mouth, nose, throat Flashcards
what is rhinitis?
Rhinitis is an inflammation of the mucous membrane within the nasal cavity.
what are the symptoms of rhinitis?
It’s commonly characterized by symptoms such as sneezing, rhinorrhea (which can be anterior or posterior, meaning it can drip out the nose or down the throat), nasal congestion, and itching in the nose and eyes.
what type of rhinitis is triggered by allergens such as pollen, dust, and pet dander. It can be seasonal (occurring at specific times of the year, like hay fever) or perennial (occurring year-round)?
allergic rhinitis
Allergic rhinitis is a common condition characterized by an allergic response to airborne allergens, which affects both adults and children.
what form of rhinitis is not caused by allergens and can be triggered by irritants like smoke, changes in weather, or strong odors?
non-allergic rhinitis
what type of rhinitis is Also known as rebound rhinitis, this occurs due to the overuse of topical decongestants. When these medications are used for more than a few days, they can cause a rebound effect, leading to increased congestion when the medication is stopped?
rhinitis medicamentosa
what symptom is exhibited when rhinitis becomes rhinosinusitis?
symptoms such as posterior nasal drainage (which may be purulent), facial pressure or pain, headaches, and sometimes a reduced sense of smell.
what are some infectious causes of rhinitis?
rhinitis can be viral, such as the common cold; bacterial, often leading to sinusitis; or less commonly, fungal, which can lead to fungal sinusitis, especially in immunocompromised individuals.
what symptom is the hallmark of allergic rhinitis which also helps differentiate it from non-allergic rhinitis?
nasal itching
nasal mucosa is often pale due to swelling and the allergic response, as opposed to being red, which is more common in infections.
what color is nasal mucosa in allergic rhinitis vs infectious rhinitis?
nasal mucosa is often pale due to swelling and the allergic response, as opposed to being red, which is more common in infections.
what is a rhinitis that happens year round called?
perennial allergic rhinitis
what are some seasonal allergens?
Include tree, grass, and weed pollens, as well as molds found outdoors.
what are some indoor allergens?
Perennial allergens often found indoors include house dust mites, cockroaches, pets, rodents, and fungi.
what type of conditions do people with allergic rhinitis also tend to struggle with?
People with allergic rhinitis may also suffer from bronchospasm (which can be part of conditions like asthma), atopic dermatitis (eczema), and chronic cough.
what gender is more commonly affected by allergic rhinitis?
males
what are some risk factors for allergic rhinitis?
The condition is more commonly seen in males and those with a family history of atopy, indicating a genetic predisposition to allergic diseases.
what other factors increases chance of developing allergic rhinitis?
Factors that may increase the likelihood of developing allergic rhinitis include being born during the pollen season, being the firstborn child, early use of antibiotics, exposure to tobacco smoke, and early or high exposure to allergens.
what is another name for allergic rhinitis?
hay fever
what is the process behind how allergic rhinitis develop?
- genetically predisposed individuals, exposure to specific allergens (like pollen, dust mites, animal dander, or mold) leads to the production of specific IgE antibodies against these allergens.
- The IgE antibodies bind to mast cells and basophils present in the nasal mucosa. Upon subsequent exposure to the same allergens, these cells degranulate, releasing a variety of inflammatory mediators.
- Preformed mediators like histamine and serotonin are released, causing symptoms such as sneezing, itching, and increased mucus production.
Newly generated mediators such as leukotrienes and prostaglandins contribute to the inflammation, causing symptoms like congestion and swelling. - As a part of the immune response, other cells like neutrophils, eosinophils, macrophages, and lymphocytes are recruited to the site of inflammation, releasing their own mediators and perpetuating the response.
- Late phase Occurs 4-6 hours after the initial allergen exposure and involves the continued recruitment of inflammatory cells to the nasal mucosa.
The symptoms are similar to the early-phase response but typically with less sneezing and itching and more congestion and mucus production.
how does the mediators released in allergic rhinitis cause congestion and pressure?
The mediators released cause increased vascular permeability, leading to plasma exudation and vasodilation, which result in congestion and pressure.
how do the mediators released in allergic rhinitis cause the sneezing and itching?
Stimulation of sensory nerves causes sneezing and itching.
how does the mediators released in allergic rhinitis cause increased secretions?
Mucous glands are stimulated, leading to increased secretions.
what are dark circles under the eyes that are often blue, gray, or purple. They occur due to congestion of the nasal passages, which can lead to venous pooling under the eyes?
allergic shiners
what describes a set of facial features that can develop in children with chronic mouth breathing, often due to enlarged adenoids. These features can include:
A long, narrow face and high-arched palate
A narrow, upturned nose due to constant upward rubbing (the “allergic salute”)
A short upper lip and a longer distance between the nose and the upper lip
Exposed upper incisors and an open-mouth posture
A recessed lower jaw, which may also be due to the mouth always being open
Forward head posture, which can be a compensatory mechanism to keep the airway open for easier breathing
adenoid facies
what is a horizontal line or crease across the lower part of the bridge of the nose. It can result from the frequent upward rubbing of the nose, a gesture often seen in children with itchy, runny noses, known as the “allergic salute.” ?
nasal crease
what is A narrow, upturned nose due to constant upward rubbing?
allergic salute
what is the main symptom of non-allergic rhinitis?
The main symptoms include nasal congestion and postnasal drip.
Nonallergic rhinitis is a medical condition characterized by inflammation of the nasal mucosa, similar to allergic rhinitis but without the allergic cause. It typically manifests later in life, and unlike allergic rhinitis, it does not usually include symptoms like nasal and eye itching or sneezing, although these can sometimes be present. The main symptoms include nasal congestion and postnasal drip. These symptoms can be constant (perennial) or they can come and go (sporadic).
which type of non-allergic rhinitis involves nasal congestion and/or a watery nasal discharge. People with this condition often have an exaggerated response to non-specific irritants, such as air pollution or changes in temperature?
vasomotor non-allergic rhinitis
which type of non-allergic rhinitis is an episodic form of rhinitis, usually triggered by eating hot or spicy foods. It is associated with a prominent watery discharge from the nose (watery rhinorrhea) and is thought to be caused by a reflex that is mediated by the vagus nerve?
Gustatory non-allergic rhinitis
which type of nonallergic rhinitis is caused by vagus nerve reflex?
gustatory nonallergic rhinitis
what are the 2 groups of nonallergic rhinitis based only on symptoms?
Wet Group: Characterized by nasal obstruction and significant watery nasal discharge, which is sometimes referred to as “runners.”
Dry Group: Characterized by nasal obstruction with minimal nasal discharge (rhinorrhea).
how do you differentiate wet group from dry group of nonallergic rhinitis?
Wet Group: Characterized by nasal obstruction and significant watery nasal discharge, which is sometimes referred to as “runners.”
Dry Group: Characterized by nasal obstruction with minimal nasal discharge (rhinorrhea).
which group of nonallergic rhinitis is referred to as runners?
wet group
what stimulates wet (runners) non-allergic rhinitis?
Increased cholinergic glandular secretory activity leads to excessive mucus production. This is sometimes referred to as “runner’s nose” and can occur in response to exercise.
what stimulates dry non-allergic rhinitis irritation?
Heightened sensitivity of nociceptive neurons to stimuli that are usually not problematic can result in symptoms like a dry, irritated nose.
what are some causes of nonallergic rhinitis?
Other causes:
Nasal decongestant sprays (rhinitis medicamentosa): Overuse of these sprays can lead to rebound congestion, where the nasal passages become swollen, leading to a cycle of continuous use and worsening symptoms.
Intranasal cocaine use: Cocaine and other substances taken intranasally can lead to chronic irritation and inflammation of the nasal mucosa.
Systemic medications: Some medications like oral contraceptives, Viagra, and NSAIDs can have side effects that include symptoms of rhinitis.
Structural abnormalities: Physical abnormalities within the nasal cavity, such as enlarged adenoids, foreign bodies, or a deviated septum, can lead to chronic symptoms.
Rhinitis of pregnancy: Hormonal changes during pregnancy can lead to swelling of the nasal passages and increased mucus production.
Systemic diseases: Diseases like Granulomatosis with Polyangiitis (formerly known as Wegener’s Granulomatosis) and cystic fibrosis can cause chronic inflammation of the nasal passages.
Which agent causing occupational rhinitis would you most likely be exposed to in a supermarket?
Detergents and perfumes are agents causing occupational rhinitis that you would most likely be exposed to in a supermarket.
Name an immunologic agent that could affect nurses and cause occupational rhinitis.
Nurses may be exposed to latex, which is an immunologic agent that can cause occupational rhinitis.
Which type of occupational rhinitis might a chemical plant worker be at risk of developing and due to what agent?
A chemical plant worker might be at risk of developing corrosive occupational rhinitis due to exposure to ammonia.
what is epistaxis?
Epistaxis, commonly known as a nosebleed, is a condition where bleeding occurs from the nasal cavity.
what are the 2 forms of epistaxis?
anterior and posterior
which type of epistaxis is the most common type of nosebleed.
These bleeds are typically self-limited, which means they stop on their own without the need for extensive medical intervention.
anterior epistaxis
what are the causes of anterior epistaxis?
The causes (etiologies) of anterior epistaxis include local trauma (such as nose picking or the insertion of foreign bodies), irritation, or nasal dryness.
which plexus causes anterior epistaxis?
Around 90% of anterior bleeds originate from Kiesselbach’s plexus, also known as Little’s area, which is a vascular-rich region in the anterior part of the nasal septum.
which type of epistaxis is less common but can be more severe and often requires medical treatment.
posterior epistaxis
what blood vessels cause posterior epistaxis?
The source of the bleeding is usually the branches of the sphenopalatine artery, but it can also come from the carotid artery.
which type of epistaxis can lead to significant hemorrhage and are more likely to require medical intervention, such as packing the nose or cauterizing the bleeding vessel?
posterior epistaxis
what are some causes of posterior epistaxis?
The causes of posterior epistaxis include the use of anticoagulant medications, bleeding disorders such as hemophilia and von Willebrand disease, aneurysms, and the presence of nasal neoplasms (tumors), which can also cause anterior epistaxis.
what are nasal polyps?
Nasal polyps are non-cancerous growths that occur on the lining of the nasal passages or sinuses. They’re often associated with chronic inflammation and can result from a variety of conditions.
Benign: They are not malignant, meaning they are not cancerous.
Semitransparent: They have a somewhat see-through appearance.
Arising from mucosa: They develop from the mucous membranes that line the nasal cavity or paranasal sinuses.
how does polyps develop?
Chronic inflammation: Long-term inflammation in the nasal passages or sinuses can lead to the growth of polyps. This inflammation can be caused by conditions such as cystic fibrosis, asthma, chronic rhinitis or rhinosinusitis, and certain forms of vasculitis, such as Churg-Strauss syndrome.
which conditions increase risk of developing nasal polyps?
Cystic fibrosis: This genetic disorder is known to be associated with a higher prevalence of nasal polyps. As the statistics suggest, nearly half of the children with cystic fibrosis develop nasal polyps.
Asthma: Chronic respiratory conditions like asthma can also contribute to the development of nasal polyps due to ongoing inflammation.
Chronic rhinitis or rhinosinusitis: Inflammation of the nasal lining or sinuses, whether due to allergy or infection, can result in polyp formation.
Vasculitis: Diseases causing inflammation of blood vessels, such as Churg-Strauss syndrome, can be associated with nasal polyps.
what percentage of children with cystic fibrosis develop nasal polyps?
48%
is nasal polyp more common in adults or children?
adults
what are the adenoids?
Lymphoid tissue located in the back of the nose (not seen in regular physical exam)
what is the Waldeyer’s ring and what 3 things make it up?
ring of lymphoid tissue known as Waldeyer’s ring. This ring also includes the palatine tonsils, which are located on either side at the back of the mouth, and the lingual tonsils, which are found at the base of the tongue. This ring of tissue forms part of the body’s immune system, acting as a first line of defense by trapping pathogens that are inhaled or ingested.
what is the function of waldeyer’s ring?
This ring of tissue forms part of the body’s immune system, acting as a first line of defense by trapping pathogens that are inhaled or ingested.
what condition can infected adenoids lead to?
Infected adenoids can lead to conditions such as adenoiditis, which can cause symptoms of nasal obstruction, snoring, and respiratory infection. Chronic enlargement of the adenoids can lead to chronic mouth breathing, snoring, and even sleep apnea.
what are symptoms of infected adenoids?
nasal obstruction, snoring, and respiratory infection
what are symptoms of chronic enlargement of adenoids?
chronic mouth breathing, snoring, and even sleep apnea.
what are symptoms of infected tonsils?
infected tonsils (tonsillitis) may cause a sore throat, difficulty swallowing, fever, and swollen lymph nodes. Tonsillitis is often due to bacterial or viral infections and can sometimes lead to the formation of pus-filled pockets (peritonsillar abscess).
what is peritonsillar abscess?
pus-filled pockets at the back of the mouth near tonsils.
which 2 lymphoid organs have Same structure and function, but diseases associated with them differ?
adenoids and tonsils
what type of conditions do enlarged adenoids contribute to?
recurrent sinusitis, chronic persistent or recurrent ear disease (can harbor a chronic infection), and to chronic airway obstruction.
Pathogenesis of Enlarged Adenoids:
When adenoids are enlarged, they can obstruct the airways, which contributes to chronic airway obstruction. This can lead to difficulty breathing, especially during sleep, resulting in conditions such as sleep apnea.
Enlarged adenoids can block the normal drainage of fluid from the sinuses and the Eustachian tubes, which connect the middle ear to the nasopharynx. This blockage can lead to recurrent sinusitis (inflammation of the sinuses) and otitis media (middle ear infections), as the trapped fluid can serve as a breeding ground for infections.
Chronic infections in the adenoids can lead to a persistent infection in the ear if the pathogens spread from the adenoids to the middle ear through the Eustachian tubes.
what are some pathogens associated with enlarged adenoids?
Common Pathogens Associated with Enlarged Adenoids:
Haemophilus influenzae (H. influenzae)
Streptococcus pyogenes (S. pyogenes)
Staphylococcus aureus (S. aureus)
Moraxella catarrhalis (M. catarrhalis)
Streptococcus pneumoniae (S. pneumoniae)
These pathogens can infect the adenoids and lead to their enlargement, perpetuating the cycle of infection and inflammation.
what is the most effective treatment of enlarged adenoids for children older than 3 years old?
Adenoidectomy, which is the surgical removal of the adenoids, has been shown to improve the signs and symptoms of rhinosinusitis associated with enlarged adenoids.
The procedure has also been effective in reducing the recurrence of persistent middle ear infections, especially in children older than 3 years, by removing the blockage and allowing normal drainage and ventilation of the sinuses and middle ear.
what is acute pharyngitis?
Acute pharyngitis refers to the sudden onset of inflammation or infection of the pharynx, which is the part of the throat behind the mouth and nasal cavity, and sometimes includes the tonsils.
what is the most common cause of acute pharyngitis?
Infection: This is the most common cause of acute pharyngitis.
Viruses: The majority of pharyngitis cases are viral in origin. Common viruses include the common cold, influenza, adenovirus, and others.
Bacteria: Group A Streptococcus (GAS), also known as strep throat, is a well-known bacterial cause. Other bacteria can also be responsible, though less commonly.
what is the most common cause of acute pharyngitis between viral and bacterial?
viral
what is the most common virus and most common bacteria to cause acute pharyngitis?
Common viruses include the common cold, influenza, adenovirus, and others.
Bacteria: Group A Streptococcus (GAS)
what is another cause of acute pharyngitis besides infection?
Irritation: The pharynx can become irritated and inflamed due to non-infectious causes.
what are the forms of irritation that causes acute pharyngitis?
Allergy: Allergic reactions can cause symptoms similar to infections, such as swelling and sore throat.
Trauma: Physical injury to the throat, such as from intubation or a foreign object, can cause pharyngitis.
Toxins: Exposure to toxic substances, including cigarette smoke or industrial chemicals, can irritate the pharynx.
Neoplasia: Tumors or growths in the throat, whether benign or malignant, can cause inflammation or mimic the symptoms of pharyngitis.
what are some symptoms for acute pharyngitis?
Symptoms of acute pharyngitis can include a sore throat, pain when swallowing, fever, swollen lymph nodes, and redness of the pharynx.
which form of acute pharyngitis normally resolve on its own, viral or bacterial?
viral
what is the difference in symptoms between group A streptococcus pharyngitis and viral pharyngitis?
for group A strep there is pharyngeal exudate like pus/fluid, there is palatal petechiae, and no cough. confirm with rapid antigen test or culture for bacterium.
for viral, there is no pharyngeal exudate but there is a cough
Group A Strep: This is a bacterial cause of pharyngitis and is responsible for less than one-third of all pharyngitis cases.
Symptoms include fever, pharyngeal exudate (pus or other fluids on the throat), cervical adenopathy (swollen lymph nodes in the neck), palatal petechiae (small red spots on the roof of the mouth), and typically a lack of cough.
Diagnosis can be confirmed with a rapid antigen test or culture, which will be positive for this bacterium.
Viral Causes:
Viral pharyngitis is often distinguished from bacterial by the absence of pharyngeal exudate and the presence of a cough.
Diagnosis is supported by a negative bacterial culture, which means that no bacteria are found to be causing the infection, suggesting a viral etiology.
Infectious mononucleosis (caused by the Epstein-Barr virus) is often accompanied by significant lymphadenopathy (swollen lymph nodes) and splenomegaly (enlarged spleen).
what is the most common viral causes of acute pharyngitis?
Common viral causes include Epstein-Barr virus (which causes infectious mononucleosis), cytomegalovirus, herpes simplex virus, adenoviruses, enteroviruses, and influenza.
LESS COMMON CAUSES
Less commonly, acute pharyngitis can be caused by other infectious agents such as Neisseria gonorrhoeae (the bacterium that causes gonorrhea), Mycoplasma species, and Candida albicans (a fungus).
These causes may present with varying symptoms and typically require specific tests for accurate diagnosis.
what is mononucleosis?
Mononucleosis (mono/kissing disease) is a viral infection that causes a sore throat and fever. Cases often happen in teens and young adults. It goes away on its own after a few weeks of rest. Transferred by saliva.
what other sign is infectious mononucleosis accompanied with?
is often accompanied by significant lymphadenopathy (swollen lymph nodes) and splenomegaly (enlarged spleen).
which virus causes infectious mononucleosis?
Epstein-Barr virus
which age group is more commonly affected by group A strep pharyngitis?
age 4-7
what increases likelihood of getting group A strep pharyngitis?
A history of contact with others who have GAS infection or rheumatic fever increases the likelihood of GAS pharyngitis.
A personal or family history of rheumatic fever can be a risk factor for GAS infection.
why might Recent orogenital contact suggest pharyngitis?
gonococcal pharyngitis, which is caused by Neisseria gonorrhoeae.
what clinical features helps you identify group A streptococcal pharyngitis?
Features Consistent with GAS Infection:
Age Group: GAS pharyngitis is most common in children aged 4-7 years.
Onset: Sudden onset of symptoms is characteristic of GAS pharyngitis.
Symptoms: Pharyngitis that follows a cough or rhinorrhea (nasal discharge) is more likely to be viral rather than bacterial. GAS infection typically does not start with these symptoms.
Exposure: A history of contact with others who have GAS infection or rheumatic fever increases the likelihood of GAS pharyngitis.
Headache: The presence of a headache can be associated with GAS infection.
Cough: The absence of a cough is a clue that may point towards GAS rather than a viral infection.
Vomiting: While not exclusive to GAS, vomiting in the context of sore throat may suggest a GAS infection.
History: A personal or family history of rheumatic fever can be a risk factor for GAS infection.
Orogenital Contact: Recent orogenital contact might suggest gonococcal pharyngitis, which is caused by Neisseria gonorrhoeae.
what is candida pharyngitis?
Candida pharyngitis is an infection of the pharynx caused by Candida species, which are fungi commonly found in the normal flora of the mouth, gastrointestinal tract, and skin.
who is at risk of developing candida pharyngitis?
Immunosuppressed individuals: People with weakened immune systems are more susceptible to infections, including fungal infections. This includes individuals with HIV/AIDS, those taking immunosuppressive drugs (such as after an organ transplant), and those with other conditions that impair the immune system.
what fungal inflammatory condition normally accompany Chemotherapy or irradiation treatment?
candida pharyngitis
Chemotherapy or irradiation: Treatments for oropharyngeal cancer, such as chemotherapy and radiation therapy, can weaken the immune system and disrupt normal mucosal barriers. This creates an opportunity for Candida to overgrow and infect the pharynx.
what is a characteristic feature for candida pharyngitis you will see on examination of oral cavity?
white patches resembling cottage cheese on the walls of the throat.
what is oral squamous cell carcinoma?
Oral squamous cell carcinoma (SCC) is a type of cancer that arises from the squamous cells lining the oral cavity.
Oral SCC can be challenging to distinguish from other noncancerous lesions in the mouth due to its varied appearance. It can mimic benign conditions, which may delay diagnosis and treatment.
what is oral hairy leukoplakia?
Oral hairy leukoplakia is a condition characterized by a white patch or plaque that appears on the side of the tongue.
The condition manifests as white patches that are slightly raised above the surface of the tongue. They have a characteristic “hairy” or corrugated texture.
