Week 5 lecture 1 Flashcards
What is characterized by a heightened sensitivity to a foreign protein?
Allergy
Allergens can be encountered through ingestion, contact, or inhalation.
Define rhinitis.
Eosinophilic inflammation of the nasal mucosa and paranasal sinuses due to an IgE-mediated reaction.
What are the main manifestations of allergic rhinitis?
- Nasal congestion
- Obstructed airflow
- Increased mucous production
- Drainage
What is the initial phase required for the onset of allergic rhinitis in an atopic individual?
Sensitization
What do antigen-presenting cells do during the sensitization phase?
Assimilate a low-dose exposure of the antigen and present it to helper T lymphocytes.
What cytokines do activated helper T lymphocytes produce?
- IL-4
- IL-5
- IL-13
What happens upon subsequent exposure to the allergen?
The specific antigen binds to two distinct IgE antibodies on mast cells, triggering activation.
What are the hallmark acute symptoms of allergic rhinitis?
- Rhinorrhea
- Nasal congestion
- Nasal irritation
- Sneezing
When does the late phase response of allergic rhinitis occur?
4-6 hours after antigen stimulation.
What mediators are released during the late phase response of allergic rhinitis?
- Cytokines
- Leukotrienes
- Histamine
What is a significant risk factor for developing allergic rhinitis?
Atopy
What are common food allergens that cause allergic rhinitis in infancy and childhood?
- Milk
- Eggs
- Soy
- Wheat
What role does gut microbiota play in allergic disease pathogenesis?
Gut microbiota composition is influenced by diet and may impact immune responses.
Name the four main classes of microbiomes.
- Bacteroidetes
- Actinobacteria
- Firmicutes
- Proteobacteria
What is dysbiosis?
An imbalance in the gut microbiota associated with atopy.
What is the relationship between Th1/Th2 homeostasis and allergic rhinitis?
Disruption can affect immunotolerance and increase the risk of allergic rhinitis.
What are common clinical features of allergic rhinitis?
- Clear and watery nasal discharge
- Nasal congestion
- Postnasal drip
- Itching of the nose, throat, and eyes
What physical examination findings may indicate allergic rhinitis?
- Mouth breathing
- Transverse supra-tip nasal crease
- Dark circles under the eyes
What distinguishes seasonal allergic rhinitis from perennial allergic rhinitis?
Seasonal occurs due to pollination; perennial is constant without seasonal variation.
What is a complication of allergic rhinitis that can lead to ear problems?
Eustachian tube dysfunction
What is rhinitis medicamentosa?
Nasal congestion caused by the overuse of topical nasal decongestants.
What hormonal changes during pregnancy contribute to rhinitis?
Increased estrogen concentrations lead to nasal congestion and edema.
What is the primary symptom of nonallergic rhinitis?
Nasal obstruction
What is the most common form of nonallergic rhinitis?
Vasomotor rhinitis
What are potential environmental triggers for vasomotor rhinitis?
- Strong odors
- Cold air exposure
- Alcohol consumption
- Spicy foods
What is chronic rhinosinusitis defined as?
Inflammation of the nasal cavity and paranasal sinuses lasting more than 12 weeks.
What is Wegener granulomatosis associated with?
Cocaine abuse
It is important to assess the size and character of turbinates and rhinorrhea.
Define chronic rhinosinusitis (CRS).
Inflammation of the nasal cavity and paranasal sinuses lasting more than 12 weeks.
What are the common symptoms of chronic rhinosinusitis?
- Nasal obstruction (81% to 95%)
- Facial congestion, pressure, and fullness (70% to 85%)
- Discolored nasal discharge (51% to 83%)
- Hyposmia (61%–69%)
What is a significant cause of bacterial growth in chronic rhinosinusitis?
Chronic inflammation blocking nasal passage and inhibiting drainage.
List some factors hypothesized to cause chronic rhinosinusitis.
- Biofilms
- Bacterial superantigens
- Osteitis
- Allergy
- Barrier and innate immune dysregulation
- General host factors
True or False: High fevers are commonly seen in patients with chronic rhinosinusitis.
False.
What are nasal polyps?
Benign inflammatory and hyperplastic growths from the sinonasal mucosa.
What is the primary cause of the majority of nasal polyps?
T-helper 2 (Th2) cell-driven eosinophilia and IgE inflammation.
What are the clinical features of nasal polyposis?
- Progressive nasal obstruction
- Facial congestion
- Decreased sense of smell
- Rhinorrhea
What is a deviated septum?
A wall composed of osteocartilaginous tissue that separates two nasal cavities.
List some clinical presentations of nasal septal deviation.
- Headaches
- Rhinosinusitis
- High blood pressure
- Obstructive sleep apnea
What is acute pharyngotonsillitis primarily caused by?
Viruses (most common) or bacteria.
What are common symptoms of acute pharyngotonsillitis?
- Fever
- Malaise
- Odynophagia
- Dysphagia
- Foul breath
Which viruses are common pathogens for acute pharyngotonsillitis?
- Adenoviruses
- Rhinoviruses
- Coronaviruses
- Epstein-Barr viruses (EBVs)
- Cytomegaloviruses (CMVs)
- Coxsackieviruses
- Herpes simplex viruses
- Influenza viruses
What is the incubation period for Epstein-Barr virus (EBV)?
2 to 6 weeks.
What is a key characteristic of acute Streptococcal pharyngotonsillitis?
Fever, sore throat, cervical lymphadenopathy, dysphagia, and odynophagia.
What are nonsuppurative complications of acute streptococcal pharyngotonsillitis?
- Scarlet fever
- Acute rheumatic fever
- Poststreptococcal glomerulonephritis
- Pediatric autoimmune neuropsychiatric disorder associated with GABHS infection (PANDAS)
What is a peritonsillar abscess?
Infection spreading from the superior pole of the tonsil into the space between the tonsillar capsule and the pharyngeal muscle bed.
What are the typical symptoms of a peritonsillar abscess?
- Severe pain
- Odynophagia
- Muffled voice
- Dysphagia
What is pharyngeal diphtheria caused by?
Corynebacterium diphtheriae.
What are the symptoms of pharyngeal diphtheria?
- Acute pharyngitis
- Grayish, tightly adherent pseudomembrane covering tonsils
- Potential airway compromise
Fill in the blank: Viral infections are responsible for approximately ______% of acute pharyngotonsillitis cases.
70 to 85%
What potential toxicities are associated with C. diphtheriae exotoxins?
Cardiac toxicity and neurotoxicity
C. diphtheriae can lead to serious health complications due to its exotoxins.
Which sexually transmitted diseases can cause tonsillar infections?
Neisseria gonorrhoeae and Treponema pallidum
These pathogens can lead to significant throat infections.
How do gonococcal infections typically present?
As an exudative pharyngitis
This presentation is common in tonsillar infections caused by Neisseria gonorrhoeae.
What are the symptoms of primary oral syphilis?
Painless chancre on the lips, buccal mucosa, or oropharynx
Primary oral syphilis can lead to lesions in the oral cavity.
What symptoms can secondary syphilis cause in the oropharynx?
Oropharyngeal and tonsillar ulcers, bilateral tonsillar hypertrophy
These symptoms indicate a more advanced stage of syphilis.
What causes oropharyngeal candidiasis, also known as ‘thrush’?
Overgrowth of Candida albicans
This condition often occurs in immunosuppressed patients.
What examination finding is typical for oropharyngeal candidiasis?
White cottage cheese-like plaques that bleed when removed
This is a characteristic sign seen during examination.
What characterizes recurrent acute tonsillitis?
Several episodes of acute tonsillitis with complete recovery in between
The pattern of infection can lead to chronic issues.
Which bacteria are most frequently isolated in recurrent tonsillitis?
- Streptococcus pneumoniae
- Staphylococcus aureus
- Haemophilus influenzae
These bacteria contribute to the recurrent nature of tonsillitis.
What are the symptoms of chronic tonsillitis?
Sore throat for at least three months, tonsillar inflammation, halitosis, persistent tender cervical adenopathy
Chronic tonsillitis can significantly affect quality of life.
What are tonsilloliths?
Microbial biofilms that form within tonsillar crypts
They are linked to chronic cryptic tonsillitis and halitosis.
What is a common association with the cause of aphthous ulcers?
Human herpesvirus 6
The exact cause remains uncertain, but this virus is frequently mentioned.
What is the appearance of a minor aphthous ulcer?
Smaller than 1 cm in diameter, heals in 10-14 days
Minor ulcers are generally less severe than major ones.
What is the characteristic appearance of major aphthous ulcers?
Exceed 1 cm in diameter and can cause significant disability due to intense pain
Major ulcers can severely affect daily activities.
What are some conditions that may present with large or persistent ulcerative stomatitis?
- Erythema multiforme
- Drug allergies
- Acute herpes simplex
- Pemphigus
- Pemphigoid
- Epidermolysis bullosa acquisita
- Bullous lichen planus
- Behçet disease
- Inflammatory bowel disease (IBD)
These conditions can mimic symptoms of aphthous ulcers.
What age group is most commonly affected by supraglottitis?
Children from 2 to 6 years of age
However, adults can also be affected.
What is the most common pathogen associated with supraglottitis?
Haemophilus influenzae type B (HIB)
The HIB vaccine has significantly reduced the incidence of this infection.
What are the clinical features of supraglottitis?
- Fever
- Difficulty breathing
- Severe odynophagia
- Drooling
- Irritable behavior in children
- Muffled voice if able to speak
- Inspiratory stridor
These symptoms are critical for diagnosis.
What should not be undertaken if supraglottitis is suspected?
Further investigation procedures like intraoral examination or venipuncture
Such actions may lead to airway obstruction.
What is the most common cause of laryngitis?
Viral upper respiratory infections (URIs)
Viral infections are the primary triggers for laryngeal inflammation.
What can parainfluenza viruses cause in children?
Croup or laryngotracheobronchitis
Croup is characterized by a barking cough.
What is a typical complication of viral laryngitis?
Bacterial laryngitis
This complication often arises around the seventh day of the illness.
What noninfectious causes can lead to laryngitis?
- Vocal trauma
- Inhalation injuries
- Allergies
- Gastroesophageal reflux disease
- Asthma
- Pollution
- Smoking
These factors can also contribute to laryngeal inflammation.
What are common symptoms of laryngitis?
- Raspy voice
- Hoarse voice
- Breathy voice
- Dry cough
- Anterior throat pain
- Need to clear throat
These symptoms help in the diagnosis of laryngitis.
What characterizes bacterial tracheitis?
Secondary bacterial colonization after a viral respiratory tract infection
This condition often follows a viral infection.
What is a common pathogen isolated in bacterial tracheitis?
Staphylococcus aureus
This bacterium is frequently involved in cases of tracheitis.
What are the clinical features of bacterial tracheitis?
- Acute exacerbation of airway obstruction
- High fever
- Toxicity
- Rapid onset of symptoms
- Narrowing of the tracheal lumen on x-rays
These features indicate a serious condition requiring prompt attention.
What is characterized by a heightened sensitivity to foreign proteins?
Allergy
Allergens can be elicited through ingestion, contact, or inhalation.
What is rhinitis defined as?
Eosinophilic inflammation of the nasal mucosa and paranasal sinuses
This results from an IgE-mediated reaction.
What are the common manifestations of allergic rhinitis?
Nasal congestion, obstructed airflow, increased mucous production, drainage
These arise from an unfavorable response to stimuli.
What is the initial phase necessary for the onset of allergic rhinitis in an atopic individual?
Sensitization
This is followed by subsequent reexposure to a designated allergen.
What cells assimilate low-dose exposure of an antigen during sensitization?
Antigen-presenting cells
Examples include dendritic cells, macrophages, or Langerhans cells.
What cytokines do activated helper T lymphocytes produce?
IL-4, IL-5, IL-13
These engage with B lymphocytes to synthesize allergen-specific IgE.
What triggers mast cell activation upon allergen exposure?
Binding of allergen to IgE antibodies on mast cells
Mast cells are prevalent in various tissues including respiratory and gastrointestinal tracts.
Which mediator is pivotal in allergic rhinitis that stimulates sensory nerve endings?
Histamine
It leads to sneezing.
What characterizes the late phase response of allergic rhinitis?
Symptoms persist for 4-6 hours after antigen stimulation
Symptoms include sneezing and nasal congestion lasting for about 18-24 hours.
What types of cells are predominantly involved in the late phase response of allergic rhinitis?
T lymphocytes, basophils, eosinophils
These cells release mediators contributing to symptom persistence.
What can upregulate the expression of adhesion molecules in the late phase response?
Cytokines like IL-4, IL-5, IL-13
This facilitates the infiltration of inflammatory cells into the nasal mucosa.
What are common risk factors for allergic rhinitis?
Atopy
Asthma
Eczema
Other allergies
Parental history
Pollen allergens become more significant in older children and adolescents.
What role does the gut microbiota play in allergic disease pathogenesis?
It may influence the formation, function, and regulation of the immune system
Dysbiosis can lead to abnormal allergic reactions.
What is dysbiosis in the context of allergic rhinitis?
Alteration in gut microbiota composition
It is associated with increased risk of allergic reactions.
What are the clinical features of allergic rhinitis?
Clear and watery nasal discharge
Nasal congestion
Postnasal drip
Itching of the nose, throat, and eyes
Physical examination may reveal mouth breathing and allergic shiners.
How is allergic rhinitis classified based on symptoms?
Seasonal Allergic Rhinitis
Perennial Allergic Rhinitis
Seasonal symptoms occur with pollination, while perennial symptoms are constant.
What are common indoor allergens causing perennial allergic rhinitis?
Dust mites
Animal dander
Mold spores
Cockroaches
These allergens can trigger symptoms year-round.
What are potential complications of allergic rhinitis?
Adenoid hypertrophy
Eustachian tube dysfunction
Chronic rhinosinusitis
Nasal polyps
Sleep disruption
Learning disturbances
These can significantly affect quality of life.
What is the relationship between gut microbiome diversity and allergic rhinitis?
Reduced gut microbiome diversity is observed in AR patients
Increased Bacteroidetes and decreased Actinobacterium are noted.
What microbiome metrics are indicative of allergic rhinitis?
Lower diversity indices (Chao1 and Shannon)
More abundant Bacteroidetes and reduced Firmicutes are also observed.
What symptoms are linked to levels of Butyrococcus and Eisenbergiella?
Moderate and severe allergic rhinitis symptoms
These levels may correlate with symptom severity.
What are the most common symptoms of nonallergic rhinitis?
Nasal obstruction and clear rhinorrhea
Sneezing and itchy, watery eyes are not common symptoms.
How does the prevalence of nonallergic rhinitis change with age?
It is more prevalent with advancing age.
What should be asked of patients with nonallergic rhinitis?
Over-the-counter nasal sprays, previous trauma, work exposure, or intranasal drug use.
What symptoms should prompt attention for possible neoplasm in nonallergic rhinitis?
Epistaxis, pain, and unilateral symptoms.
What is viral rhinitis commonly accompanied by?
Headaches, malaise, body aches, and coughing.
What are typical characteristics of nasal drainage in viral rhinitis?
Clear or white nasal drainage.
What pollutants can affect occupational rhinitis?
Dust, ozone, sulfur dioxide, cigarette smoke, and garden sprays.
What symptoms are typical in occupational rhinitis?
Dry nasal passages, reduced airflow, rhinorrhea, and sneezing.
What has exposure to wood particles and chronic cigarette smoke been associated with?
Reduced ciliary movements in the nose.
What management strategies are effective for occupational rhinitis?
Protective mask, avoidance, improving ventilation, and removing the causal agent.
What is vasomotor rhinitis (VMR)?
The most common form of nonallergic rhinitis observed clinically.
What triggers vasomotor rhinitis?
Environmental conditions that normally do not affect normal individuals.
What causes increased mucus production in vasomotor rhinitis?
An imbalance among mediators affecting submucosal nasal glands.
What neurotransmitter governs mucous secretion in vasomotor rhinitis?
Acetylcholine.
What neurotransmitters regulate vascular tone in vasomotor rhinitis?
Norepinephrine and neuropeptide Y.
What types of environmental triggers can exacerbate vasomotor rhinitis?
- Strong odors
- Cold air exposure
- Alcohol consumption
- Spicy foods
What is Nonallergic Rhinitis with Eosinophilia (NARES)?
A syndrome of nasal obstruction and congestion with severe exacerbations.
What is rhinitis medicamentosa?
Nasal congestion caused by the overuse of topical nasal decongestants.
What are common topical nasal decongestants that can cause rhinitis medicamentosa?
- Oxymetazoline
- Phenylephrine
What physiological changes occur during pregnancy that affect nasal congestion?
Increased hyaluronic acid, decreased nasal cilia, and increased mucous glands.
What systemic disorders can exhibit symptoms of chronic inflammation in rhinitis?
- Wegener granulomatosis
- Cocaine abuse
What defines chronic rhinosinusitis (CRS)?
Inflammation of the nasal cavity and paranasal sinuses lasting more than 12 weeks.
What are common symptoms of chronic rhinosinusitis?
- Nasal obstruction
- Facial congestion
- Discolored nasal discharge
- Hyposmia
What can chronic inflammation in CRS lead to in terms of bacterial growth?
It can block nasal passages, inhibit drainage, and reduce oxygen tension.
What are some hypothesized causes of chronic rhinosinusitis?
- Biofilms
- Bacterial superantigens
- Osteitis
- Allergy
- Barrier and innate immune dysregulation
- General host factors
What is a significant clinical feature of chronic sinusitis?
Purulent drainage: green or yellow nasal discharge.
What are nasal polyps?
Benign inflammatory and hyperplastic growths from sinonasal mucosa.
What is the most common cause of nasal polyps?
T-helper 2 (Th2) cell-driven eosinophilia.
What symptoms should prompt suspicion of nasal polyposis?
- Progressive nasal obstruction
- Nasal congestion
- Decreased sense of smell
- Rhinorrhea
What is the structure of the nasal septum?
A wall composed of osteocartilaginous tissue that separates two nasal cavities.
What are common clinical presentations of nasal septal deviation?
- Headaches
- Rhinosinusitis
- High blood pressure
- Obstructive sleep apnea
What can nasal septal deviations lead to in terms of sleep disorders?
Obstructive sleep apnea (OSA).
What is pharyngotonsillitis?
An infection of the tonsils and pharynx that can be caused by various organisms including bacteria, viruses, fungi, and parasites.
Common bacteria include staphylococcus, nonhemolytic streptococci, lactobacilli, bacteroides, and actinomyces.
What are the common symptoms of acute pharyngotonsillitis?
- Fever
- Malaise
- Odynophagia
- Dysphagia
- Foul breath
Airway obstruction may occur due to tonsillar enlargement.
What percentage of acute pharyngotonsillitis cases are caused by viral infections?
Approximately 70 to 85%
Common viral pathogens include adenoviruses, rhinoviruses, and Epstein-Barr viruses.
Which virus is known to cause infectious mononucleosis?
Epstein-Barr virus (EBV)
EBV has a preference for infecting human B-lymphocytes.
What are the symptoms of EBV infection?
- High fever
- Generalized malaise
- Lymphadenopathy
- Hepatosplenomegaly
- Pharyngitis
Severe tonsillar enlargement and grayish-white exudate can also occur.
What is the main bacterial cause of acute bacterial pharyngotonsillitis in children?
Group A beta-hemolytic streptococcus (GABHS)
Transmission occurs through droplet spread.
What is scarlet fever and its association with GABHS?
A condition resulting from endotoxins produced during acute streptococcal pharyngotonsillitis, characterized by an erythematous rash and ‘strawberry tongue.’
Symptoms also include fever, lymphadenopathy, and dysphagia.
What is acute rheumatic fever and when does it develop?
A complication that develops 1 to 4 weeks after GABHS pharyngotonsillitis, causing heart muscle damage due to cross-reactive antibodies.
It can lead to endocarditis, myocarditis, or pericarditis.
What is a peritonsillar abscess?
An infection spreading from the tonsil into the space between the tonsillar capsule and the pharyngeal muscle bed, presenting with severe pain and dysphagia.
Common pathogens include GABHS and Staphylococcus aureus.
What is the hallmark of infectious mononucleosis caused by EBV?
Lymphoid hypertrophy, especially in the posterior nodes.
Symptoms in younger individuals are often milder.
What is laryngitis and its common causes?
Inflammation of the larynx, most commonly caused by viral upper respiratory infections.
Bacterial laryngitis may arise as a complication of viral laryngitis.
What are the symptoms of laryngitis?
- Raspy voice
- Dry cough
- Anterior throat pain
Physical examination may reveal redness and swelling of the vocal cords.
What is the main pathogen responsible for bacterial tracheitis?
Staphylococcus aureus
It often occurs following a viral respiratory tract infection.
What is the incubation period for acute retroviral syndrome associated with HIV?
1 to 5 weeks
Symptoms include fever and lymphadenopathy.
What are tonsilloliths?
Microbial biofilms that form within tonsillar crypts, linked to chronic cryptic tonsillitis and halitosis.
Patients may feel foreign body sensations in their throats.
What is the significance of the HIB vaccine in relation to supraglottitis?
It has significantly reduced the incidence of supraglottitis by more than 90%.
Haemophilus influenzae type B is the most common pathogen.
True or False: Aphthous ulcers are associated with human herpesvirus 6.
True
They appear as painful ulcerations on nonkeratinized mucosa.
What is the typical presentation of pharyngeal diphtheria?
Characterized by a grayish, tightly adherent pseudomembrane covering the tonsils and pharynx.
It can lead to airway compromise and systemic toxicity.
What condition may develop following GABHS infection in children, characterized by obsessive-compulsive behaviors?
Pediatric autoimmune neuropsychiatric disorder associated with group A streptococcal infection (PANDAS)
Similar pathophysiology is thought to exist for Sydenham chorea.
What are the complications of untreated parapharyngeal abscess?
Potential spread down the carotid sheath and into the mediastinum.
Symptoms include trismus and decreased neck range of motion.
What is the effect of prolonged antibiotic treatment on oropharyngeal candidiasis?
It can lead to overgrowth of Candida albicans, causing thrush.
Examination reveals white plaques that bleed when removed.
