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Nasal discharge TBL

Non-allergic rhinitis and Nasal Discharge, CJ, 1/3/2012

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