American Board of Internal Medicine (ABIM) Certification Practice Exam

What is an alternative method to decrease sneezing and rhinorrhea during viral upper respiratory infections?

1. Inhaled ipratropium

2. Leukotriene modifiers

3. Systemic corticosteroids

4. Saline nasal irrigation

The correct answer is: Inhaled ipratropium

Ipratropium is an anticholinergic agent that can be used intranasally to reduce rhinorrhea (runny nose) during viral upper respiratory infections. Its mechanism involves inhibiting the action of acetylcholine, which subsequently decreases mucus secretion from the glands in the nasal mucosa. This can be particularly useful when a patient is experiencing significant nasal discharge and congestion due to a viral infection. The use of inhaled ipratropium provides targeted relief from symptoms by directly affecting the nasal passages, and it is generally well-tolerated with a favorable side effect profile. In cases where traditional antihistamines are less effective, especially where rhinorrhea is the primary concern and sneezing occurs, ipratropium can provide an alternative approach for symptomatic relief. Other methods, such as leukotriene modifiers, systemic corticosteroids, and saline nasal irrigation, have different indications or mechanisms that may not be as directly effective for managing these specific symptoms during a viral upper respiratory infection. For example, while systemic corticosteroids may reduce inflammation, they are not the go-to option for short-term symptom relief during a viral illness. Saline nasal irrigation, while beneficial for overall nasal health and hydration, may not provide immediate symptomatic relief similar to