Nasal Obstruction 1

Question 1

barrier function of nasal physio

Answer 1

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

Question 2

immunologic function of nasal physio

Answer 2

• observed by commensal flora

- secrete ig and proinflammatory molecules

Question 3

nasal congestion vs obstruction

Answer 3

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

Question 4

narrowest portion of the nasal cavity

Answer 4

internal nasal valve

Question 5

regular respiration vs sniffing

Answer 5

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

sniff: air goes up to olfactory cleft

Question 6

exhalation

Answer 6

• turbulent flow

- retronasal olfaction

Question 7

normal changes in airflow

Answer 7

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

Question 8

laterality of obstructoin

Answer 8

alternating = physiologic
bilateral = rhinitis
unilateral = foreign body, fixed obstruction

Question 9

what is anterior rhinoscopy

Answer 9

• checking septum, turbinates, nasal valve

- look before and after decongestion

Question 10

what is rigid nasal endoscopy

Answer 10

• for tumors, mucosa, polyps, masses, adenoidal size

Question 11

what is gross nasal valve assessment

Answer 11

checking for normal and exaggerated breathing

Question 12

maneuvers in internal nasal valve assessment

Answer 12

• cottle maneuver (lateral)

- bachman’s maneuver (open internal nasal valve)

Question 13

t/f xray can be used to visualize the nose

Answer 13

false, only for suspected metallic foreign object

Question 14

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

Answer 14

true

Question 15

mucosal vs anatomic ddx

Answer 15

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

Question 16

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

Answer 16

false

Question 17

common allergens

Answer 17

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

Question 18

pathophysio of allergic rhinitis

Answer 18

phase 1: sensitization
- primer, no symptoms

phase 2: clinical disease

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

Question 19

in diagnosing allergic rhinitis, if you suspect asthma do ___

Answer 19

auscultate the lungs

Question 20

intermittent vs persistent symptoms

Answer 20

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

Question 21

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

Answer 21

false

Question 22

mild severity of ar symptoms

Answer 22

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

Question 23

moderate to severe severity of ar symptoms

Answer 23

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

Question 24

treatment for intermittent mild ar

Answer 24

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

Question 25

treatment for intermittent moderate severe and persistent mild ar

Answer 25

intermittent mild + review patient after 2-4 wks of treatment ``` failure = step up improve = continue for 1 more month ```

Question 26

treatment for persisntent moderate severe ar

Answer 26

- 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

Question 27

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

Answer 27

true

Question 28

if ar patient has conjunctivitis, add __

Answer 28

h1 blocker, intraocular h1 blocker, intraocular cromone or saline

Question 29

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

Answer 29

true

Question 30

mediators for ar symptoms

Answer 30

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

Question 31

actions of antihistamines

Answer 31

- blocks histamine release from basophils and mast cells - inhibits eicosanoids from mast cells and macrophages - inhibit release of ltc4 and histamine - reduce icam 1

Question 32

action of intranasal corticosteroids

Answer 32

suppress inflammatory process and effective in prevention and treatment of ar

Question 33

what is senile rhinitis

Answer 33

- >65 yo - no endonasal mucosal or anatomic pathology - neurogenic dysregulation - tx: ipratropium bromide

Question 34

what is gustatory rhinitis

Answer 34

- water rhinorrhea after ingestion of hot and spicy food (neurogenic inflammation)

Question 35

what is occupational rhinitis

Answer 35

- hmw agents trigger ige mediated allergic inflammation | - prolonged exposure = asthma

Question 36

what is hormonal rhinitis

Answer 36

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

Question 37

what is drug induced rhinitis

Answer 37

- due to neuronal imbalance | - abuse in decongestive nasal therapy = rhinitis medicamentosa

Question 38

treatments for non allergic rhinitis

Answer 38

- nonallergic senile rhinitis: ipratropium bromide - gustatory rhinitis: avoid nasal capsaicin - nonallergic occupational: avoid - hormonal: nasal cs - drug induced: avoid - idiopathic: nasal cs, nasal capsaicin

Question 39

allergic vs nonallergic rhinitis

Answer 39

table 2