Course 6207 > Chapter 75 Rhinitis > Flashcards

Chapter 75 Rhinitis Flashcards

(43 cards)

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1
Q

What are the red flags associated with rhinitis?

A
  • Recurrent epistaxis
  • Sinusitis
  • Pulmonary involvement
  • Visual changes
  • Unilateral symptoms
  • Hilar adenopathy

These symptoms may indicate more serious underlying conditions.

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2
Q

Define allergic rhinitis.

A

A heterogeneous, inflammatory response affecting the paranasal and sinus mucosa characterized by sneezing, rhinorrhea, mucosal swelling, obstruction, conjunctivitis, and itching

Also known as allergic rhinosinusitis (AR).

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3
Q

What is the hallmark of allergic rhinitis?

A

Temporal correlation of symptoms with exposure to allergens

Symptoms may vary seasonally based on allergen types.

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4
Q

List common indoor allergens associated with perennial allergic rhinitis.

A
  • Animal dander
  • Dust mites
  • Foods
  • Insect stings
  • Cockroach droppings
  • Mold spores
  • Chemicals

These allergens are often present in the patient’s living area.

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5
Q

What type of immune response is involved in allergic rhinitis?

A

Immunoglobulin E (IgE)–mediated mast cell hypersensitivity response

This response affects individuals of any age, particularly those with atopy.

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6
Q

What are the primary mediators released during an allergic reaction?

A
  • Histamine
  • Proteases
  • Chemotactic factors (ECF, NCF)

These mediators cause local tissue edema and increased drainage.

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7
Q

What are common symptoms of allergic rhinitis?

A
  • Sneezing
  • Rhinorrhea
  • Nasal congestion
  • Dry mouth
  • Postnasal discharge
  • Fatigue

Symptoms may also include watery, itchy, and puffy eyes.

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8
Q

True or false: Fever and chills are common symptoms of allergic rhinitis.

A

FALSE

Fever and chills are unusual in allergic rhinitis.

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9
Q

What is the preferred diagnostic method for allergic rhinitis?

A

Skin testing

Skin testing is more sensitive than radioallergo-sorbent tests (RASTs).

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10
Q

List some common medications associated with rhinitis.

A
  • Reserpine
  • Methyldopa
  • NSAIDs
  • Oral contraceptives
  • β-blockers
  • Street drugs (e.g., cocaine, heroin)

These medications can contribute to rhinitis symptoms.

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11
Q

What is the role of immunotherapy in treating allergic rhinitis?

A

Effective for severe symptoms or when allergens cannot be avoided

Immunotherapy can involve subcutaneous or sublingual methods.

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12
Q

What is the most important treatment for allergic rhinitis?

A

Environmental control

Controlling exposure to allergens is crucial for symptom management.

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13
Q

What are some strategies for controlling indoor allergens?

A
  • Keeping pets out of the bedroom
  • Regular cleaning with HEPA filters
  • Minimizing carpeting and upholstered furniture
  • Washing bedding in hot water weekly

These strategies help reduce allergen exposure in the home.

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14
Q

What are the seasonal allergens associated with allergic rhinitis?

A
  • Pollen
  • Ragweed
  • Grass pollens
  • Tree pollens

Seasonal allergies occur in relation to specific times of the year.

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15
Q

What symptoms indicate a need for specialist referral in allergic rhinitis?

A
  • Recurrent epistaxis
  • Sinusitis
  • Pulmonary involvement
  • Visual changes
  • Unilateral symptoms
  • Hilar adenopathy

Referral may be necessary if the condition does not respond to standard treatments.

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16
Q

What are some nonpharmacologic interventions for allergic rhinitis?

A
  • Machine-washable polyester pillows
  • Wet dusting
  • Washing stuffed animals, sheets, and comforters in hot water
  • Removing house plants and books
  • Trimming bushes from the house
  • Cleaning central heating and air-conditioning units
  • Using mold inhibitors when painting
  • Reducing mold growth and humidity
  • Using a frost-free refrigerator
  • HEPA furnace filters and room cleaners

These interventions aim to limit environmental exposures and control symptoms.

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17
Q

When should pharmacologic interventions be considered for allergic rhinitis?

A

If strict environmental control has not worked sufficiently

Pharmacologic agents should be used only when allergies significantly affect the person’s quality of life.

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18
Q

What is the first-line treatment for allergic rhinitis?

Study These Flashcards
A

Intranasal steroids

They provide a targeted dose of steroids, allowing maximal efficacy and minimizing systemic side effects.

19
Q

What are the common side effects of intranasal steroids?

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A
  • Nasal burning
  • Stinging
  • Dryness
  • Headaches
  • Epistaxis
  • Pharyngitis

Intranasal steroids have a good safety profile with few systemic side effects.

20
Q

What is the role of oral antihistamines in allergic rhinitis treatment?

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A
  • Reduce sneezing
  • Reduce pruritus
  • Reduce rhinorrhea

They are less effective than intranasal steroids in reducing nasal congestion.

21
Q

Name some second-generation antihistamines.

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A
  • Loratadine
  • Desloratadine
  • Cetirizine
  • Levocetirizine
  • Fexofenadine

These antihistamines are preferred due to fewer side effects and once-daily administration.

22
Q

True or false: First-generation antihistamines are preferred for daytime use due to their non-sedating effects.

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A

FALSE

First-generation antihistamines are more sedating and should be reserved for nighttime symptoms.

23
Q

What is nasal saline irrigation used for in allergic rhinitis?

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A

To rinse the nares and potentially sinus cavities with isotonic saline

It is an effective nonpharmacologic intervention.

24
Q

What are some complications of allergic rhinitis?

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A
  • Increased asthma exacerbations
  • Other pulmonary disease exacerbations
  • Sleep apnea

These complications can arise if rhinitis is untreated.

25
What should be assessed in patients with **new nasal congestion**?
Anatomic disorders ## Footnote A nasal examination is necessary to exclude conditions like nasal polyps or neoplasms.
26
What is **vasomotor rhinitis**?
A nonallergic, noninfectious cause of perennial nasal congestion and rhinorrhea ## Footnote It is triggered by environmental factors and does not involve itchiness or sneezing.
27
What triggers **idiopathic rhinitis**?
* Cold air * Strong smells * Irritants * Changes in weather * Certain medications * Stress * Exercise * Certain foods * Increased estrogen levels ## Footnote Symptoms occur year-round and are chronic.
28
What is the **pathophysiology** of nonallergic rhinitis?
Involves an abnormal balance favoring parasympathetic control over sympathetic control of the nasal mucosa ## Footnote This leads to intermittent vascular engorgement of the nasal mucous membranes.
29
What is the proposed cause of **nonallergic rhinitis**?
Neurogenic imbalance favoring parasympathetic control ## Footnote This leads to intermittent vascular engorgement of the nasal mucous membranes.
30
What are common **symptoms** of nonallergic rhinitis?
* Perennial nasal congestion * Slight watery discharge * Obstructive symptoms * Rhinorrhea ## Footnote Symptoms can begin shortly after getting out of bed and are triggered by environmental factors.
31
True or false: **Itching and sneezing** are common symptoms of nonallergic rhinitis.
FALSE ## Footnote These symptoms are characteristic of allergic rhinitis (AR), not nonallergic rhinitis.
32
What is the typical appearance of the **nasal mucosa** in allergic rhinitis (AR) compared to idiopathic rhinitis?
* AR: Pale * Idiopathic rhinitis: Erythematous ## Footnote This difference can be observed during physical examination.
33
What are the **initial diagnostics** for idiopathic rhinitis?
* Nasal eosinophils * Skin testing ## Footnote Skin testing results are often positive in allergic rhinitis but not in idiopathic rhinitis.
34
What should be included in the **priority differentials** for idiopathic rhinitis?
* Trauma * Tumor * Cancer * Foreign bodies * Bacterial infections ## Footnote Patient history is crucial for distinguishing idiopathic rhinitis from allergic rhinitis.
35
What is the recommended **management** for idiopathic rhinitis?
* Environmental avoidance * Oral decongestants * Saline irrigations * Intranasal steroids ## Footnote Immunotherapy is often not practical for chronic idiopathic rhinitis.
36
What are potential **complications** of idiopathic rhinitis?
* Sleep deprivation * Diminished quality of life ## Footnote Chronic issues can arise, although long-term complications are not well-documented.
37
What is the **cause** of infectious rhinitis?
* Upper respiratory tract infections * Viral infections (e.g., rhinovirus, coronavirus) ## Footnote Symptoms typically resolve with the underlying disease.
38
What is the most common cause of **viral rhinitis**?
Rhinovirus ## Footnote Infection occurs through direct contact with infected secretions.
39
What are the **anatomic causes** of rhinitis?
* Deviated nasal septum * Nasal polyps * Nasal tumors ## Footnote Nasal polyps are the most common cause of anatomic-related rhinitis.
40
What can chronic administration of **topical decongestants** lead to?
Rebound engorgement of the nasal mucosa ## Footnote This occurs after approximately 1 or 2 weeks of use.
41
What are some **pharmacologic causes** of rhinitis?
* β-blockers * ACE inhibitors * Chlorpromazine * Estrogen * Oral contraceptives ## Footnote These medications can cause symptoms that mimic allergic rhinitis.
42
What is the treatment for **food- or drink-related rhinitis**?
Avoidance of the trigger food or drink ## Footnote Symptoms may occur after ingestion and could be due to a cholinergic reaction.
43
What are other **medical causes** of rhinitis?
* Pregnancy * Hypothyroidism * Cocaine use * Atrophic changes ## Footnote Treatment is directed at the underlying medical condition.
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