Stuffy Nose

Question 1

what are the 2 main mediators of inflammation released by mast cells in type 1 sensitivity?

Answer 1

histamine

leukotrines

Question 2

how does histamine cause blocked nose?

Answer 2

causes vasodilation of vessels

Question 3

what types of drugs are used for stuffy nose?

Answer 3

topical corticosteroids
anti-histamines
decongestants
anticholinergics

Question 4

what are the 4 core nasal symptoms?

Answer 4

blockage - stuffy
loss of smell - smell
discharge - snot
facial pain - sore

Question 5

5 secondary symptoms of nasal problem?

Answer 5

dry mouth
sore throat
snoring
halitosis
loss of taste

Question 6

name 4 other nasal symptoms

Answer 6

sneezing
itching
crusting
epistaxis

Question 7

3 components of nasal examination?

Answer 7

airway patency
external nose
rhinoscopy

Question 8

what are the 2 groups of rhinitis and what causes each?

Answer 8

infective = viral URTI
non-infective = allergic/non-allergic

Question 9

what might suggest an underlying allergy in rhinitis?

Answer 9

itching (nose, eyes, soft palate)

Question 10

what can cause intermittent allergic rhinitis?

Answer 10

grass pollen
tree pollen
fungal spores

Question 11

what can cause persistent allergic rhinitis?

Answer 11

house dust mite
cat
dog

Question 12

what is the aria classification?

Answer 12

classification of severity of allergic rhinitis

Question 13

intermittent allergic rhinitis?

Answer 13

symptoms <4 days per week

or symptoms present <4 weeks

Question 14

mild allergic rhinitis?

Answer 14

normal sleep
no impairment of daily activities, sport and leisure
normal work and school
no troublesome symptoms

Question 15

persistent allergic rhinitis?

Answer 15

symptoms > 4 days per week
and
>4 weeks duration

Question 16

moderate-severe allergic rhinitis?

Answer 16

abnormal sleep
impaired daily activities, sport, leisure
missing work or school
troublesome symptoms

Question 17

describe the step-wise approach to allergic rhinitis

Answer 17

allergen avoidance = best
antihistamines > topical steroids > topical steroids and antihistamines > immunotherapy for selected patients with IgE mediated disease > surgery for specific indications for relief of obstruction

Question 18

causes of nasal obstruction?

Answer 18

mucosal hypertrophy

nasal polyps

Question 19

what are nasal polyps associated with and how are they managed?

Answer 19

associated with non-allergic asthma

treatment = topical steroids, surgery if no better

Question 20

how can you tell the difference between nasal poly and inferior turbinate?

Answer 20

polyp does not have sensation so can be touched and moved without being uncomfortable

Question 21

what are 3 features of acute infective rhinosinusitis?

Answer 21

facial pain
discharge
nasal blockage/loss of smell

Question 22

what normally causes acute infective sinusitis and how is it managed?

Answer 22

98% are viral
most are self limiting with analgesia and decongestants
only add antibiotic if persisting/worsening after a while

Question 23

what is the danger in orbital cellulitis?

Answer 23

infection can spread to cavernous sinus which can cause thrombosis

Question 24

how is rhinitis investigated if though to be allergic?

Answer 24

skin prick test

RAST (IgE)

Question 25

what methods of investigations are not used in rhinitis?

Answer 25

nasal and sinus X rays

Question 26

how is non-infective rhinitis managed non-pharmacologically?

Answer 26

allergen/irritant avoidance HDM (house dust mites) specific IgE change drug therapy reduce alcohol etc

Question 27

how is non-infective rhinitis managed pharmacologically?

Answer 27

topical nasal steroid +/- antihistamine | topical anticholinergic

Question 28

how is infective rhinosinusitis managed?

Answer 28

nasal decongestant analgesia broad spectrum antibiotic if needed

Question 29

how is nasal trauma managed?

Answer 29

assess breathing and any immediate problems leave alone and reassess in 1 week then surgery if needed (should be performed in <3 weeks)

Question 30

how is nasal septal haematoma managed?

Answer 30

drain it out and suture perichondrium back together

Question 31

how is a child with unilateral discharge managed?

Answer 31

refer urgently | possible foreign body in the nose

Question 32

how is an adult with unilateral discharge managed?

Answer 32

refer urgently | possible nasal or paranasal tumour

Question 33

orbital cellulitis can result as a complication of what?

Answer 33

acute sinusitis

Question 34

what might ipratropium be used for?

Answer 34

to dry up a very runny nose