The Stuffy Nose

Question 1

what are the two mediators of inflammation released by mast cells

Answer 1

histamine (causes blocked noses by causing vasodilation of vessels)

leukotrienes (attract other inflammatory cells)

Question 2

what drugs are used to treat allergy related stuffy nose

Answer 2

topical corticosteroids (beclomethasone)
anti-histamines -cetirizine
decongestants - pseudoephedrine
anticholinergics - ipratropium (relaxes muscles in airway)

Question 3

what key symptoms should you ask about with a stuffy nose

Answer 3

blockage
loss of smell
discharge
facial pain

Question 4

what is unilateral clear discharge from the nose suggestive of

Answer 4

CFS leak

Question 5

what are some symptoms of allergy related stuffy nose

Answer 5

sneezing
itching
crusting
epitaxis

Question 6

what are some secondary symptoms caused by nasal problems

Answer 6

dry mouth
sore throat (can be caused by breathing through mouth all night)
snoring
halitosis (from dry mouth leading to bacterial growth)
loss of taste (from dry mouth)

Question 7

key things to do in a nasal exam

Answer 7

check airway potency
(by covering 1 nostril at a time of looking for vapour spots on mirror)
check external nose (alignment)
rhinoscopy (look inside nose)

Question 8

what is rhinitis

Answer 8

inflammation of the nose

Question 9

what are infective causes of rhinitis

Answer 9

viral URTI

Question 10

What are non-infective causes of rhinitis

Answer 10

allergic

non-allergic

Question 11

what is the classification for intermittent rhinitis

Answer 11

symptoms <4 days per week

symptoms <4 week duration

Question 12

what is the classification for persistent rhinitis

Answer 12

symptoms >4 days per week

symptoms >4 week duration

Question 13

causes of intermittent allergic rhinitis

Answer 13

grass pollen (summer) 
tree pollen (spring) 
fungal spores (autumn)

Question 14

what are causes of persistent allergic rhinitis

Answer 14

house dust mites
cat
dog

Question 15

classification of mild rhinitis

Answer 15

normal sleep
no impairment of daily activities
normal work and school
no troublesome symptoms

Question 16

classification of moderate-severe rhinitis

Answer 16

one or more or:

abnormal sleep
impairment of daily activities
missing work or school
troublesome symptoms

Question 17

what is step 1 of allergic rhinitis management

Answer 17

allergen avoidance

antihistamine

Question 18

what is step 2 of allergic rhinitis management

Answer 18

allergen avoidance

topical steroids

Question 19

what is step 3 of allergic rhinitis management

Answer 19

allergen avoidance
topical steroids
antihistamines

Question 20

when do you give immunotherapy

Answer 20

for selected patents with severe IgE related disease

Question 21

when is the best time to start treatment for allergic rhinitis

Answer 21

before the month they get problems

Question 22

what are nasal polyps

Answer 22

growths within the nose with have a high association with non-allergic asthma AND adult onset asthma

Question 23

how do you treat nasal polyps

Answer 23

oral then topical steroids

if no improvement - surgery

Question 24

how do polyps cause a stuffy nose

Answer 24

grow to fill the whole nasal cavity

Question 25

how to differentiate between a polyp and a turbinate

Answer 25

polyps have no sensation but turbinates do

Question 26

signs of acute infective rhino sinusitis

Answer 26

facial pain discharge nasal blockage

Question 27

most common cause of infective rhino sinusitis and treatments

Answer 27

98% are viral analgesics and decongestants if persisting/worsening add antibiotic

Question 28

what investigations would you do if allergy is suspected

Answer 28

skin prick tests RAST (IgE level check) Screening tests for different allergens

Question 29

what allergens would you screen for in suspected allergic rhinitis

Answer 29

cat dog dust mites grass pollen

Question 30

what is the management for non-infective (allergic/drug related) rhinitis

Answer 30

``` allergen/ irritant avoidance House dust mite specific IgE Change drug therapy decrease alcohol topical steroid +/- antihistamine topical anticholinergic ```

Question 31

management for infective rhinitis

Answer 31

nasal decongestant analgesia broad spectrum antibiotic

Question 32

steps for nasal trauma

Answer 32

check airways and deal with immediate issues send home for week then reassess and decide if surgery is needed (needs to be done <3 weeks after injury)

Question 33

what is a septal haematoma

Answer 33

blood in the septum underneath the lining (perichondrium)

Question 34

management of septal haematoma

Answer 34

drain it out and suture the perichondrium back together

Question 35

how should you suspect in a child with unilateral nasal discharge

Answer 35

foreign body in the nose refer urgently

Question 36

what would you suspect in an adult with unilateral nasal discharge

Answer 36

nasal or paranasal tumour refer urgently

Question 37

what is an important complication of acute sinusitis

Answer 37

orbital cellulitis emergency referral needed