1. Which of the following is a symptom experienced by almost all patients with chronic rhinosinusitis with nasal polyps?
A. Rash around the nares
B. Loss of taste or smell
C. Difficulty hearing
D. Sore throat
E. Unsure
2. Which of the following describes the results of a large study conducted to investigate genetic risk factors associated with chronic rhinosinusitis with nasal polyps?
A. First-degree relatives of patients who have chronic rhinosinusitis with nasal polyps are unlikely to have the condition, indicting no genetic predisposition.
B. First-degree relatives of patients who have chronic rhinosinusitis with nasal polyps are slightly more likely to have the condition, but the findings were insignificant.
C. First-degree relatives of patients who have chronic rhinosinusitis with nasal polyps are 4.1 times more likely to have the condition.
D. Second-degree relatives of patients who have chronic rhinosinusitis with nasal polyps are 4.1 times more likely to have the condition.
E. Unsure
3. Which of the following is a list of diseases commonly associated with Th2-related nasal polyps?
A. Asthma, atopic dermatitis, chronic rhinosinusitis with nasal polyps with a hyperplastic component, or ulcerative colitis
B. Chronic rhinosinusitis with nasal polyps, chronic obstructive pulmonary disease, psoriasis, or Crohn's disease
C. Churg-Strauss syndrome and cystic fibrosis
D. Asthma, atopic dermatitis, Churg-Strauss syndrome, chronic obstructive pulmonary disease, psoriasis, or Crohn's disease
E. Unsure
4. A patient notices acute exacerbations of her chronic rhinosinusitis after she runs a few miles or has a glass of red wine with dinner. After sharing this observation with the pharmacist, she mentions that she often takes an ibuprofen before running to prevent pain. Which of the following conditions might be responsible for her exacerbations and should be investigated?
A. Nasal polyposis
B. Asthma
C. Aspirin-exacerbated respiratory disease
D. Chronis obstructive pulmonary disease
E. Unsure
5. A primary care provider calls the pharmacist and says that a CT scan indicates his patient has mild-to-moderate nasal polyps. He asks for a recommendation for a first-step regimen for her. Which of the following would be the best response?
A. High-volume, low-pressure nasal saline irrigations and intranasal glucocorticoids
B. Intranasal first-generation corticosteroids and insertion of a corticosteroid-releasing stent
C. A short course of systemic oral steroids followed by nasal saline irrigations
D. Macrolide antibiotics for 21 days with methylprednisolone followed by as-needed over-the-counter products
E. Unsure
6. Gerry Lafitte visits the pharmacy and shows the pharmacist his CT scan, pointing out that the areas where his sinuses are located is grayish and opaque, and his nasal polyp score is 8. He has been using nasal irrigation and intranasal glucocorticoids. He took 3 rounds of systemic oral corticosteroids last year and 2 the previous year. What would be the next step in the treatment plan?
A. A compounded corticosteroid irrigation
B. Intranasal glucocorticoids
C. Endoscopic surgery
D. Benralizumab
E. Unsure
7. A patient has tried many medications to help reduce her nasal polyps and has had two surgeries. She is now eligible for a biologic and her insurer has provided prior authorization. She has moderate-to-severe asthma with an eosinophilic phenotype. Which biologic should the pharmacist recommend?
A. Benralizumab
B. Dupilumab
C. Mepolizumab
D. Omalizumab
E. Unsure
8. Proper intranasal administration technique is especially important for patients who have chronic rhinosinusitis with nasal polyps because it helps prevent or reduce
A. Infection
B. Shortness of breath
C. Sleep apnea and insomnia
D. Epistaxis
E. Unsure
9. Alma Lake fills a prescription for a short course of oral corticosteroids—her first one ever—for a severe exacerbation of her chronic rhinosinusitis with nasal polyps. She asks the pharmacist what to expect in terms of the duration of response. The pharmacist's best response is that significant improvements in health-related quality of life and symptom severity can be expected, but
A. The benefit usually disappears within 3 months.
B. A significant decline in bone marrow density may occur.
C. Another course of oral corticosteroids will likely be needed every 2 months.
D. Surgery could be necessary within a couple years.
E. Unsure
10. Which of the following is an appropriate counseling point for patients who are starting biologics for nasal polyps?
A. Discontinue corticosteroids immediately.
B. Store these tablets in a cool, dry place.
C. Adherence is less important with these medications.
D. Polyps may return if the biologics are stopped.
E. Unsure
