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13 ENT > Nasal Obstruction 1 > Flashcards

Nasal Obstruction 1 Flashcards

1
Q

barrier function of nasal physio

A
  • mucociliary system: mucous cells to trap foreign substances, ciliated cells to eliminate infected mucous
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2
Q

immunologic function of nasal physio

A
  • observed by commensal flora

- secrete ig and proinflammatory molecules

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3
Q

nasal congestion vs obstruction

A

congestion: intermittent, has triggers
obstruction: more permanent, progressive

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4
Q

narrowest portion of the nasal cavity

A

internal nasal valve

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5
Q

regular respiration vs sniffing

A

regular respiration: air passes through common and middle meatus -> nasopharynx

sniff: air goes up to olfactory cleft

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6
Q

exhalation

A
  • turbulent flow

- retronasal olfaction

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7
Q

normal changes in airflow

A
  • nasal cycle
  • “opening up” associated with elevated pulse that occurs during exercise
  • “recumbency rhrinitis”
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8
Q

laterality of obstructoin

A 
alternating = physiologic
bilateral = rhinitis
unilateral = foreign body, fixed obstruction
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9
Q

what is anterior rhinoscopy

A
  • checking septum, turbinates, nasal valve

- look before and after decongestion

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10
Q

what is rigid nasal endoscopy

A
  • for tumors, mucosa, polyps, masses, adenoidal size
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11
Q

what is gross nasal valve assessment

A

checking for normal and exaggerated breathing

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12
Q

maneuvers in internal nasal valve assessment

A
  • cottle maneuver (lateral)

- bachman’s maneuver (open internal nasal valve)

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13
Q

t/f xray can be used to visualize the nose

A

false, only for suspected metallic foreign object

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14
Q

t/f before doing ct/mri, refer to ent for nasal endoscopy

A

true

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15
Q

mucosal vs anatomic ddx

A

mucosal: rhinitis, sinusitis, nasal polyposis, adenoid hypertrophy
anatomic: septal deviation, internal/ext nasal valve narrowing, nasal cavity and nasopharyngeal neoplasm

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16
Q

t/f allergic rhinitis can be caused by perfumes or changes in temperature

A

false

17
Q

common allergens

A
  • dust mites
  • cat dander and cockroaches
  • others (spores, mildew, molds)
18
Q

pathophysio of allergic rhinitis

A

phase 1: sensitization
- primer, no symptoms

phase 2: clinical disease

  • re-exposure
  • early: sneezing, rhinorrhea, congestion, IGE AND MEDIATORS
  • late phase: more congestion, leukotrienes
19
Q

in diagnosing allergic rhinitis, if you suspect asthma do ___

A

auscultate the lungs

20
Q

intermittent vs persistent symptoms

A

intermittent: <4 d per week OR < 4 weeks at a time
persistent: >/= 4 days per week AND >/= 4 weeks at a time

21
Q

t/f you can diagnose a patient with AR if symptoms are present daily for 2 weeks

A

false

22
Q

mild severity of ar symptoms

A

normal sleep, daily activities, work and school, no troublesome symptoms

23
Q

moderate to severe severity of ar symptoms

A

abnormal sleep OR impairment of daily activities OR problems with work or school OR troublesome symptoms

24
Q

treatment for intermittent mild ar

A

oral antihistamines, intranasal antihistamines, decongestants, or leukotriene receptor antagonist (montelukast with asthma)

25
Q

treatment for intermittent moderate severe and persistent mild ar

A

intermittent mild
+ review patient after 2-4 wks of treatment

failure = step up
improve = continue for 1 more month
26
Q

treatment for persisntent moderate severe ar

A
  • intranasal cs > h1 blocker > ltra
  • review after 2-4 wks
  • improved = step down and continue for 1 mo
  • failure = review dx, compliance, query
  • –> add or icnrease intranasal cs dose
  • —> for rhinorrhea add ipratroprium
  • —> for blockage add decongestant or oral cs
  • —> persistent symptoms = refer
27
Q

t/f for all severities of ar, allergen and irritant avoidance is appropriate

A

true

28
Q

if ar patient has conjunctivitis, add __

A

h1 blocker, intraocular h1 blocker, intraocular cromone or saline

29
Q

t/f multimodal environmental control strategies are better than any single strategy

A

true

30
Q

mediators for ar symptoms

A

sneezing: histamine, endothelin
rhinorrhea: histamine, leukotrienes, endothelin
itching: histamine, endothelin
blockage: histamine, leukotrienes, prostaglandins, kinins

31
Q

actions of antihistamines

A
  • blocks histamine release from basophils and mast cells
  • inhibits eicosanoids from mast cells and macrophages
  • inhibit release of ltc4 and histamine
  • reduce icam 1
32
Q

action of intranasal corticosteroids

A

suppress inflammatory process and effective in prevention and treatment of ar

33
Q

what is senile rhinitis

A
  • > 65 yo
  • no endonasal mucosal or anatomic pathology
  • neurogenic dysregulation
  • tx: ipratropium bromide
34
Q

what is gustatory rhinitis

A
  • water rhinorrhea after ingestion of hot and spicy food (neurogenic inflammation)
35
Q

what is occupational rhinitis

A
  • hmw agents trigger ige mediated allergic inflammation

- prolonged exposure = asthma

36
Q

what is hormonal rhinitis

A
  • menstrual, puberty, pregnancy, menopause
  • estrogens exert vascular engorgement effect in the nose (more histamine and eosinophils)
  • testosterone decreases eosinophil activation and viability
37
Q

what is drug induced rhinitis

A
  • due to neuronal imbalance

- abuse in decongestive nasal therapy = rhinitis medicamentosa

38
Q

treatments for non allergic rhinitis

A
  • nonallergic senile rhinitis: ipratropium bromide
  • gustatory rhinitis: avoid nasal capsaicin
  • nonallergic occupational: avoid
  • hormonal: nasal cs
  • drug induced: avoid
  • idiopathic: nasal cs, nasal capsaicin
39
Q

allergic vs nonallergic rhinitis

A

table 2

13 ENT (18 decks)

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