Respiratory

Front 1

Is empiric treatment with classic symptoms appropriate?

Back 1

yes

Front 2

Treatment for allergic rhinitis is typicallY:

Back 2

-intranasal steroid

- nonsedating antihistamine

Front 3

_____ is effective in treating ocular symptoms associated with allergic rhinitis.

Back 3

intranasal steroids

Front 4

When is allergy testing indicated?

Back 4

- severe symptoms

- failed other therapy

-unclear diagnosis

Front 5

______ can produce long-lasting remission of allergic rhinitis symptoms.

Back 5

subcutaneous/sublingual immunotherapy

Front 6

Allergic Rhinitis is characterized by:

Back 6

IgE-mediated inflammation of the mucus membranes lining the nasal passages in a sensitized individual, leading to the typical symptoms of sneezing, nasal obstruction, nasal itching, and mucus discharge, all of which are reversible spontaneously or with treatment

Front 7

There is association between _______ and Allergic rhinitis.

Back 7

otitis media with effusion

Front 8

Allergic rhinitis with atopy is related to worsening of ______

Back 8

asthma

Front 9

What leads to symptoms of Allergic rhinitis?

Back 9

exposure to allergen

Front 10

What is pathophysiology of allergic rhinitis?

Back 10

inhaled trigger allergen is bound by specific IgE antibodies to IgE receptors on mast cells of respiratory mucosa

Front 11

What is mechanism of allergic rhinitis?

Back 11

Mast cells degranulate, releasing chemical mediators of inflammation. These mediators synthesize further mediators and chemicals that attract other inflammatory cells, causing a delayed phase of inflammation

Front 12

Does Maternal dietary restrictions during pregnancy have a major role in preventing atopic disease?

Back 12

no

Front 13

Does Parental cleaning of pacifiers with their own mouth decrease the likelihood of allergy sensitization, asthma, and eczema?

Back 13

yes

Front 14

Does Postponing introduction of solid food (nuts, fish, or eggs) and cow’s milk decrease incidence of AR?

Back 14

No

Front 15

Does Early life supplementation with probiotics protect against AR, asthma, eczema, or food allergy at age 5 years?

Back 15

no

Front 16

Does Dust mite-proof covers for beds and pillows decrease atopic disease in the first 2 years of life?

Back 16

no

Front 17

How do you diagnosis allergic rhinitis?

Back 17

- History, exam, response to therapy

Front 18

_________________ may be used when skin testing is impractical

Back 18

measurement of allergen-specific IgE

Front 19

DDX for Allergic Rhinitis:

Back 19

- Acute viral rhinitis- Usually less than 7 days

- Vasomotor rhinitis- Less sneezing, associated with physical stimuli such as temperature change, humidity

- Drug-induced rhinitis- Associated with initiation of medication (ACE I, beta blockers, alpha blockers, NSAIDs)

- Hormonally associated rhinitis- Pregnancy, oral contraceptives, hypothyroidism

- Irritant-related rhinitis- Related to chemical exposure like tobacco smoke, formaldehyde, hair spray

- Rhinosinusitis- Purulent discharge

- Rhinitis medicamentosa- Occurs with withdrawal from nasal decongestants

- Non-AR with eosinophilia syndrome- Classic AR symptoms without demonstrable allergy

Front 20

Allergic Rhinitis is devided into:

Back 20

AR is classically divided into seasonal and perennial

Front 21

WHO divides allergic rhinitis into:

Back 21

intermittent (<4 days/week or <4 weeks/year) or persistent disease (>4 days/week and >4 weeks/year).

Front 22

Allergic rhinitis typically develops before age of ______ years old

Back 22

20

Front 23

Engorgement of nasal mucosa can lead to:

Back 23

- eustachian tube dysfunction

- cough

- sinus pressure

Front 24

PE findings of Allergic rhinitis:

Back 24

“boggy” appearing, pale, swollen nasal mucosa, clear discharge, and allergic “shiners.”

Front 25

_______ is less sensitive but more specific than intradermal testing.

Back 25

skin prick testing

Front 26

Allergen-specific IgE antibody testing (radioallergosorbent test [RAST]) is most useful if:

Back 26

percutaneous testing is not practical or if the patient is taking interfering medications.

Front 27

___________ is not specific and should not be used to diagnose AR

Back 27

serum total IgE

Front 28

Blood or nasal _______ suggests allergies; neutrophils suggest infection

Back 28

eosinophilia

Front 29

When do you consider skin testing or IgE testing?

Back 29

if no medical therapy is working (avoid allergen; intranasal steroid; antihistamine; nasal antihistamine; nasal ipratropium; nasal mast cell stabilizer; montelukast

Front 30

Nasal steroids are ______ effective than oral antihistamines for nasal symptoms and equally effective for eye symptoms

Back 30

more

Front 31

Once daily ______ is effective and does not appear to suppress the hypothalamic-pituitary-adrenal-axis.

Back 31

nasal beclomethasone dipropionate use at 320 μg/day

Front 32

patients with moderate to severe seasonal AR, the ______ was comparable to intranasal fluticasone in reduction in total nasal symptom score and reduced score from baseline

Back 32

intranasal antihistamine azelastine

Front 33

intranasal combination azelastine (a second-generation, selective, histamine antagonist) and fluticasone propionate was _______ to either intranasal drug alone, based on the nasal symptom score.

Back 33

superior

Front 34

Intranasal ipratropium (Atrovent) may be useful to decrease the _______ of AR

Back 34

rhinorrhea

Front 35

Intranasal decongestants are effective but should not be used for more than ___ days to decrease the risk of rhinitis medicamentosa

Back 35

10 days

Front 36

Other agents with minimal benefit:

Back 36

- systemic steroids

- montelukast po

- mast cell stabilizer (cromolyn)

Front 37

________ are surgical procedures used for drug therapy-resistant, intractable AR

Back 37

Transnasal resection of the posterior nasal nerve (TRPN), submucous inferior turbinectomy, and turbinoplasty with resection of peripheral branches of the posterior nasal nerve

Front 38

True/false: Interventions designed to decrease dust mite exposure (acaricides, HEPA filters, bedroom-based environmental control procedures) may be of some benefit for highly sensitized patients

Back 38

true

Front 39

True/false: Removal of carpets and humidity control decreases house dust mite load and may alleviate symptoms in sensitive individuals.

Back 39

true

Front 40

True/false: Topical therapies, including intranasal steroids, and antihistamines (chlorpheniramine, loratadine and cetirizine) are widely considered safe in pregnancy

Back 40

true

Front 41

True/false: Cetirizine causes sedation (slower reaction times and decreased performance) in children but does not cause drowsiness (subjective feeling of being tired).

Back 41

true

Front 42

True/false: Nasal steroids are effective and do not cause significant growth suppression in children

Back 42

true