Allergic Rhinitis Flashcards
- Pick the symptom that is least characteristic of allergic rhinitis.
A. Nasal itch
B. Ocular itch
C. Rhinorrhea
D. Sneezing
E. Wheezing
E
- Pick the symptom of allergic rhinitis that is usually the most bothersome.
A. Allergic salute
B. Chemosis
C. Nasal congestion
D. Postnasal drip (posterior rhinitis)
E. Tearing eyes
C
- Which category of medication is the most effective for the majority of symptoms of allergic rhinitis?
A. Intranasal antihistamine
B. Intranasal antimuscarinic
C. Intranasal corticosteroid
D. Intranasal decongestant
E. Intranasal mast cell stabilizer/cromone
C
- Which approach is best for treatment of rhinitis medicamentosa, along with
tapering the intranasal decongestant?
A. Intranasal olopatadine
B. Intranasal fluticasone propionate + azelastine
C. Intranasal saline irrigation
D. Oral corticosteroid burst and taper
E. Oral pseudoephedrine for 5 to 7 days
D
- Which agent would you recommend for treatment of ocular itch and tearing that is
unresponsive to intranasal fluticasone propionate + azelastine?
A. Intranasal cromolyn
B. Intraocular ketotifen
C. Intranasal mometasone
D. Intraocular naphazoline
E. Oral pseudoephedrine
B
- Which mode of therapy underlies the management of all patients with allergic
rhinitis?
A. Education about allergen avoidance
B. Education about complications of allergic rhinitis
C. Intranasal corticosteroids
D. Intranasal saline irrigation
E. Sublingual immunotherapy
A
- Which choice would be your recommendation to a 30-year-old woman who complains of runny nose, sneezing, and ocular tearing and itch, when episodically exposed to her friend’s cats, as an OTC agent she could use for preexposure?
A. Intranasal cromolyn
B. Intranasal ipratropium
C. Intranasal triamcinolone
D. Intraocular ketotifen
E. Oral pseudoephedrine
A
- Which choice would you recommend as an OTC medication for initial therapy of
mild, intermittent (probably seasonal) allergic rhinitis in an otherwise healthy 7-
year-old child?
A. Intranasal cromolyn
B. Intranasal oxymetazoline
C. Intranasal triamcinolone
D. Oral loratadine
E. Oral phenylephrine
D
- A 24-year-old woman, who is known to be 8 weeks pregnant, has been on oral
montelukast, oral loratadine, and intranasal cromolyn for moderately severe,
persistent allergic rhinitis. Her symptoms of nasal congestion, rhinorrhea, sneezing,
and ocular itching are still poorly controlled, despite good adherence. Pick the most appropriate drug from the choices below to recommend as an additional and/or replacement medication.
A. Intranasal budesonide
B. Intranasal ipratropium
C. Intranasal naphazoline
D. Intranasal olopatadine
E. Oral pseudoephedrine
A
- Pick the most appropriate recommendation for relief of severe persistent allergic rhinitis symptoms in a patient who complains of bad taste, nasal irritation, and occasional epistaxis while using intranasal triamcinolone.
A. Add intranasal olopatadine
B. Add oral fexofenadine
C. Add oral pseudoephedrine
D. Replace triamcinolone with intranasal ciclesonide as HFA metered-dose
pump
E. Replace triamcinolone with intranasal fluticasone propionate + azelastine
D
- Pick the drug that should generally be used for no more than 3 consecutive days.
A. Intranasal azelastine
B. Intranasal cromolyn
C. Intranasal ipratropium
D. Intranasal oxymetazoline
E. Oral pseudoephedrine
D
- Pick the therapy, from the choices below, which is best limited only to patients with concurrent allergic rhinitis and asthma.
A. Intranasal beclomethasone as HFA metered-dose ipump
B. Intranasal fluticasone propionate + azelastine
C. Intraocular ketotifen
D. Oral montelukast
E. Subcutaneous omalizumab
E
- Pick the most accurate statement about intranasal corticosteroids.
A. Chronic use of intranasal corticosteroids for allergic rhinitis is associated with frequent systemic side effects.
B. Intranasal corticosteroids are effective for both phases of the allergic response in allergic rhinitis.
C. Intranasal corticosteroids should not be used in pregnant women.
D. Mometasone is the only intranasal corticosteroid indicated for children younger than 6 years.
E. Only fluticasone propionate, among the intranasal corticosteroids, is available OTC.
B
- Pick the best recommendation for additional chronic therapy of a 68-year-old male patient with symptomatic benign prostatic hyperplasia/hypertrophy (BPH),
marginally controlled hypertension, and persistent rhinorrhea due to a mixed
vasomotor and allergic rhinitis, unresponsive to appropriate doses of oral
fexofenadine and intranasal fluticasone propionate + azelastine.
A. Intranasal budesonide
B. Intranasal ipratropium
C. Intranasal oxymetazoline
D. Oral prednisolone burst and taper
E. Oral pseudoephedrine
B
- Pick the most accurate statement about nasal saline irrigation therapy for allergic
rhinitis.
A. Hypertonic sodium chloride solutions are more effective for allergic rhinitis
than “normal” (0.9%) saline when used as a nasal irrigation.
B. Iodized sodium chloride (salt) is best to use for nasal saline irrigations
because the iodine exerts additional osmotic effects that reduce nasal
congestion.
C. Nasal saline irrigation may provide some benefit to any patient with allergic rhinitis.
D. Nasal saline irrigation therapy is contraindicated in pregnant women
because of the potential for excess sodium absorption, which can predispose
to polyhydramnios and preeclampsia.
E. Nasal saline irrigation therapy is a poor choice in the elderly due to their
increased incidence of rhinorrhea.
C
- Which symptom is least typical of allergic rhinitis?
A. Nasal and/or ocular itching
B. Sleep disturbance
C. Sneezing
D. Rhinorrhea
B
- JR a 25-year-old man, reports that his allergic rhinitis symptoms occur less than 4 days per week, without sleep disturbance, impairment of daily activity, or troublesome symptoms. Which term most appropriately describes JR’s allergic rhinitis?
A. Intermittent and mild
B. Persistent and mild
C. Intermittent and moderate/severe
D. Persistent and moderate/severe
A
- WW is a 35-year-old woman seen at the family medicine clinic for allergic rhinitis with rhinorrhea, nasal itching and congestion, sneezing, and ocular itching every day of the week and for more than 4 consecutive weeks. She reports that her symptoms cause her difficulty sleeping and being able to do daily activities like running and working in her garden. She does not have any medication allergies and no other past medical history. She is not currently on any medications except a multivitamin. She says she needs to stay alert for her work so does not want to take anything that would make her sleepy or tired,
if all possible. Which is the most appropriate treatment for WW at this time?
A. Diphenhydramine tablet
B. Cromolyn intranasal spray
C. Loratadine tablet
D. Triamcinolone nasal spray
D
- PT is a 28-year-old man who presents to the clinic with rhinitis medicamentosa or
rebound congestion. Which of his current medications is most likely the cause?
A. Saline nasal spray
B. Phenylephrine nasal spray
C. Fluticasone propionate nasal spray
D. Azelastine nasal spray
B
- JJ is a 45-year-old man who is currently on fluticasone nasal spray for allergic rhinitis; however, his symptoms are not well controlled on this treatment alone. The physician would like to add on an oral antihistamine. JJ works with heavy machinery as a part of construction firm and states “I cannot be sleepy or tired while at work.” Which oral antihistamine is the most appropriate for JJ?
A. Fexofenadine
B. Diphenhydramine
C. Chlorpheniramine
D. Cetirizine
A
- QB is a 6-year-old boy with allergic rhinitis requiring treatment with an intranasal Steroid. His also has concurrent moderate persistent asthma and eczema of which he is prescribed fluticasone propionate 110 mcg HFA MDI 2 puff twice a day and triamcinolone cream. Mom is concerned about how QB’s overall steroid exposure and asks the team to prescribe a nasal steroid that minimize additional exposure, if possible. Which intranasal corticosteroid is most appropriate for QB?
A. Beclomethasone
B. Budesonide
C. Flunisolide
D. Mometasone
D
- BN is a 14-year-old girl who is prescribed azelastine nasal spray. Her Dad asks you, what are the common side effects she may experience. Which is the most appropriate response to his question?
A. Insomnia
B. Bitter taste
C. Rash
D. Nausea
B
- SS is a 30-year-old man who comes to clinic with ongoing AR symptoms despite
treatment with fluticasone nasal spray daily. After further assessment it is found that his AR is of mixed etiology. Which is the most appropriate medication to help treat SS’s symptoms?
A. Azelastine nasal spray
B. Ipratropium nasal spray
C. Mometasone nasal spray
D. Oral fexofenadine
B
- AZ is a 24-year-old woman who presents to allergy clinic as a possible candidate for
SLIT for her house dust mite allergy. Which SLIT product is most appropriate for this
patient?
A. Grastek
B. Oralair
C. Odactra
D. Ragwitek
C
- Which medication is mostly likely to cause paradoxical CNS stimulation in young children?
A. Cetirizine
B. Diphenhydramine
C. Fluticasone
D. Montelukast
B
- LM is a 19-year-old woman with asthma and diabetes. Her asthma is well-controlled but notes she has rhinorrhea, nasal and ocular itching when around dogs and cats. Despite this, she is animal lover and is volunteering at a local pet shelter once to twice a month. Which is the most appropriate recommendation for LM for use prior to her volunteering sessions?
A. Intranasal cromolyn
B. Oral diphenhydramine
C. Oral loratadine
D. Intranasal triamcinolone
A
- RD is a 58-year-old male patient with poorly controlled hypertension, diabetes, and persistent rhinorrhea and nasal itch due to allergic rhinitis. He admits he is not great with medication adherence, especially if he has to take medications multiple times a day. He has not had good response to oral fexofenadine and intranasal fluticasone propionate.
Which is the most appropriate added treatment for him at this time?
A. Intranasal azelastine
B. Oral cetirizine
C. Intranasal cromolyn
D. Oral pseudoephedrine
A
- JD is a 15-year-old boy with concurrent moderate persistent asthma and allergic rhinitis. His medications include fluticasone propionate/salmeterol 230 mcg/21 mcg 2 puff inhaled twice a day, montelukast 10 mg daily, fluticasone nasal spray, and azelastine nasal spray. Which additional tests would be needed to evaluate if omalizumab is appropriate for his asthma and AR?
A. Complete blood count (CBC) with differential assessing total eosinophils
B. Serum creatine (SCr) and blood urea nitrogen (BUN)
C. Serum immunoglobulin (IgE)
D. Hepatic function panel (HFP)
C
- A 32-year-old woman, who is known to be 12 weeks pregnant, has been on saline nasal rinses and oral loratadine for her allergic rhinitis. Her symptoms of nasal congestion, rhinorrhea, sneezing, and ocular itching are still poorly controlled, despite good adherence. Which is the most appropriate to recommend as possible added therapy?
A. Beclomethasone nasal spray
B. Capsaicin nasal spray
C. Cromolyn nasal spray
D. Oral phenylephrine
C
- JS is a 10-year-old girl treated for her AR with the following: fexofenadine, mometasone nasal spray, azelastine nasal spray, and montelukast. Her mother comes to you with a question about drug-related issues and change in behavior. JS appears more withdrawn, sleeping more, and has stopped participating in activities she used to love such as sports. Which medication is most likely associated with these new symptoms?
A. Montelukast
B. Fexofenadine
C. Mometasone
D. Azelastine
A
