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Nasal discharge TBL
Non-allergic rhinitis and Nasal Discharge, CJ, 1/3/2012
| Question | Answer |
|---|---|
| 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
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