Rhinorrhea Flashcards
This part of the respiratory mucosa is composed of basal cells, goblet cells, cells that produce mucus, and ciliary cells that propels mucus backwards
Epithelium
This nerve primary supplies for sensory innervation. It is a branch of the pterygopalatine ganglion
Trigeminal Nerve
Cilia moves at a frequency of ___ beats/min to move the mucosa.
Mucus envelopes the nose from the environment, with a stream rate of ___ ml/min
10-15 beats/min
2.5-7.5 mL/min
T/F: Venous erectile tissue is abundant in the superior turbinate
F
It is abundant in the inferior turbinate
T/F: During expiration, the moisture and heat is returned to the nose via condensation
T
Most important mechanical defense of the nose
Mucociliary Apparatus
Immune cell involved in allergic rhinitis
Mast cells
T/F: Autonomic nervous system regulates the mucosal vasculature and glandular secretions
T
Effect of neuropeptide Y in the nasal reflex arc
Vasoconstriction as it is sympathetic
Effect of acetylcholine in the nasal reflex arc
increased mucus secretions
What is the pathophysiology of acute rhinitis?
Viruses like influenza and coronavirus enter the nose, damage the epithelium and the mucociliary transport system, thus promoting bacterial (?) colonization
T/F: Topical decongestants must be used for at least 2 weeks to take effect against acute rhinitis
F
It must not be used for more than 1 week to avoid rebound congestion
2 stages of acute rhinitis
Dry stage
Catarrhal stage
This stage of acute rhinitis causes malaise and local discomfort of the nose and nasopharynx
Dry stage
This stage of acute rhinitis causes watery/serous nasal discharge and nasal obstruction
Catarrhal stage
5 types of Non-allergic Rhinitis
Vasomotor rhinitis
Idiopathic rhinitis
Gustatory Rhinitis
Hormonal Rhinitis
Atrophic Rhinitis
This non-allergic rhinitis is a neurovascular autonomic disturbance in regulating the tonus of the nasal mucosa
Vasomotor rhinitis
What makes you feel symptoms if you have vasomotor rhinitis?
Temperature changes
Drinking hot liquid or alcohol
Perfumes
Emotional stress
In this non-allergic rhinitis, there is mucus gland hyperactivity. Nasal douche or neti pots serve as treatment
Hormonal Rhinitis
T/F: Among pregnant women, low estrogen = less nasal congestion
T
This condition is a side effect of long term use of topical nasal decongestants, with daily usage in a span of ____
What are the signs and symptoms of this condition?
Rhinitis Medicamentosa
1 year
Obstructive nasal breathing, dry mucosa, and occasional olfactory disturbances
What is atrophic rhinitis?
What is its pathophysiology?
It is characterized by pronounced dryness of the nasal mucosa, with fetid nasal odor
There is non-functional lining of nonciliated squamous metaplasia and loss of mucociliary clearance and neurologic regulation usually due to removal of lining of the nose during nose surgeries
What is the treatment for persistent AR not responsive to topical steroids for 1 month?
Short course oral steroids
What is the treatment for severe AR symptoms?
Short course oral steroids
Alternative to oral antihistamines for intermittent AR
Topical antihistamine
T/F:: Goal of surgery as a treatment for allergic rhinitis is to remove the turbinates
F
reduce size only
What is the predominantly involved sinus among children in acute sinusitis?
How about in adults?
Ethmoid sinus in children
Maxillary sinus in adults (maxillary > ethmoid > frontal > sphenoid)
Acute rhinosinusitis is an inflammatory condition involving what and lasts up to when?
involves the paranasal sinuses and linings of the nasal passages; lasts up to 4 weeks
How is acute bacterial rhinosinusitis diagnosed?
It is diagnosed among adults with symptoms of a viral upper respiratory infection that has not improved after 10 days or worsen after 5-7 days
T/F: H. influenzae is commonly isolated from the maxillary sinuses of adults causing ABRS
T
alongside S. pneumoniae, M. catarrhalis
T/F: ABRS is commonly found in patients with Wegener’s granulomatosis
Diagnostic criteria must include 2 or more of the ff:
T
as it causes inflammation in various tissues in the respiratory tract
Nasal blockage or congestion, anterior and/or posterior purulent drainage, facial pain/pressure/fullness, hyposmia or anosmia
Diagnostic tests for ABRS
Sinus puncture of culture aspiration
PNS Xray
CT scan (more accurate than MRI) to look at sinuses
MRI- if there is neoplastic or fungal process
What is the first line treatment for ABRS for a patient with no recent antimicrobial use in the past 4-6 weeks?
Amoxicillin
Amoxicillin/Clavulanate
Cefpodoxime proxetil
Cefuroxime axetil
What is the first line treatment for ABRS for a patient with recent antimicrobial use in the past 4-6 weeks?
High dose Amoxicillin
Amoxicillin/Clavulanate
Ceftriaxone
Gatifolaxin
Levofloxacin
Moxifloxacin
What is the alternative treatment for ABRS for a patient with recent antimicrobial use in the past 4-6 weeks and is allergic to beta lactams?
Gatifolaxin
Levofloxacin
Moxifloxacin
Clindamycin
What is the alternative treatment for ABRS for a patient with no antimicrobial use in the past 4-6 weeks and but is allergic to beta lactams?
TMP-SMX Doxycyline
Azithromycin
Clarithromycin
Erythromycin
Most common mechanism of acute viral rhinosinusitis
It frequently affects what sinus(es)?
Impaired ventilation of the ostiomeatal unit
Maxillary and ethmoid sinuses
T/F: Decongestants can’t be given for more than 7 days
T
due to risk of developing Rhinitis Medicamentosa
Only definitive treatment for Acute viral Rhinosinusitis
Functional Endoscopic Sinus Surgery
It enlarges tight passages to drain sinuses properly
T/F: Cause of nasal polyps are generally unknown
T
but it could be genetic, due to chronic mucosal irritation, allergic rhinitis and aspirin allergy, cystic fibrosis
What is the grade if polyps do not prolapse beyond the most anterior part of the middle turbinate
Pharmacologic tx?
Grade 1
Intranasal corticosteroid for 4-6 wks
Grading of polyps that can be seen with a nasal speculum (extending below the middle turbinate)
Pharmacologic tx?
Grade 2
short term systemic steroids + Intranasal corticosteroid
Grading of massive polyps that occlude the entire nasal cavity
Pharmacologic tx?
Grade 3
Surgery
Alternative drug if there’s no response to intranasal corticosteroid among grades 1 and 2 nasal polyps
Oral systemic steroids can be added
Sinuses involved in orbital complications
Ethmoid and Frontal sinuses
