Lec 01: Allergic Rhinitis and Bronchial Asthma

Question 1

Which antibody is involved in allergic rhinitis?

Answer 1

IgE

Question 2

What is allergic rhinitis?

Answer 2

a symptomatic disorder of the nose induced after allergen exposure by an IgE-mediated inflammation

Question 3

(T/F) Allergic rhinitis more commonly affects male adults.

Answer 3

F. adulthood prevalence: males = females

Question 4

(T/F) Allergic rhinitis more commonly affects male children.

Answer 4

T

Question 5

What are the main signs and symptoms of allergic rhinitis?

Answer 5

1. Rhinorrhea
2. Nasal obstruction and congestion
3. Nasal itching/pruritus
4. Sneezing

Question 6

What are the Ssx of clear rhinorrhea?

Answer 6

chronic postnasal drip, cobblestone throat, frequent throat clearing, itchy throat, non-productive cough

Question 7

What are the Ssx of nasal congestion?

Answer 7

allergic shiners, pale turbinates, mouth breathing, abnormal facial development, dental malocclusion, snoring, sleep disturbance

Question 8

What are the Ssx of nasal itching?

Answer 8

facial grimace, allergic salute, nasal crease

Question 9

Which of the following is false about Dennie-Morgan lines?
A. also known as panda eyes
B. marker for allergy
C. occurs in people with good capillary refill around the eyes
D. occurs in people with frequent nasal congestion

Answer 9

C.

Question 10

(T/F) The previous classification of allergic rhinitis was based on the time of exposure.

Answer 10

T

Question 11

Which of the following is not a classification of AR based on the time of exposure?
A. perennial
B. occasional
C. seasonal
D. occupational

Answer 11

B.

Question 12

What are the bases of the ARIA classification?

Answer 12

1. frequency of occurence

2. severity of symptoms

Question 13

(T/F) AR is considered to have an intermittent frequency when it occurs two days in a week for 3 weeks.

Answer 13

T

Question 14

What are the criteria used to determine the severity of AR?

Answer 14

sleep pattern, impairment of daily activities, functioning at work/school, “troublesome” symptoms

Question 15

(T/F) Allergic rhinitis is a type 2 hypersensitivity reaction.

Answer 15

F

Question 16

What are the two phases of a type 1 hypersensitivity reaction?

Answer 16

sensitization phase/elicitation phase

Question 17

(T/F) IL-4 is secreted by TH2 cells.

Answer 17

T

Question 18

What substances are released during mast cell degranulation?

Answer 18

histamine, leukotrienes, cytokines

Question 19

Which of the three (histamine, leukotrienes, cytokines) is primarily responsible for a late-phase reaction?

Answer 19

cytokines

Question 20

(T/F) A late phase reaction may occur several hours after initial exposure to antigen but requires additional exposure.

Answer 20

F

Question 21

What are the risk factors for allergic rhinitis?

Answer 21

increasing age, atopy, higher socioeconomic class, family history, positive allergy skin test, pollution, tobacco smoke/indoor allergens, early introduction to food/milk formulas

Question 22

What are the 4 most common comorbidities of allergic rhinitis?

Answer 22

conjunctivitis, rhinosinusitis, otitis media w/effusion, asthma

Question 23

(T/F) Conjunctivitis associated with AR is commonly associated with eye discharges.

Answer 23

F

Question 24

Which is the most important part of the history in diagnosing AR?

Answer 24

environmental history

Question 25

What are the most common indoor aeroallergens according to the PGH allergy clinic?

Answer 25

house dustmite, cockroach

Question 26

(T/F) ELISA is more sensitive than the skin-prick test in determining whether there is IgE specific hypersensitivity.

Answer 26

F

Question 27

What is the gold standard radiological investigation for sino-nasal disorders?

Answer 27

coronal CT scan

Question 28

What are the components of the four-pronged approach to the management of allergic diseases?

Answer 28

allergen avoidance, pharmacotherapy, immunotherapy, patient education

Question 29

What are the pharmacologic options for mild intermittent rhinitis?

Answer 29

oral or intranasal antihistamine, intranasal decongestants, antileukotrienes

Question 30

What are the pharmacologic options for moderate-severe intermittent/mild persistent rhinitis?

Answer 30

oral or intranasal antihistamine, decongestants, antileukotrienes, chromones, intranasal corticosteroids

Question 31

What are the pharmacologic options for moderate-severe persistent rhinitis?

Answer 31

intranasal corticosteroids as first line, antihistamine or antileukotrienes, chromones

Question 32

(T/F) asthma is more common among male children

Answer 32

T

Question 33

(T/F) Chronic production of sputum in a patient would increase suspicion for asthma.

Answer 33

F

Question 34

``` Which of the following is the most frequently observed respiratory abnormality in asthmatic patients? A. expiratory wheezing B. inspiratory wheezing C. stridor D. rales ```

Answer 34

A.

Question 35

What is the normal FEV1/FVC ratio?

Answer 35

>0.75- 0.80 in healthy adults and >0.90 in children

Question 36

(T/F) A large bronchodilator reversilbility is supportive evidence for asthma

Answer 36

T

Question 37

What is the cut-off in PEF variation that is indicative of asthma?

Answer 37

20%

Question 38

What are the long-term goals of asthma management?

Answer 38

symptom control, risk reduction

Question 39

What are the risk factors for asthma exacerbation?

Answer 39

previous asthma intubation, uncontrolled asthma symptoms, >=1 exacerbation in the past year, low FEV1, incorrect inhaler technique, smoking, obesity, pregnancy, blood eosinophilia

Question 40

What are the risk factors for fixed airflow limitation?

Answer 40

no ICS treatment, smoking, occupational exposure, mucus hypersecretion, eosinophilia

Question 41

What are the risk factors for asthma medication side-effects?

Answer 41

frequent oral steroids, potent ICS/P450 inhibitors

Question 42

What is the prevalence rate of allergic rhinitis among asthmatic patients?

Answer 42

80%