unit 5 Flashcards
meningitis symptoms
What is a hypersensitivity reaction?
It’s an exaggerated or inappropriate immune response to foreign antigens, which can harm the host. These responses may also target the body’s own tissues, causing autoimmune disorders.
What are the four types of hypersensitivity reactions?
- Type I – Immediate (IgE-mediated)
- Type II – Antibody-dependent cytotoxic
- Type III – Immune complex-mediated
- Type IV – Delayed (T-cell-mediated)
Describe the mechanism of Type I hypersensitivity.
Involves IgE antibodies binding to allergens. IgE then binds to mast cells and basophils, releasing histamine, prostaglandins, and leukotrienes upon re-exposure, causing allergic reactions.
What are examples of local and systemic Type I hypersensitivity reactions?
- Local: hay fever, asthma, hives, GI symptoms
- Systemic: anaphylaxis (life-threatening)
What is atopy? How does it differ from allergy?
Atopy is an exaggerated IgE-mediated immune response (all Type I). Allergy refers to any exaggerated immune response; not all allergic reactions are atopic.
List common atopic allergic disorders.
- Allergic conjunctivitis
- Atopic dermatitis
- Urticaria and angioedema
- Allergic asthma and rhinitis
- Food allergies
- Venom reactions (e.g., bee stings)
What does the hygiene hypothesis suggest?
Reduced exposure to microbes in cleaner environments may increase atopic/allergic disorders due to an overreactive immune system.
Which 14 food allergens must be labeled due to risk of anaphylaxis?
- Celery
- Cereals (gluten)
- Crustaceans
- Eggs
- Fish
- Lupin
- Milk
- Molluscs
- Mustard
- Nuts
- Peanuts
- Sesame seeds
- Soya
- Sulphur dioxide/sulphites
What is Type II hypersensitivity and how does it cause damage?
Antibodies (IgG or IgM) bind to cell surface antigens → activate complement or cytotoxic cells → tissue damage.
Give examples of Type II hypersensitivity disorders.
- Drug-induced neutropenia and thrombocytopenia
- Hyperacute graft rejection
- Hashimoto thyroiditis
- Goodpasture syndrome
What is Type III hypersensitivity?
Involves immune complex formation (antibody + soluble antigen) that deposit in tissues and trigger inflammation via complement activation.
List examples of Type III hypersensitivity diseases.
- Serum sickness
- Systemic lupus erythematosus (SLE)
- Rheumatoid arthritis
- Hypersensitivity pneumonitis (e.g., farmer’s lung)
What is Type IV hypersensitivity?
A delayed, T-cell-mediated response involving Th1, CD8, and cytotoxic T cells causing inflammation and cytokine release.
Give examples of Type IV hypersensitivity reactions.
- Tuberculin skin test reaction
- Contact dermatitis
- Drug hypersensitivity
- Reactions to mosquito/tick bites
What role do Th0 cells play in the immune system?
Th0 cells are naïve T helper cells that differentiate into Th1, Th2, Th17, or Treg cells depending on innate signals.
What happens with weak vs. excessive immune activity?
- Weak immunity → more infections
- Excessive/improper activity → allergies and autoimmune disorders
What is organ rejection?
It’s the immune system’s response against transplanted tissues or organs, recognizing them as foreign and attacking them.
What are the three types of organ rejection?
- Hyperacute – occurs within minutes/hours (pre-existing antibodies attack graft)
- Acute – occurs days to weeks post-transplant (T-cell response)
- Chronic – occurs months to years later (gradual loss of graft function due to fibrosis)
What causes hyperacute rejection?
Pre-formed antibodies (e.g., ABO mismatch) rapidly attack the graft, activating the complement system and destroying tissue.
How does acute rejection occur?
Mainly through T-cell activation that targets donor MHC antigens, causing inflammation and tissue injury.
What is chronic rejection and how does it present?
It’s a long-term immune response causing progressive damage (fibrosis and vessel narrowing), leading to slow graft failure.
How can organ rejection be prevented?
Through HLA matching, immunosuppressive drugs (like corticosteroids, calcineurin inhibitors), and close monitoring of immune markers.
What are chronic immune diseases?
Long-term conditions caused by inappropriate immune responses, including autoimmune diseases and persistent inflammation.
Name examples of autoimmune chronic diseases.
- Systemic lupus erythematosus (SLE)
- Rheumatoid arthritis
- Hashimoto thyroiditis
- Type 1 diabetes mellitus
- Multiple sclerosis
What is the role of T cells in chronic immune diseases?
Dysregulated T-cell responses can lead to continuous inflammation, tissue damage, or failure to regulate immune tolerance.
What is the function of regulatory T cells (Tregs)?
They suppress excessive immune responses and maintain self-tolerance. Defects in Tregs can lead to autoimmunity.
What is the general treatment approach for chronic immune diseases?
- Immunosuppressants (e.g. methotrexate, corticosteroids)
- Biologics (e.g. TNF inhibitors)
- Lifestyle modifications to manage inflammation and symptoms
How does the immune system respond to cancer cells?
Through immunosurveillance — detecting tumour-specific antigens using innate and adaptive immunity. Tumour-infiltrating lymphocytes (TILs) are a positive sign of this.
Immunoediting is a process through which the immune system interacts with cancer cells.
What is cancer immunoediting and how do tumours evade immunity?
Immunoediting involves destroying or suppressing tumours, but resistant cells may survive. Tumours can suppress immunity by releasing TGF-β and IL-10, which inhibit T cells and NK cells.
Immunoediting has phases of elimination, equilibrium, and escape.
Why do transplant patients have a higher cancer risk?
Due to immunosuppression, which reduces the immune system’s ability to detect and destroy early cancer cells. Risk is 2–30x higher.
Immunosuppressive therapy is essential to prevent graft rejection.
What are primary vs secondary immunodeficiencies?
Primary (PIDs): Genetic/congenital (e.g. SCID, IgA deficiency, DiGeorge)
Secondary: Acquired from external factors (e.g. HIV, chemo, diabetes)
Primary immunodeficiencies are often diagnosed in childhood.
How does HIV/AIDS lead to immunodeficiency?
HIV destroys CD4 T cells, severely weakening immune responses and increasing infection risk.
CD4 T cells are crucial for coordinating the immune response.
What is acute inflammation and what are its signs?
Rapid response to injury/infection with redness, heat, swelling, pain, and loss of function due to increased blood flow and fluid.
Acute inflammation is a protective response that aims to eliminate the initial cause of cell injury.
What are the phases of acute inflammation?
- Initiation – blood vessels dilate, leukocytes enter tissue
- Amplification – cytokines (e.g. TNF-α, IL-1, IL-6) enhance response
- Termination – repair via angiogenesis and fibroblasts
Each phase is critical for the resolution of inflammation and tissue repair.
What triggers inflammation?
- Microbes (bacteria, viruses, fungi)
- Tissue damage (burns, trauma)
- Immune reactions (autoimmunity, hypersensitivities)
Inflammation is a complex biological response to harmful stimuli.
How is chronic inflammation different from acute?
Chronic is long-term, dominated by macrophages and lymphocytes, with less neutrophil activity. It occurs in persistent infections or autoimmune diseases.
Chronic inflammation can lead to tissue damage and contribute to various diseases.
How do Th0 cells differentiate and what are their roles?
Th0 cells → Th1, Th2, Th17, or Treg based on cytokine signals:
* Th1: cell-mediated defense
* Th2: IgE/allergy
* Th17: inflammation/autoimmunity
* Treg: suppresses immune responses
The differentiation of Th0 cells is influenced by the microenvironment and cytokine presence.
What do fibroblasts and angiogenesis do during inflammation?
- Fibroblasts repair tissue by producing collagen
- Angiogenesis restores blood flow to the healing area
These processes are essential for tissue regeneration and healing.
What are the main categories of anti-inflammatory and immunosuppressive drugs?
Antihistamines & mast cell stabilisers
Cyclo-oxygenase inhibitors (NSAIDs)
Cysteinyl-leukotriene antagonists
Glucocorticoids
DMARDs (Disease-modifying antirheumatic drugs)
Anticytokines and biopharmaceuticals
T-cell activation inhibitors
Lymphocyte proliferation inhibitors
Each category serves distinct therapeutic roles in managing inflammation and immune responses.
How do antihistamines work and what are examples?
Block H1 histamine receptors to reduce allergy symptoms.
* Sedative: chlorphenamine, promethazine
* Non-sedative: loratadine, fexofenadine, cetirizine
Antihistamines are commonly used to treat allergic reactions.
What do mast cell stabilisers do?
Prevent mast cells from releasing histamine and inflammatory mediators.
Examples: sodium cromoglicate, nedocromil sodium (used for asthma maintenance).
Mast cell stabilisers are particularly effective in asthma management.
How do NSAIDs reduce inflammation?
Inhibit COX-1 and COX-2 enzymes, reducing prostaglandin production.
Examples: ibuprofen, aspirin, diclofenac
NSAIDs are widely used for pain relief and inflammation reduction.
What is the difference between COX-1 and COX-2 inhibition?
COX-1: found in most cells; protects stomach lining → inhibition causes GI issues
COX-2: induced during inflammation → selective inhibitors (like celecoxib) reduce inflammation with fewer GI side effects but may increase heart risks
Understanding the differences helps in selecting appropriate NSAIDs.
What are the main side effects of NSAIDs?
GI: nausea, ulcers, bleeding
CV: hypertension, heart risks
Kidneys: nephropathy, insufficiency
Skin reactions
Bronchospasm (esp. aspirin-sensitive pts)
Liver and bone marrow suppression (rare)
Awareness of side effects is crucial for safe NSAID use.
How is diclofenac used and what is the max dose?
Oral: 75–150 mg/day in 2–3 doses
Topical: for local pain; thin layer applied several times/day
Max dose: 150 mg/day
Use lowest effective dose for shortest time
Diclofenac is effective for both systemic and localized pain relief.
What are the uses of aspirin and why is it avoided in children?
Low dose: prevents heart attacks (blocks TXA2 in platelets)
Avoided in children due to Reye’s syndrome, a serious brain/liver condition linked to aspirin use in viral fevers
Aspirin’s benefits must be weighed against its risks in pediatric populations.
What do cysteinyl-leukotriene (CysLT) antagonists do?
Block leukotrienes (produced by 5-lipoxygenase), reducing bronchoconstriction and inflammation in asthma.
Example: Montelukast
CysLT antagonists are important in asthma management.
What are DMARDs and when are they used?
Disease-Modifying Antirheumatic Drugs used when NSAIDs are ineffective. They aim to slow or reverse autoimmune disease progression.
Examples: methotrexate, sulfasalazine, chloroquine
DMARDs are critical in the long-term management of autoimmune diseases.
What are anticytokines and biopharmaceuticals?
Drugs that target specific immune mediators (like TNF-α or IL-6) to reduce inflammation in autoimmune diseases (e.g., rheumatoid arthritis, Crohn’s).
These therapies represent a newer class of treatment options for autoimmune conditions.
How do T-cell activation and lymphocyte proliferation inhibitors work?
T-cell inhibitors: block IL-2 production/mTOR (e.g., cyclosporine, tacrolimus, sirolimus)
Lymphocyte inhibitors: interfere with DNA synthesis (e.g., azathioprine, mycophenolate mofetil, leflunomide)
These inhibitors are often used in transplant medicine and autoimmune disease treatment.
What are the key structural features of viruses?
Genetic material: DNA or RNA, single-stranded (ss) or double-stranded (ds)
Small genome: codes only for replication
Often rely on host cells to replicate
None
What is the general process of viral infection?
Infection of host cells
Local replication
Spread
Shedding – virus exits to infect new hosts
None
What factors affect how viruses infect and damage the host?
Cellular tropism – which cells a virus targets
Binding/entry ability
Host immune defences
Degree of cell damage
None
What are the stages of viral replication within host cells?
Attachment – virus binds to host cell receptor
Penetration – virus enters cell
Uncoating – genetic material is released
Replication – host replicates viral genome
Assembly – new virus particles formed
Release – viruses exit (by lysis or budding)
None
What are the characteristics of rhinoviruses and coronaviruses?
Rhinoviruses: ssRNA, no envelope, many types → cause the common cold
Coronaviruses: ssRNA, with envelope, crown-like surface → cause common cold & COVID-19
None
How does HIV infect the body and progress to AIDS?
HIV targets CD4 T cells, lowering count within 2–6 weeks (flu-like symptoms)
Long incubation (8–10 yrs untreated)
Symptoms (e.g. weight loss, infections) appear when CD4 < 500
AIDS: CD4 < 200, life expectancy 1–3 years
None
What are the characteristics of HIV as a retrovirus?
ssRNA genome
Has envelope
Uses reverse transcriptase to insert RNA into host DNA, making host cells produce viruses
None
What is norovirus and why is it so contagious?
Causes vomiting & diarrhoea
Highly contagious, can spread for weeks
Survives up to 2 weeks on surfaces
Common in schools and hospitals
None
Name antiviral drugs and their mechanisms of action (MOA).
Aciclovir – herpes: inhibits viral DNA replication
Maraviroc – HIV: blocks CCR5 receptor to stop entry
Oseltamivir – flu: inhibits neuraminidase, prevents spread
Raltegravir – HIV: blocks integration of viral DNA
Zidovudine – HIV: inhibits reverse transcriptase
Molnupiravir – COVID-19: introduces RNA errors, stops replication
None
What is meningitis and what causes it?
Inflammation of the meninges (brain coverings) caused by viruses, bacteria, or fungi. May occur with septicaemia (blood poisoning).
What is septicaemia and its link to meningitis?
Bacteria enter the bloodstream → causes sepsis. Meningitis and septicaemia often occur together and can be life-threatening.
What are the outcomes of bacterial meningitis?
10% mortality
1 in 3 survivors have complications:
* brain damage
* hearing/sight loss
* limb loss
* scarring
Common in children, especially <5 and teenagers.
What are symptoms/signs of meningitis in babies/toddlers?
Fever, poor feeding, vomiting, irritability, high-pitched cry, floppy, seizures, bulging fontanelle.
What is the ‘glass test’ for meningitis/sepsis?
Press a glass on a rash — if it doesn’t fade (non-blanching), it’s a medical emergency.
Bacterial meningitis – causative agents and urgent treatment?
Common bacteria:
* Neisseria meningitidis
* Streptococcus pneumoniae
* Group B Strep
Urgent hospital transfer.
Empiric treatment: IV cephalosporins (ceftriaxone/cefotaxime). Add dexamethasone if >3 months old. Add amoxicillin/ampicillin if Listeria suspected (elderly/immunocompromised).
What is meningococcal disease and how is it managed?
Caused by Neisseria meningitidis (MenA, B, C, W, X, Y). May present with non-blanching rash. Treat urgently with benzylpenicillin if suspected. Close contacts may need antibiotics/vaccine.
Describe viral meningitis: cause, severity, and treatment.
More common, less fatal than bacterial.
Causes:
* Enteroviruses
* herpesviruses
* mumps
Not usually contagious.
Treatment: fluids, rest, pain/fever relief; antivirals only for suspected herpesvirus. Recovery in 7–10 days.
What is fungal meningitis and how is it treated?
Affects immunocompromised individuals.
Slower onset, milder symptoms.
Treated with amphotericin + flucytosine.
What vaccines can help prevent meningitis?
Protect against pathogens causing meningitis:
* MenACWY
* MenB
* pneumococcal
* Hib
* MMR
No vaccine for Group B Strep (S. agalactiae).
What is encephalitis and how does it differ from meningitis?
Encephalitis = inflammation of brain tissue, usually viral, can be autoimmune or tick-borne. Meningitis affects brain coverings.
What is sepsis and what is its pathophysiology?
Infection → excessive cytokine release. Capillary dilation + fluid leak → edema. Hypotension → reduced organ perfusion. Anaerobic respiration → ↑ blood lactate. Outcome = multi-organ failure, death.
What infections are linked to increased cancer risk?
HPV → cervical, anal, penile, oropharyngeal cancer.
Hepatitis B/C → liver cancer, lymphoma.
H. pylori → gastric cancer.
What is antimicrobial resistance (AMR)?
When pathogens become resistant to treatment by antibiotics, antivirals, antifungals, etc. Caused by misuse or overuse of medications.
What are superbugs and examples?
Superbugs = resistant pathogens.
Examples:
* MRSA (methicillin-resistant Staph aureus)
* C. difficile (bowel infection).
Name 3 bacterial resistance mechanisms.
- Modify antibiotic target site
- Alter uptake
- Inactivate antibiotic.
What is co-amoxiclav and how does it work?
Combination of amoxicillin + clavulanic acid. Clavulanic acid = beta-lactamase inhibitor → prevents bacteria from destroying amoxicillin.
What is antimicrobial stewardship?
Organisational approach promoting careful, effective, and appropriate antimicrobial use to preserve future treatment efficacy.
When should someone with a cold/flu see a GP?
Symptoms worsen after 7 days.
Chest pain, breathlessness.
Blood in sputum.
Rash develops.
Who is eligible for free flu vaccination?
Age 65+
Chronic conditions (e.g. asthma, diabetes, kidney, heart disease)
Immunocompromised
Pregnant
Carers, care home residents, healthcare workers.
What is pharmacogenomics and why is it important?
Study of how genes affect individual drug response. Helps personalize treatment and identify resistance genes in pathogens.
What is spirometry used for?
Spirometry is a diagnostic test that evaluates lung health and is used to diagnose respiratory conditions like asthma, COPD, and other lung diseases. It measures inhalation and exhalation capabilities.
What are the main types of lung volumes measured in spirometry?
- Tidal Volume – Air inhaled/exhaled during normal breathing
- Residual Volume – Air remaining in the lungs after exhaling
- Inspiratory Reserve Volume – Extra air that can be inhaled after normal inhalation
- Expiratory Reserve Volume – Extra air that can be exhaled after normal exhalation
What are respiratory capacities?
Respiratory capacities are combinations of lung volumes, including:
* Inspiratory Capacity
* Functional Residual Capacity
* Vital Capacity
* Total Lung Capacity
What is the role of surfactant in the lungs?
Surfactant reduces surface tension in the alveoli to prevent them from collapsing during exhalation, aiding in efficient gas exchange and helping with lung compliance.
Why do premature babies struggle with breathing?
Premature babies often have low levels of surfactant, which leads to respiratory distress syndrome. Postnatal surfactant therapy is used to treat this condition.
How does aging affect respiratory health?
With age, lung function declines due to:
* Loss of elastic tissue
* Ribcage calcification (reduced chest wall flexibility)
* Weakened diaphragm and intercostal muscles
* Reduced ciliary function in airways and fewer macrophages in alveoli
What is an Upper Respiratory Tract Infection (URTI)?
URTI is an infection of the nose, sinuses, pharynx, larynx, and large airways, typically caused by viruses or bacteria.
What are common treatments for URTI?
- Decongestants (e.g., pseudoephedrine) to reduce nasal swelling
- Antihistamines for allergy-related symptoms
- Analgesics like ibuprofen or paracetamol for pain and fever
- Cough suppressants (e.g., dextromethorphan) and Expectorants (e.g., guaifenesin)
What are decongestants, and how do they work?
Decongestants are medications (e.g., phenylephrine, oxymetazoline) that constrict blood vessels in the nasal passages to reduce swelling and improve airflow.
When should you seek medical attention for URTI?
Seek medical help if:
* The patient has underlying conditions like heart disease or asthma
* Severe symptoms like wheezing, chest pain, or coughing up blood occur
* Symptoms persist beyond 3 weeks or worsen
* There’s a high fever, confusion, or difficulty breathing
What is the function of Type II alveolar cells?
Type II alveolar cells secrete surfactant, a phospholipid that reduces surface tension and prevents alveolar collapse during expiration.
What is the pathophysiology of sepsis?
Sepsis involves:
* Infection by an organism
* Excessive cytokine release
* Amplification of the immune response, leading to capillary dilation, increased permeability, and tissue edema
* Hypotension, organ failure, and potentially death
What is the most common cause of bacterial meningitis in babies?
Group B Streptococcus (Streptococcus agalactiae) is the main cause of bacterial meningitis in babies, particularly in those under 1 month old.
How can viral meningitis be treated?
Viral meningitis is generally less severe than bacterial meningitis and is treated with supportive care such as fluids and symptom management for fever and pain.
What are the main categories of bacterial meningitis?
- Meningococcal meningitis – Caused by Neisseria meningitidis
- Pneumococcal meningitis – Caused by Streptococcus pneumoniae
- Group B Streptococcal meningitis – Common in infants
What are the signs of meningitis or sepsis in babies and toddlers?
Symptoms include:
* High fever
* Vomiting
* Irritability
* Poor feeding
* Abnormal crying
* Rash (which may not fade under pressure)
What should you do when suspecting bacterial meningitis?
Immediate transfer to a hospital is critical. Antibiotics like benzylpenicillin are given as soon as possible, especially if meningococcal meningitis is suspected.
What is the main difference between bacterial and viral meningitis?
Bacterial meningitis is more severe, often fatal, and requires antibiotics. Viral meningitis is usually less severe but can still have long-term effects.
How is bacterial resistance to antibiotics developed?
Bacteria can develop resistance through:
* Modifying the target site of antibiotics
* Altering antibiotic uptake
* Inactivating the antibiotic
What is ‘antimicrobial stewardship’?
Antimicrobial stewardship is a healthcare approach that promotes the appropriate use of antibiotics to reduce the development of resistance and preserve their effectiveness.
What is the role of vaccines in preventing meningitis?
Vaccines help protect against common pathogens that cause meningitis, such as Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae.
What is the Human Papillomavirus (HPV), and how does it relate to cancer risk?
HPV is a virus that can lead to cancers such as cervical, anal, penile, and oropharyngeal cancers. It is sexually transmitted.
What are ‘superbugs’?
Superbugs are pathogens that have developed resistance to multiple antibiotics, making them harder to treat.
What are the common signs of an upper respiratory tract infection (URTI)?
Symptoms of a URTI include:
* Nasal congestion
* Sore throat
* Cough
* Mild fever
* Sneezing
How are cold and flu symptoms managed?
- Antipyretics like paracetamol or ibuprofen for fever
- Decongestants for nasal congestion
- Hydration and rest to support the immune system
When should you avoid using decongestants?
Decongestants should not be used in children, pregnant or breastfeeding women, or those with hypertension.
What are common ingredients in inhalants used for respiratory conditions?
- Menthol
- Eucalyptus oil
- Camphor
- Methyl salicylate
- Peppermint oil
What is the purpose of cough suppressants?
Cough suppressants like codeine or dextromethorphan reduce the urge to cough by acting on the brain’s cough center.
When should antibiotics be used for URTI?
Antibiotics are not typically used for viral URTIs. They may be prescribed if a bacterial infection is confirmed.
What are the dangers of misusing antibiotics?
Misusing antibiotics can contribute to antibiotic resistance, making infections harder to treat.
What are the potential long-term effects of viral meningitis?
Long-term effects of viral meningitis can include headaches, fatigue, memory problems, and occasional cognitive difficulties.
What is rhinitis?
Rhinitis refers to inflammation of the nasal mucous membranes, which can be caused by infections (viral or bacterial), allergens, or other irritants. It can be acute or chronic.
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What are the two main types of rhinitis?
- Acute Rhinitis – Usually caused by viral infections such as the common cold.
- Chronic Rhinitis – Persistent symptoms that last for more than 12 weeks, often due to allergies or other underlying conditions.
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What are common symptoms of rhinitis?
- Nasal congestion
- Sneezing
- Runny nose (rhinorrhea)
- Facial pain or pressure (sinus pain)
- Reduced sense of smell
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What are ‘red flag’ symptoms for rhinitis or sinus infection?
- High fever (over 38°C or 100.4°F)
- Severe facial pain
- Persistent symptoms lasting longer than 10 days
- Unilateral (one-sided) symptoms
- Presence of blood in nasal discharge
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What is the main treatment for acute viral rhinitis?
- Symptomatic treatment:
- Analgesics like acetaminophen or ibuprofen for pain.
- Decongestants (nasal sprays or oral) for nasal congestion.
- Rest, hydration, and humidified air to help relieve symptoms.
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When should antibiotics be used for rhinitis?
Antibiotics should only be used for bacterial rhinitis or when there is a secondary bacterial infection (e.g., bacterial sinusitis). They are not recommended for viral infections.
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What is acute bacterial rhinosinusitis?
This condition occurs when a bacterial infection causes inflammation of the sinuses, often following a viral upper respiratory infection. Symptoms may include:
* Facial pain or pressure
* Nasal congestion
* Fever
* Thick, yellow/green nasal discharge
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How is acute bacterial rhinosinusitis treated?
- First-line treatment:
- Antibiotics (e.g., amoxicillin-clavulanate).
- Symptomatic treatment:
- Analgesics (acetaminophen, ibuprofen).
- Nasal saline irrigation or sprays.
- Decongestants (if not contraindicated).
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What is chronic rhinitis, and how is it managed?
Chronic rhinitis involves persistent inflammation of the nasal mucosa, often due to allergies, irritants, or nasal polyps. Management includes:
* Antihistamines for allergic rhinitis.
* Intranasal corticosteroids for inflammation.
* Avoiding triggers such as allergens or irritants.
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What are common causes of allergic rhinitis?
- Pollen
- Dust mites
- Animal dander
- Mold
- Cockroach allergens
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What is the role of nasal corticosteroids in treating rhinitis?
Nasal corticosteroids help reduce inflammation in the nasal passages, making them effective for treating both allergic rhinitis and chronic rhinitis symptoms. They are usually the first-line treatment for chronic rhinitis.
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What are the complications of untreated chronic rhinitis?
- Nasal polyps
- Chronic sinus infections
- Sleep disturbances
- Impaired sense of smell
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How do you differentiate between viral and bacterial rhinitis/sinusitis?
- Viral rhinitis usually improves within 7-10 days with no fever or only mild fever.
- Bacterial rhinosinusitis has more severe symptoms, such as persistent fever, purulent nasal discharge, and facial pain, lasting longer than 10 days.
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What are first-line treatments for allergic rhinitis?
- Antihistamines (oral or intranasal).
- Intranasal corticosteroids for inflammation.
- Decongestants (short-term use).
- Avoidance of known allergens.
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What should be considered if rhinitis symptoms do not resolve with standard treatments?
- Referral to a specialist (e.g., an ENT or allergist) might be necessary for further evaluation, especially if there are concerns of chronic sinusitis or nasal polyps.
- Imaging (CT scan) may be used to evaluate sinus involvement.
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What is the typical duration of acute viral rhinitis?
Acute viral rhinitis typically lasts for 7-10 days. If symptoms persist beyond 10 days or worsen, consider a bacterial cause.
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What are the characteristics of first-generation antihistamines?
First-generation antihistamines cause sedation and drowsiness. Common side effects include dry mouth and blurred vision.
Provide an example of a first-generation antihistamine.
Chlorpheniramine is a common first-generation antihistamine used for allergic reactions.
What are the characteristics of second-generation antihistamines?
Second-generation antihistamines are less sedating and have fewer central nervous system side effects.
Give examples of second-generation antihistamines.
Cetirizine, loratadine, and fexofenadine are common second-generation antihistamines.
What are the benefits of topical nasal antihistamines?
They help relieve nasal symptoms of allergic rhinitis by blocking histamine receptors directly in the nasal passage.
Give an example of a topical nasal antihistamine.
Azelastine is a topical nasal antihistamine used to treat allergic rhinitis.
What is the primary action of intranasal corticosteroids?
Intranasal corticosteroids reduce inflammation in the nasal passages, helping to control allergic rhinitis symptoms.
Provide examples of intranasal corticosteroids.
Fluticasone, budesonide, and mometasone are examples of intranasal corticosteroids.
How do decongestants work?
Decongestants reduce nasal congestion by constricting blood vessels in the nasal mucosa, which decreases swelling.
What are common decongestants used for allergic rhinitis?
Pseudoephedrine and oxymetazoline are commonly used decongestants.
What is the purpose of saline nasal sprays?
Saline nasal sprays help moisten nasal passages and clear mucus, providing relief from nasal congestion.
Are saline nasal sprays safe for everyone?
Yes, saline nasal sprays are safe for most individuals, including pregnant women and those with respiratory conditions.
How does cromolyn sodium work in treating allergic rhinitis?
Cromolyn sodium prevents the release of histamine and other inflammatory chemicals from mast cells, helping to control allergic reactions.
What is a common approach for managing allergic rhinitis symptoms?
First-line treatment includes antihistamines (oral or nasal) and corticosteroids, combined with decongestants for severe symptoms.
What are some non-pharmacological treatments for allergic rhinitis?
Avoiding allergens, using air purifiers, and saline nasal irrigation are helpful non-pharmacological treatments.
Which treatments are safe for managing allergic rhinitis during pregnancy?
Saline nasal sprays, certain antihistamines like loratadine, and intranasal corticosteroids like budesonide are considered safe during pregnancy.
Which medications should be avoided during pregnancy for allergic rhinitis?
Oral decongestants, particularly pseudoephedrine, should be avoided during pregnancy due to potential risks to the fetus.
What are the types of non-allergic rhinitis?
Common types include vasomotor rhinitis, hormonal rhinitis, and drug-induced rhinitis.
What triggers vasomotor rhinitis?
Vasomotor rhinitis is typically triggered by irritants like smoke, strong odors, or changes in weather, rather than allergens.
What is vasomotor rhinitis?
It is a type of non-allergic rhinitis where symptoms are triggered by environmental factors like temperature or air quality rather than allergens.
How is vasomotor rhinitis managed?
Management includes avoiding environmental triggers, using nasal saline sprays, and occasionally using intranasal steroids or antihistamines for relief.
What environmental factors can trigger non-allergic rhinitis?
Temperature changes, air pollution, and exposure to strong odors are common triggers of non-allergic rhinitis.
What medications commonly cause drug-induced rhinitis?
Common culprits include nasal decongestant sprays (when used longer than recommended), aspirin, and beta-blockers.
What are the key symptoms of the common cold?
Symptoms include a runny nose, sore throat, cough, congestion, and sometimes mild fever.
What is the main treatment for the common cold?
Supportive treatments such as rest, hydration, and symptomatic relief with pain relievers and decongestants.
How is influenza different from the common cold?
Influenza tends to have a more abrupt onset, with symptoms like high fever, body aches, chills, and fatigue, while the common cold has milder symptoms.
What antiviral medications are used to treat influenza?
Oseltamivir (Tamiflu) and zanamivir are antiviral medications used to treat the flu.
How is influenza managed?
Treatment includes antiviral medications (if prescribed early), rest, fluids, and fever management. Severe cases may require hospitalization.
What are some prevention strategies for allergic rhinitis and asthma?
These include avoiding allergens, using air filters, ensuring proper ventilation, and getting vaccinated for flu and pneumonia.
Are nasal corticosteroids safe for long-term use?
Yes, nasal corticosteroids are generally safe for long-term use when used correctly, but they may have side effects like nasal dryness and irritation.
What are common tests for diagnosing allergies?
Skin prick tests and blood tests (like the RAST test) are commonly used to diagnose specific allergens.
What is asthma, and what are the primary symptoms?
Asthma is a chronic inflammatory disease of the airways, leading to episodes of wheezing, shortness of breath, chest tightness, and coughing. Symptoms are often worse at night or in the early morning and may be triggered by allergens, irritants, respiratory infections, or exercise.
What is the pathophysiology of asthma?
Inflammation: The airway lining becomes inflamed, leading to increased mucus production and airway swelling.
Bronchoconstriction: Smooth muscle tightening occurs in the airways, causing narrowing and difficulty in breathing.
Hyperresponsiveness: The airways become excessively responsive to triggers, leading to a heightened inflammatory response.
Mucus Production: Overproduction of mucus contributes to airway obstruction.
What are the common triggers for asthma exacerbations?
Allergens: Dust mites, pollen, mold, pet dander.
Respiratory Infections: Viral infections like the common cold or flu.
Environmental Irritants: Smoke, air pollution, strong odors, chemical fumes.
Exercise: Exercise-induced asthma may occur with physical activity.
Weather: Cold, dry air or sudden changes in temperature can trigger asthma symptoms.
How is asthma diagnosed?
Medical History: Review of symptoms, family history of asthma or allergies.
Spirometry: Measures airflow, specifically FEV1 (Forced Expiratory Volume in 1 second) and FVC (Forced Vital Capacity).
FEV1/FVC ratio: A lower ratio suggests airway obstruction.
Bronchodilator reversibility test: Evaluates how much airflow improves after using a bronchodilator.
Peak Flow Monitoring: Measurement of how fast a patient can exhale.
What medications are used for long-term control of asthma?
Inhaled Corticosteroids (ICS): Reduce inflammation in the airways, preventing asthma attacks. Examples include fluticasone, budesonide.
Long-Acting Beta-Agonists (LABAs): Help keep airways open. Used in combination with ICS. Examples include salmeterol and formoterol.
Leukotriene Modifiers: Block the action of leukotrienes, chemicals that cause inflammation. Examples include montelukast and zafirlukast.
Theophylline: A bronchodilator that relaxes the muscles around the airways.
What are the quick-relief medications for asthma?
Short-Acting Beta-Agonists (SABAs): Rapidly relieve acute bronchoconstriction. Examples include albuterol, levalbuterol.
Anticholinergics: Reduce mucus production and help open the airways. Example: ipratropium bromide.
Oral Corticosteroids: Used for severe exacerbations, e.g., prednisone.
What is the management of an asthma exacerbation?
Immediate Treatment:
SABAs (e.g., albuterol) are used for rapid relief.
Oral Corticosteroids may be given for moderate to severe exacerbations.
Oxygen Therapy: Used if oxygen saturation levels are low.
Monitoring: Continuous monitoring of symptoms and peak flow to determine if additional treatments are necessary.
Hospitalization: In severe cases where symptoms do not improve with initial treatments.
What is the stepwise approach to asthma management?
Step 1: Intermittent Asthma – Use SABAs for quick relief as needed.
Step 2: Mild Persistent Asthma – Add low-dose ICS or leukotriene modifiers.
Step 3: Moderate Persistent Asthma – Increase ICS dose or add LABAs.
Step 4: Severe Persistent Asthma – Use high-dose ICS and LABAs, consider biologics.
Step 5: Very Severe Asthma – Add biologics (e.g., omalizumab) or oral corticosteroids.
What are the key considerations for managing asthma in children?
Age-appropriate medications: Use medications suitable for children’s age and weight.
Inhaler technique: Proper use of inhalers or spacers is crucial for effective drug delivery.
Frequent monitoring: Use peak flow meters to track symptoms and adjust treatment.
Education: Teach children and parents how to recognize early signs of asthma attacks.
What impact does smoking have on asthma?
Worsens asthma symptoms: Smoking irritates the airways, leading to more frequent and severe asthma attacks.
Reduces the effectiveness of asthma medications.
Increases the risk of developing chronic obstructive pulmonary disease (COPD).
What are common comorbidities associated with asthma?
Allergic Rhinitis, Gastroesophageal Reflux Disease (GERD), Obesity, Sinusitis, Sleep Apnea
These comorbidities can exacerbate asthma symptoms and complicate management.
What are biologic therapies for asthma, and when are they used?
Biologic therapies target specific immune system pathways for severe asthma not controlled by standard treatments. Examples include:
* Omalizumab (targets IgE)
* Mepolizumab and Benralizumab (target IL-5)
* Dupilumab (targets IL-4 and IL-13)
These therapies are tailored for specific asthma phenotypes.
What is the role of the pharmacist in asthma management?
Medication Management, Patient Education, Monitoring, Adherence Support, Collaborative Care
Pharmacists play a critical role in ensuring effective asthma management and medication adherence.
What are some common triggers for asthma exacerbations?
Environmental Factors, Respiratory Infections, Allergens, Exercise, Irritants
Identifying and avoiding these triggers is essential for asthma control.
What are the different types of inhalers, and how are they used?
Types include:
* Metered-Dose Inhalers (MDIs)
* Dry Powder Inhalers (DPIs)
* Nebulizers
Technique varies by type, ensuring proper inhalation is crucial.
What is important to consider when managing asthma in pregnant patients?
Maintaining Asthma Control, Medications, Monitoring
Keeping asthma under control is vital to prevent risks to both mother and fetus.
How is asthma managed in elderly patients?
Coexisting Conditions, Polypharmacy, Inhaler Technique, Medication Choice
Special considerations are necessary due to the complexity of treatment in older adults.
What are the pregnancy categories of asthma medications?
Inhaled Corticosteroids (ICS): Category C, Albuterol (SABA): Category C, Montelukast: Category B, Oral Corticosteroids: Category C
Category B drugs are generally considered safer during pregnancy.
Does diet play a role in asthma management?
Omega-3 Fatty Acids, Vitamin D, Antioxidants, Avoidance of Triggers
Certain dietary components may help improve asthma control.
What are Leukotriene Receptor Antagonists used for and how do they work?
They are used for prophylaxis of asthma by blocking leukotrienes, reducing bronchoconstriction and mucus secretion.
Examples include Montelukast and Zafirlukast.
How are Leukotriene Receptor Antagonists administered and what are their common side effects?
Administered orally. Common side effects include GI disturbance, dry mouth, headache.
Side effects may vary by individual.
What is the mechanism of action of Mast-Cell Stabilizers?
They stabilize antigen-sensitized mast cells, reducing calcium influx and mediator release.
Useful in young patients with allergic disease and moderate asthma.
How are Glucocorticoids used in asthma treatment, and what are their side effects?
They reduce inflammation by inhibiting cytokine release. Side effects include oral candidiasis, hoarse voice, dysphonia.
Regular use is essential for effectiveness.
What is the role of Anti-IgE drugs in asthma treatment?
They bind to free IgE, preventing it from binding to mast cells.
Used in severe asthma requiring continuous corticosteroid treatment.
How do Mucolytics help in COPD?
They reduce the viscosity of sputum, aiding expectoration and reducing exacerbations.
This can lead to improved symptoms and quality of life.
What are the main treatment options for Pneumonia?
Antibiotics like amoxicillin, clarithromycin, doxycycline.
Treatment varies based on the causative organism and patient factors.
What is Inhalation Therapy, and what are its types?
Preferred method for drug delivery to the lungs. Types include nebulizers, metered-dose inhalers (MDIs), soft mist inhalers (SMIs), dry powder inhalers (DPIs).
Effective delivery is crucial for managing respiratory conditions.
What are the advantages and disadvantages of Nebulizers and DPIs?
Nebulizers: higher doses, useful in hospitals, but expensive and need power. DPIs: portable, require technique, moisture-sensitive.
Each type has its specific use cases and limitations.
How do spacers improve MDI use?
They improve drug delivery by reducing oropharyngeal deposition and aiding patient coordination.
Spacers can enhance the effectiveness of MDIs for many patients.
What factors should be considered when choosing an inhaler?
Ease of use, patient capability, drug availability, device portability, cost, side effects, patient preferences.
Personalization is key in effective asthma management.
What are key patient considerations for treating pneumonia?
Pneumonia risk factors include:
* Asthma
* Cancer
* Heart disease
* Diabetes
* Recovery from cold/flu
Individuals in these groups may be offered a pneumococcal vaccine.
What should be evaluated when treating COPD?
When treating COPD, evaluate:
* Choice of treatment (e.g., mucolytics, bronchodilators)
* Context of exacerbations
* Chronic cough
Careful evaluation is essential for effective management.
What factors should be considered for asthma patients?
Consider the following factors for asthma patients:
* Age
* Ability to use inhalers correctly
* Need for combination therapy (e.g., B2-agonists with corticosteroids)
These factors influence treatment effectiveness.
What is the importance of inhaler use education?
Patient education on inhaler use is crucial:
* Correct use of device (MDI, DPI, nebulizer)
* Understanding proper technique
* Adherence to treatment
Effective inhaler use enhances drug delivery.
What does MART (Maintenance-Reliever Therapy) combine?
MART combines:
* Long-acting beta-agonist (LABA)
* Corticosteroid
This combination is used for both maintenance and acute treatment.
What is the role of a fast-acting LABA like formoterol in MART?
A fast-acting LABA, such as formoterol, provides:
* Immediate bronchodilation
It is essential for MART to be effective as reliever therapy.
Why is salmeterol unsuitable for MART?
Salmeterol is unsuitable for MART because:
* It is not fast-acting enough for effective reliever therapy
Fast action is necessary for reliever medications.
How does steroid dosage change during MART therapy?
Steroid dosage during MART therapy:
* Increases as condition worsens and more reliever doses are used
* Decreases back to maintenance level as condition improves
This adjustment helps manage symptoms effectively.
When should high-flow O2 be administered in respiratory distress?
High-flow O2 should be given unless:
* Patient has COPD
* Hypoxic drive is present
In these cases, lower oxygen concentrations are recommended.
What is the optimal particle size for inhaled beta-2 agonists?
The ideal particle size for beta-2 agonists is:
* 2-5 microns
This size ensures effective deposition in the proximal-distal airways.
What is the optimal particle size for inhaled corticosteroids?
The optimal particle size for inhaled corticosteroids is:
* 1-5 microns
This size ensures deposition throughout the respiratory tract.
What factors affect the deposition of inhaled drugs in the lungs?
Factors affecting deposition include:
* Inhaler device
* Inhalation technique
* Particle size of the aerosol
These factors are critical for effective drug delivery.
What is the purpose of a metered-dose inhaler (MDI)?
An MDI requires:
* Slow and deep inhalation
* Coordination to ensure medication reaches the lungs
Proper technique minimizes oral deposition.
How does using a spacer with an MDI improve medication delivery?
Using a spacer improves delivery by:
* Reducing oropharyngeal deposition
* Enhancing lung deposition
This is especially beneficial for patients with inhaler coordination issues.
What is required for effective use of dry powder inhalers (DPIs)?
DPIs require:
* Rapid, forcible inhalation
This generates turbulent energy to disaggregate the powder into smaller particles.
Why is shaking an MDI essential before use?
Shaking an MDI ensures:
* Uniform drug dose in the aerosol
This is crucial for consistent medication delivery.
What are the hazards of smoking?
Smoking leads to:
* Respiratory diseases
* Cardiovascular issues
* Cancer
* Lower blood oxygen levels
* Paralysis of cilia
* Lung damage
These factors contribute to COPD and lung cancer.
What chemicals in tobacco smoke contribute to health risks?
Tobacco smoke contains:
* Carcinogens (e.g., polycyclic aromatic hydrocarbons)
* Ammonia
* Arsenic
* Benzene
* Cadmium
* Carbon monoxide
These compounds pose significant health risks.
How does smoking affect pregnancy?
Smoking during pregnancy increases the risk of:
* Reduced oxygen supply to the baby
* Miscarriage
* Low birth weight
* Sudden infant death syndrome (SIDS)
* Nicotine withdrawal after birth
These effects can have lasting implications for infant health.
What are the main withdrawal symptoms when quitting smoking?
Withdrawal symptoms include:
* Irritability
* Anxiety
* Insomnia
* Lack of concentration
* Low mood
Symptoms typically last for about two weeks.
What are the benefits of smoking cessation?
Benefits of smoking cessation include:
* Reduced risk of respiratory diseases
* Lower cancer risk
* Decreased cardiovascular diseases
* Improved overall health
* Increased life expectancy
Quitting smoking has profound health benefits.
What are some methods to support smoking cessation?
Methods to support smoking cessation include:
* Nicotine replacement therapy (NRT)
* Behavioral counseling
* Acupuncture
* Hypnotherapy
* Avoiding triggers (e.g., ashtrays, lighters)
These approaches can help individuals quit successfully.
How do e-cigarettes compare to traditional cigarettes?
E-cigarettes do not contain:
* Carcinogens
* Tar
However, they may cause skin irritation or nausea and should be used cautiously.
What is the role of a pharmacist in smoking cessation?
A pharmacist’s role includes:
* Identifying patients
* Providing education
* Selecting appropriate products
* Offering support in the smoking cessation cycle
Pharmacists play a vital role in promoting smoking cessation.
What is the relationship between nicotine and dopamine?
Nicotine stimulates nicotinic receptors in the brain, which triggers the release of dopamine, causing pleasurable effects and reinforcing the addiction to nicotine.
What are some common barriers to smoking cessation?
Barriers include:
* weight gain
* social pressures
* withdrawal symptoms
* previous failed attempts
* high costs of cessation aids
* enjoyment of smoking.
How does smoking affect cardiovascular health?
Nicotine causes an increase in heart rate, blood pressure, and vasoconstriction, contributing to cardiovascular disease, including heart attacks and strokes.
What is nicotine replacement therapy (NRT) and how does it help?
NRT provides a controlled dose of nicotine to ease withdrawal symptoms, helping individuals quit smoking gradually by reducing cravings and withdrawal effects.
What are the benefits of using nicotine patches in smoking cessation?
Nicotine patches provide a steady release of nicotine over 16 to 24 hours, helping to reduce cravings and withdrawal symptoms throughout the day.
How do e-cigarettes work?
E-cigarettes are battery-powered devices that vaporize a nicotine solution, delivering nicotine through inhalation without the harmful tar and carcinogens found in traditional cigarettes.
What are the potential side effects of using e-cigarettes?
Side effects may include:
* skin irritation
* coughing
* dry mouth
* nausea
E-cigarettes may also lead to a sense of dependence or continued smoking behavior.
What role do spacers play in inhaler therapy?
Spacers help reduce the likelihood of the medication depositing in the oropharynx and improve the amount of drug reaching the lungs by allowing more time for inhalation.
What are some common challenges with using dry powder inhalers (DPIs)?
Common challenges include:
* patients not generating enough inhalation flow, leading to ineffective dose delivery
* difficulties in disaggregating the powder particles for lung deposition.
Why is it important for patients to ‘hold their breath’ after inhaling from an MDI?
Breath-holding helps the medication settle in the lungs and increases its effectiveness. Inhaling too quickly can lead to deposition in the mouth and throat instead of the lungs.
