1. When should tiotropium be considered when choosing therapy for patients with asthma?

A) Prescribers should consider tiotropium in patients with the appropriate

phenotype;
+ B) Only patients with asthma step 5 according to the GINA guidelines are eligible for
tiotropium;
C) Tiotropium should be considered for patients who require a rapid onset of action for their add-
on therapy
D) Tiotropium is an appropriate alternative only for patients who cannot receive long-acting
beta2 antagonist (LABA) therapy due to severe side effects;

2. .The____ T cell-APC interaction is MHC____-restricted, and the____ T cell-target cell

interaction is MHC____-restricted.
a) CD4+; Class I; CD8+; Class II
+ b) CD4+; Class II; CD8+; Class I
c) CD8+; Class I; CD4+; Class II
d) CD8+; Class II; CD4+; Class I

3. Boy seven years old, with continuous snoring and a tendency to sleep apnea, nasal stuffiness,
morning headache and worsening of asthma symptoms previous history: Family history: Mother
atopic dermatitis and asthma since early childhood. The boy has suffered from atopic dermatitis
and recurrent wheezing since 12 months of age. Skin prick test at 4 years of age showed positive
reaction against house dust mites since four years of age treated with inhaled steroids and inhaled
beta-2-agonists on demand. Tentative diagnosis?
a) Nasal infection
b) Nasal polyposis
c) Hypertrophy of the tonsils
d) Nasal septum deviation
+e) Allergic rhinitis

4. Decongestants have a vasoconstricting effects. What defines them?

+A. Adrenergic agonists
B. Adrenergic antagonists
C. Anti-cholinergics
D. Cholinergic stimulants

5. The immunoglobulin most commonly found in mucous secretions is: Show Explanation
A. +IgA
B. IgD
C. IgE
D. IgG
E. IgM

6. Girl aged 7 years, with long lasting nasal symptoms and more recently significant snoring and
sleep disturbance and also intermittent hearing impairment.
Family history: Mother has asthma and father allergic rhinitis
Clinical History: History of “chronic cold” (stuffy nose, frequent rhinorrhea, repeated sneezing,
frequent nasal itch). Usually worse during autumn and winter. Several episodes of acute otitis
media Occasional mild wheezing during respiratory infections. Partial relief with antihistamines.
If your diagnosis was Rhinitis, how would you classify its gravity according to the ARIA
guidelines?
a) Intermittent mild
b) Intermittent moderate to severe
c) Persistent mild
+d) Persistent moderate to severe
e) Perennial moderate to severe

7. Mike is a 40-year-old male with Type I HAE. He called your office saying he woke up this
morning with hand swelling. Due to the frequent and disabling nature of Mike's HAE symptoms,
you discuss treatment options with him. Which of the following has been demonstrated most
effective for long term-prophylaxis in HAE in clinical trials?
A) Icatibant;
B) Intravenous C1-inhibitor

+C) Subcutaneous C1-inhibitor

D) Tranexamic acid

8. When initiating therapy, what is the most appropriate instruction to give patients with CSU
regarding when to take antihistamines?

a) Take as needed when symptoms are bothersome

+b) Take daily
c) Take only at bedtime
d) Take a high dose when symptoms are bothersome and a low dose when they are not

9. After 4 weeks on a higher dose of her antihistamine, Maria returns for follow-up with a 40%
reduction in her symptoms. What is the most appropriate next step in her treatment?
+ a) Add omalizumab
b) Taper the antihistamine
c) Add an additional antihistamine
d) Consider use of corticosteroids for at least 3 months

10. Which of the following do you routinely prescribe as third-line therapy for patients with CSU
refractory to all doses of H1-antihistamines?
+a) Omalizumab
b) Cyclosporine
c) Oral corticosteroids
d) Montelukast
e) Dapsone
f) H2-antihistamines

11. In a patient with CSU, what duration of antihistamine treatment is recommended before
escalating therapy?

A) 5 to 7 days
b) 1 to 4 weeks
+c) 4 to 8 weeks
d) 8 to 12 weeks

12. Which of the following factors can predispose you having allergies?

a) A family history of allergies;

b) Environmental conditions;
c) Number and type of Exposure;
+d) All of the above;

13. Which of the following treatment can be used to reduce allergic reaction to unavoidable
substances?
a) Milk thistle three times daily;
b) Mist inhalation therapy;
c) Regularly wearing a face mask;
+d) Desensitization (allergy shots);

14. Which of these can trigger an asthma attack?

a) Exercise;
b) Aspirin;
c) Laughing;
+d) All of the above;
e) None of the above;

15. What product of the immune system attached to bacteria, making them easier to eat by white
blood cells?
a) Hemoglobin;
+b) Antibody;
c) Antigen;
d) Both A and B;
e) Both B and C;

16. Name the process a cell such as a neutrophil or a macrophage uses to ingest its prey.
a) Chemotaxis;
b) Pinocytosis;
+c) Phagocytosis;
d) Both A and B;

17. How many asthma attacks per week is considered as mild asthma attacks?
+A. Maximum of 2 per week
B. Maximum of 1 per week
C. Maximum of 3per week
D. Minimum of 2 per week

18. Eosinophilia in allergic diseases such as allergic rhinitis or asthma is driven by allergen
activated Th2 cells. Which cytokine is the most critical cytokine mediating increased eosinophils
differentiation, activation and survival?
(A) IL-4
(B) IL-13
(C) INF-gamma
+(D) IL-5
(E) Eotaxin
19. Which of the following features is characteristic of serum sickness?
a) Immediate anaphylactoid reaction;
+b) Presents 7 to 14 days after antigen exposure;
c) IgE mediated hypersensitivity reaction;
d) Type 4 cell mediated immunity reactions;

20. Patient presents with worsening asthma symptoms. Pulmonary function tests reveal an FEV1
of 50%. How would this patient’s asthma be classified?
a) Mild;
b) Controlled;
c) Moderate rere;
+d) Severe persistent;

21. Type 4 hypersensitivity is also called as:

a) Immediate hypersensitivity;
+b) Delayed hypersensitivity;
c) Cytotoxic hypersensitivity;
d) Immune complex hypersensitivity;

22. T cells are made in the____ and complete their differentiation in the____.
1) Spleen; Thyroid
2) Spleen; Thymus
+3) Bone marrow; Thymus
4) Bone marrow; Thyroid
5) Bone marrow; Thalamus

23. Match the following innate immune system cell types with their
function: Tissue mast cells

1) Phagocytosis and bacteriocidal mechanisms, antigen presentation

2) Lysis of some virally infected cells
3) Killing parasites;
+4) Release of histamine and other mediators;
5) Phagocytosis and bacteriocidal mechanisms

24. The definition of obstruction of PFTs is best defined by

+a) an FEV1/FVC that is less than 70 to 75 percent of predicted.
b) an FVC that is less than 75 percent of predicted.
c) a maximal midexpiratory flow that is les than 70 to 75 percent of predicted.
d) a total lung capacity that is les than 70 to 75 percent of predicted.

25. Which option is a recommendation for physical activity in patients with severe asthma?
a) No physical activity is recommended
b) Outdoor exercise is recommended during midday and afternoon
+c) A short-acting beta-2 agonist can be used 15-30 minutes before exercise
d) Weight training is recommended over aerobic exercise

26. .Which of the following tests should be done if wheals persist for > 48 h or if the diagnosis is
uncertain?
a) Cryoglobulin titer
b) Hepatitis serologies
c) Ova and parasites
+d) Skin biopsy

27. A 52-year-old male with known asthma for 27 years is seen in your office for a follow up of
his asthma. He states his asthma has been in good control on his low dose of inhaled
corticosteroid. But when asked about albuterol use, he says he uses it 2-3 times daily. When
asked about nighttime awakening due to asthma, he states he awakes because of asthma 3 times
per month. He also tells you his asthma has been in good control and that he has not missed a
day of work. A PFT indicates he has an FEV1 of 81% predicted. You would characterize his
asthma as:
A. Mild intermittent
+ B. Mild persistent
C. Moderate persistent
D. Severe persistent
E. Well controlled asthma

28. A 45-year-old woman with a strong family history of both allergies and glaucoma presents
with frequent red eyes that sometimes itch, sometimes feel dry and sometimes water. On exam,
bulbar conjunctivae are injected, palpebral conjunctiva are normal in color. Nasal mucosa is
moderately swollen and pale. Which of the following is the most likely diagnosis?
A. Vernal conjunctivitis
+ B. Allergic conjunctivitis
C. Glaucoma
D. Dryness from hormone replacement
E. Behcet’s disease

29. Hereditary angioedema (C1 inhibitor deficiency) is characterized by all of the following
except:
A. Frequent abdominal pain
+B. Urticaria or hives
C. Low C4 levels during and between attacks
D. Family history of swelling
E. Absence of symptoms before puberty

30. Which of the following is most accurate concerning the control of dust mites?

a) Washing bedding in cold temperatures is recommended

+b) Decreasing room humidity can help reduce exposure to dust mites
c) Freezing soft toys is ineffective for controlling exposure to dust mites
d) Air filtration is very effective for controlling dust mites
31. Which of the following is accurate regarding the workup for urticaria?
a)Imaging studies are routinely indicated to confirm diagnosis of urticaria
+b) Cholinergic urticaria can be diagnosed using exercise testing
c)Autologous serum skin testing for allergy is routinely indicated in patients with chronic
urticaria
d)A skin biopsy is required for confirmation before conclusive urticaria diagnosis

32. 33 y/o male with a history of asthma says he uses his inhaler about 2 times a week, wakes up
“almost once a week, but not quite” coughing, takes a whiff from his inhaler and is able to go
back to sleep. He has a normal FEV1/FVC ratio. How would you classify his asthma?
A. Intermittent
+B. Mild persistent
C. Moderate persistent
D. Severe persistent

33. Fluticasone, budesonide, triamcinolone are examples of what type of drug?

A. LABA
B. Oral Corticosteroids
C. Immunomodulators
+D. Inhaled Corticosteroids
F. SABA

34. A 5-year-old is brought into the emergency department for trouble breathing. He was at a
family picnic playing when his symptoms began. The patient is currently struggling to breathe
and has red, warm extremities. The patient has an unknown medical history and his only
medications include herbs that his parents give him. His temperature is 99.5°F (37.5°C), pulse is
112/min, blood pressure is 70/40 mmHg, respirations are 20/min, and oxygen saturation is 82%
on 100% O2. Which of the following is the best initial step in management?

a) Albuterol
 + b) Epinephrine- 150 micrograms (0.15 mL) intramuscularly;
c) Epinephrine- 500 micrograms (0.5 mL) intramuscularly;
d) Magnesium;

35. The following are examples of 2nd Generation H1 antihistamines:

a) Diphenhydramine;
b) Hydroxyzine;
c) Chlorpheniramine;
+d) Fexofenadine;

36. Systemic anaphylaxis is NOT caused by which one of the following:

A. Wasp venom
+ B. ACE inhibitors
C. Penicillin
D. Nut ingestion
E. Latex

37. Which one of the following is a true statement about chronic urticaria?

A By definition, it must be present for at least 3 weeks.

B It is commonly due to urticarial vasculitis.

C It can be triggered by IgE antibodies to aspirin.

+ D It can be associated with autoantibodies to FcepsilonRI.

E Systemic steroids are usually required to suppress attacks

38. Which of the following is NOT true when comparing innate to adaptive immunity?

A) Innate responds quickly and adaptive adaptive responds slowly;

B) Innate has few pathogen(non-self) recognition mechanisms and adaptive has many;
C) ++Innate has immunological memory and adaptive does not;
D) Innate does not show response improvements over time and adaptive does;
E) Innate response is non-specific and adaptive is very specific;

39. Which of the following is an advantage of skin testing over RAST to determine specific IgE?
a) Skin testing is not affected by administration of antihistamines;
b) ++Skin testing has greater sensitivity than RAST;
c) Skin testing is associated with less risk of allergic reaction;
d) Skin testing is not confounded by dermographism;

40. Which of the following is an advantage of second-generation antihistamines over firs-

generation antihistamines?
a) Second-generation antihistamines are often less expensive;
b) Second-generation antihistamines are more frequently available in oral preparations;
c) Second-generation antihistamines has less of a sedative effect and produce less
cognitive impairment;
d) +++Second-generation antihistamines are generally more effective than firs-
generation antihistamines;
1. Boy seven years old, with continuous snoring and a tendency to sleep apnoea, nasal stuffiness,
morning headache and worsening of asthma symptoms previous history: Family history: Mother
atopic dermatitis and asthma since early childhood. The boy has suffered from atopic dermatitis
and recurrent wheezing since 12 months of age. Skin prick test at 4 years of age showed positive
reaction against house dust mites Since four years of age treated with inhaled steroids and
inhaled beta-2-agonists on demand..
Which tests would you perform/consider?

a) Autologous skin serum test (ASST)

+ b) skin prick test or specific IgE for standard allergens
c) Patch test;
d) Biopsy from the nose for histological examination

2. Which of the following factors is characteristic of an atopic response?

A) Th1 release of cytokines promoting phagocytosis;
B) Th1 release of cytokines promoting synthesis of opsonizing antibodies;
C) Th2 release of cytokines promoting phagocytosis;
D) +Th2 release of cytokines promoting synthesis of IgE antibodies;

3.Boy aged 10 years, with bothersome nasal and ocular symptoms during the last two springs
Family history: mother has possible allergic rhinitis Environment: House in a rural area, built 15
years ago. No apparent moulds, no carpets or soft toys in the room. Dog usually outside. Father
smokes out of the house Clinical History: Since the age of 9, from April to June, he has daily
complaints of nasal and eye itch, frequent sneezes and sometimes, very abundant rhinorrhoea.
This year, eye itch was particularly intense. Symptoms are often very bothersome and interfere
with his school and social activities. He gets better when it rains. There is no history of
wheezing, even with exercise. He is well during the rest of the year.

Which diagnosis seems more probable?

a)Allergic Rhinoconjuntivitis triggered by House Dust Mites

+b) Allergic Rhinoconjunctivitis triggered by Pollens
c) Allergic Rhinoconjuntivitis triggered by Moulds
d) Vasomotor Rhinitis
e) b and/or c

4. What is the primary mediator of swelling in hereditary angioedema (HAE)?

+A) Bradykinin
B) Histamine
C) Prostaglandin E2
D) Tryptase

5. What is the most appropriate routine diagnostic test to perform in a patient with suspected
CSU?
a) Skin prick test (SPT)
+b) Complete blood count (CBC) with differential for white blood cell (WBC) count
c) Autologous skin serum test (ASST)
d) Lesional biopsy;

6. What is the most appropriate first-line pharmacologic treatment for a patient with a new
diagnosis of CSU?
a) First-generation H1-antihistamine at standard dose;
b) First-generation H1-antihistamine at 2 to 4 times the standard dose;
+c) Second-generation H1-antihistamine at standard dose;
d) Second-generation H1-antihistamine at 2 to 4 times the standard dose;

7. What is the most appropriate treatment modification in patients with CSU and severe
idiopathic symptoms who are nonresponsive to antihistamines and omalizumab?
a) Add a topical corticosteroid
+b) Add cyclosporine
c) Add dapsone
d) Add montelukast

8. Which of the following do you routinely prescribe as third-line therapy for patients with CSU
refractory to all doses of H1-antihistamines?

+ a) Omalizumab
b) Cyclosporine
c) Oral corticosteroids
d) Montelukast
e) Dapsone
f) H2-antihistamines

9. What is considered an appropriate approach to the use of corticosteroid treatment in the

management of chronic urticaria?
a) Use as long-term treatment when antihistamines do not work
b) Use as long-term treatment in patients with angioedema
+c) Use as little as possible, max for a couple of days
d) Use for the first 8 weeks of omalizumab treatment to improve efficacy and reduce side effects

10. Which of the following is NOT an indication for allergen immunotherapy?

a) Seasonal allergic rhinoconjunctivitis;

b) Allergic asthma;
+c) Allergic urticaria;
d) Perennial Allergic conjunctivitis;

11. State one from airborne substances listed below is Perennial allergen;

+a) dust mite;

b) Ragweed;
c) Perfume;
d) Cigarette smoke;

12. Which of these produces and secretes antibodies in the body;

a) Bacteria;
+b) Plasma cell;
c) Red blood cell;
d) Virus;
e) Both A and D;
13. Recognition by T cells is a very important tool for any response to a certain antigen. How
does the T cell recognize antigen?
(A) The T cell recognizes antigen via pattern recognition receptors.
(B) ) The T cell receptor recognizes antigens via the CD3 structure
+ (C) The T cell recognizes antigen via the T cell receptor for antigen (TCR), which has a high
diversity generated at the level of DNA.
(D) The T cell receptor recognizes antigens via binding to membrane-bound IgD antibodies.

14. A 22 year old woman was referred to the clinic with a history of three episodes of lip
swellings for the last year. There is no obvious trigger for her swellings. The swellings lasted for
2-4 days. She was not on any regular medications apart from oral combined contraceptive for the
last year. Her mother had recurrent angioedema since puberty. On examination, she had normal
concentration and normal functional activity of C1 inhibitor (C1-INH). Allergy screening tests
were not revealing any IgEmediated sensitization. Which is the probable diagnosis in this
patient?

(A) Drug allergy to oral contraceptives

(B) Idiopathic angioedema
+ (C) Hereditary angioedema type III
(D) Oral allergy syndrome
(E) Exercise induced urticaria/anaphylaxis

15. Which of the following is recommended as the initial and primary therapy in patients with
persistent asthma?
(A) Inhaled salmeterol xinafoate.
(B) Inhaled ipratropium.
(C) Inhaled tiotropium.
(D) Inhaled formeterol fumarate.
+(E) Inhaled corticosteroids.

16. Treatment with omalizumab decreases serum levels of which of the following
immunoglobulins?
a) IgM
b) IgG
+c) IgE
d) IgA

17. Which of the following is NOT an example of type 2 hypersensitivity?

a) Goodpasture syndrome;
b) Graves’ disease;
c) Pernicious anemia;
+d) Atopic dermatitis;

18. A young female patients with a six month history of recurrent urticaria with residual
discoloration occasionally. She also has arthralgias. Erythrocyte sedimentation rate is
80mm_hour. Which of the following procedures would yield the diagnosis?
a) Patch testing;
b) Measurement of C1 esterase inhibitor activity;
+c) Skin biopsy;
d) Allergy skin testing;

19. What is the etiology of hereditary angioedema?

+a) C1 inhibitor deficiency;
b) C1 inhibitor excess;
c) C9 factor deficiency;
d) C9 factor excess;

20. Humoral immunity is mediated by antibodies from____ and is involved in the elimination
of____ pathogens. Cell-mediated immunity is mediated by____ and is involved in the
elimination of____ pathogens.
1) B lymphocytes; Intracellular; T lymphocytes; Extracellular
+2) B lymphocytes; Extracellular; T lymphocyt; Intaceliular
3) T lymphocyte; Intacellular ; B lymphocytes; Extracellular;
4) T lymphocyts ; Extracellular; ) B lymphocytes; Intacellular;

21. If you are at risk for anaphylaxis, the best way to manage your condition is:
a) Avoid allergens that trigger symptoms
b) Carry autoinjectable epinephrine
c) Know how to use epinephrine
d) Develop an anaphylaxis action plan
+e) All of the above

22. One of your adult patients with severe chronic asthma recently was placed on two inhalations
of salmeterol bid 3 months ago in addition to four inhalations of beclomethasone bid and as
needed albuterol. He states that he has never felt better. On questioning him, he states that he
occasionally awakens at night, although only once or twice per week, and that he did require a 7-
day burst of prednisone for an upper respiratory tract infection last month. He is in to refill his
albuterol, which was filled last month. This patient should.
a) Continue with current therapy because he is improving.
+b) consider increasing inhaled corticosteroid dose.
c) Consider adding regular inhaled ipratropium bromide.
d) Consider increasing salmeterol dose.

23. Type I hypersensitivity reactions are called:

a) Autoimmune reactions
b) Delayed-type reactions
c) Immune complex reactions
d) Cytotoxic reactions
+e) Allergic or immediate reactions

24. Which of the following is a sign of very poorly controlled asthma?

a) FEV1 or peak flow > 60%-80% predicted/personal best
b) Symptoms two or fewer days per week
c) Two or more exacerbations per year requiring oral systemic corticosteroids
+ d) Nighttime awakenings one to three times per week
25. Common causes of acute urticaria include all of the following except:

A. Food allergy
B. Drug allergy
C. Viral infection
+ D. Inhalant allergy
E. Hymenoptera stings

26. The major advantage of second generation antihistamines is:

A. They do cross the blood brain barrier and help patients to relax
B. They are very long acting
C. They cause decongestion as well as decreasing rhinorrhea
+ D. They minimally cross the blood brain barrier and have a decreased sedation effect
E. They decrease appetite

27. As part of the work up of adult asthma, which of the following reproducible, pre and post
bronchodilator pulmonary function test results would be interpreted as showing significant
reversibility?
A. a 15% increase in FEF 25-75%
+ B. a 12% increase in FEV1
C. a 20% increase in FEV1
D. a 15% increase in FEV1/FVC ratio
E. a 15% increase in FVC

28. n June, a 24-year-old female presents with angioedema of the face, including eyelids and lips.
She has had two previous similar episodes. Her father has also had recurrent angiodema of the
face and extremities. Neither has associated pruritis with the angioedema. Which diagnosis is
suggested?
+ A. Hereditary angioedema
B. Food allergy
C. Enterovirus infection
D. Idiopathic angioedema
E. An ACE inhibitor was prescribed by her internist for hypertension

29. The first time a person is exposed to an allergen, the person's immune system:
a. Reacts violently
b. Shuts down
+c. Forms antibodies
d. Ignores the allergen

30. 16 y/o male has episodic wheezing, and dyspnea. His mother tells you that he wakes up about
twice a week coughing. He is unable to keep up with the rest of the kids on the baseball team
because of shortness of breath. You perform a PFT, and find out the FEV1 is 77%. How would
you classify his asthma?
A. Intermittent
B. Mild Persistent
+C. Moderate Persistent
D. Severe Persistent

31. Patient presents with worsening asthma symptoms. Pulmonary function tests reveal an FEV1
of 50%. How would this patient’s asthma be classified?
a) Mild;
b) Controlled;
c) Moderate rere;
+d) Severe persistent;

32. A 3-year-old girl is brought to the emergency department by her father for acute-onset
shortness of breath and wheezing. The rash shown in Figure A is found upon brief examination
of the patient; the patient reports that the rash itches. While in the emergency department, the
patient vomits and has an episode of diarrhea. Her vital signs are as follows: T 38.2, HR 155, BP
75/45, RR 38, and SpO2 99%. Examination is significant for the rash mentioned previously and
rapid breathing, but there is no facial or oral swelling noted. On further discussion with the
father, he relates that she has been otherwise healthy, except for an ear infection that developed a
few days ago. She was seen by her pediatrician yesterday and started on her first dose of a course
of amoxicillin this morning. The father relates that she took this medication for a previous ear
infection without any issue. Which of the following best describes the pathophysiology of the
skin lesions seen in this patient?

A) Histamine- and leukotriene-induced subscutaneous smooth muscle contraction;

B) Type IV hypersensitivity reaction
+C) Histamine-mediated vasodilatation with increased vascular permeability resulting in
dermal fluid accumulation
D) Acquired anti-desmoglein antibodies disrupt keratinocyte adherence, leading to
epidermal bullae

33. What is the adult and pediatric treatment for anaphylactic shock?
+A. Epi 1:1,000 0.01 mg/kg IM for a max single dose of 0.5 mg; may repeat every 5 mintutes for
a total of 3 doses. Additional does require medical consultation.
B. With medical consultation Epi 1:10,000 0.01 mg/kg slow IVP for a max of 1 mg
C. Diphenhydramine 50 mg slow IVP/IM
D. With medical consultation Epi 1:1,000 0.01 mg/kg slow IVP for a max of 1 mg

34. Which of the following downstream inflammatory markers are produced with a type 2
inflammatory response?
a) IFN-ɣ and IL-2
+b)IL-4, IL-5, and IL-13
c) IL-17 and IL-22
d) TGF-β

35. The following are examples of 1st Generation H1 antihistamines:

+a) Diphenhydramine;
b) Cetirizine
c) Loratadine
d) Fexofenadine

36. Which one of the following commonly causes perennial allergic rhinitis?
A Tree pollen
B Chlamydia
C Grass pollen
D Fungal spores
+ E Cat dander

37. Ig unit is composed of:

+ A 2 identical heavy and 2 identical light chains.
B 2 identical heavy and 2 different light chains.
C 2 different heavy and 2 identical light chains.
D 2 different heavy and 2 different light chains.
E Non-covalently bound polypeptide chains.

39. The radioallergosorbent tests (RAST) determines:

a) Bronchial reactivity to subcutaneous serotonin;
b) Bronchial reactivity after inhalation bronchial provocation test;
c) The proportion of total allergic immunoglobulin;
d) ++Allergen-specific serum IgE concentration;

40. Which of the following types of cells are distributed throughout connective tissues, often,
adjacent to blood vessels and below epithelial surfaces that are exposed to the external
environment, and release a diverse array of mediators of allergic inflammation?

a) Eosinophils;
b) Basophils;
 +c) Mast cells;
d) Th2 cells

NEW

1. An 18 year old female presents with an acute exacerbation of asthma associated

with a chest infection. She is unable to complete a sentence and her peak flow
rate was 35% of her normal level. She is treated with high flow
oxygen, nebulised bronchodilators and oral steroids but this is associated with
little change in her condition.
Which of the following treatments, given intravenously, would be the most
appropriate for this patient?

1) Aminophylline
2 ) Augmentin
3 ) Hydrocortisone
+4 ) Magnesium
5 ) Salbutamol

2. Which one of the following is true of IgE?

1) Is present in plasma in the same concentration as IgG

2) Is increased acutely in an asthmatic attack
3) Crosses the normal placenta
+ 4) Is increased in the serum of atopic individuals
5) Is involved in type 2 hypersensitivity

3. A 78-year-old man reports a 5-month history of recurrent swelling of the orbits,

lips, and tongue. The swelling occurs every 2 to 3 weeks and lasts for 3 days.
There is no associated pruritus or hives. He denies the use of any blood pressure
medications. He also reports fatigue and a 4.5-kg weight loss. He
 cannot relate the swelling episodes to food ingestion, over-thecounter medication
ingestion, or environmental changes.

What is the most likely underlying cause of the angioedema?

+a. Hereditary C1 esterase inhibitor deficiency

b. Hematologic malignancy
c. Superior vena cava syndrome
d. Mastocytosis
e. Allergy to food preservative

4. Patients with hay fever:

+ a- may develop asthma

b- are not improved by moving to different locations
c- are not more prone to develop upper respiratory infections
d- are severely disturbed emotionally

5. Which of the following arecharacteristic of allergens?

A .Proteins of molecular weight <10 kd

+ b. Proteins of molecular weight 10-70 kd
c. Proteins of molecular weight >70 kd
d. Lipopolysaccharidese. Carbohydrates

6. Which of the following factors is characteristic of atopic response?

a. Th1 release of cytokines promoting phagocytosis (activate)
b. Th1 release of cytokines promoting synthesis of opsonizing. antibodies
c.Th1 and Th2 release of cytokines promoting synthesis of (only Th1) complement-
fixingantibodies
d .Th2 release of cytokines promoting phagocytosis
+e. Th2 release of cytokines promoting synthesis of IgE antibodies
7. Which of the following types of cells are distributed throughout connective tissues, often
adjacent to blood vessels and below epithelial surfaces that are exposed to the external
environment, and release a diverse array of mediators of allergic inflammation?
a. Eosinophils
b. Basophils
+c.Mast cells
d. Th2 cells
e. Dendritic cells

8. Which of the following antigen-presenting cells APC are actively phagocytic and reside in
peripheral sites such as the skin, intestinal lamina propria, and lungs?
a. Eosinophils
b. Basophils
c. Mast cells
d. Th2 cells
+e. Dendritic cell

9. Which of the following statements best describes the relationship between allergic disorders
and a possible genetic basis?
a. Allergic disorders are a response to only environmental factors
b. Allergic disorders are a response to only environmental factors and infectious agents
c. Asthma and allergic rhinitis are the only allergic disorders with a familial predisposition
+d. Any familial predisposition is related to polymorphisms of a single gene located on
chromosome 10
e. Any familial predisposition is related to many genetic loci and also many polymorphisms
10. All of the following may be signs of moderate to severe airway obstruction resulting from
allergic response except:
+a. Dennie lines (Dennie-Morgan folds)
b. Supraclavicular and intercostal retractions
C. Cyanosis
d. Pulsus paradoxus
e. Respiratory distress with minimal wheezing and a few crackles

11. The radioallergosorbenttest (RAST)determines:

a. Bronchial reactivity to subcutaneous serotonin
b.Bronchial reactivity after inhalation bronchial provocation test
c.The proportion of total allergic immunoglobulin
+ d.Antigen-specific serum IgE concentrations
e.The overall allergic risk profile based on absolute eosinophil count, total IgE, and skin test
result

12. All of the following statements regarding skin testing for allergic reactivity are true except:
a. Antihistamines given prior to testing may inhibit the reaction
b. Intradermal tests are more sensitive than puncture tests
+ c. Positive skin test results by intradermal testing correlate better than results by puncture
tests with clinical symptoms
d. The reaction peaks within approximately 20 min and usually resolves over 20-30 min
e. Larger reactions have greater clinical

13. Which of the following is an advantage of skin testing over RAST to determine specific IgE?
a. Skin testing is not affected by administration of antihistamines b.Skin testing has greater
sensitivity than RAST
c. Skin testing is semiquantitative
d. Skin testing is associated with less risk of allergic reaction
e. Skin testing is not confounded by dermographism

14. Which of the following physical findings would be least likely on examination of a child with
moderate to severe asthma?a.Tachypnea
b.Wheezing
+c.Clubbing
d.Decreased air exchange over the right middle lobe
e.An increased anterior-posterior diameter of the chest

15. Which of the following statements regarding antihistamines is true?a. Classification of

antihistamines from type I to type VI is based on increasing antihistamine activity
b. Second-generation antihistamines are distinguished by greater effectiveness than first-
generation antihistamines
c. Antihistamines should not be administered in combination with decongestants
d. Antihistamines are more effective in treating than preventing the action of histamine
+ e. The choice of antihistamines should be based on associated adverse effects

16. Which of the following is an advantage of second-generation antihistamines over first-

generation antihistamines?
a. Second-generation antihistamines are often less expensive
b. Second-generation antihistamines are more frequently available in oral preparations
+c. Second-generation antihistamines have less of a sedative effect and produce less cognitive
impairment
d. Many more second-generation antihistamines are available as over-the-countermedications
e. Second-generation antihistamines are generally more effective than first-generation
antihistamines

17. Which of the following statements regarding the use of cromolyn in the management of
asthma is true?
a. Cromolyn prevents antibody-mediated mast cell degranulation and mediator release
b. Cromolyn prevents non-antibody-mediated mast cell degranulation
c. Cromolyn has no bronchodilator properties
d. The incidence of adverse effects is low
+e. All of the above

18. The type of adrenergic activity of drugs most desirable treatment of asthma is:
a.alfa1
b.Alfa2
c.Beta1
+d.Beta2

19. A 4-yr -old boy experiences perennial clear rhinorrhea, nasal congestion, conjunctival
injection, allergic shiners, nasal and ocular pruritus, and occasional fits of sneezing.
Environmental history is significant for two cats in the home and flooding of the basement when
it rains. He keeps twenty stuffed animals on his bed and sleeps with a feather pillow on an old
mattress. He lives in a warm climate. Seasonal worsening of his symptoms has not been
observed. He has perennial allergic rhinitis. Which of the following groups of allergens would be
the most likely to contribute to his symptoms?
a. Dust mites, tree pollens, and weed pollens
+ b. Dust mites, animal danders, and molds
c. Tree, weed, and grass pollens
d. Tree pollen, grass pollen, and milk protein

20. A 7-yr-old girl presents with allergic nasal symptoms that are prominent from the middle of
August through the first frost. Which of the following allergens is the most likely cause of her
symptoms?
a. Milk protein
b. Tree pollen
c. Grass pollen
+d. Weed pollen

21. A 12-yr-old presents with sneezing, clear rhinorrhea, and nasal itching. Physical examination
reveals boggy, pale nasal edema with a clear discharge. The most likely diagnosis is:

a. Foreign body
b. Vasomotor rhinitis
c. Neutrophilic rhinitis
d. Nasal mastocytosis
+ e. Allergic rhinitis

22.Two weeks later, the patient described inQuestion 23 complains of headache, poor nasal
airflow requiring mouth breathing, fever , and a change in the nature of the nasal discharge to
mucopurulent discharge. The most likely diagnosis is:
+ a. Sinusitis (complic. Of Allergic rhinitis)
b. Foreign body
c. Rhinitis medicamentosa
d. Choanal stenosis
e. Ciliary dyskinesia

23. A 12-yr -old child presents with watery rhinorrhea, paroxysmal sneezing, and nasal
obstruction. The serum IgE level is normal, and the skin test results are negative. The physical
examination is remarkable only for swollen turbinates and clear nasal secretions. Atrial of
antihistamine-decongestant therapy for3 wk has not relieved symptoms. Which of the following
is the recommended management?
a. Institute strict measures to avoid outdoor allergen exposure.
b. Begin seasonal use of oral sympathomimetic drugs
+ c. Begin seasonal use of topical intranasal corticosteroids.
d. Give a 10-day course of amoxicillin
e. Give a 10- to 14-day course of cefpodoxime
24.Which of the following is most useful in establishing the diagnosis of seasonal allergic
rhinitis?
a. History of good clinical response to an intranasal corticosteroid preparation
+ b. History of exacerbation of symptoms in the spring
c. Elevated serum IgE level
d. Positive result on skin testing for the house dust mite allergen
e. Nasal eosinophils

25.Common triggers of asthma in children include all of the following, except:

a. Secondary tobacco smoke
b. Ozone
c. Cold air
d. Exercise
+ e. Gelatin
26.The parents of an a3-yr-old girl with a history of several previous coughing and wheezing
exacerbations are wondering if their toddler is likely to develop persistent asthma. Which of the
following is a strong risk factor for persistent asthma in toddlers with recurrent wheezing?
+ a. Eczema
b. Colic
c. Living on a farm
d. Female gender

27. A 15-year-old boy is brought to the emergency department due to the sudden onset of difficulty
breathing for the past 45 minutes. He also complains of nausea, colicky abdominal pain, and a swollen
face. His mother says that he had a similar episode 2 years ago. On examination, there is an edematous
swelling of his face including the lips, hands, arms, legs, and genitals without a rash. Temperature is 36.8
C (98.4 F), blood pressure is 120/80 mm Hg, pulse is82/min, and respirations are 18/min. Which of the
following best explains the pathological process of this patient's condition?
A. Antibody-mediated hypersensitivity

+ B. C1 inhibitor deficiency

C. Cell-mediated hypersensitivity

D. Depressed C1q

E. Immune complex-mediated hypersensitivity

28. A 62-year-old man comes to the office with a 4-week history of itchy, dry skin on the hands. He has
experienced scaly, cracking skin at the dorsum of both hands extending to the fingers. The patient has
tried moisturizer lotions with some relief, but the symptoms are persistent. Medical history is notable for
seasonal allergies, hypertension, benign prostatic hyperplasia. He works as a dentist and does not use
tobacco, alcohol, or illicit drugs. Examination shows dry, crusted, and irritated skin with erythema at the
fingers, finger webs, and dorsum of the hands, as shown in the image.. No other skin lesions are seen.
Which of the following is the most likely diagnosis?

+ A. Contact dermatitis

B. Herpetic whitlow

C. Psoriasis

D. Scabies

E. Tinea manuum

29. In Controller treatment which of the following has been shown to

result in reduced death and hospitalizations for patients with asthma?
+ a) Inhaled corticosteroids
b) Nedocromil
c) Leukotriene modifiers
d) Salmeterol
30. A 70-kg female arrives at the emergency department with an acute
exacerbation of asthma. A peak-flow measurement was obtained, and the results
are 40 percent of the predicted value. Oxygen by nasal canula has been started.
Which of the following is appropriate initial drug therapy?

+a) Albuterol

b) Aminophylline

c) Prednisone

d) Ipratropium bromide

31. Type I hypersensitivity reactions are called:

a) Autoimmune reactions

b) Delayed-type reactions

c) Immune complex reactions

d) Cytotoxic reactions

+e) Allergic or immediate reactions

32. The main cells involved in type I hypersensitivity are:

a) B cells and monocytes

b) Monocytes and mast cells

c) T cells and eosinophils

d) Neutrophils and dendritic cells

+ e) Mast cells and basophils

33. Which of the following is the initial intervention for AD?

a) Topical corticosteroid creams

+b) Skin moisturizers

c) Targeted biologic therapies

d) Immunomodulator medication
34. Match the following innate immune system cell types with their
function: Tissue mast cells
1) Phagocytosis and bacteriocidal mechanisms, antigen presentation
2) Lysis of some virally infected cells
3) Killing parasites;
+4) Release of histamine and other mediators;
5) Phagocytosis and bacteriocidal mechanisms

35. If you are at risk for anaphylaxis, the best way to manage your condition is:

a) Avoid allergens that trigger symptoms

b) Carry autoinjectable epinephrine
c) Know how to use epinephrine
d) Develop an anaphylaxis action plan
+e) All of the above

37. The definition of obstruction of PFTs is best defined by

+a) FEV1/FVC that is less than 70 to 75 percent of predicted.
b) FVC that is less than 75 percent of predicted.
c) a maximal midexpiratory flow that is less than 70 to 75 percent of
predicted.
d) a total lung capacity that is less than 70 to 75 percent of predicted.

38. One of your adult patients with severe chronic asthma recently was placed on
two inhalations of salmeterol 3 months ago in addition to four inhalations of
beclomethasone and as needed albuterol. He states that he has never felt better.
On questioning him, he states that he occasionally awakens at night, although only
once or twice per week, and that he did require a 7-day burst of prednisone for an
upper respiratory tract infection last month. He is in to refill his albuterol, which
was filled last month. This patient should.

a) Continue with current therapy because he is improving.

+b) Consider increasing inhaled corticosteroid dose.
c) Consider adding regular inhaled ipratropium bromide.
d) Consider increasing salmeterol dose.

39. Which of the following is a symptom of allergic rhinitis that usually appears
immediately after exposure to an allergen?

a) Headache;
b) Low blood sugar;
+c) Itchy, watery eyes;
d) Increased respirations;

40 . Which of the following are two absolute risk factors for AD?
a) Obesity and poor economic status
b) Scabies infestation and skin infections in family members of patients
c) Cradle cap of greasy, flaking skin as an infant, followed by a scattered greasy,
flaking rash
+d) Family history of AD and mutations in the filaggrin (FLG) gene

1. Which of the following is accurate regarding pharmacologic treatment of

urticaria?

+a) If patients with urticaria do not sufficiently respond to standard dosing with
H1antihistamines, increasing the dose up to fourfold is permitted
b) According to most guidelines, first-generation sedating antihistamines remain the
first choice for therapy in patients with urticaria
c) Monotherapy with an H2antagonist is equally as effective as combination therapy
with an H1and H2antagonist for most patients with urticaria
d) Corticosteroids are contraindicated in patients with urticarial vasculitis

2. Children with eczema are more likely to get:

a) Hay fever
b) Food allergies
c) Asthma
d) All of the above

3. Which of the following tests should be done if wheals persist for > 48 h or if the
diagnosis is uncertain?

a) Cryoglobulin titer
b) Hepatitis serologies
c) Ova and parasites
+d) Skin biopsy

4. If angioedema recurs without a clear cause, which of the following should be

considered?

a) An autoimmune disorder
b) An environmental allergy
+c) Hereditary or acquired angioedema
d) Emotional or psychologic triggers

5. Which of the following are known major food allergens?

A) Milk
B) Eggs
C) Fish
+D) All of the above