Question 1

A patient has seasonal rhinitis symptoms and allergy testing reveals sensitivity to various trees and grasses. What is the first-line treatment for this patient?&#10;A) Antihistamine spray&#10;B) Intranasal cromolyn&#10;C) Intranasal steroids&#10;D) Oral antihistamines

Accepted Answer

Intranasal steroids are considered the first-line treatment for seasonal allergic rhinitis. They have a proven track record of efficacy and safety and can control multiple symptoms, including nasal congestion, itchiness, sneezing, and runny nose. Antihistamines, both oral and nasal, can also be added to the treatment if needed for symptom relief. Intranasal cromolyn and antihistamine sprays are alternative options, but they are generally considered second-line due to lower efficacy and/or a slower onset of action.

Question 2

A patient is concerned about frequent nasal stuffiness and congestion that begins shortly after getting out of bed in the morning. The patient denies itching and sneezing. A physical examination reveals erythematous nasal mucosa with scant watery discharge. What treatment will the provider recommend for this patient?

A) Consultation for immunotherapy
B) Daily intranasal steroids
C) Oral antihistamines each morning
D) Oral decongestants as needed

B

Accepted Answer

The patient's symptoms of frequent morning nasal congestion without itching or sneezing suggest non-allergic rhinitis. The physical exam findings of erythematous nasal mucosa with scant watery discharge further support this diagnosis. Intranasal steroids are recommended as a first-line treatment for non-allergic rhinitis to reduce inflammation and congestion. Consultation for immunotherapy and oral antihistamines are not indicated in this case, as the symptoms are not suggestive of allergies. Oral decongestants may provide temporary relief, but their use is associated with potential side effects such as hypertension and should be used with caution.

Question 3

A patient has recurrent sneezing, alterations in taste and smell, watery, itchy eyes, and thin, clear nasal secretions. The provider notes puffiness around the eyes. The patient's vital signs are normal. What is the most likely diagnosis for this patient?

A) Acute sinusitis
B) Allergic rhinitis
C) Chronic sinusitis
D) Viral rhinitis

B

Accepted Answer

The recurrent sneezing, alterations in taste and smell, watery, itchy eyes, and thin, clear nasal secretions along with puffiness around the eyes are consistent with allergic rhinitis, which is an allergic reaction. Other options such as acute sinusitis, chronic sinusitis, or viral rhinitis would present with different symptoms and/or physical exam findings.

Deck 73: Rhinitis