ALLERGIC AND IMMUNOLOGIC DISORDERS 1.2 (AB)

Question 1

What are the hallmark symptoms of allergic rhinitis (AR)?

Answer 1

Nasal congestion, rhinorrhea, itching, sneezing, and conjunctival irritation.

Question 2

How is allergic rhinitis (AR) currently classified?

Answer 2

As seasonal or perennial, terms now being replaced by intermittent or persistent.

Question 3

What is the main cause of allergic rhinitis (AR)?

Answer 3

Inhalant allergens, regardless of classification.

Question 4

What defines intermittent allergic rhinitis?

Answer 4

Symptoms <4 days/week or <4 weeks at a time.

Question 5

What defines persistent allergic rhinitis?

Answer 5

Symptoms ≥4 days/week and/or ≥4 weeks at a time.

Question 6

What symptoms indicate moderate-to-severe allergic rhinitis?

Answer 6

Abnormal sleep, impaired daily activities, school/work issues, and troublesome symptoms.

Question 7

What symptoms indicate mild allergic rhinitis?

Answer 7

Normal sleep, normal daily activities, normal work/school, and no troublesome symptoms.

Question 8

What is the early-phase response in allergic rhinitis?

Answer 8

Initiated by mast cell degranulation, releasing histamine, prostaglandin D2, and leukotrienes.

Question 9

What is the late-phase response in allergic rhinitis?

Answer 9

Occurs 4-8 hours after exposure, involving cellular infiltration to sustain chronic inflammation.

Question 10

What are common physical signs of allergic rhinitis?

Answer 10

Allergic shiners, Dennie-Morgan lines, nasal crease, and cobblestoning.

Question 11

What is the ‘allergic salute’?

Answer 11

A gesture where children rub their nose upward, often resulting in a nasal crease.

Question 12

What is the gold standard therapy for persistent allergic rhinitis?

Answer 12

Intranasal corticosteroids.

Question 13

Which second-generation antihistamines are approved for children >6 months old?

Answer 13

Cetirizine and Desloratadine.

Question 14

Which antihistamines are preferred for less sedation?

Answer 14

Second-generation antihistamines.

Question 15

What is rhinitis medicamentosa?

Answer 15

Drug-induced rhinitis due to overuse of topical vasoconstrictors.

Question 16

What nonallergic conditions can mimic allergic rhinitis?

Answer 16

Infectious rhinitis, anatomic abnormalities, rhinitis medicamentosa, hormonal rhinitis, neoplasms, etc.

Question 17

What symptom suggests a non-allergic or infectious etiology rather than allergic rhinitis?

Answer 17

Nasal congestion continuous throughout the day.

Question 18

Which nasal spray is an anticholinergic for serous rhinorrhea?

Answer 18

Ipratropium bromide (Atrovent).

Question 19

What intranasal spray is a mast cell stabilizer that requires frequent use?

Answer 19

Cromolyn sodium (NasalCrom).

Question 20

Which decongestant should not be used for more than 3 days?

Answer 20

Oxymetazoline or Phenylephrine.

Question 21

What is asthma?

Answer 21

Asthma is a chronic inflammatory condition of the lung airways resulting in episodic airflow obstruction.

Question 22

What causes the episodic nature of asthma symptoms?

Answer 22

Asthma symptoms occur episodically due to airway hyperresponsiveness (AHR) to provocative exposures.

Question 23

What is airway hyperresponsiveness (AHR)?

Answer 23

AHR is the heightened ‘twitchiness’ of the airways due to chronic inflammation.

Question 24

What are the goals of asthma management?

Answer 24

Reducing airways inflammation, using daily controller medications, and controlling co-morbid conditions.

Question 25

How can asthma exacerbations be minimized?

Answer 25

Through reduced inflammation, fewer exacerbations occur, and there's decreased need for quick-reliever medications.

Question 26

What can reduce the severity of asthma exacerbations?

Answer 26

Early intervention with systemic corticosteroids.

Question 27

What enables most children with asthma to live normally?

Answer 27

Advances in asthma management and pharmacotherapy.

Question 28

What factors contribute to the development of childhood asthma?

Answer 28

A combination of environmental exposures and genetic/biologic susceptibilities.

Question 29

What are examples of common airway exposures that can trigger asthma?

Answer 29

Respiratory viruses, allergens, tobacco smoke, and air pollutants.

Question 30

What processes lead to altered airways in mature age for asthma patients?

Answer 30

Lung dysfunction, airway hyperresponsiveness, and airway remodeling during early lung growth.

Question 31

What early life factors worsen asthma persistence?

Answer 31

Ongoing inflammatory exposures.

Question 32

What are the major early childhood risk factors for persistent asthma?

Answer 32

Parental asthma, atopic dermatitis, inhalant allergen sensitization.

Question 33

What are other risk factors for persistent asthma?

Answer 33

Allergic rhinitis, food allergy, severe respiratory infections, male gender, low birthweight, ETS exposure, reduced lung function at birth, formula feeding.

Question 34

What are the two common types of childhood asthma?

Answer 34

Recurrent wheezing due to viral infections, and chronic asthma associated with allergy.

Question 35

What asthma pattern is associated with the highest risk for persistence?

Answer 35

Persistent atopy-associated asthma.

Question 36

What is transient nonatopic wheezing?

Answer 36

Asthma triggered by viral infections in early childhood, typically resolving by school age.

Question 37

How is asthma severity classified?

Answer 37

Intermittent or persistent (mild, moderate, or severe).

Question 38

How is asthma control classified?

Answer 38

Well controlled, not well controlled, or very poorly controlled.

Question 39

What are the asthma management patterns?

Answer 39

Easy-to-control, difficult-to-control, exacerbators, and refractory asthma.

Question 40

What contributes to airflow obstruction in asthma?

Answer 40

Bronchoconstriction, inflammatory cell infiltrates, and mucus production.

Question 41

What immune cells are involved in asthma inflammation?

Answer 41

Eosinophils, neutrophils, lymphocytes, mast cells, basophils, monocytes.

Question 42

Which cytokines mediate asthma inflammation?

Answer 42

IL-4, IL-5, IL-13.

Question 43

What are the most common symptoms of asthma?

Answer 43

Intermittent dry cough and expiratory wheezing.

Question 44

What symptoms are more common in older children with asthma?

Answer 44

Shortness of breath, chest congestion, and tightness.

Question 45

What are subtle asthma symptoms in children?

Answer 45

Fatigue, reduced activity, difficulty keeping up with peers.

Question 46

What increases suspicion for asthma diagnosis?

Answer 46

Improvement with bronchodilator use.

Question 47

What suggests a condition masquerading as asthma?

Answer 47

Lack of response to bronchodilators and corticosteroids.

Question 48

What are common asthma triggers?

Answer 48

Viral infections, indoor and outdoor allergens, pollutants, cold dry air, exercise, emotional stress.

Question 49

Which indoor allergens can trigger asthma?

Answer 49

Animal dander, dust mites, cockroaches, molds.

Question 50

What are some air pollutants that can trigger asthma?

Answer 50

Environmental tobacco smoke, ozone, nitrogen dioxide, sulfur dioxide, particulate matter.

Question 51

Which drugs can trigger asthma?

Answer 51

Aspirin, NSAIDs, beta-blockers.