Week 5 lecture 1 Flashcards
(149 cards)
1
Q
What is characterized by a heightened sensitivity to a foreign protein?
A
Allergy
Allergens can be encountered through ingestion, contact, or inhalation.
2
Q
Define rhinitis.
A
Eosinophilic inflammation of the nasal mucosa and paranasal sinuses due to an IgE-mediated reaction.
3
Q
What are the main manifestations of allergic rhinitis?
A
- Nasal congestion
- Obstructed airflow
- Increased mucous production
- Drainage
4
Q
What is the initial phase required for the onset of allergic rhinitis in an atopic individual?
A
Sensitization
5
Q
What do antigen-presenting cells do during the sensitization phase?
A
Assimilate a low-dose exposure of the antigen and present it to helper T lymphocytes.
6
Q
What cytokines do activated helper T lymphocytes produce?
A
- IL-4
- IL-5
- IL-13
7
Q
What happens upon subsequent exposure to the allergen?
A
The specific antigen binds to two distinct IgE antibodies on mast cells, triggering activation.
8
Q
What are the hallmark acute symptoms of allergic rhinitis?
A
- Rhinorrhea
- Nasal congestion
- Nasal irritation
- Sneezing
9
Q
When does the late phase response of allergic rhinitis occur?
A
4-6 hours after antigen stimulation.
10
Q
What mediators are released during the late phase response of allergic rhinitis?
A
- Cytokines
- Leukotrienes
- Histamine
11
Q
What is a significant risk factor for developing allergic rhinitis?
A
Atopy
12
Q
What are common food allergens that cause allergic rhinitis in infancy and childhood?
A
- Milk
- Eggs
- Soy
- Wheat
13
Q
What role does gut microbiota play in allergic disease pathogenesis?
A
Gut microbiota composition is influenced by diet and may impact immune responses.
14
Q
Name the four main classes of microbiomes.
A
- Bacteroidetes
- Actinobacteria
- Firmicutes
- Proteobacteria
15
Q
What is dysbiosis?
A
An imbalance in the gut microbiota associated with atopy.
16
Q
What is the relationship between Th1/Th2 homeostasis and allergic rhinitis?
A
Disruption can affect immunotolerance and increase the risk of allergic rhinitis.
17
Q
What are common clinical features of allergic rhinitis?
A
- Clear and watery nasal discharge
- Nasal congestion
- Postnasal drip
- Itching of the nose, throat, and eyes
18
Q
What physical examination findings may indicate allergic rhinitis?
A
- Mouth breathing
- Transverse supra-tip nasal crease
- Dark circles under the eyes
19
Q
What distinguishes seasonal allergic rhinitis from perennial allergic rhinitis?
A
Seasonal occurs due to pollination; perennial is constant without seasonal variation.
20
Q
What is a complication of allergic rhinitis that can lead to ear problems?
A
Eustachian tube dysfunction
21
Q
What is rhinitis medicamentosa?
A
Nasal congestion caused by the overuse of topical nasal decongestants.
22
Q
What hormonal changes during pregnancy contribute to rhinitis?
A
Increased estrogen concentrations lead to nasal congestion and edema.
23
Q
What is the primary symptom of nonallergic rhinitis?
A
Nasal obstruction
24
Q
What is the most common form of nonallergic rhinitis?
A
Vasomotor rhinitis
25
What are potential environmental triggers for vasomotor rhinitis?
* Strong odors
* Cold air exposure
* Alcohol consumption
* Spicy foods
26
What is chronic rhinosinusitis defined as?
Inflammation of the nasal cavity and paranasal sinuses lasting more than 12 weeks.
27
What is Wegener granulomatosis associated with?
Cocaine abuse
## Footnote
It is important to assess the size and character of turbinates and rhinorrhea.
28
Define chronic rhinosinusitis (CRS).
Inflammation of the nasal cavity and paranasal sinuses lasting more than 12 weeks.
29
What are the common symptoms of chronic rhinosinusitis?
* Nasal obstruction (81% to 95%)
* Facial congestion, pressure, and fullness (70% to 85%)
* Discolored nasal discharge (51% to 83%)
* Hyposmia (61%–69%)
30
What is a significant cause of bacterial growth in chronic rhinosinusitis?
Chronic inflammation blocking nasal passage and inhibiting drainage.
31
List some factors hypothesized to cause chronic rhinosinusitis.
* Biofilms
* Bacterial superantigens
* Osteitis
* Allergy
* Barrier and innate immune dysregulation
* General host factors
32
True or False: High fevers are commonly seen in patients with chronic rhinosinusitis.
False.
33
What are nasal polyps?
Benign inflammatory and hyperplastic growths from the sinonasal mucosa.
34
What is the primary cause of the majority of nasal polyps?
T-helper 2 (Th2) cell-driven eosinophilia and IgE inflammation.
35
What are the clinical features of nasal polyposis?
* Progressive nasal obstruction
* Facial congestion
* Decreased sense of smell
* Rhinorrhea
36
What is a deviated septum?
A wall composed of osteocartilaginous tissue that separates two nasal cavities.
37
List some clinical presentations of nasal septal deviation.
* Headaches
* Rhinosinusitis
* High blood pressure
* Obstructive sleep apnea
38
What is acute pharyngotonsillitis primarily caused by?
Viruses (most common) or bacteria.
39
What are common symptoms of acute pharyngotonsillitis?
* Fever
* Malaise
* Odynophagia
* Dysphagia
* Foul breath
40
Which viruses are common pathogens for acute pharyngotonsillitis?
* Adenoviruses
* Rhinoviruses
* Coronaviruses
* Epstein-Barr viruses (EBVs)
* Cytomegaloviruses (CMVs)
* Coxsackieviruses
* Herpes simplex viruses
* Influenza viruses
41
What is the incubation period for Epstein-Barr virus (EBV)?
2 to 6 weeks.
42
What is a key characteristic of acute Streptococcal pharyngotonsillitis?
Fever, sore throat, cervical lymphadenopathy, dysphagia, and odynophagia.
43
What are nonsuppurative complications of acute streptococcal pharyngotonsillitis?
* Scarlet fever
* Acute rheumatic fever
* Poststreptococcal glomerulonephritis
* Pediatric autoimmune neuropsychiatric disorder associated with GABHS infection (PANDAS)
44
What is a peritonsillar abscess?
Infection spreading from the superior pole of the tonsil into the space between the tonsillar capsule and the pharyngeal muscle bed.
45
What are the typical symptoms of a peritonsillar abscess?
* Severe pain
* Odynophagia
* Muffled voice
* Dysphagia
46
What is pharyngeal diphtheria caused by?
Corynebacterium diphtheriae.
47
What are the symptoms of pharyngeal diphtheria?
* Acute pharyngitis
* Grayish, tightly adherent pseudomembrane covering tonsils
* Potential airway compromise
48
Fill in the blank: Viral infections are responsible for approximately ______% of acute pharyngotonsillitis cases.
70 to 85%
49
What potential toxicities are associated with C. diphtheriae exotoxins?
Cardiac toxicity and neurotoxicity
## Footnote
C. diphtheriae can lead to serious health complications due to its exotoxins.
50
Which sexually transmitted diseases can cause tonsillar infections?
Neisseria gonorrhoeae and Treponema pallidum
## Footnote
These pathogens can lead to significant throat infections.
51
How do gonococcal infections typically present?
As an exudative pharyngitis
## Footnote
This presentation is common in tonsillar infections caused by Neisseria gonorrhoeae.
52
What are the symptoms of primary oral syphilis?
Painless chancre on the lips, buccal mucosa, or oropharynx
## Footnote
Primary oral syphilis can lead to lesions in the oral cavity.
53
What symptoms can secondary syphilis cause in the oropharynx?
Oropharyngeal and tonsillar ulcers, bilateral tonsillar hypertrophy
## Footnote
These symptoms indicate a more advanced stage of syphilis.
54
What causes oropharyngeal candidiasis, also known as 'thrush'?
Overgrowth of Candida albicans
## Footnote
This condition often occurs in immunosuppressed patients.
55
What examination finding is typical for oropharyngeal candidiasis?
White cottage cheese-like plaques that bleed when removed
## Footnote
This is a characteristic sign seen during examination.
56
What characterizes recurrent acute tonsillitis?
Several episodes of acute tonsillitis with complete recovery in between
## Footnote
The pattern of infection can lead to chronic issues.
57
Which bacteria are most frequently isolated in recurrent tonsillitis?
* Streptococcus pneumoniae
* Staphylococcus aureus
* Haemophilus influenzae
## Footnote
These bacteria contribute to the recurrent nature of tonsillitis.
58
What are the symptoms of chronic tonsillitis?
Sore throat for at least three months, tonsillar inflammation, halitosis, persistent tender cervical adenopathy
## Footnote
Chronic tonsillitis can significantly affect quality of life.
59
What are tonsilloliths?
Microbial biofilms that form within tonsillar crypts
## Footnote
They are linked to chronic cryptic tonsillitis and halitosis.
60
What is a common association with the cause of aphthous ulcers?
Human herpesvirus 6
## Footnote
The exact cause remains uncertain, but this virus is frequently mentioned.
61
What is the appearance of a minor aphthous ulcer?
Smaller than 1 cm in diameter, heals in 10-14 days
## Footnote
Minor ulcers are generally less severe than major ones.
62
What is the characteristic appearance of major aphthous ulcers?
Exceed 1 cm in diameter and can cause significant disability due to intense pain
## Footnote
Major ulcers can severely affect daily activities.
63
What are some conditions that may present with large or persistent ulcerative stomatitis?
* Erythema multiforme
* Drug allergies
* Acute herpes simplex
* Pemphigus
* Pemphigoid
* Epidermolysis bullosa acquisita
* Bullous lichen planus
* Behçet disease
* Inflammatory bowel disease (IBD)
## Footnote
These conditions can mimic symptoms of aphthous ulcers.
64
What age group is most commonly affected by supraglottitis?
Children from 2 to 6 years of age
## Footnote
However, adults can also be affected.
65
What is the most common pathogen associated with supraglottitis?
Haemophilus influenzae type B (HIB)
## Footnote
The HIB vaccine has significantly reduced the incidence of this infection.
66
What are the clinical features of supraglottitis?
* Fever
* Difficulty breathing
* Severe odynophagia
* Drooling
* Irritable behavior in children
* Muffled voice if able to speak
* Inspiratory stridor
## Footnote
These symptoms are critical for diagnosis.
67
What should not be undertaken if supraglottitis is suspected?
Further investigation procedures like intraoral examination or venipuncture
## Footnote
Such actions may lead to airway obstruction.
68
What is the most common cause of laryngitis?
Viral upper respiratory infections (URIs)
## Footnote
Viral infections are the primary triggers for laryngeal inflammation.
69
What can parainfluenza viruses cause in children?
Croup or laryngotracheobronchitis
## Footnote
Croup is characterized by a barking cough.
70
What is a typical complication of viral laryngitis?
Bacterial laryngitis
## Footnote
This complication often arises around the seventh day of the illness.
71
What noninfectious causes can lead to laryngitis?
* Vocal trauma
* Inhalation injuries
* Allergies
* Gastroesophageal reflux disease
* Asthma
* Pollution
* Smoking
## Footnote
These factors can also contribute to laryngeal inflammation.
72
What are common symptoms of laryngitis?
* Raspy voice
* Hoarse voice
* Breathy voice
* Dry cough
* Anterior throat pain
* Need to clear throat
## Footnote
These symptoms help in the diagnosis of laryngitis.
73
What characterizes bacterial tracheitis?
Secondary bacterial colonization after a viral respiratory tract infection
## Footnote
This condition often follows a viral infection.
74
What is a common pathogen isolated in bacterial tracheitis?
Staphylococcus aureus
## Footnote
This bacterium is frequently involved in cases of tracheitis.
75
What are the clinical features of bacterial tracheitis?
* Acute exacerbation of airway obstruction
* High fever
* Toxicity
* Rapid onset of symptoms
* Narrowing of the tracheal lumen on x-rays
## Footnote
These features indicate a serious condition requiring prompt attention.
76
What is characterized by a heightened sensitivity to foreign proteins?
Allergy
## Footnote
Allergens can be elicited through ingestion, contact, or inhalation.
77
What is rhinitis defined as?
Eosinophilic inflammation of the nasal mucosa and paranasal sinuses
## Footnote
This results from an IgE-mediated reaction.
78
What are the common manifestations of allergic rhinitis?
Nasal congestion, obstructed airflow, increased mucous production, drainage
## Footnote
These arise from an unfavorable response to stimuli.
79
What is the initial phase necessary for the onset of allergic rhinitis in an atopic individual?
Sensitization
## Footnote
This is followed by subsequent reexposure to a designated allergen.
80
What cells assimilate low-dose exposure of an antigen during sensitization?
Antigen-presenting cells
## Footnote
Examples include dendritic cells, macrophages, or Langerhans cells.
81
What cytokines do activated helper T lymphocytes produce?
IL-4, IL-5, IL-13
## Footnote
These engage with B lymphocytes to synthesize allergen-specific IgE.
82
What triggers mast cell activation upon allergen exposure?
Binding of allergen to IgE antibodies on mast cells
## Footnote
Mast cells are prevalent in various tissues including respiratory and gastrointestinal tracts.
83
Which mediator is pivotal in allergic rhinitis that stimulates sensory nerve endings?
Histamine
## Footnote
It leads to sneezing.
84
What characterizes the late phase response of allergic rhinitis?
Symptoms persist for 4-6 hours after antigen stimulation
## Footnote
Symptoms include sneezing and nasal congestion lasting for about 18-24 hours.
85
What types of cells are predominantly involved in the late phase response of allergic rhinitis?
T lymphocytes, basophils, eosinophils
## Footnote
These cells release mediators contributing to symptom persistence.
86
What can upregulate the expression of adhesion molecules in the late phase response?
Cytokines like IL-4, IL-5, IL-13
## Footnote
This facilitates the infiltration of inflammatory cells into the nasal mucosa.
87
What are common risk factors for allergic rhinitis?
*Atopy*
*Asthma*
*Eczema*
*Other allergies*
*Parental history*
## Footnote
Pollen allergens become more significant in older children and adolescents.
88
What role does the gut microbiota play in allergic disease pathogenesis?
It may influence the formation, function, and regulation of the immune system
## Footnote
Dysbiosis can lead to abnormal allergic reactions.
89
What is dysbiosis in the context of allergic rhinitis?
Alteration in gut microbiota composition
## Footnote
It is associated with increased risk of allergic reactions.
90
What are the clinical features of allergic rhinitis?
*Clear and watery nasal discharge*
*Nasal congestion*
*Postnasal drip*
*Itching of the nose, throat, and eyes*
## Footnote
Physical examination may reveal mouth breathing and allergic shiners.
91
How is allergic rhinitis classified based on symptoms?
*Seasonal Allergic Rhinitis*
*Perennial Allergic Rhinitis*
## Footnote
Seasonal symptoms occur with pollination, while perennial symptoms are constant.
92
What are common indoor allergens causing perennial allergic rhinitis?
*Dust mites*
*Animal dander*
*Mold spores*
*Cockroaches*
## Footnote
These allergens can trigger symptoms year-round.
93
What are potential complications of allergic rhinitis?
*Adenoid hypertrophy*
*Eustachian tube dysfunction*
*Chronic rhinosinusitis*
*Nasal polyps*
*Sleep disruption*
*Learning disturbances*
## Footnote
These can significantly affect quality of life.
94
What is the relationship between gut microbiome diversity and allergic rhinitis?
Reduced gut microbiome diversity is observed in AR patients
## Footnote
Increased Bacteroidetes and decreased Actinobacterium are noted.
95
What microbiome metrics are indicative of allergic rhinitis?
Lower diversity indices (Chao1 and Shannon)
## Footnote
More abundant Bacteroidetes and reduced Firmicutes are also observed.
96
What symptoms are linked to levels of Butyrococcus and Eisenbergiella?
Moderate and severe allergic rhinitis symptoms
## Footnote
These levels may correlate with symptom severity.
97
What are the most common symptoms of nonallergic rhinitis?
Nasal obstruction and clear rhinorrhea
## Footnote
Sneezing and itchy, watery eyes are not common symptoms.
98
How does the prevalence of nonallergic rhinitis change with age?
It is more prevalent with advancing age.
99
What should be asked of patients with nonallergic rhinitis?
Over-the-counter nasal sprays, previous trauma, work exposure, or intranasal drug use.
100
What symptoms should prompt attention for possible neoplasm in nonallergic rhinitis?
Epistaxis, pain, and unilateral symptoms.
101
What is viral rhinitis commonly accompanied by?
Headaches, malaise, body aches, and coughing.
102
What are typical characteristics of nasal drainage in viral rhinitis?
Clear or white nasal drainage.
103
What pollutants can affect occupational rhinitis?
Dust, ozone, sulfur dioxide, cigarette smoke, and garden sprays.
104
What symptoms are typical in occupational rhinitis?
Dry nasal passages, reduced airflow, rhinorrhea, and sneezing.
105
What has exposure to wood particles and chronic cigarette smoke been associated with?
Reduced ciliary movements in the nose.
106
What management strategies are effective for occupational rhinitis?
Protective mask, avoidance, improving ventilation, and removing the causal agent.
107
What is vasomotor rhinitis (VMR)?
The most common form of nonallergic rhinitis observed clinically.
108
What triggers vasomotor rhinitis?
Environmental conditions that normally do not affect normal individuals.
109
What causes increased mucus production in vasomotor rhinitis?
An imbalance among mediators affecting submucosal nasal glands.
110
What neurotransmitter governs mucous secretion in vasomotor rhinitis?
Acetylcholine.
111
What neurotransmitters regulate vascular tone in vasomotor rhinitis?
Norepinephrine and neuropeptide Y.
112
What types of environmental triggers can exacerbate vasomotor rhinitis?
* Strong odors
* Cold air exposure
* Alcohol consumption
* Spicy foods
113
What is Nonallergic Rhinitis with Eosinophilia (NARES)?
A syndrome of nasal obstruction and congestion with severe exacerbations.
114
What is rhinitis medicamentosa?
Nasal congestion caused by the overuse of topical nasal decongestants.
115
What are common topical nasal decongestants that can cause rhinitis medicamentosa?
* Oxymetazoline
* Phenylephrine
116
What physiological changes occur during pregnancy that affect nasal congestion?
Increased hyaluronic acid, decreased nasal cilia, and increased mucous glands.
117
What systemic disorders can exhibit symptoms of chronic inflammation in rhinitis?
* Wegener granulomatosis
* Cocaine abuse
118
What defines chronic rhinosinusitis (CRS)?
Inflammation of the nasal cavity and paranasal sinuses lasting more than 12 weeks.
119
What are common symptoms of chronic rhinosinusitis?
* Nasal obstruction
* Facial congestion
* Discolored nasal discharge
* Hyposmia
120
What can chronic inflammation in CRS lead to in terms of bacterial growth?
It can block nasal passages, inhibit drainage, and reduce oxygen tension.
121
What are some hypothesized causes of chronic rhinosinusitis?
* Biofilms
* Bacterial superantigens
* Osteitis
* Allergy
* Barrier and innate immune dysregulation
* General host factors
122
What is a significant clinical feature of chronic sinusitis?
Purulent drainage: green or yellow nasal discharge.
123
What are nasal polyps?
Benign inflammatory and hyperplastic growths from sinonasal mucosa.
124
What is the most common cause of nasal polyps?
T-helper 2 (Th2) cell-driven eosinophilia.
125
What symptoms should prompt suspicion of nasal polyposis?
* Progressive nasal obstruction
* Nasal congestion
* Decreased sense of smell
* Rhinorrhea
126
What is the structure of the nasal septum?
A wall composed of osteocartilaginous tissue that separates two nasal cavities.
127
What are common clinical presentations of nasal septal deviation?
* Headaches
* Rhinosinusitis
* High blood pressure
* Obstructive sleep apnea
128
What can nasal septal deviations lead to in terms of sleep disorders?
Obstructive sleep apnea (OSA).
129
What is pharyngotonsillitis?
An infection of the tonsils and pharynx that can be caused by various organisms including bacteria, viruses, fungi, and parasites.
## Footnote
Common bacteria include staphylococcus, nonhemolytic streptococci, lactobacilli, bacteroides, and actinomyces.
130
What are the common symptoms of acute pharyngotonsillitis?
* Fever
* Malaise
* Odynophagia
* Dysphagia
* Foul breath
## Footnote
Airway obstruction may occur due to tonsillar enlargement.
131
What percentage of acute pharyngotonsillitis cases are caused by viral infections?
Approximately 70 to 85%
## Footnote
Common viral pathogens include adenoviruses, rhinoviruses, and Epstein-Barr viruses.
132
Which virus is known to cause infectious mononucleosis?
Epstein-Barr virus (EBV)
## Footnote
EBV has a preference for infecting human B-lymphocytes.
133
What are the symptoms of EBV infection?
* High fever
* Generalized malaise
* Lymphadenopathy
* Hepatosplenomegaly
* Pharyngitis
## Footnote
Severe tonsillar enlargement and grayish-white exudate can also occur.
134
What is the main bacterial cause of acute bacterial pharyngotonsillitis in children?
Group A beta-hemolytic streptococcus (GABHS)
## Footnote
Transmission occurs through droplet spread.
135
What is scarlet fever and its association with GABHS?
A condition resulting from endotoxins produced during acute streptococcal pharyngotonsillitis, characterized by an erythematous rash and 'strawberry tongue.'
## Footnote
Symptoms also include fever, lymphadenopathy, and dysphagia.
136
What is acute rheumatic fever and when does it develop?
A complication that develops 1 to 4 weeks after GABHS pharyngotonsillitis, causing heart muscle damage due to cross-reactive antibodies.
## Footnote
It can lead to endocarditis, myocarditis, or pericarditis.
137
What is a peritonsillar abscess?
An infection spreading from the tonsil into the space between the tonsillar capsule and the pharyngeal muscle bed, presenting with severe pain and dysphagia.
## Footnote
Common pathogens include GABHS and Staphylococcus aureus.
138
What is the hallmark of infectious mononucleosis caused by EBV?
Lymphoid hypertrophy, especially in the posterior nodes.
## Footnote
Symptoms in younger individuals are often milder.
139
What is laryngitis and its common causes?
Inflammation of the larynx, most commonly caused by viral upper respiratory infections.
## Footnote
Bacterial laryngitis may arise as a complication of viral laryngitis.
140
What are the symptoms of laryngitis?
* Raspy voice
* Dry cough
* Anterior throat pain
## Footnote
Physical examination may reveal redness and swelling of the vocal cords.
141
What is the main pathogen responsible for bacterial tracheitis?
Staphylococcus aureus
## Footnote
It often occurs following a viral respiratory tract infection.
142
What is the incubation period for acute retroviral syndrome associated with HIV?
1 to 5 weeks
## Footnote
Symptoms include fever and lymphadenopathy.
143
What are tonsilloliths?
Microbial biofilms that form within tonsillar crypts, linked to chronic cryptic tonsillitis and halitosis.
## Footnote
Patients may feel foreign body sensations in their throats.
144
What is the significance of the HIB vaccine in relation to supraglottitis?
It has significantly reduced the incidence of supraglottitis by more than 90%.
## Footnote
Haemophilus influenzae type B is the most common pathogen.
145
True or False: Aphthous ulcers are associated with human herpesvirus 6.
True
## Footnote
They appear as painful ulcerations on nonkeratinized mucosa.
146
What is the typical presentation of pharyngeal diphtheria?
Characterized by a grayish, tightly adherent pseudomembrane covering the tonsils and pharynx.
## Footnote
It can lead to airway compromise and systemic toxicity.
147
What condition may develop following GABHS infection in children, characterized by obsessive-compulsive behaviors?
Pediatric autoimmune neuropsychiatric disorder associated with group A streptococcal infection (PANDAS)
## Footnote
Similar pathophysiology is thought to exist for Sydenham chorea.
148
What are the complications of untreated parapharyngeal abscess?
Potential spread down the carotid sheath and into the mediastinum.
## Footnote
Symptoms include trismus and decreased neck range of motion.
149
What is the effect of prolonged antibiotic treatment on oropharyngeal candidiasis?
It can lead to overgrowth of Candida albicans, causing thrush.
## Footnote
Examination reveals white plaques that bleed when removed.
