Tag: Allergic Rhinitis

Allergic Rhinitis

Allergic Rhinitis

Q. 1

Which test is most useful in diagnosis of allergic rhinitis?

 A

Radioallergosorbent test

 B

Serum IgE levels

 C

PBF

 D

Immediate hypersensitivity skin test

Q. 1

Which test is most useful in diagnosis of allergic rhinitis?

 A

Radioallergosorbent test

 B

Serum IgE levels

 C

PBF

 D

Immediate hypersensitivity skin test

Ans. D

Explanation:

An accurately ap­plied skin test is the most valuable tool for identifying the causative antigen in allergic rhi­nitis, yielding results in approximately 20-30 minutes.

The radioallergosorbent test (RAST), albeit accurate, is more expensive and less dis­criminative than skin testing.

Elevated immu­noglobulin E (IgE) levels are observed in only 30%-40% of patients with allergic rhinitis and may be secondary to other unrelated dis­orders.

Although eosinophils are usually iden­tified in nasal secretions from patients with al­lergic rhinitis, they are also detected in eosinophilic nonallergic rhinitis and hyperplas­tic sinusitis.

peripheral eosinophilia seen in a peripheral blood smear is an inconsistent finding.


Q. 2

A 45 year old lady presented with features suggestive of mononeuritis multiplex. She gives a h/o regular attacks of bronchial asthma preceded by allergic rhinitis. She also has cutaneous purpura. Blood routine examination revealed eosinophilia. The diagnosis to be considered in this clinical scenario is?

 A

Microscopic polyangiitis

 B

Endogenous bronchial asthma

 C

Churg strauss syndrome

 D

Wegeners vasculitis

Q. 2

A 45 year old lady presented with features suggestive of mononeuritis multiplex. She gives a h/o regular attacks of bronchial asthma preceded by allergic rhinitis. She also has cutaneous purpura. Blood routine examination revealed eosinophilia. The diagnosis to be considered in this clinical scenario is?

 A

Microscopic polyangiitis

 B

Endogenous bronchial asthma

 C

Churg strauss syndrome

 D

Wegeners vasculitis

Ans. C

Explanation:

When small-vessel vasculitis is associated with peripheral eosinophilia, cutaneous purpura, mononeuritis, asthma, and allergic rhinitis, a diagnosis of Churg-Strauss syndrome is considered.

Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 2344


Q. 3

Rhinolalia clausa is associated with all of the following, EXCEPT:

 A

Allergic rhinitis

 B

Palatal paralysis

 C

Adenoids

 D

Nasal polyps

Q. 3

Rhinolalia clausa is associated with all of the following, EXCEPT:

 A

Allergic rhinitis

 B

Palatal paralysis

 C

Adenoids

 D

Nasal polyps

Ans. B

Explanation:

Palatal paralysis is a cause of Rhinolalia Aperta (Hypernasality) and not Rhinolilia Clausa (Hyponasality).
 
Rhinolalia Aperta (Hypernasality or hyperrhinolalia or open nasality) is defined as excess resonance of vowels and voiced consonants within the nasal cavities. The anatomic-physiologic basis is open coupling between the oral and nasal cavities due to incomplete closure of the hard palate and/or velopharyngeal sphincter.
 

Q. 4

Early mediators of allergic rhinitis are:

 A

Leukotriene

 B

IL-4

 C

IL-5

 D

All

Q. 4

Early mediators of allergic rhinitis are:

 A

Leukotriene

 B

IL-4

 C

IL-5

 D

All

Ans. D

Explanation:

Ans. is All


Q. 5

In Allergic rhinitis nasal mucosa is:

 A

Pale and swollen

 B

Pink and swollen

 C

Atrophied

 D

Bluish and atrophied

Q. 5

In Allergic rhinitis nasal mucosa is:

 A

Pale and swollen

 B

Pink and swollen

 C

Atrophied

 D

Bluish and atrophied

Ans. A

Explanation:

Ans. is a i.e Pale and swollen

  • Nasal mucosa pale, boggy, swollen and bluish
  • Nasal mucosa congested and swollen (Hypertrophic)
  • Mulberry appearance
  • Pale and atrophied nasal mucosa
  • Allergic rhinitis
  • Vasomotor rhinitis
  • Chronic hypertrophic rhinitis
  • Atrophic rhinitis



Q. 6

All of the following surgical procedures are used for allergic rhinitis except:

 A

Radiofrequency ablation of the inferior turbinate

 B

Laser ablation of the inferior turbinate

 C

Submucosal placement of silastic in inferior turbinate

 D

Inferior turbinectomy

Q. 6

All of the following surgical procedures are used for allergic rhinitis except:

 A

Radiofrequency ablation of the inferior turbinate

 B

Laser ablation of the inferior turbinate

 C

Submucosal placement of silastic in inferior turbinate

 D

Inferior turbinectomy

Ans. C

Explanation:

Ans. is c i.e. Submucosal placement of sialistic in inferior turbinate

  • Surgery is done in a case of allergic rhinitis when other methods have failed or when there is marked septal deviation or bony turbinate enlargement which makes topical nasal spray usage difficult
  • It should never be used as first line of treatment.

Q. 7

Allergic rhinitis treatment includes all except:

 A

Antibiotics

 B

Avoiding allergen

 C

Corticosteroids

 D

Surgery

Q. 7

Allergic rhinitis treatment includes all except:

 A

Antibiotics

 B

Avoiding allergen

 C

Corticosteroids

 D

Surgery

Ans. A

Explanation:

Q. 8

Causes of epistaxis are all except:

 A

Allergic rhinitis

 B

Foreign body

 C

Tumor

 D

Hypertension

Q. 8

Causes of epistaxis are all except:

 A

Allergic rhinitis

 B

Foreign body

 C

Tumor

 D

Hypertension

Ans. A

Explanation:

 

 Many nasal problems can lead to epistaxis viz nasal trauma, viral rhinitis, chronic infections of nose (which lead to crust formation like atrophic rhinitis, rhinits sicca, TB of nose), foreign bodies in nose (maggots and non living), DNS, neoplasms (hemangioma, papilloma, carcinoma or sarcoma).

Two nasal conditions which donot lead to epistaxis:

  • Nasal polyps
  • Allergic rhinitis

Pharyngeal conditions which lead to epistaxis:

  • Adenoiditis
  • Juvenile angiofibroma
  • Malignant tumors

Q. 9

Rhinolalia clausa is associated with all of the following except:

 A

Allergic rhinitis

 B

Palatal paralysis

 C

Adenoids

 D

Nasal polyps

Q. 9

Rhinolalia clausa is associated with all of the following except:

 A

Allergic rhinitis

 B

Palatal paralysis

 C

Adenoids

 D

Nasal polyps

Ans. B

Explanation:

Q. 10

All of the following statements about Churg Strauss Syndrome are true, except:

 A

Marked Eosinophilia

 B

Mononeuritis multiplex is common

 C

Renal failure is common

 D

Often associated with Allergic Rhinitis

Q. 10

All of the following statements about Churg Strauss Syndrome are true, except:

 A

Marked Eosinophilia

 B

Mononeuritis multiplex is common

 C

Renal failure is common

 D

Often associated with Allergic Rhinitis

Ans. C

Explanation:

Answer is C (Renal failure is common):

Churg Strauss Syndrome is not prominent and renal failure is rare.

The Renal disease in Churg Strauss Syndrome is less common and generally less severe than with granulomatosis with polyangitis (Wegener’s) and microscopic polyangitis ‘- Harrison’s 18th/2793

‘Renal failure is rare in Churg Strauss syndrome – Pulmonary Involvement in Systemic Autoimmune Disease


Q. 11

MC cause of discharge from the nose is

 A

CSF rhinorrhea

 B

Lupus erythematosus

 C

Trauma

 D

Allergic rhinitis

Q. 11

MC cause of discharge from the nose is

 A

CSF rhinorrhea

 B

Lupus erythematosus

 C

Trauma

 D

Allergic rhinitis

Ans. D

Explanation:

Q. 12

Which of the following is the preformed toxin involved in mechanism of allergic rhinitis ‑

 A

Histamine

 B

Leukotriene

 C

TXA2

 D

PGD2

Q. 12

Which of the following is the preformed toxin involved in mechanism of allergic rhinitis ‑

 A

Histamine

 B

Leukotriene

 C

TXA2

 D

PGD2

Ans. A

Explanation:

Ans. is ‘a’ i.e., Histamine


Q. 13

Allergic rhinitis is which type of hypersensitivity reaction?

 A

Type -1

 B

Type-2

 C

Type-3

 D

Type-4

Q. 13

Allergic rhinitis is which type of hypersensitivity reaction?

 A

Type -1

 B

Type-2

 C

Type-3

 D

Type-4

Ans. A

Explanation:

 

Pathogenesis of allergic rhinitis

Allergic rhinitis is a type I hypersensitivity. It occurs in two phases:‑

1) Initial response/Acute or early phase

After first antigen exposure, this antigen is presented to CD-4 helper T cells (TH2 type) by antigen presenting cells. These primed TH, cells release IL-4 that acts on B-cells to form Ig E specific for that particular antigen. The antigen specific Ig E antibodies then bind to the surface receptors of mast cells and basophils. The process from first antigen exposure to the coating of mast cells by Ig E acts as sensitization (prior sensitization) and first exposure is also called priming or sensitizing exposure (dose). Subsequent exposure (shocking dose) to same antigen then results in activation of mast cells and basophils with release of inflammatory mediators 

  1. Histamine (most important)
  2. PAF
  3. Heparin
  4. Cytokines (IL-1, 3, 4, 5, 6; INF)
  5. Leukotriens (B4, Ch D4)
  6. Eosinophil chemolactic factor (ECF)
  7. PGD2
  8. Neutrophil chemolactic factor (NCF)
  • The release of these mediators result in : –
  1. Increased vascular permeability and vasodilatation which result in tissue edema – Nasal blockage and sneezing.
  2. Smooth muscle spasm → Bronchoconstriction
  3. Hyperactivity of glands → Rhinorrhea
  4. Recruitment of inflammatory cells.

2) Late phase response

  • Recruited inflammatory cells of initial phase amplify and sustain the inflammatory response without additional exposure to the triggered antigen. PAF is the most important mediator in initiation of late phase response. Eosinophils are particularly important cells among the recruited cells which also include neutrophils, basophils, monocytes and T-cells. It causes symptoms like nasal congestion and post nasal drip.



Q. 14

Allergic salute is seen in

 A

Allergic rhinitis

 B

Chronic sinusitis

 C

Nasal Myiasis

 D

Chronic conjunctivitis

Q. 14

Allergic salute is seen in

 A

Allergic rhinitis

 B

Chronic sinusitis

 C

Nasal Myiasis

 D

Chronic conjunctivitis

Ans. A

Explanation:


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