Blocked nose

Question 1

what are the types of rhinitis

Answer 1

infective and non-infective

Question 2

what causes infective rhinitis

Answer 2

rhinosinusitis - viral

Question 3

types of non-infective rhinitis

Answer 3

allergic

non-allergic

Question 4

types of allergic rhinitis

Answer 4

intermittent rhinitis

persistent rhinitis

Question 5

causes of non-allergic rhinitis

Answer 5

idiopathic rhinitis (vasomotor)
polyps

Question 6

what is idiopathic rhinitis

Answer 6

parasympathetic overdrive (blocks the nose)

Question 7

management of idiopathic rhinitis

Answer 7

ipratropium - anticholinergic

Question 8

what are polyps

Answer 8

like asthma but polyps in the nose

Question 9

what 3 conditions are linked / crossover

Answer 9

asthma
allergic rhinitis
nasal polyps

Question 10

functions of the nose

Answer 10

smell
cleans and warms the air
immune system

Question 11

symptoms of allergic rhinitis

Answer 11

rhinorrhoea 
sneezing 
nasal blockage 
itch
(can also get inferior turbinate hypertrophy not just polyps)

Question 12

symptoms usually switch from side to side, true or false

Answer 12

true

unless there is a physical obstruction

Question 13

what guidelines are used in allergic rhinitis

Answer 13

ARIA guidelines

Question 14

allergic rhinitis has a strong genetic drive, true or false

Answer 14

true

Question 15

how do you diagnosis allergic rhinitis

Answer 15

2 or more of: watery rhinorrhoea, sneezing, nasal obstruction, itch +- conjunctivitis
demonstration of allergen specific IgE
post nasal drip

Question 16

what do mast cells release

Answer 16

histamine - causes sneezing

leukotrienes - cause more blockage

Question 17

drugs for allergic rhinitis

Answer 17

steroids 
anti histamines 
leukotriene receptor antagonist 
immunotherapy 
omalizumab

Question 18

what antihistamines are used

Answer 18

citirazine, loratidine - non sedating
chlorphenamine - sedating
H1 receptor antagonists

Question 19

example of leukotriene antagonist

Answer 19

montelukast

Question 20

how do steroids work

Answer 20

act on nuclear receptors

dont work immediately

Question 21

why doesnt everyone just get steroids

Answer 21

many side effects

immunosuppression, bones, skin, muscles, thrush…

Question 22

examples of steroids

Answer 22

beclomethasone BD - bigger systemic bioavailability - becanase
fluticasone - flixonase
mometasone - masonex

Question 23

causes of persistent allergic rhinits aka perennial

Answer 23

dogs, cats, house dust mites

Question 24

causes of intermittent allergic rhinitis aka seasonal

Answer 24

pollens - grass and tree

rarely flowers

Question 25

allergic crease

Answer 25

line across nose seen in patient with allergic rhinitis

Question 26

investigations for allergic rhinitis

Answer 26

``` skin prick tests RAST - blood test peak nasal inspiratory flow PEFR smell testing rhinomanometry / spirometry ```

Question 27

history taking

Answer 27

fixed block or switches side block vary or persistent examine nose

Question 28

what do people usually mistake inferior turbinates for

Answer 28

nasal polyps

Question 29

4 main allergens

Answer 29

mites dogs and cats pollen moulds

Question 30

how can you reduce exposure to house dust mite allergens

Answer 30

``` mattress and pillow covers wash sheets at 60' remove carpet damp dusting modern vacuum cleaner ```

Question 31

steroids target blocked nose, true or false

Answer 31

true

Question 32

antihistamines are for itch, true or false

Answer 32

true