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clin med I exam II > rhinitis > Flashcards

rhinitis Flashcards

1
Q

what is the nose composed of

A

membranous, cartilaginous + bony components

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2
Q

what is located on the lateral nasal wall and what are their functions

A

superior, middle + inferior turbinates

warm, humidify + filter inspired air

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3
Q

what is the nasal cycle

A

regular, cyclicle pattern of turbinate swelling - alternates btw sides at interval of 2-5hrs

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4
Q

nasal functions

A 
olfaction
filtration
humidification/warming of air passing through
vocal resonance
aesthetic function
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5
Q

rhinitis overview

A

marked by presence of 1+ of the following:

sneezing, rhinorrhea (anterior/posterior), nasal congestion (stuffiness), nasal itchy

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6
Q

most common forms of rhinitis

A 
allergic
non-allergic
rhinitis d/t structural nasal problems
atrophic rhinitis
rhinitis of pregnancy
occupational rhinitis
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7
Q

what is the most common form of rhinitis

A

allergic

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8
Q

what is allergic rhinitis

A

some combo of nasal itching, watery rhinorrhea, nasal congestion + sneezing

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9
Q

common comorbidities of allergic rhinitis

A

headaches
rhinosinusitis
asthma

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10
Q

what is intermittent allergic rhinitis

A

sx occur in response to specific exposures

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11
Q

what is seasonal allergic rhinitis

A

sx occur at certain times of year

pts have associated allergic conjunctivitis in ~70% of cases - red, itchy, watery eyes

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12
Q

what is persistent/perennial allergic rhinitis

A

sx occur year round

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13
Q

clinical history in pts w allergic rhinitis

A

personal, family, occupational, environmental

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14
Q

occupational factors of allergic rhinitis

A 
animals
grains
chemicals 
pollens
latex
carpeting
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15
Q

environmental factors of allergic rhinitis

A 
perennial allergens
seasonal allergens 
air quality
bugs
carpeting
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16
Q

nasal mucosa presentation in different types of rhinitis

A

allergic- edematous + pale
non-allergic- normal in color
acute viral/rhinitis medicamentosa- beefy red

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17
Q

allergic shiners

A

blue/grey to purple disocloration under eyes in allergic rhinitis

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18
Q

allergic salute

A

transverse nasal creased formed from repeatedly rubbing the nose + pushing tip of nose up w the hand in response to nasal itching

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19
Q

when would you perform imaging tests in allergic rhinitis

A 
concomitant condition (chronic rhinosinusiis- CRS) is suspected
history of facial trauma
features to suggest anatomic abnormalities (unilateral congestion or obstruction)
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20
Q

skin testing for allergic rhinitis

A

quick, cost effective + safe
usually performed by allergy specialists
if sensitive- results in wheal + flare rxn a skin test site w.i 20 min

21
Q

tx for allergic rhinitis

A 
avoid allergens
steroids
oral antihistamines (1st + 2nd gen)
leukotriene receptor antagonists
referrals
immunotherapy (allergy vaccine)
22
Q

steroids used to treat allergic rhinitis

A 
intranasal glucocorticoids (INGCs)- most effective single maintenance therapy for allergic rhinitis + cause few SEs at recommended doses
most have onset of action of a few hrs
intranasal, oral, parenteral

bioavailability differs
1st gen- beclomethasone, flunisolide, bedesonide (10-50% bioavail)
2nd gen- fluticasone propionate (<2%), mometasone furoate, fluticasone furoate (<1%)

23
Q

oral antihistamines used to treat allergic rhinitis

A

reduce itching, sneezing + rhinorrhea w less impact on nasal congestion compared w intranasal glucocorticoids
H1 antihistimes- 1st + 2nd gen (DO NOT USE IN COMBO TO TX ALLERGIC RHINITIS)

24
Q

1st gen H1 antihistamines used to treat allergic rhinitis

A

diphenhydramine, chlorpheniramine, hydroxyzine, brompheniramine
OTC
significant sedation (cross BBB), ~20% report CNS sx
SEs- dry mouth, dry eyes, urinary hesitancy, confusion

25
Q

2nd gen H1 antihitamines used to treat allergic rhinitis

A

loratidine, cetirizine, fexofenedine
lipophobic- avoid unwanted CNS sx of 1st gen
onset = w.i 1hr for most
longer acting + dosed

26
Q

leukotriene receptor antagonists used to treat allergic rhinitis

A

nasal congestion- correlates best w leukotriene C4 levels
sneezing + nasal itching- correlate w histamine levels
montelukast (only one used)
not as effective as INGCs

27
Q

mast cell stabilizers used to treat allergic rhinitis

A

cromolyn sodium
inhibits mast cell release of histamine + other inflam factors
blocks sx associated w immediate + late phase nasal allergen challenge
no serious SEs + available as OTC nasal spray
less effective than INGCs or 2nd gen antihistamines
limited by frequent dosing
try if other agents are not well tolerated

28
Q

treatment referral for allergic rhinitis

A

allergy/immunology referral if tx has provided no relief

may benefit from allergy testing

29
Q

immunotherapy for allergic rhinitis

A

very effective, long term
expensive, shots
<1 death/million
many never complete tx course

30
Q

nonallergic rhinitis description

A 
chronic presence of 1+ of the following:
nasal congestion (stuffiness)
rhinorrhea
postnasal drainage 
diagnosis of exclusion
31
Q

how is allergic rhinitis distinguished from non-allergic?

A

non-allergic- later age of onset, absence of nasal + occular itching + prominent sneezing, nasal congestion + postnasal drainage are prominent, sx are perennial not seasonal

32
Q

what is vasomotor rhinitis

A

intermittent sx of congestion +/or watery nasal discharge + an exaggerated rxn to nonspecific irritants (air pollution, temp changes, especially exposure to cold, dry air)

33
Q

what is mixed rhinitis

A

combo of allergic + nonallergic rhinitis- most common form of rhinitis
~45% of population

34
Q

what is gustatory rhinitis

A

episodic condition w prominent watery rhinorrhea triggered by hot or spicy food (vagally-mediated reflex)

35
Q

what is occupational rhinitis

A

caused by airborne allergens or irritants in pts workplace
more prominent sx at work, better on days off
may be allergic or irritant

36
Q

common examples of occupational rhinitis

A

proteins from urine + fur of lab animals
food proteins in food processing workers
enzymatic proteins in detergent manufacturers
organic dusts in wood workers

37
Q

other causes of rhinitis

A 
nasal decongestants
intranasal cocaine use
systemic medications
structural abnormalities
rhinitis of pregnancy
systemic diseases
normal nasal reflexes
38
Q

what is rhinitis medicamentosa

A

caused by nasal decongestants- OTC sprays lead to rebound nasal congestion as meds wear off -> pt administers med more frequently to obtain relief
dx based on hx of use of causative med
limit use to a max of 5 days to minimize use
less likely if pt is using intranasal glucocorticoid concurrently
stop using med

39
Q

what systemic meds cause rhinitis

A

antihypertensives - alpha blockers, ACE inhibitors, beta blockers, CCBs, HCTZ
erectile dysfunction drugs
some antidepressants, benzos, psychotropics + antiepileptics
NSAIDs
estrogens

40
Q

what structural abnormalities can cause rhinitis

A

congenital or acquired

enlarged adenoids, foreign bodies, septal deviation + perforation, nasal polyps, tumors

41
Q

what is rhinitis of pregnancy

A

nasal congestion in last 6+ weeks of pregnancy w.o other signs of RTI + no known allergic cause

42
Q

systemic diseases that cause rhinitis

A

cystic fibrosis

sarcoidosis

43
Q

what are postural reflexes

A

increased congestion w supine position + increased congestion in lower nasal passage when lying on one side

44
Q

what are hot + cold cutaneous temperature reflexes

A

sneezing upon sudden exposure of skin to dramatic temp extremes

45
Q

what are bronchonasal reflexes

A

bronchoconstriction in response to nasal stimulation (e.g. cold air)

46
Q

what are crutch reflexes

A

inc congestion w pressure in ipsilateral axilla

47
Q

what is ovulatory rhinitis

A

inc nasal congestion in periovulatory period of menstrual cycle in women

48
Q

what stimuli can trigger sneezing

A

after meals
sexual ideation
orgasms

49
Q

what are visible + infrared light reflexes

A

sneezing upon sudden exposure to bright light

clin med I exam II (10 decks)

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