The Nose & Control of Nasal Airflow 2022

Question 1

1. When considering limitations to nasal airflow in a healthy individual, the narrowest portion of the entire airway from the tip of the nose to the alveoli is described best by which of the following?
   A. Between the middle and superior turbinates
   B. Between the nasal vestibule and the main nasal cavity
   C. Immediately posterior to the choanae
   D. In the larynx between the vocal cords

Answer 1

1. B, Between the middle and superior turbinates, p. 626.
   The narrowest portion of the airway from the tip of the nose to the alveoli is the area between the nasal vestibule and the main nasal cavity.

Chapter 39: The Nose and Control of Nasal Airflow
Middleton’s Allergy Principles and Practice, 9th Edition

Question 2

Which option represents the nasal vestibule?
A. Between middle and inferior turbinates
B. Between the middle and superior turbinates
C. just inside the tip of the nose/@the nare
D. Just above the opening of the eustachian tube

Answer 2

2. C, C, p. 626, Fig. 39.3.
   The narrowest point of the nasal airway is at the junction between the nasal vestibule and the main nasal cavity, just anterior to the tip of the inferior turbinate. This area is the nasal valve or internal ostium, and it is the narrowest point of the whole airway from nostril to alveoli if the total cross-sectional area at each level of the airway is considered. At the junction of the nasal valve and the main nasal cavity, the cross-sectional area of the airway abruptly expands to about 130 mm, and at this point, the airflow bends through almost 90 degrees.

Chapter 39: The Nose and Control of Nasal Airflow
Middleton’s Allergy Principles and Practice, 9th Edition

Question 3

3. A 74-year-old man with a history of rhinitis is in for follow-up from surgical procedure by an ear, nose, and throat specialist. He was told that during the surgery he experienced significant injury to the parasympathetic fibers of the pterygoid canal.
   Significant reduction in which of the following would most likely be the outcome of this
   surgery?
   A. Anterior rhinorrhea
   B. Nasal congestion
   C. Post-nasal drip
   D. Visual acuity

Answer 3

3. A, Anterior rhinorrhea, p. 628.
   The parasympathetic fibers relay in the sphenopalatine ganglion, and postganglionic nerves reach the nasal glands through branches of the posterior nasal nerve. Electrical stimulation of parasympathetic nerves causes a profuse watery nasal secretion. Section of the nerve of the pterygoid canal, which contains parasympathetic fibers, has been used successfully for the
   treatment of rhinitis.

Chapter 39: The Nose and Control of Nasal Airflow
Middleton’s Allergy Principles and Practice, 9th Edition

Question 4

4. Which of the following cell types are found in the nose?
A. Columnar
B. Nonciliated receptor
C. Serous
D. Stratified squamous

Answer 4

4. D, Stratified squamous, p. 626.
   Nose is lined by three distinct types of epithelium: a stratified squamous epithelium in the nasal vestibule and nasopharynx, a pseudostratified ciliated columnar epithelium in the main
   respiratory area of the nasal cavity, and a specialized olfactory epithelium with ciliated receptor cells in the olfactory area.

Chapter 39: The Nose and Control of Nasal Airflow
Middleton’s Allergy Principles and Practice, 9th Edition

Question 5

5. A 45-year-old man complains of nasal congestion which has significantly impacted his quality of life. He also states that he has noticed a change in his ability to smell.
   Which of the following is a most likely diagnosis?
   A. Acute rhinosinusitis due to viral disease
   B. Chronic rhinosinusitis due to fungal disease
   C. Chronic rhinosinusitis with nasal polyps
   D. Chronic rhinosinusitis without nasal polyps

Answer 5

5. C, Chronic rhinosinusitis with nasal polyps, p. 660.
   Inflammation of the nose and the paranasal sinuses characterized by two or more symptoms – any of which may be first or second:
   • Nasal blockage/obstruction/congestion
   • Nasal discharge (anterior/posterior nasal drip)
   • Facial pain/pressure
   • Reduction or loss of smell

Chapter 39: The Nose and Control of Nasal Airflow
Middleton’s Allergy Principles and Practice, 9th Edition

Question 6

6. Which of the following sources is nasal fluid derived from?
   A. Alveolar secretions
   B. Exudation of plasma from the capillaries in tongue
   C. Goblet cells in respiratory tract
   D. Seromucous glands within the nasal epithelium

Answer 6

6. D, Seromucous glands within the nasal epithelium, p. 627.
   Nasal fluid is derived from four sources in the respiratory area of the nasal cavity:
   • Seromucous glands within the nasal epithelium
   • goblet cells distributed along the surface of the nasal epithelium
   • exudation of plasma from capillaries and veins within the nasal epithelium
   • secretions and cellular debris from leukocytes and epithelial cells

Chapter 39: The Nose and Control of Nasal Airflow
Middleton’s Allergy Principles and Practice, 9th Edition

Question 7

7. A mother of a 2-month-old infant girl states the infant has noisy breathing and wonders if there is something wrong with her nose. You attempt to explain the function of the nasal passages to the parent.
   Which of the following statements can help eliminate her concerns?
   A. Infants are obligatory nasal breathers during the first few months of life
   B. Nasal resistance increases into adulthood
   C. Nasal resistance is higher in girls
   D. Nasal resistance is lowest at the time of infancy

Answer 7

7. A, Infants are obligatory nasal breathers during the first few months of life, p. 630.
   Infants have been described to be “obligatory nasal breathers” during the first few months of life, although the qualifying term “preferred nose breathers” has been proposed to indicate
   that infants can breathe through the mouth. Nasal obstruction in infancy may cause distress, and disturb suckling and growth.

Chapter 39: The Nose and Control of Nasal Airflow
Middleton’s Allergy Principles and Practice, 9th Edition

Question 8

8. A 15-year-old teenage boy presents with complaints of a constant stuffy nose. While performing exercise pulmonary function testing, he tells you that he feels his nasal passages have “opened up” and he is able to breathe “better through his nose.”
   Which statement is the best way to explain his post-test response?
   A. Exercise causes a generalized increase in parasympathetic nervous activity
   B. Exercise increases vasoconstrictor tone of the nasal venous sinuses and results in reduction in nasal airway resistance
   C. Exercise is normally accompanied by a switch to mouth breathing at a work rate of about 50 watts
   D. The effect of exercise may be mimicked by topical administration of pyridostigmine

Answer 8

8. B, Exercise increases vasoconstrictor tone of the nasal venous sinuses and results in
   reduction in nasal airway resistance, p. 632.
   Exercise causes a generalized increase in sympathetic nervous activity. The first study of the
   effect of exercise on nasal resistance was conducted by Richerson and Seebohm, who demonstrated that when patients with allergic rhinitis performed strenuous exercise, there was a marked reduction in nasal airway resistance. They also established that the reduction in nasal airway resistance was caused by increased sympathetic vasoconstrictor tone of the nasal venous sinuses, because the response was reduced by topical application of the alpha antagonist phentolamine or by local anesthesia of the stellate ganglion.

Chapter 39: The Nose and Control of Nasal Airflow
Middleton’s Allergy Principles and Practice, 9th Edition

Question 9

9. Which statement explains the pharmacology of menthol?
   A. Intranasal d-menthol has cooling properties as opposed to l-menthol
   B. Nasal inhalation of menthol results in improved nasal airflow
   C. Oral administration of menthol results in improved nasal airflow
   D. The cool sensation of nasal airflow is mediated by cold receptors supplied by cranial nerve V

Answer 9

9. D, The cool sensation of nasal airflow is mediated by cold receptors supplied by cranial nerve V. 633.
   The sensation of nasal airflow is increased by intranasal application of menthol or inhalation of menthol, providing a false sensation of decongestion and improved airflow. Oral administration of menthol by means of a lozenge causes a similar sensation of nasal coolness
   and increased nasal airflow.

Chapter 39: The Nose and Control of Nasal Airflow
Middleton’s Allergy Principles and Practice, 9th Edition

Question 10

10. A healthy 29-year-old woman fellow presents with extreme nasal congestion. She has researched and found that female sex hormones, hypothyroidism, and acromegaly may be associated with nasal congestion. She questions which endocrine gland may produce a hormone that causes the most obvious and acute improvement in nasal congestion.
    Which gland(s) produce(s) the hormone that supports this improvement?
    A. Adrenal glands
    B. Ovaries
    C. Pituitary gland
    D. Thyroid gland

Answer 10

The development and activity of the nasal epithelium are influenced by many hormones, but epinephrine secreted from the adrenal medulla has the most obvious and acute effects. Epinephrine is released in response to stressful stimuli such as pain or asphyxia, and it causes pronounced nasal vasoconstriction and reduction in nasal airway resistance. The nasal blood
vessels are extremely sensitive to circulating epinephrine, up to four times as sensitive as the heart

Chapter 39: The Nose and Control of Nasal Airflow
Middleton’s Allergy Principles and Practice, 9th Edition