Non-allergic rhinitis and Nasal Discharge, CJ, 1/3/2012
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| In allergic rhinitis, allergins bind to which immunoglobin in the nose? | IgE
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| If a serum specific IgE immunoassay is negative, the patient is classified as having | Nonallergic rhinitis
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| Immunocap/RAST is also known as | A serum specifi IgE immunoassay
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| Which is more common, allergic or nonallergic rhinitis | Allergic
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| Rhinitis is classified by which symptoms | Nasal congestion, clear rhinorrhea, sneezing and itching
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| Patient reports with sneezing and itching (allergic or nonallergic?) | Allergic
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| Patient develops symptoms at a late age (allergic or nonallergic?) | Nonallergic
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| Patient is triggered when in contact with dog/cat (allergic or nonallergic?) | Allergic
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| Common triggers of nonallergic rhinitis? | Changes in weather and temperature, food, perfumes, odors, smoke and fumes
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| Patient has no complaints of allergic conjuctivitis aka itching, watering, redness or swelling (allergic or nonallergic?) | Nonallergic
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| Patient does not find any benefit or relief from antihistamines (allergic or nonallergic?) | Nonallergic
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| Patient has no other atopic disease such as eczema or food allergies and has no family history of atopy (allergic or nonallergic?) | Nonallergic
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| Patient presents with "allergic crease" and gothic arch (allergic or nonallergic?) | Long-standing allergic
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| Turbinates are found to be pale, moist, and boggy with a blueish tinge (allergic or nonallergic?) | Allergic
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| Types of vasomotor rhinitis | Irritant-sensitive, Weather-sensitive, Temperature-sensative and Gustatory rhinitis
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| Clear Rhinorrhea while eating and drinking alcohol | Gustatory Rhinitis
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| Treatment for Gustatory rhinitis? | Nasal ipratropium(Atrovert)before meals
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| Acute vasomotor rhinitis symptoms brought on by strong odors, cigarette smoke, air pollution or perfume | Irritant-sensitive vasomotor rhinitis
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| Weather- or temperature- sensitive vasomotor rhinitis does not not respond well to | Intranasal steroids
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| Honeymoon rhinitis | Rhinitis triggered by sexual arousal
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| Local inflammatory rhinitis | Aspirin-exacerbated respiratory disease characterized by nasal polyposis, rhinosinusitis, hyposmia and asthma
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| Treatment of local inflammatory rhinitis | Avoidance of NSAIDs
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| Neurogenic type rhinitis | Occurs with sympatholytic drugs (alpha receptor agonists and antagonists, vasodilators)
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| Rhinitis brought on by Sildenafil | Anniversary rhinitis
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| How do you identify the offending medication in drug induced rhinitis | Correlate the initiation of a drug with the onset of rhinitis
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| First line treatment in Drug-induced rhinitis | Stop the drug if possible
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| Rhinitis medicamentosa | Overuse of OTC topical nasal decongestants, mucosa appears beefy red without mucous
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| Treatment for Rhinitis medicamentosa withdrawal | Topical intranansal steroids or 5-7 days of oral steroids
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| Patient presents with chronic irritation, nosebleeds, crusting and scabbing. What should you suspect? | Cocaine use
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| Acute viral upper respiratory infections present with | Thick nasal discharge, sneezing and nasal obstruction that usually clears within 7-10 days but can last up to 3 weeks
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| Bacterial sinusitis can follow an acute viral URTI and presents with | Persistent nasal congestion, discolored mucous, facial pain, cough and sometimes fever
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| Chronic Rhinosinsitis | Lasts more than 12 weeks, CT shows thickened sinus cavity, symptoms include Facial pain, congestion, obstruction, purulent discharge and change in olfaction
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| Treatment for chronic rhinosinusitis | 3 or more weeks of an oral antibiotic and a short course of an oral (or nasal) steroid
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| NARES presentation | Symptoms present in middle aged patients, perennial symptoms, sneezing, itching, hyposmia, more than 5% of cells on nasal smear are eosinophils and allergy testing is negative
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| Treatment for NARES | Intranasal steroids
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| Granulomatous infection sin the nose may lead to | Crusting, bleeding and nasal obstruction
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| Occupational rhinitis often presents along with | Asthma
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| Hormonal rhinitis is triggered most often by which hormone | Estrogen
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| Treatment of hormonal rhinitis during pregnancy | Rhinocort
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| Structurally related rhinitis can arise from | Nasal septum deviation, turbinate hypertrophy, enlarged adenoids, tumors and foreign bodies
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| A salty, metallic taste in the mouth along with clear spontaneous rhinorrhea is linked to | CSF leakage
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| Definitive diagnosis of CSF leak is made by | Beta-2 transferrin in nasal secretions
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| Primary atrophic rhinitis is cause by | Klebsiella ozaenae
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| Primary atrophic rhinitis is found most in which patients | Young patients in warm climates
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| Secondary atrophic rhinitis usually follows | Surgery or trauma
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| Secondary atrophic rhinitis is treated with | Daily saline rinse with or without antibiotics
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| First treatment for nonallergic rhinitis | Intranasal steroid spray and follow up in 2-4 weeks
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| If you cannot avoid your trigger, pretreat with | Intranasal steroid or antihistamine
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| First line therapy for rhinorrhea | Intranasal steroid spray
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| Nasal steroid sprays are most helpful with the dominant symptom is | Congestion, but they also help rhinorrhea, sneezing, and itching
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| Side effects of intranasal steroid sprays | Nasal irritation and epistaxis (nose bleeds)
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| Intranasal antihistamines are particularly useful for treating | Sneezing, congestion, and rhinorrhea
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| Intranasal antihistamine side effects | Bitter or sweet taste in mouth, headache and somnolence(drowsiness)
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| Oral antihistamines are helpful for those bothered by | Sneezing but not effective for nonallergic rhinitis
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| First generation oral antihistamines may help with rhinorrhea because of their | Anticholinergic effects
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| Oral antihistamines are avaiable | OTC
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| Ipratropium is a ___ agent | Antimuscarinic
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| Ipratropium works by | Decreasing secretions by inhibiting the nasal parasympathetic mucous glands
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| When dominant symptom is rhinorrhea, a first line treatment considered is | Intranasal ipratropium
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| Higher dose intranasal Ipratropium can be used to treat | rhinorrhea related to the common cold or allergic rhinorrhea
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| Ipratropium side effect | Nasal dryness
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| Decongestants are used for which symptoms | Congestion and rhinorrhea
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| Length of use for decongestant | Short term only
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| Side effects of decongestant | Tachycardia, increase blood pressure and insomnia
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| Presumed benefits from saline rinse | Clears secretions, increases nasociliary function and removes irritants
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| CT imaging is done when you are concerned about a possible | Chronic rhinosiusitis, polyps or anatomical problems
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| Kartagener syndrome is an autosomal ____ disease | Recessive
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| Kartegener disease is characterized by | Defective cilia motility, most often due to missing dynein arms
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| Sterility and poor mucociliary clearance is often associated with | Kertangener disease
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| Situs inversus is found in 50% of patients with | Kertangener disease
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| A decrease in dynein arms leads to a decrease in | Beat frequency
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| A normal central to microtubule ratio is 2:9. Kertangener patients often present with an abnormal ratio of | 1:8
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| Defect in the dynein arms leads to | Hypomotility
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| Defect in microtubulars leads to | asynchrony
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| PCD tissues are thought to have impaired action in which ion transport? | Chloride
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| The most common facial fracture | Nasal
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| Classifying a nasal fracture as open or closed is based on | The integrity of the mucosa
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| First step in treating a nasal/septum fracture is | Confirmation that there is no septal hematoma
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| Force from the front to the nose will cause | A simple fracture to flattening of the nose
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| Lateral force to the nose will cause | One or both bones to break and seveve septal displacement
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| Superior force to the nose will cause | Severe septal fracture and displacement of quadrangular cartilage
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| Epistaxis occurs when | The mucosa is eroded to expose vessels
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| Anterior epistaxis comes from | Little's area (Kiesselbach plexus)
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| Anterior epistaxis presents as a | Constant ooze, not a severe bleed
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| Posterior epistaxis comes from | Sphenopalatine artery
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| Which is more severe bleeding and more dangerous, anterior or posterior epistaxis? | Posterior
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| Which foreign bodies produce earlier and more irritating symptoms in the nose? | Organic bodies
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| Where are the two most common sites for foreign bodies in the nose | Anterior to the middle turbinate or below inferior turbinate
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| Which side is most often affected by foreign bodies in the nose | Right
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| Most common age for foreign bodies in the nose | Ages 2-5
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| Sinonasal malignant neoplasm accounts for what percent of URT tumors | 3%
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| Requirements for Cluster Headache | Unilateral, 15-180 minutes long, up to 8 times a day but at least every other day
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| Symptoms for cluster headache can include | Conjunctival injection, lacrimation, nasal congestion, rhinorrhea, sweating, miosis, ptosis, and eyelid edema
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| Two types of cluster headaches | Episodic (1 month break with no headache) or chronic (break of less than 1 month)
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| Cluster headaches are thought to be because of a defect in the | Hypothalamic gray matter
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| Which neurons carry sensory and motor impulses in the maxillary and ophthalmic divisions of the trigeminal nerve | Substance P
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| What is Somatostatin? | Drug that inhibits substance P, therefor reducing duration and intensity of cluster headaches
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| Vascular change in cluster headaches is found to be | Secondary to pain
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| Cluster headaches can be precipitated with small amounts of | Histamine
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