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Nose/Throat - Clinical Medicine IV > Rhinitis > Flashcards

Rhinitis Flashcards

1
Q

What are the three types of rhinitis?

A

allergic, vasomotor, rhinitis medicamentosa

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2
Q

What are allergic rhinitis?

A

seasonal allergic rhinitis and perennial allergic rhinitis (SAR and PAR)

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3
Q

What are inflammatory rhinitis?

A

infections (viral)
nonallergic rhinitis with eosinophilia syndrome (NARES)
chronic sinusitis with or without nasal polyposis
Laryngopharyngeal reflux

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4
Q

What are hormonal causes of rhinitis?

A

pregnanct, hypothyroidism, hyperthyroidism

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5
Q

What is rhinitis medicamentosa?

A

topical or oral decongestants
Antihypertensive
cocaine

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6
Q

What are vasomotor causes of rhinitis?

A

irritant, cold air induce, gustatory (food induced)

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7
Q

What are anatomic rhinitis causes?

A

nasal septal deviation, tumor or neoplasm, foreign body, CSF leak, atrophic

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8
Q

Where does maxillary sinus drain?

A

btw middle turbinates

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9
Q

What are nasal symptoms that result from an inflammatory hypersensitivity reaction to aeroallergens deposited on the nasal mucosa?

A

Allergic rhinitis

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10
Q

What is the most common chronic disease in US?

A

allergic rhinitis

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11
Q

What is some comorbid conditions in AR pts?

A

asthma, acute and chronic sinusitis, nasal polyposis, secretory otitis media, sleep disorders

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12
Q

What is the allergic march?

A

eczema –> food allergy –> rhinitis –> asthma

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13
Q

What is the allergic triangle?

A

allergic rhinitis, asthma, eczema

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14
Q

What is the pathology of AR?

A

hypersensitivity immune reaction

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15
Q

What are some seasonal AR?

A

pollens and molds

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16
Q

What are examples of seasonal AR?

A

grass pollen - may to june
ragweed - aug to oct
Tree pollen - feb to april
outdoor molds - march to oct

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17
Q

What are perennial AR?

A

indoor allergies

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18
Q

What are examples of perennial AR?

A

indoor fungi, animal dander, dust mites, insects (moths, crickets ect)

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19
Q

What produces that most indoor allergens?

A

dust mites and cats

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20
Q

How does mast cell mediated AR respond?

A

good to antihistamines

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21
Q

How does eosinophil mediated AR respond?

A

less responsive to antihistamines - chronic inflammation

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22
Q

What are symptoms of AR?

A

sneezing, itching, rhinorrhea, vasoactive mediator release (histamine), congestion, occular itching, lacrimation, injection

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23
Q

What causes the hypersecretion in AR?

A

cytokine presisting and inflammatory mediators

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24
Q

As AR increases severity…

A

histamines don’t responds as well

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25
Q

What do you see on PE of AR?

A

cyanotic and swollen mucosa

26
Q

What is hansel sign?

A

smears of nasal secretions revealing eosinophils - AR

27
Q

What are dark circles around eyes related to vasodilation or nasal congestion?

A

allergic shiners

28
Q

What is horizontal crease across lower half of bridge of nose caused by repeated upward rubbing of tip of nose?

A

nasal crease

29
Q

What is the upward rubbing of tip of nose with palm of hand?

A

allergic salute

30
Q

How do you dx AR?

A

clinically, confirm with IgE ab to relevant allergen

31
Q

What is the preferred method to confirm an IgE mediated response taking advantage of hypersensitivity rxn?

A

skin testing

32
Q

What is a serum measurement of total IgE and IgE levels against allergy antigens?

A

RAST - Radioallergosorbent test

33
Q

What are the benefits of RAST?

A

no risk for allergic rxn, results not affected by meds or skin condition, no need for extensive testing material or rescue medications

34
Q

When do you get a false positive skin test?

A

dermographism

35
Q

What is the tx for AR?

A

avoid or eliminate the allergens

36
Q

What is dust mite avoidance involve?

A

use allergen impermeable mattress and pillow covers, keep humidity

37
Q

What is good for seasonal allergies?

A

air condition with closed windows, dehumidification

38
Q

What is the OTC treatment for AR?

A

loratadine (5 mg twice a day or 10 mg a day)
cetirizine hydrochloride (10 mg a day)
Fexofenadine (180mg a day)

39
Q

What drugs can you use for AR?

A

antihistamines, topical steroids, topical antihistamines, oral sterids, leukotriene modifiers, allergic desensitization

40
Q

What is first line for AR?

A

antihistamines

41
Q

What does antihistamines do?

A

compete with histamine for H1 receptor sites that contribute to sneezing, itching, rhinorrhea and conjunctivitis

42
Q

What do you no longer use?

A

first generation antihistamines - crosses BBB and sedative and anticholinergic

43
Q

What are second generation antihistamines?

A

cetirizine, levocetirizine, fexofenadine, descarboxyloratadine, and loratadine

44
Q

Does second generation cross BBB?

A

NO

45
Q

What are intranasal antihistamines?

A

azelastine and olopatadine, more rapid

46
Q

What are leukotriene modifier drugs?

A

zileuton, zafirlukast, montelukast

47
Q

Is luekotriene modifers first line for AR?

A

NO, not recommended

48
Q

What are some intranasal steroids?

A 
fluticasone [Flonase, Veramyst]
beclomethasone [Qnasl]
triamcinolone [Nasacort]
flunisolide [Nasarel]
budesonide [Rhinocort]
mometasone [Nasonex]
ciclesonide [Omnaris]
49
Q

What is the most effective AR treatment?

A

intranasal steroids

50
Q

What is the bad thing about nasal sprays?

A

not as compliant

51
Q

What are allergy shots?

A

make cocktail of allergies and shooting it into their body for 3-5 years, can have an effect for 10 years

52
Q

What are allergy drops?

A

new to US, has only approved allergy drops for grass, ragweed and dust mites

53
Q

What is drops vs shots?

A

shots - in office, high risk anaphylaxis, FDA approved

Drops - no anaphylaxis, done at home, safer, non FDA approved, not covered by insurance but cost is comparable to shots

54
Q

What does viral rhinitis produce?

A

thicker, purulent secretions with neutrophils present on smear, lack of pruritis or sneezing

55
Q

What is infectious rhinitis defined by the presence of?

A

polymorphonuclear leukocytes

56
Q

How is viral rhinitis treated?

A

supportive care, fluid replacement, NSAIDs, oral decongestats, mucolytic, ipratopium bromide

57
Q

What is the standard tx of vasomotor rhinitis?

A

atrophine - nasal ipratropium

others:
topical antihist
topical steroids - fluticoasone

58
Q

What medication causes rhinitis medicamentosa?

A

afrin

59
Q

What is chronic reboung/reflex vasodilation of the turbinates occurs as a response to topical sympathomimetics?

A

rhinitis medicamentosa

60
Q

What is the treatment for rhinitis medicamentosa?

A

discontinue the offending agent, taper it down

61
Q

When does rebound occur over rhinitis medicamentosa?

A

after 4-5 days

Nose/Throat - Clinical Medicine IV (12 decks)

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