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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
What do you see on PE of AR?
cyanotic and swollen mucosa
26
What is hansel sign?
smears of nasal secretions revealing eosinophils - AR
27
What are dark circles around eyes related to vasodilation or nasal congestion?
allergic shiners
28
What is horizontal crease across lower half of bridge of nose caused by repeated upward rubbing of tip of nose?
nasal crease
29
What is the upward rubbing of tip of nose with palm of hand?
allergic salute
30
How do you dx AR?
clinically, confirm with IgE ab to relevant allergen
31
What is the preferred method to confirm an IgE mediated response taking advantage of hypersensitivity rxn?
skin testing
32
What is a serum measurement of total IgE and IgE levels against allergy antigens?
RAST - Radioallergosorbent test
33
What are the benefits of RAST?
no risk for allergic rxn, results not affected by meds or skin condition, no need for extensive testing material or rescue medications
34
When do you get a false positive skin test?
dermographism
35
What is the tx for AR?
avoid or eliminate the allergens
36
What is dust mite avoidance involve?
use allergen impermeable mattress and pillow covers, keep humidity
37
What is good for seasonal allergies?
air condition with closed windows, dehumidification
38
What is the OTC treatment for AR?
loratadine (5 mg twice a day or 10 mg a day) cetirizine hydrochloride (10 mg a day) Fexofenadine (180mg a day)
39
What drugs can you use for AR?
antihistamines, topical steroids, topical antihistamines, oral sterids, leukotriene modifiers, allergic desensitization
40
What is first line for AR?
antihistamines
41
What does antihistamines do?
compete with histamine for H1 receptor sites that contribute to sneezing, itching, rhinorrhea and conjunctivitis
42
What do you no longer use?
first generation antihistamines - crosses BBB and sedative and anticholinergic
43
What are second generation antihistamines?
cetirizine, levocetirizine, fexofenadine, descarboxyloratadine, and loratadine
44
Does second generation cross BBB?
NO
45
What are intranasal antihistamines?
azelastine and olopatadine, more rapid
46
What are leukotriene modifier drugs?
zileuton, zafirlukast, montelukast
47
Is luekotriene modifers first line for AR?
NO, not recommended
48
What are some intranasal steroids?
``` fluticasone [Flonase, Veramyst] beclomethasone [Qnasl] triamcinolone [Nasacort] flunisolide [Nasarel] budesonide [Rhinocort] mometasone [Nasonex] ciclesonide [Omnaris] ```
49
What is the most effective AR treatment?
intranasal steroids
50
What is the bad thing about nasal sprays?
not as compliant
51
What are allergy shots?
make cocktail of allergies and shooting it into their body for 3-5 years, can have an effect for 10 years
52
What are allergy drops?
new to US, has only approved allergy drops for grass, ragweed and dust mites
53
What is drops vs shots?
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
What does viral rhinitis produce?
thicker, purulent secretions with neutrophils present on smear, lack of pruritis or sneezing
55
What is infectious rhinitis defined by the presence of?
polymorphonuclear leukocytes
56
How is viral rhinitis treated?
supportive care, fluid replacement, NSAIDs, oral decongestats, mucolytic, ipratopium bromide
57
What is the standard tx of vasomotor rhinitis?
atrophine - nasal ipratropium others: topical antihist topical steroids - fluticoasone
58
What medication causes rhinitis medicamentosa?
afrin
59
What is chronic reboung/reflex vasodilation of the turbinates occurs as a response to topical sympathomimetics?
rhinitis medicamentosa
60
What is the treatment for rhinitis medicamentosa?
discontinue the offending agent, taper it down
61
When does rebound occur over rhinitis medicamentosa?
after 4-5 days

Nose/Throat - Clinical Medicine IV (12 decks)

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