Continuing Medical Education examination

Chronic Rhinosinusitis

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Instructions for category 1 Continuing Medical Education credit

The American Academy of Allergy, Asthma & Immunology is accredited as a provider of Continuing Medical Education (CME) bythe Accreditation Council for Continuing Medical Education.

Test ID no.: jaip003Contact hours: 1.0Expiration date: June 30, 2014

Category 1 credit can be earned by reading the text material and taking this CME examination online. For complete instructions, visitthe Journal’s Web site at www.jaci-inpractice.org.

Learning objectives: “Chronic Rhinosinusitis”

1. To appreciate the multiple causes and differential diagnosis in patients presenting with nasal obstruction.

2. To recognize the presentation of the various subtypes of chronic rhinosinusitis.

3. To initiate appropriate treatment options for aspirin-exacerbated respiratory disease.

CME items

Question 1. In general, chronic rhinosinusitis with nasal polyps(CRSwNP) can be distinguished from chronic rhinosinusitiswithout nasal polyps (CRSsNP) bywhich of the following features?

A. A higher prevalence, accounting for 60% to 65% of cases ofchronic rhinosinusitis

B. Histologically there is a prominent mononuclear cell infiltrateand fibrosis.

C. Immunologic skewing toward a TH2 phenotype, with thepresence of markers of allergic inflammation such as IL-4,IL-5, and eosinophilic cationic protein (ECP)

D. Symptoms of facial/sinus pain and purulent nasal discharge

Question 2. The pathogenesis of aspirin-exacerbated respiratorydisease (AERD) results from inhibition of cyclo-oxygenase-1(COX-1), which results in profound inhibition of which of thefollowing molecules?

A. Leukotriene D4

B. Leukotriene E4

C. Prostaglandin E2

D. 5-Lipoxygenase

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Question 3. Which of the following is the recommended treat-ment modality for allergic fungal rhinosinusitis (AFRS)?

A. Aggressive systemic and topical antifungal antibiotics

B. Nasal irrigation with topical corticosteroids

C. Surgical removal of all obstructing allergic mucin anddiseased mucosa

D. Prednisone, 0.5 to 1.0 mg/kg, daily for 2 weeks, followed byevery other day, tapering over several months

Question 4. A 26-year-old woman with seasonal allergic rhinitis,controlled with antihistamines as needed, presents to your officewith 3 days of progressively worsening headache, maxillary sinustenderness, purulent nasal discharge, and hyposmia. What is theappropriate treatment at this time?

A. Symptomatic treatment with decongestants and nasal salinerinses

B. Dedicated computed tomographic scan of the sinuses

C. 5-Day course of azithromycin

D. Referral to otolaryngology for nasal cultures

J ALLERGY CLIN IMMUNOL: IN PRACTICEVOLUME 1, NUMBER 3

CONTINUING MEDICAL EDUCATION EXAMINATION 213

Question 5. A patient with aspirin-exacerbated respiratory disease(AERD) that you have been following for 4 years asks you aboutaspirin desensitization. Which of the following statements isaccurate regarding aspirin desensitization in this disease?

A. After a successful desensitization it is acceptable for a patientto miss a dose of aspirin for up 72 hours without need fora repeat desensitization.

B. Aspirin desensitization can be safely performed at home aslong as the patient has an EpiPen and albuterol at hand.

C. Aspirin desensitization has been shown to significantly reducenasal polyp size and computed tomographic score.

D. Aspirin desensitization has been shown to significantly reducethe number of sinus infections per year.