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Nurse Practitioner:
doi: 10.1097/01.NPR.0000445725.16107.31
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Allergic rhinitis: Diagnosis through management

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INSTRUCTIONS Allergic rhinitis: Diagnosis through management

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Allergic rhinitis: Diagnosis through management

General Purpose: The purpose of this learning activity is to provide information about the pathophysiology, diagnosis, and treatment of AR. Learning Objectives: After reading this article and taking this test, you should be able to: 1. Explain the pathophysiology of AR. 2. Describe the clinical presentation, assessment, and diagnostic testing for AR. 3. Select evidence-based treatment approaches for AR.

1. AR is

a. caused by repeated exposure to histamines.

b. an abnormal immunologic response.

c. mediated by immunoglobulin G.

d. a hypersensitivity disorder of the entire respiratory system.

2. An atopic patient

a. has no allergies.

b. can exhibit an immune response.

c. has developed a skin rash.

d. can suppress an immune response to allergens.

3. Leukotrienes

a. are released by stimulated mast cells.

b. constitute an early phase response in AR.

c. cause a cessation of symptoms.

d. inhibit the action of eosinophils.

4. Which statement accurately differentiates SAR from PAR?

a. Patients with SAR are more likely to experience symptom relief by keeping pets out of the bedroom.

b. Dust mites are more likely to cause SAR.

c. Patients with PAR are often more symptomatic outdoors.

d. SAR is more often associated with the release of pollens.

5. When assessing for AR, which of the following is the least relevant finding in the patient history?

a. exposure to respiratory irritants

b. age of onset of symptoms

c. deficiencies associated with smell

d. environmental conditions

6. Physical exam of the patient with AR reveals

a. infraorbital lightening of the skin.

b. enlarged inferior turbinates and clear watery discharge.

c. a reddened cobblestone appearance of the inferior turbinates.

d. ruddy nasal mucosa.

7. Which statement about acute infectious rhinosinusitis is true?

a. A common symptom is purulent nasal discharge.

b. Bacterial rhinosinusitis symptoms resolve in 7–10 days.

c. Viral upper respiratory infection symptoms persist beyond 10 days.

d. It is usually caused by bacteria.

8. Which total serum IgE level is most suggestive of an allergy?

a. 10 units/mL

b. 50 units/mL

c. 100 units/mL

d. 480 units/mL

9. Skin testing for AR

a. is the least sensitive diagnostic methodology.

b. can be performed I.using a histamine solution.

c. causes the antigen to bind to the surface of mast cells and release histamine.

d. causes leukocytes to releases leukotrienes.

10. During RAST testing,

a. a local skin reaction confirms allergen sensitivity.

b. nasal swabs are examined for presence of leukocytes.

c. serum is incubated with tagged antibodies of suspected antigens.

d. allergen sensitivity is indicated by the presence of serum eosinophils.

11. Which of the following is among the most problematic allergens in the home?

a. carpeting

b. synthetic fibers

c. humidity

d. molds

12. Which is a second-generation oral antihistamine?

a. loratadine

b. diphenhydramine

c. chlorpheniramine

d. triprolidine

13. Which statement about topical nasal antihistamines is accurate?

a. They are less effective than oral antihistamines.

b. They have a slow onset of action.

c. They have a fast onset of action.

d. They provide poor control of sneezing.

14. Topical decongestants can cause

a. hypotension.

b. bradycardia and sedation.

c. increased blood flow to nasal vascular tissue.

d. dependency.

15. Cromolyn sodium

a. is prescribed orally once a day.

b. is more effective in reducing allergic symptoms than antihistamines.

c. has a long half-life.

d. is a mast cell stabilizer with limited efficacy.

16. When corticosteroids are used for symptoms of AR,

a. they are only effective for treating nasal decongestion.

b. they cannot be given parenterally.

c. topical use results in a high incidence of significant adverse reactions.

d. topical application is often used as primary first-line therapy.

17. Ipratropium bromide

a. is used to relieve nasal congestion.

b. is a topical anticholinergic that reduces the volume of rhinorrhea.

c. inhibits the release of histamine in patients with AR.

d. can be converted into methamphetamine.

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