Nasal Conditions: Rhinitis, Sinusitis & Congestion

Question-and-answer flashcards covering definitions, symptoms, causes, treatments, drug details and guideline points for nasal congestion, rhinitis and sinusitis.

What is nasal congestion (blocked nose) primarily characterized by?

Nasal obstruction or stuffiness that can vary in severity and is often accompanied by discharge, post-nasal drip, facial pain, loss of smell, sneezing, itching or crusting.

List four common causes of nasal congestion.

Nasal deformity, foreign body, mucosal swelling/inflammation (e.g., sinusitis), and allergy such as hay fever.

Name three first-line non-drug treatments for simple nasal congestion.

Steam inhalation (with menthol/eucalyptus), saline sprays or drops, and saline nasal irrigation.

Give two drug classes commonly used for congestion relief.

Corticosteroid nasal sprays and decongestants (oral or intranasal).

Define rhinitis.

Irritation and inflammation of the nasal mucosal membrane, classified as allergic or non-allergic.

State four hallmark symptoms of allergic rhinitis.

Sneezing, nasal congestion, rhinorrhoea (runny nose), and nasal itching.

Which immunoglobulin mediates allergic rhinitis?

Immunoglobulin E (IgE).

Differentiate between ‘seasonal’ and ‘perennial’ allergic rhinitis.

Seasonal occurs during specific times of year in response to seasonal allergens (e.g., pollen); perennial occurs all year because of constant exposure (e.g., dust mites).

How is ‘intermittent’ allergic rhinitis defined in terms of duration?

Symptoms <4 days per week or <4 consecutive weeks.

What is the preferred first step in managing allergic rhinitis before pharmacotherapy?

Identify and avoid known triggers or allergens; consider saline nasal irrigation.

List six pharmacological classes used in allergic rhinitis.

(1) Antihistamines, (2) Intranasal cromones, (3) Intranasal decongestants, (4) Intranasal anticholinergics, (5) Leukotriene receptor antagonists, (6) Intranasal corticosteroids.

What is the usual adult dose of oral cetirizine for allergic rhinitis?

10 mg once daily (dose reduction in renal impairment).

Which oral antihistamine requires alternate-day dosing in hepatic impairment?

Loratadine 10 mg.

Name two common side effects shared by oral antihistamines.

Drowsiness and dry mouth (others include blurred vision, headache, diarrhoea).

At what age can azelastine nasal spray be started and what is the dose?

From 6 years; 1 spray into each nostril twice daily.

Why should intranasal decongestants like xylometazoline be limited to 5–7 days?

To avoid rebound congestion and mucosal hypertrophy.

Give two medical cautions for xylometazoline use.

Hypertension and hyperthyroidism (others: diabetes, cardiovascular disease, glaucoma, BPH).

State one key counselling point for ipratropium bromide nasal spray.

Avoid spraying near the eyes to prevent anticholinergic ocular effects.

What evening dose of montelukast is recommended for patients aged ≥15 years?

10 mg once daily in the evening.

List two behavioural or environmental triggers of non-allergic rhinitis.

Smoke/irritant fumes and changes in temperature or humidity (others: alcohol, spicy food, medications).

Define sinusitis (rhinosinusitis).

Inflammation of the paranasal sinuses and nasal cavity.

How long do symptoms last in acute versus chronic sinusitis?

Acute:

Give three common causes of sinusitis.

Viral upper-respiratory infection, bacterial infection, and allergic rhinitis (others: asthma, smoking, nasal polyps).

Name two serious orbital complications of sinusitis.

Orbital cellulitis and cavernous sinus thrombosis.

When is antibiotic therapy NOT recommended for acute sinusitis?

If symptoms have been present for <10 days, suggesting a likely viral cause.

What intranasal medication may be considered for acute sinusitis persisting >10 days?

High-dose nasal corticosteroid for 14 days.

List two referral criteria for acute sinusitis.

Frequent recurrent episodes or treatment failure after extended antibiotic courses (others: anatomic defects, immunocompromised, nasal polyps).

State one key piece of advice for chronic sinusitis self-management.

Use nasal irrigation and continue intranasal corticosteroids for up to 3 months; avoid smoking and known triggers.

Give three analgesic options for sinus pain.

Paracetamol, NSAIDs (e.g., ibuprofen), and aspirin (weak opioids for moderate pain if required).

Name three intranasal corticosteroid preparations available from age 12+.

Beclometasone (Beconase), Mometasone (Nasonex), and Fluticasone (Flixonase/Avamys/Dymista).

State one absolute contraindication to intranasal corticosteroid use.

Untreated fungal, bacterial or viral nasal infection.

Describe the correct head position when using a nasal spray.

Tilt head slightly forward, keep the bottle upright, close one nostril, and breathe in slowly through the nose while spraying.

What class of antibiotic is phenoxymethylpenicillin and its mechanism?

A β-lactam that interrupts bacterial cell-wall synthesis (narrow spectrum).

Provide the standard adult dose of phenoxymethylpenicillin for acute sinusitis.

500 mg four times daily for 5 days.

Which two patient groups require dose reduction when using amoxicillin?

Those with eGFR <30 mL/min/1.73 m² and severe renal impairment.

What additional component in co-amoxiclav protects amoxicillin from β-lactamase?

Clavulanic acid.

List one contraindication specific to co-amoxiclav (not shared with plain penicillin).

History of co-amoxiclav-associated jaundice or hepatic dysfunction.

Which macrolide is preferred in pregnancy for penicillin-allergic patients?

Erythromycin.

Name two major drug classes that interact with clarithromycin by prolonging the QT interval.

Calcium-channel blockers and other QT-prolonging agents such as amiodarone.

Why is doxycycline contraindicated in children under 12 years?

Risk of permanent teeth discoloration and effects on bone growth.

State one key counselling message about antibiotics and hormonal contraception.

Routine penicillins, macrolides and tetracyclines do NOT reduce contraceptive efficacy; additional precautions only needed if vomiting or severe diarrhoea occurs.

What phenomenon can result from overuse of topical nasal decongestants?

Rebound congestion (rhinitis medicamentosa).

Identify the maximum recommended duration of xylometazoline use in adults.

7 days.

Which drug used in allergic rhinitis is generally safe in pregnancy and breastfeeding?

Intranasal sodium cromoglicate (cromone).

List two local adverse effects common to intranasal corticosteroids.

Nasal dryness/irritation and epistaxis (nosebleeds).

What simple OTC measure can help both allergic rhinitis and chronic sinusitis?

Regular saline nasal irrigation with 0.9 % NaCl solution.