8: Stuffy nose

Question 1

Which cytokines are released by mast cells after IgE causes their degranulation?

Answer 1

Histamine

Leukotrienes (interleukins)

Question 2

What are some examples of

a) topical corticosteroids
b) anti-histamines
c) anti-cholinergics
d) decongestants

used in allergic rhinitis?

Answer 2

a) Beclometasone

b) Cetirizine

c) Ipratropium

d) Pseudoephedrine

Also: montelukast

Question 3

What are the four core nasal symptoms?

Answer 3

Blocked nose

Discharge

Loss of smell

Facial pain

Question 4

What are the 4 Ss of nasal symptoms?

Answer 4

Stuffy

Snot

Smell

Sore

Question 5

What symptoms are seen in allergic nose disease?

Answer 5

Sneezing

Itch

Crusting

Epistaxis

Question 6

What are the three steps of a nasal examination?

Answer 6

Examine airway patency

Examine external nose

Rhinoscopy

Question 7

What should you ask the patient to do when you stick a scope up their nose?

Answer 7

Stop breathing

so the lens isn’t steamed up

Question 8

What is another name for a nasal concha?

Answer 8

Turbinate

Question 9

Rhinitis can be either ___ or ___.

Answer 9

infective

non-infective

Question 10

What infection commonly results in infectious rhinitis?

Answer 10

URTI

Question 11

Non-infectious rhinitis is further divided into ___ and ___ rhinitis.

Answer 11

allergic

non-allergic

Question 12

What are some associated symptoms that come along with allergic rhinitis?

Answer 12

Sneezing

Itch

Crusty eyes

Watery eyes

Question 13

What allergens cause allergic rhinitis?

Answer 13

Pollen

Dust mites

Pet hair

Question 14

What are the two timings of allergic rhinitis?

Answer 14

Intermittent

Persistent

Question 15

Persistent allergic rhinitis tends to be caused by allergens in your ___.

Answer 15

home

dust mites, cat and dog hair

Question 16

What terms are used to describe the severity of allergic rhinitis?

Answer 16

Mild

Moderate/Severe

Question 17

How allergic rhinitis is treated depends on its ___ and ___.

Answer 17

timing - intermittent or persistent

severity - mild or severe

Question 18

Which antibody mediates allergic disease?

Answer 18

IgE

Question 19

What is the mainstay for relieving symptoms of allergic rhinitis?

Answer 19

Allergen avoidance

Question 20

Which drugs are used to treat allergic rhinitis?

Answer 20

Oral antihistamines

Inhaled steroids

+/- cromones, interleukin antagonists

Immunotherapy

Question 21

What experimental treatment can be done to reduce a patient’s sensitivity to allergens?

Answer 21

Immunotherapy

Question 22

Why would surgery be indicated for allergic rhinitis?

Answer 22

Chronic inflammation leading to fibrosis and loss of airway function

Question 23

What nose lesions are seen alongside non-allergic rhinitis?

Answer 23

Nasal polyps

Question 24

How may nasal polyps be treated if they are causing airway problems?

Answer 24

Oral steroids

then Topical steroids

then Surgery

Question 25

What are the symptoms of **infectious rhinosinusitis**?

Answer 25

**Blocked nose** **Discharge** - yellow/green **Facial pain**

Question 26

What causes the vast majority of **infectious rhinosinusitis**?

Answer 26

**Viruses**

Question 27

How is **infectious rhinosinusitis** treated?

Answer 27

**Supportive** - analgesia and decongestion Add **antibiotic** if persistent

Question 28

What are some serious complications of **infectious rhinosinusitis?**

Answer 28

**Cavernous sinus compression** **Orbital cellulitis** **Meningitis** **Rheumatic fever**

Question 29

How is **non-allergic, non-infective** rhinitis treated?

Answer 29

**Anti-muscarinics** e.g ipratropium

Question 30

How is **allergic rhinitis** investigated?

Answer 30

**Skin PRICK test** (Type I hypersensitivity) **RAST** (picks up specific IgE levels)

Question 31

Which type of **imaging** isn't helpful in allergic rhinits?

Answer 31

**Nasal / Sinus X-rays**

Question 32

What are some possible triggers for non-allergic rhinitis?

Answer 32

**Drugs** **Alcohol**

Question 33

How is **non-allergic** rhinitis managed?

Answer 33

**Topical steroid** **Antihistamines** Topical anticholinergic for vasomotor rhinitis

Question 34

How is **infectious rhinitis** managed?

Answer 34

**Analgesia** **Decongestants** +/- Topical antibiotic

Question 35

What can form between the cartilage and bone/soft tissue of the ear/nose in trauma?

Answer 35

**Haematoma** Collapse due to necrosis (perichondrium raised off its blood supply)

Question 36

What surgery can be done to repair a fractured nose?

Answer 36

**Rhinoplasty**

Question 37

What type of symptom should make you seriously concerned?

Answer 37

**Unilateral** refer them

Question 38

**(Bilateral / unilateral)** symptoms should give you serious cause for concern.

Answer 38

**Unilateral**