BAILEY BRIDGE EXAM EXAM SCRIPT
FINAL PAPER QUESTIONS ANSWERS
COMPREHENSIVE STUDY RESOURCE
●● allergic rhinitis sx
Answer: sx: nasal congestion, clear rhinorrhea, sneezing, nasal pruritis,
post-nasal drip, non-productie cough, chronic sinusitis
often a/w asthma and atopic dermatitis (eczema), family hx, triggers,
known allergens via allergy testing
●● allergic conjunctivitis / rhinitis clinical presentation (KNOW THIS)
Answer: often p/w Dennie's lines, allergic shinrs, & periorbital edema
●● Dennie's lines
Answer: infraorbital transverse creases and are associated with mild
chronic inflammation of conjunctivae, as in allergic conjunctivitis
●● allergic shiners
Answer: Darkening of the lower eyelids as a result of venous stasis;
Discoloration under the eyes seen with allergic conjunctivitis
●● Allergic rhinitis: History & HPI
,Answer: make sure to ask:
-when do sx occur?
-hx of drug abuse, drug self-treatment (i.e. using nasal sprays)
-family hx (asthma, eczema, allergies)
-PMH allergies, asthma, skin issues
●● Allergic rhinitis: Physical Exam
Answer: -general inspection of face: dennie's lines & allergic shiners
-nose: mucosal edema, thin/clear secretion, potential nasal polyps
-palpate sinuses for tenderness (may contribute to sinusitis)
-frequent sniffing & throat clearing
-eyes: allergic conjunctivitis
ears: eustachian tube dysfunction w/ pneumatic otoscope
-breath sounds: wheezy
-skin: ?dermatitis
-neck: swollen lymph nodes
diagnostic: response to tx / based on H&P; can consider skin allergy
testing or serum testing
●● allergic rhinitis treatment
,Answer: #1=allergen avoidance! (shower at night to rinse off pollen,
keep windows closed, replace filters in vents, wash bedding, remove
carpets)
mild / episodic sx:
-minimally sedating oral antihistamine (Cetirizine [Zyrtec], Loratidine
[Claritin])
-antihistamine nasal spray (Azelastine, Olopatadine) or glucocorticoid
nasal spray (fluticasone)
Persistent or moderate/severe sx:
-glucocorticoid nasal sprays
-minimally sedating oral antihistamine / decongestant combination
-consider injection immunotherapy
●● pharyngitis (sore throat)
Answer: infection/inflammation that can be caused by viral pathogens
(adenovirus, influenza, coronaviruses, coxsackie virus, EBV & CMV),
bacterial pathogens (Group A Strep, N. gonorrhea), as well as allergic
rhinitis, GERD, postnasal drip, or mouth breathing
●● Pharyngitis History / HPI / Physical
Answer: -determine onset/duration of sx
-cough or rhinorrhea? (suggests URI or allergic)
, -fever/ systemic sx? (HA, fatigue, abdominal pain, vomiting, know strep
exposure --> suggests GABHS)
-difficulty swallowing, drooling (?Peritonsillar abscess)
--sexual practices (oral sex w/ infected partner)
Exam: VS, eyes / ears / nose / throat / sinuses / lymph nodes / pharynx /
heart & lungs / abdomen / genitourinary if needed
●● viral pharyngitis*
Answer: pharyngeal edema, tonsillar edema that has a subacute onset
-associated w/ other sx such as nasal & lacrimal edema & congestion,
cough, conjunctivitis, hoarse voice
-low-grade or absent fever
-can sometimes be a/w tonsillar exudates, oral ulcers
tx: NSAIDs, Tylenol, gargle, lozenges (supportive care)
●● streptococcal pharyngitis*
confirmatory testing is needed w/ rapid antigen testing! don't miss this
dx
Answer: pharyngeal edema, tonsillar edema that has acute onset of a
sore throat
-associated w/ tender/swollen anterior cervical lymph nodes, patchy
tonsillar exudates / beefy throat (red & raw)
FINAL PAPER QUESTIONS ANSWERS
COMPREHENSIVE STUDY RESOURCE
●● allergic rhinitis sx
Answer: sx: nasal congestion, clear rhinorrhea, sneezing, nasal pruritis,
post-nasal drip, non-productie cough, chronic sinusitis
often a/w asthma and atopic dermatitis (eczema), family hx, triggers,
known allergens via allergy testing
●● allergic conjunctivitis / rhinitis clinical presentation (KNOW THIS)
Answer: often p/w Dennie's lines, allergic shinrs, & periorbital edema
●● Dennie's lines
Answer: infraorbital transverse creases and are associated with mild
chronic inflammation of conjunctivae, as in allergic conjunctivitis
●● allergic shiners
Answer: Darkening of the lower eyelids as a result of venous stasis;
Discoloration under the eyes seen with allergic conjunctivitis
●● Allergic rhinitis: History & HPI
,Answer: make sure to ask:
-when do sx occur?
-hx of drug abuse, drug self-treatment (i.e. using nasal sprays)
-family hx (asthma, eczema, allergies)
-PMH allergies, asthma, skin issues
●● Allergic rhinitis: Physical Exam
Answer: -general inspection of face: dennie's lines & allergic shiners
-nose: mucosal edema, thin/clear secretion, potential nasal polyps
-palpate sinuses for tenderness (may contribute to sinusitis)
-frequent sniffing & throat clearing
-eyes: allergic conjunctivitis
ears: eustachian tube dysfunction w/ pneumatic otoscope
-breath sounds: wheezy
-skin: ?dermatitis
-neck: swollen lymph nodes
diagnostic: response to tx / based on H&P; can consider skin allergy
testing or serum testing
●● allergic rhinitis treatment
,Answer: #1=allergen avoidance! (shower at night to rinse off pollen,
keep windows closed, replace filters in vents, wash bedding, remove
carpets)
mild / episodic sx:
-minimally sedating oral antihistamine (Cetirizine [Zyrtec], Loratidine
[Claritin])
-antihistamine nasal spray (Azelastine, Olopatadine) or glucocorticoid
nasal spray (fluticasone)
Persistent or moderate/severe sx:
-glucocorticoid nasal sprays
-minimally sedating oral antihistamine / decongestant combination
-consider injection immunotherapy
●● pharyngitis (sore throat)
Answer: infection/inflammation that can be caused by viral pathogens
(adenovirus, influenza, coronaviruses, coxsackie virus, EBV & CMV),
bacterial pathogens (Group A Strep, N. gonorrhea), as well as allergic
rhinitis, GERD, postnasal drip, or mouth breathing
●● Pharyngitis History / HPI / Physical
Answer: -determine onset/duration of sx
-cough or rhinorrhea? (suggests URI or allergic)
, -fever/ systemic sx? (HA, fatigue, abdominal pain, vomiting, know strep
exposure --> suggests GABHS)
-difficulty swallowing, drooling (?Peritonsillar abscess)
--sexual practices (oral sex w/ infected partner)
Exam: VS, eyes / ears / nose / throat / sinuses / lymph nodes / pharynx /
heart & lungs / abdomen / genitourinary if needed
●● viral pharyngitis*
Answer: pharyngeal edema, tonsillar edema that has a subacute onset
-associated w/ other sx such as nasal & lacrimal edema & congestion,
cough, conjunctivitis, hoarse voice
-low-grade or absent fever
-can sometimes be a/w tonsillar exudates, oral ulcers
tx: NSAIDs, Tylenol, gargle, lozenges (supportive care)
●● streptococcal pharyngitis*
confirmatory testing is needed w/ rapid antigen testing! don't miss this
dx
Answer: pharyngeal edema, tonsillar edema that has acute onset of a
sore throat
-associated w/ tender/swollen anterior cervical lymph nodes, patchy
tonsillar exudates / beefy throat (red & raw)
