Rhinitis, Sinusitis, Epistaxis, Paranasal Sinus Neoplasms

Question 1

Inflammated nose mucosa

Answer 1

Rhinits

Question 2

The most common type of rhinitis

Answer 2

Non-allergic

Question 3

3 basic symptoms of rhinitis

Answer 3

Nasal obstruction
Hyperirritability
Hypersecretion

Question 4

The most common cause of rhinitis

Answer 4

Viral infection

Question 5

Truth or Fake: eosinophilia in rhinitis patient will always mean it’s allergic because of hypersecretion, nasal obstruction and irritability

Answer 5

Fake: NARES is a particular syndrome of non allergic rhinits. The cause is unknown. The symptoms of this and anyother rhinits are not caused by allergy.

Question 6

Epistaxis, pain and unilateral symptoms maybe harbingers of…

Answer 6

Neoplasm

Question 7

This is the first you need to question to the patient with nonallergic rhinitis

Answer 7

Use of over-the-counter sprays, previous trauma, work, chemical exposure and previous intranasal drug use.

Question 8

Truth or Fake: sneezing and itchy watery eyes are part of a typical presentation of nonallergic rhinitis.

Answer 8

Fake

Question 9

Truth or Fake: patient as old as increasing incidence of non allergic rhinitis

Answer 9

Fake

Question 10

The chronic use of on type of nasal drug in sprays could lead to non allergic rhinitis medicamentosa. What’s the name of these over-the-counter drugs?

Answer 10

Vasoconstrictive nasal sprays

Question 11

The nose is an efficent airflow conduit, better than mouth breathing. Some functions are:

Answer 11

Warming, humidifying and cleansing the inspired air.

Question 12

Oximetazolin is a drug that as much the patient uses it, a more dosis need increases. What’s the name of this physiopathologic cause of rhinitis medicamentosa?

Answer 12

Thachyphylaxis

Question 13

This shift helps a resting nostril to get moist again. Spontaneous shift during the day . We are talking about…

Answer 13

Nasal Cycle

Question 14

Sympathetic System will make the turbinates to…

Answer 14

Be swollen / Congested

Question 15

The epithelium of the nasal mucosa is…

Answer 15

Ciliated Columnar Pseudostratified

Question 16

This syndrome is characterized by primary discinesia ciliar (inmotile cilia)

Answer 16

Kartagener Syndrome

Question 17

Ethmoid sinuses drain in the middle meatus. The only exception is…

Answer 17

Posterior Ethmoid Sinuses (drain into the superior meatus)

Question 18

Sinuses versus turbinates

Answer 18

Sinus is the space…Turbinate is the tissue that envaginates

Question 19

What’s Epiphora?

Answer 19

Watery Eyes. Critical inflammation in the meatus (drainage sites) can cause it

Question 20

Nasal irrigation is fed by these arteries

Answer 20

Both Carotids Branches: anterior and posterior ethmoid arteries and sphenopalatine artery

Question 21

The venous drainage of the nose is primarily through…

Answer 21

Pterygoid and Ophthalmic Plexuses

Question 22

The use of nasal speculum to explore some sites of the nose is known as…

Answer 22

Rhinoscopy

Question 23

Clinical signs it is nonallergic rhinitis

Answer 23

Medical history: sprays, trauma, occupation, tabaquism.

Some symptoms of any type of rhinitis: headache, malaise, body aches, cough…dryness, reduced airflow rhinorrhea…nasal obstruction and congestion…eosinophilia…sneezing, itchy watery eyes (not always)

Question 24

This anticolinergic agent is the first line of treatment for mild intermittent rhinitis

Answer 24

Azelastine

Question 25

This type of rhinitis has a different treatment from the other 3. 1st line is INAH and ICS, 2nd line is Azelastine and 3rd line is INCS

Answer 25

Moderate/Severe Persistent Rhinitis

Question 26

It’s an important risk of using NeilMed Sinus Rinse, and it’s due to incorrect using or application technique.

Answer 26

Ear Infections

Question 27

Allergy is adverse inmune response after repeated contact with a harmless substance. Nasal mucous membrane course with inflammation, an its immunologic reason is…

Answer 27

An IgE-mediated reaction to 1 or more allergens (Type 1 Hypersensivity)

Question 28

What’s more common AR or NAR? And which type of them?

Answer 28

AR, viral infection type

Question 29

The excess production of IgE antibodies ir termed an atopic reaction. These other two diseases are condisered to have the same cause…

Answer 29

Asthma and atopic dermatitis

Question 30

One of these is NOT a factor for hypersensivity reactions:
1. Atopic hereditary history
2. Chronic use of antihistaminic sprays
3. Sensitization to a specific allergen
4. Living in CDMX

Answer 30

2. Chronic use of AH sprays

(Even 4 could be incorrect…hypersensivity physiopatology is due to a first exposition and repeated future expositions, and genetic influence increases the process)

Question 31

RECOMMENDATION: Read about physio of type 1 sensiviy. There are two phases: Early-phase/humoral reaction and late-phase/cellular reaction. If you turn this card, youl’ll find the explanation for the EARLY-PHASE

Answer 31

Patients with atopic predisposition. They start sensitization to an specific allergen, which induces IgE production. The allergen attaches to 2 gE antibodies attaches to the surface of mast cells (more prevalent in respiratory, GI tract, subconjuntiva and subcutaneous tissues). The reaction causes degranulation of mast cells, which provokes and inflammatory response with the release of mediators as histamine, leuktrienes, cytokines, prostaglandines and platelet-activating factor. This EARLY-PAHE occurs within 10-15 minutes of allergen exposure. The symptoms are caused by the release of histamine: sneezing, rinorrea, itching, vascular permeability, vasodilatation and grandular secretion.

Question 32

RECOMMENDATION: the EARLY-PHASE of type 1 hypersensivity reaction subsequently causes the release of cytokines and leukotrienes. If you turn this card, you’ll find and explanation of LATE-PHASE or celular reaction

Answer 32

Cytokines and leukotrienes causes influx of inflammatory cells (mainly eosinophils) into the affected area (chemotaxis). It can begin 4 to 6 hours after the initial sensitization and may prolongue and enhance the allergic cascade for as long as 48 hours. This response is the main cause of nasal congestion and post nasal drip AR. These meditators also produce hyperreaction to both specific allergens and nonspecific irritants, referred as the priming effect.

Question 33

Factors that influence the development of atopy…

Answer 33

Genetic susceptibility, environmental factors, exposure to allergens, passive exposure to tobacco smoke and diesel exhaust particles…

Question 34

These are the testing we offer te patient to determinate allergens responsible for AR

Answer 34

Skin-prick test (low cost option), intradermal Testing (the best option) and in vitro testing (allergen-specific serum IgE testing in vitro)

Question 35

Findings you could find by rhinoscopy in a patient with suggestion of AR

Answer 35

Conjunctivitis, Eczema, Asmathic Wheezing, Nasal Salute, OME

Question 36

In case your patient is pretty resistant to rhinitis treatment, you can suggest immunotherapy to block IgE. What’s the name of you possible options?

Answer 36

Dupilumab (block reaction IL4-IL13)
Reslizumab
Omalizumab

Question 37

Age major presentation in population for allergic rhinits

Answer 37

Male, before 20 years.