The stuffy nose Flashcards

(16 cards)

1
Q

What are the main symptoms to ask for nose problems?

A
Core symptoms:
•	Blockage
¥	Loss of smell
¥	Discharge
¥	Facial pain
Stuffy/smell/snot/sore
Other nasal symptoms:
¥	sneezing
¥	itch
¥	crusting
¥	epistaxis
Secondary symptoms – from breathing out of mouth instead of nose:
¥	dry mouth
¥	sore throat
¥	snoring
¥	halitosis
¥	loss of taste
`
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2
Q

What are the aetiologies of a ‘stuffy nose’?

  • non-infective
  • infective
A

Non-infective and allergic:

  • intermittent rhinitis
  • persistent rhinitis

Non-infective and non-allergic:

  • vasomotor rhinitis
  • polyps

Infective:
-rhinosinusitis

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3
Q

For allergic rhinitis:

what are triggers for intermittent and what are triggers for persisten?

A

Intermittent

  • Grass pollen
  • Tree pollen
  • Fungal spores

Persistent

  • House dust mite
  • Cat
  • Dog
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4
Q

What classification is used for allergic rhinitis?

A

ARIA classification:

Intermittant = symptoms:

  • less than 4 days a week
  • symptoms for less than 4 weeks

Persistent = symptoms:
-more than 4 days a week and last longer than 4 weeks

Mild = ALL

  • normal sleep
  • no impairments of lifestyle/function
  • no troublesome symptoms

Moderate-severe = 1 or more

  • abnormal sleep
  • impairment daily activities/sport/leisure
  • missing work/school
  • troublesom symptoms
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5
Q

What type of hypersensitivity is allergic rhinitis?

A

type 1: igE mediated

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6
Q

what is the treatment for allergic rhinitis?

A

-allergen avoidance

Step 1: antihistamine
¥ anti-histamines e.g. cetirizine

Step 2: topical steroids
¥ topical corticosteroids e.g. beclomethasone

Step : Both steroids and antihistamine

decongestant for symptomatic relief:
-pseudoephedrine

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7
Q

What is a nasal polyp?

A

These are composed of nasal mucosal tissues. They can cause complete nasal obstruction.

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8
Q

What are the clinical features of nasal polyps?

A
  • Nasal polyposis will usually be accompanied by evidence of widespread mucosal disease throughout the sinuses when seen on a CT scan – which will only be needed to help plan surgery (diagnosis is clinical)
  • They may be a feature of long-standing rhinitis of any cause and are often associated with non-allergic asthma
  • Beware of unilateral polyps – may be a neoplastic lesion
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9
Q

What is the treatment of nasal polyps?

A
  • Treat with oral then topical steroids

* If no better = surgery

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10
Q

What can cause acute coryza? what is the treatment?

A

The common cold is the result of a viral infection.
• Self-limiting and no treatment is required other than paracetamol
• Discourage prolonged use of vasoconstrictor nose drops – can cause harmful effects on nasal mucosa

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11
Q

What is the cause of acute infective rhinosinusitis?

A

• Many cases are secondary to acute viral illness (coryza) – this causes nasal mucosal oedema and interferes with ventilation and mucous clearance of the sinuses (98%)
• Paranasal sinuses become infected
• Usually more than one sinus is involved
• Bacterial infection supervenes causing purulent rhinorrhea:
⎯ Strep. Pneumonia
⎯ Heamophilus influenzae
⎯ Staph. Pyogenes
⎯ Anaerobes may be involved esp. in dental infections

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12
Q

What are the symptoms of acute infective rhinosinusitis?

A
  • Facial pain
  • Discharge
  • Nasal blockage
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13
Q

What is the treatment for acute infective rhinosinusitis?

A
  • Adequate analgesia
  • Decongestants
  • If persisting/worsening add antibiotic – cefaclor is useful 1st line
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14
Q

What are the 6 complications of acute infective rhinosinusitis?

A

• Orbital complications e.g. abscess /cellulitis
o Marked oedema of eyelids, diplopia, redness, chemosis REFER

• Meningitis
o Extradural and subdural abscesses may occur = neurosurgical emergency

• Cerebral abscess (frontal lobe)
o Any patient with history of recent frontal sinus infection headache or who exhibits any abnormality of behavior

• Osteomyelitis of frontal bone
o Persistent headache, oedema of scalp in vicinity of frontal sinus

• Cavernous sinus thrombosis
o Rare

• Mucocoele
o Poor sinus drainage can cause bony swelling as secretions build up in obstructed sinus

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15
Q

What is vasomotor rhinitis? and what can be used as treatment?

A

Autonomic imbalance favoring the parasympathetic system increases nasal blood flow, edema, and secretions, creating an overall presentation of rhinorrhea and nasal obstruction.

Can use anticholinergics: ipratriopium

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16
Q

What warrants a referral for a stuffy nose?

A

Unilateral discharge in child: foreign body in nose REFER

Unilateral discharge in adult: nasal or paranasal tumour REFER