Allergic Rhinitis — MCQs
A young boy came to OPD with complaints of difficulty in breathing. On examination, bilateral polyps were found. On aspiration, bleeding was seen. What will be the initial management?
Which is the best investigation to confirm diagnosis of anaphylaxis?
All of the following are true about nasal myiasis except which of the following?
What condition is characterized by atrophic dry nasal mucosa, extensive encrustations, and a woody hard external nose?
A 24-year-old male presents with asymptomatic scaly lesions over the body as shown in the image below. What is the likely diagnosis?
All of the following are features of a nasal foreign body except:
Which test is most useful in diagnosis of allergic rhinitis?
What is the most likely finding in the CT image of the left maxillary sinus in a patient with a history of allergic rhinitis?
A child with a known peanut allergy accidentally ingests a food containing peanuts and develops urticaria, vomiting, and wheezing within minutes. What is the first-line treatment?
Which of the following statements about vasomotor rhinitis is NOT true?
Allergic Rhinitis Indian Medical PG Practice Questions and MCQs
Question 1: A young boy came to OPD with complaints of difficulty in breathing. On examination, bilateral polyps were found. On aspiration, bleeding was seen. What will be the initial management?
- A. Septoplasty
- B. I and D
- C. Topical corticosteroids (Correct Answer)
- D. Antihistaminic
Explanation: ***Topical corticosteroids*** - **Topical corticosteroids** are the **first-line medical management** for **nasal polyps**, helping to reduce inflammation and shrink polyp size. - They work by reducing local inflammation and edema, improving nasal airway patency and breathing. - **Important note**: The presence of **bleeding on aspiration** suggests a **vascular lesion** (such as juvenile nasopharyngeal angiofibroma in young males), which would require **imaging (CT/MRI) before any intervention** and **no biopsy** due to hemorrhage risk. However, if these are inflammatory polyps, topical steroids remain the initial medical management. *Antihistaminic* - **Antihistamines** are not first-line treatment for nasal polyps, as polyps are primarily an **eosinophilic inflammatory condition** rather than a simple IgE-mediated allergic reaction. - While antihistamines may help with associated allergic rhinitis symptoms, they do **not shrink polyps** or address the underlying inflammatory pathology. *Septoplasty* - **Septoplasty** is a surgical procedure to correct a **deviated nasal septum**, not for treating nasal polyps. - This would not address the bilateral polyps causing difficulty in breathing. *I and D* - **Incision and drainage (I&D)** is performed for abscesses or pus collections, which is not the presentation here. - Nasal polyps are benign inflammatory masses, not infectious collections requiring drainage.
Question 2: Which is the best investigation to confirm diagnosis of anaphylaxis?
- A. IgA levels
- B. Serum tryptase (Correct Answer)
- C. IgD levels
- D. Serum precipitins
Explanation: ***Serum tryptase*** - **Serum tryptase** is released from activated mast cells and is a reliable biomarker for confirming anaphylaxis, particularly when measured within 1-3 hours of symptom onset. - Elevated levels help differentiate anaphylaxis from other conditions with similar symptoms, especially when the clinical picture is ambiguous. *IgA levels* - **IgA levels** are relevant in diagnosing conditions like selective IgA deficiency or celiac disease, but they do not play a direct role in confirming acute anaphylaxis. - They reflect long-term immune status rather than immediate hypersensitivity reactions. *IgD levels* - **IgD levels** have no established role in the diagnosis or confirmation of anaphylaxis. - Their physiological function is not fully understood, but they are not used as biomarkers for acute allergic reactions. *Serum precipitins* - **Serum precipitins** are antibodies detected in various hypersensitivity reactions, especially to inhaled antigens, and are not specific for anaphylaxis [1]. - They are primarily associated with conditions like hypersensitivity pneumonitis, reflecting different immunological mechanisms [1].
Question 3: All of the following are true about nasal myiasis except which of the following?
- A. Common in vasomotor rhinitis
- B. Nasal myiasis can cause intense nasal irritation.
- C. Meningitis may occur in severe nasal myiasis.
- D. Nasal myiasis is typically asymptomatic (Correct Answer)
Explanation: ***Nasal myiasis is typically asymptomatic*** - This statement is **INCORRECT** and is the correct answer to this "except" question. - **Nasal myiasis** is characterized by infestation of the nasal cavity with **fly larvae (maggots)**, which typically causes **significant symptoms** rather than being asymptomatic. - Patients usually experience **nasal obstruction**, **epistaxis (nosebleeds)**, **foul-smelling nasal discharge**, **intense irritation**, and a sensation of movement in the nose due to the feeding and movement of the larvae. - The condition is rarely asymptomatic and usually prompts patients to seek medical attention due to the distressing symptoms. *Common in vasomotor rhinitis* - This statement is **INCORRECT** as a factual claim about myiasis. Nasal myiasis is **NOT** commonly associated with vasomotor rhinitis. - Nasal myiasis is more commonly associated with **atrophic rhinitis**, **ozena**, neglected nasal wounds, poor hygiene, open mouth breathing during sleep, and immunosuppression. - **Vasomotor rhinitis** is a non-allergic condition characterized by fluctuating nasal congestion, rhinorrhea, and sneezing, without any direct association with parasitic infestations. - However, this option may cause confusion as it could also be considered false. The most clearly false statement is that myiasis is "typically asymptomatic." *Nasal myiasis can cause intense nasal irritation* - This statement is **TRUE**. The presence and movement of **maggots** within the nasal cavity leads to severe **irritation**, pain, and a foreign body sensation. - The feeding activity of the larvae causes **tissue destruction**, mucosal damage, and secondary bacterial infections, intensifying discomfort. - Patients often describe a crawling sensation and severe itching in the nasal cavity. *Meningitis may occur in severe nasal myiasis* - This statement is **TRUE**. In advanced or neglected cases, the **larvae** can erode through the nasal structures, sinuses, and skull base, potentially breaching the **meninges**. - This invasion can result in serious intracranial complications such as **meningitis**, **brain abscess**, **cavernous sinus thrombosis**, or other central nervous system infections. - These complications are life-threatening and require urgent surgical debridement and antimicrobial therapy.
Question 4: What condition is characterized by atrophic dry nasal mucosa, extensive encrustations, and a woody hard external nose?
- A. Chronic rhinosinusitis
- B. Rhinitis sicca (Correct Answer)
- C. Allergic rhinitis
- D. Nasal polyps
Explanation: ***Rhinitis sicca*** - This condition is precisely described by **atrophic dry nasal mucosa** and the presence of **extensive encrustations**, alongside a **woody hard external nose**. - It involves a chronic inflammatory process leading to atrophy and dryness of the nasal lining, often with thick crust formation. *Allergic rhinitis* - Characterized by symptoms like **sneezing, rhinorrhea, nasal congestion**, and **itchy eyes/nose**, triggered by allergens. - It does not typically present with severe dryness, extensive encrustations, or a woody hard external nose. *Chronic rhinosinusitis* - Involves inflammation of the paranasal sinuses and nasal cavity for more than 12 weeks, leading to symptoms like **facial pain/pressure, nasal obstruction, and discharge**. - While it can involve crusting, the primary features of severe dryness and a woody hard external nose are not typical. *Nasal polyps* - These are **benign, grape-like growths** within the nasal passages or sinuses, often leading to nasal obstruction and reduced sense of smell. - They are a structural issue and do not primarily cause atrophic dry mucosa, extensive encrustations, or a woody hard external nose.
Question 5: A 24-year-old male presents with asymptomatic scaly lesions over the body as shown in the image below. What is the likely diagnosis?
- A. Atopic Dermatitis
- B. Lichen planus
- C. Seborrheic Dermatitis
- D. Pityriasis Rosea (Correct Answer)
Explanation: ***Pityriasis Rosea*** - The image shows numerous **scaly, erythematous plaques** distributed over the trunk, with a characteristic "Christmas tree" pattern often observed in Pityriasis Rosea. - The lesions are described as **asymptomatic**, which is consistent with Pityriasis Rosea, although mild pruritus can occur. *Atopic Dermatitis* - Typically presents with **intensely pruritic, erythematous, and eczematous lesions** often found in flexural areas (e.g., antecubital and popliteal fossae). - While it can be widespread, the morphology of the lesions (eczematous vs. scaly plaques) and the absence of pruritus make this less likely. *Lichen planus* - Characterized by **pruritic, violaceous, polygonal papules** and plaques, often appearing on the flexor surfaces of wrists, ankles, and oral mucosa. - The appearance of the lesions in the image does not match the typical morphology of lichen planus. *Seborrheic Dermatitis* - Primarily affects areas with a high density of sebaceous glands, such as the **scalp, face (nasolabial folds, eyebrows), and chest**. - Presents with **greasy, yellowish scales** on an erythematous base, which is distinct from the dry, scaly plaques seen in the image.
Question 6: All of the following are features of a nasal foreign body except:
- A. Epistaxis
- B. Nasal obstruction
- C. Nasal polyps (Correct Answer)
- D. Foul smelling discharge
Explanation: ***Nasal polyps*** - While chronic inflammation can lead to nasal polyps, they are **not a direct or acute feature** of a nasal foreign body. - Nasal foreign bodies typically present with more immediate and obstructive symptoms rather than polyp formation. *Epistaxis* - A nasal foreign body can **irritate and traumatize the delicate nasal mucosa**, leading to bleeding. - This is a common symptom, especially if the foreign body is sharp or has been in place for some time. *Nasal obstruction* - The presence of any object in the nasal cavity will inevitably cause some degree of **physical blockage of airflow**. - This is one of the most common presenting symptoms, particularly in children. *Foul smelling discharge* - If a foreign body remains in the nasal cavity for an extended period, it can lead to **stasis of secretions and secondary bacterial infection**. - This infection often results in a **purulent, unilateral, and foul-smelling discharge**.
Question 7: Which test is most useful in diagnosis of allergic rhinitis?
- A. Immediate hypersensitivity skin test (Correct Answer)
- B. Radioallergosorbent test
- C. PBF
- D. Serum IgE levels
Explanation: ***Immediate hypersensitivity skin test*** - This test, such as a **skin prick test**, is highly sensitive and specific for identifying specific allergens that trigger **allergic rhinitis** [1]. - It involves introducing small amounts of common allergens into the skin, and a **wheal-and-flare reaction** indicates a positive result [1]. *Radioallergosorbent test* - The **radioallergosorbent test (RAST)** measures specific IgE antibodies in the blood, which can be useful but is generally considered less sensitive and more expensive than skin testing. - While it can identify allergens, it is typically reserved for cases where skin testing is contraindicated or unreliable. *PBF* - **PBF (Peripheral Blood Film)** is used to examine blood cells for abnormalities and is not directly related to the diagnosis of allergic rhinitis. - It might show an **eosinophilia** in allergic conditions, but this is a general indicator and not specific for diagnosis or identification of allergens. *Serum IgE levels* - Measuring total **serum IgE levels** can indicate an allergic predisposition but does not identify the specific allergens causing the symptoms. - Elevated IgE levels can be present in various allergic and parasitic conditions, making it a non-specific diagnostic tool for allergic rhinitis.
Question 8: What is the most likely finding in the CT image of the left maxillary sinus in a patient with a history of allergic rhinitis?
- A. Ground-glass opacity (Correct Answer)
- B. Honeycomb appearance
- C. Onion peel appearance
- D. Double density
Explanation: ***Ground-glass opacity*** - This image shows diffuse opacification of the left maxillary sinus with a characteristic **ground-glass appearance**, which is often associated with allergic fungal rhinosinusitis (AFRS), a condition that can complicate allergic rhinitis. - The patient's history of **allergic rhinitis** makes AFRS a strong consideration, and the CT finding of ground-glass opacity within the sinus lumen is a classic imaging feature of this condition, representing fungal elements and mucin. *Honeycomb appearance* - A **honeycomb appearance** on CT is typically seen in the lungs and indicates **pulmonary fibrosis**, characterized by clustered cystic airspaces with thickened walls. - This finding is not associated with paranasal sinus pathology, especially not with allergic rhinitis or its common complications. *Onion peel appearance* - The **onion peel appearance** on imaging refers to periosteal reaction with multiple concentric layers of new bone formation. - This is a hallmark feature of conditions like **Ewing sarcoma** and chronic osteomyelitis, primarily affecting bone, not the soft tissue or mucosal lining of a sinus in the context of allergic rhinitis. *Double density* - **Double density** is a term primarily used in echocardiography to describe specific findings related to left atrial enlargement, or occasionally in chest radiography where it might represent superimposed densities. - This term does not describe a finding relevant to paranasal sinus pathology on CT imaging.
Question 9: A child with a known peanut allergy accidentally ingests a food containing peanuts and develops urticaria, vomiting, and wheezing within minutes. What is the first-line treatment?
- A. Oral antihistamines
- B. Subcutaneous epinephrine
- C. Intramuscular epinephrine (Correct Answer)
- D. High-dose corticosteroids
Explanation: ***Intramuscular epinephrine*** - This patient is experiencing **anaphylaxis**, characterized by rapid-onset **urticaria**, **vomiting** (gastrointestinal involvement), and **wheezing** (respiratory involvement). - **Epinephrine** is the **first-line treatment** for anaphylaxis due to its alpha-1 agonist effects (vasoconstriction to counteract hypotension and reduce angioedema) and beta-2 agonist effects (bronchodilation to relieve wheezing). Intramuscular administration ensures rapid absorption and systemic effect. *Oral antihistamines* - While antihistamines can help manage cutaneous symptoms like **urticaria** and **itching**, they do not address the life-threatening respiratory or cardiovascular symptoms of anaphylaxis. - They are considered **adjunctive therapy** for mild allergic reactions but are not sufficient as first-line treatment for anaphylaxis. *Subcutaneous epinephrine* - **Subcutaneous administration** is historical and **not recommended** for anaphylaxis because it has a slower and less predictable absorption compared to intramuscular injection. - The delay in onset of action can be critical in a rapidly progressing anaphylactic reaction. *High-dose corticosteroids* - **Corticosteroids** act too slowly to be useful as a primary treatment for acute anaphylaxis, as their effects take several hours to manifest. - They are used as **adjunctive therapy** to prevent protracted or biphasic reactions, but not for the initial management of acute symptoms.
Question 10: Which of the following statements about vasomotor rhinitis is NOT true?
- A. It is due to parasympathetic overactivity
- B. Resistant cases may need cryotherapy
- C. It may lead to hypertrophic rhinitis
- D. It is caused by an allergic reaction (Correct Answer)
Explanation: ***It is caused by an allergic reaction.*** - Vasomotor rhinitis, also known as nonallergic rhinitis, is characterized by symptoms similar to allergic rhinitis but is **not mediated by an allergic reaction** or an IgE-mast cell response. - Its etiology is related to the **dysregulation of the autonomic nervous system**, specifically an imbalance in the vascular tone of nasal blood vessels, rather than an allergic trigger. *It is due to parasympathetic overactivity* - **Parasympathetic overactivity** is a recognized underlying mechanism in vasomotor rhinitis, leading to increased vascular permeability and glandular secretion. - This overactivity results in symptoms such as **nasal congestion**, rhinorrhea, and sneezing, mimicking allergic rhinitis without an identifiable allergen. *Resistant cases may need cryotherapy* - For severe and **medically refractory cases** of vasomotor rhinitis, **cryotherapy** (specifically cryoablation of the posterior nasal nerve) can be a treatment option. - This procedure targets the nerves responsible for parasympathetic outflow to the nasal mucosa, thereby reducing symptoms like rhinorrhea and congestion. *It may lead to hypertrophic rhinitis* - Chronic inflammation and vascular engorgement associated with long-standing vasomotor rhinitis can lead to **mucosal hypertrophy**, particularly of the inferior turbinates. - This condition, known as **hypertrophic rhinitis**, can exacerbate nasal obstruction and may require surgical intervention to improve airflow.
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