteria infection (GABHS in kids) of pharynx and tonsils
33
sx of acute pharyngotonsillitis
fever, malaise, odynophagia (pain when swallow), dysphagia, and foul breath. airway obstruction --> mouth breathing, snoring, sleep problems
34
viruses that cause phayngotonsillitis
adenoviruses, rhinoviruses, Coronaviruses, Epstein-Barr viruses (EBVs), cytomegaloviruses (CMVs), Coxsackieviruses, herpes simplex viruses, HIVs, and influenza viruses.
35
EBV causing pharyngotonsillits
part of herpes family; infections mononucleosis (via oral) infect B cells then T cells links to lymphomas and carcinomas
36
EBV causing phayngotonsillitis sx
high fever, generalized malaise, lymphadenopathy, hepatosplenomegaly, and pharyngitis. exudate and obstruct airways on tonsils typhoid hypertrophy (esp posterior nodes)
37
HIV causing phayngotonsillitis
acute retroviral syndrome
38
sx of HIV causing phayngotonsillitis
fever, nonexudative pharyngitis, lymphadenopathy, and systemic symptoms such as arthralgia, myalgia, and lethargy.
39
Acute Streptococcal Pharyngotonsillitis - Group A beta-hemolytic streptococcus (GABHS) causing pharyngotonsillitis sx
fever, sore throat, cervical lymphadenopathy, dysphagia, and odynophagia. Tonsillar and pharyngeal erythema with purulent exudate
40
nonsuppurative complications of Acute Streptococcal Pharyngotonsillitis - Group A beta-hemolytic streptococcus (GABHS)
scarlet fever (endotoxin causes rash, fever, dysphagia, strawberry tongue) acute rheumatic fever (cross reactive antibodies cause Endo,myo or pericarditis) post streptococcal glomerulonephritis (acute nephrotic syndrome)
41
suppurative complications of Acute Streptococcal Pharyngotonsillitis - Group A beta-hemolytic streptococcus (GABHS)
Pediatric autoimmune neuropsychiatric disorder associated with group A streptococcal (PANDAS) infection (causes compulsive tics and behaviours from anti neuronal antibodies cross reacting in basal ganglia) Peritonsillar abscess (unilateral pain, odynophagia, dysphagia, voice, trsimus/lock jaw, uvular deviation) parapharyngeal abscess (peritonsillar abscess spreads- trsimus, decreased neck ROM) retropharyngeal abscess (from peritonsilar abscess spread to lymph- cervical lymphadenopathy, stiff neck)
42
causes of peritonsillar abscess
GABHS, s. aureus, H influenza....
43
non group A streptococcal pharyngitis causing pharyngotonsillits which group
group C and G stretocococci similar sx but less severe
44
pharyngeal diphtheria causing pharyngotonsillitis what type of diphtheria and cause and sx
Corynebacterium diphtheria from childhood immunization gray pseudomembrane on tonsils, compromised airway, cardiac toxicity and neurotoxicity from exotoxins
45
STIs that cause pharyngotonsillitis sx
n. gonorrhoea and t. pallidum exudative pharyngitis, oral syphillis (chancre, ulcers)
46
fungal infections causing pharyngotonsillitis cause sx
Candida albicans --> oropharyngeal candidiasis "thrush" cottage cheese like plaques
47
recurrent acute tonisilits vs chronic tonsillitis causing pharyngotonsillitis
Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae CHRNOIC > 3 months with halitosis (bad breath) and cervical adenopathy Staphylococcus aureus, Haemophilus influenza, and Bacteroides
48
tonsilloliths causing phayrngotonsillitis
microbial biofilms formed in tonsillar crypts --> hard white masses
49
aphthous ulcers (canker sores) caused by appearance risks
human herpesvirus 6 yellow-gray fibrinoid center with red halo stress, bedtime after 11pm, ulcerative stomatitis
50
supraglottitis (epiglottitis) cause sx
haemophilus influenza type B fever, odynophagia, drooling, muffled voice, inspiratory stridor
51
laryngitis causes
mostly viral (parainfluenza viruses) bacterial (neumoniae, H influenzae, and M catarrhalis) fungal (if immunosuppressed or on antibiotics) non infectious (vocal trauma like screaming, allergies, GERD, asthma, smoking)
52
laryngitis sx
raspy, hoarse voice or loss of voice dry cough
53
bacterial tracheitis cause SX
staphylococcus aureus airway obstruction, fever, (no drooling or dysphagia like in supraglottitis(

BMS250 (52 decks)

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