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clin med I exam II > rhinitis > Flashcards

rhinitis Flashcards

(49 cards)

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1
Q

what is the nose composed of

A

membranous, cartilaginous + bony components

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2
Q

what is located on the lateral nasal wall and what are their functions

A

superior, middle + inferior turbinates

warm, humidify + filter inspired air

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3
Q

what is the nasal cycle

A

regular, cyclicle pattern of turbinate swelling - alternates btw sides at interval of 2-5hrs

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4
Q

nasal functions

A 
olfaction
filtration
humidification/warming of air passing through
vocal resonance
aesthetic function
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5
Q

rhinitis overview

A

marked by presence of 1+ of the following:

sneezing, rhinorrhea (anterior/posterior), nasal congestion (stuffiness), nasal itchy

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6
Q

most common forms of rhinitis

A 
allergic
non-allergic
rhinitis d/t structural nasal problems
atrophic rhinitis
rhinitis of pregnancy
occupational rhinitis
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7
Q

what is the most common form of rhinitis

A

allergic

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8
Q

what is allergic rhinitis

A

some combo of nasal itching, watery rhinorrhea, nasal congestion + sneezing

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9
Q

common comorbidities of allergic rhinitis

A

headaches
rhinosinusitis
asthma

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10
Q

what is intermittent allergic rhinitis

A

sx occur in response to specific exposures

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11
Q

what is seasonal allergic rhinitis

A

sx occur at certain times of year

pts have associated allergic conjunctivitis in ~70% of cases - red, itchy, watery eyes

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12
Q

what is persistent/perennial allergic rhinitis

A

sx occur year round

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13
Q

clinical history in pts w allergic rhinitis

A

personal, family, occupational, environmental

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14
Q

occupational factors of allergic rhinitis

A 
animals
grains
chemicals 
pollens
latex
carpeting
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15
Q

environmental factors of allergic rhinitis

A 
perennial allergens
seasonal allergens 
air quality
bugs
carpeting
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16
Q

nasal mucosa presentation in different types of rhinitis

A

allergic- edematous + pale
non-allergic- normal in color
acute viral/rhinitis medicamentosa- beefy red

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17
Q

allergic shiners

A

blue/grey to purple disocloration under eyes in allergic rhinitis

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18
Q

allergic salute

A

transverse nasal creased formed from repeatedly rubbing the nose + pushing tip of nose up w the hand in response to nasal itching

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19
Q

when would you perform imaging tests in allergic rhinitis

A 
concomitant condition (chronic rhinosinusiis- CRS) is suspected
history of facial trauma
features to suggest anatomic abnormalities (unilateral congestion or obstruction)
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20
Q

skin testing for allergic rhinitis

Study These Flashcards
A

quick, cost effective + safe
usually performed by allergy specialists
if sensitive- results in wheal + flare rxn a skin test site w.i 20 min

21
Q

tx for allergic rhinitis

Study These Flashcards
A 
avoid allergens
steroids
oral antihistamines (1st + 2nd gen)
leukotriene receptor antagonists
referrals
immunotherapy (allergy vaccine)
22
Q

steroids used to treat allergic rhinitis

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A 
intranasal glucocorticoids (INGCs)- most effective single maintenance therapy for allergic rhinitis + cause few SEs at recommended doses
most have onset of action of a few hrs
intranasal, oral, parenteral

bioavailability differs
1st gen- beclomethasone, flunisolide, bedesonide (10-50% bioavail)
2nd gen- fluticasone propionate (<2%), mometasone furoate, fluticasone furoate (<1%)

23
Q

oral antihistamines used to treat allergic rhinitis

Study These Flashcards
A

reduce itching, sneezing + rhinorrhea w less impact on nasal congestion compared w intranasal glucocorticoids
H1 antihistimes- 1st + 2nd gen (DO NOT USE IN COMBO TO TX ALLERGIC RHINITIS)

24
Q

1st gen H1 antihistamines used to treat allergic rhinitis

Study These Flashcards
A

diphenhydramine, chlorpheniramine, hydroxyzine, brompheniramine
OTC
significant sedation (cross BBB), ~20% report CNS sx
SEs- dry mouth, dry eyes, urinary hesitancy, confusion

25
2nd gen H1 antihitamines used to treat allergic rhinitis
loratidine, cetirizine, fexofenedine lipophobic- avoid unwanted CNS sx of 1st gen onset = w.i 1hr for most longer acting + dosed
26
leukotriene receptor antagonists used to treat allergic rhinitis
nasal congestion- correlates best w leukotriene C4 levels sneezing + nasal itching- correlate w histamine levels montelukast (only one used) not as effective as INGCs
27
mast cell stabilizers used to treat allergic rhinitis
cromolyn sodium inhibits mast cell release of histamine + other inflam factors blocks sx associated w immediate + late phase nasal allergen challenge no serious SEs + available as OTC nasal spray less effective than INGCs or 2nd gen antihistamines limited by frequent dosing try if other agents are not well tolerated
28
treatment referral for allergic rhinitis
allergy/immunology referral if tx has provided no relief | may benefit from allergy testing
29
immunotherapy for allergic rhinitis
very effective, long term expensive, shots <1 death/million many never complete tx course
30
nonallergic rhinitis description
``` chronic presence of 1+ of the following: nasal congestion (stuffiness) rhinorrhea postnasal drainage diagnosis of exclusion ```
31
how is allergic rhinitis distinguished from non-allergic?
non-allergic- later age of onset, absence of nasal + occular itching + prominent sneezing, nasal congestion + postnasal drainage are prominent, sx are perennial not seasonal
32
what is vasomotor rhinitis
intermittent sx of congestion +/or watery nasal discharge + an exaggerated rxn to nonspecific irritants (air pollution, temp changes, especially exposure to cold, dry air)
33
what is mixed rhinitis
combo of allergic + nonallergic rhinitis- most common form of rhinitis ~45% of population
34
what is gustatory rhinitis
episodic condition w prominent watery rhinorrhea triggered by hot or spicy food (vagally-mediated reflex)
35
what is occupational rhinitis
caused by airborne allergens or irritants in pts workplace more prominent sx at work, better on days off may be allergic or irritant
36
common examples of occupational rhinitis
proteins from urine + fur of lab animals food proteins in food processing workers enzymatic proteins in detergent manufacturers organic dusts in wood workers
37
other causes of rhinitis
``` nasal decongestants intranasal cocaine use systemic medications structural abnormalities rhinitis of pregnancy systemic diseases normal nasal reflexes ```
38
what is rhinitis medicamentosa
caused by nasal decongestants- OTC sprays lead to rebound nasal congestion as meds wear off -> pt administers med more frequently to obtain relief dx based on hx of use of causative med limit use to a max of 5 days to minimize use less likely if pt is using intranasal glucocorticoid concurrently stop using med
39
what systemic meds cause rhinitis
antihypertensives - alpha blockers, ACE inhibitors, beta blockers, CCBs, HCTZ erectile dysfunction drugs some antidepressants, benzos, psychotropics + antiepileptics NSAIDs estrogens
40
what structural abnormalities can cause rhinitis
congenital or acquired | enlarged adenoids, foreign bodies, septal deviation + perforation, nasal polyps, tumors
41
what is rhinitis of pregnancy
nasal congestion in last 6+ weeks of pregnancy w.o other signs of RTI + no known allergic cause
42
systemic diseases that cause rhinitis
cystic fibrosis | sarcoidosis
43
what are postural reflexes
increased congestion w supine position + increased congestion in lower nasal passage when lying on one side
44
what are hot + cold cutaneous temperature reflexes
sneezing upon sudden exposure of skin to dramatic temp extremes
45
what are bronchonasal reflexes
bronchoconstriction in response to nasal stimulation (e.g. cold air)
46
what are crutch reflexes
inc congestion w pressure in ipsilateral axilla
47
what is ovulatory rhinitis
inc nasal congestion in periovulatory period of menstrual cycle in women
48
what stimuli can trigger sneezing
after meals sexual ideation orgasms
49
what are visible + infrared light reflexes
sneezing upon sudden exposure to bright light

clin med I exam II (10 decks)

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