Immunology Review Corner

Immunology Review Corner: Chapter 69 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al.

Prepared by Drs. Karla R. Davis, Walter Reed Medical Center, and Anne K. Ellis, McMaster University

Chapter 69: Asthma in Adults: Evaluation and Management

1. Which of the following statements regarding the role of air pollution and asthma is true?

A. Diesel exhaust particles can enhance human IgE production, and have been implicated in the worldwide increased prevalence of allergic asthma.
B. Endotoxin is not an important factor contributing to asthma exacerbations.
C. Nitrogen dioxide at 0.3 ppm (six times the National Ambient Air Quality Standard) will have an effect on exercising individuals with stable asthma.
D. Asthma severity correlates better with levels of dust mite allergen in house dust than endotoxin in house dust, in dust mite-sensitive asthmatics.

2. Pulmonary function tests (PFTs) can be used to establish the diagnosis of asthma, to quantify the severity of the disease, and to monitor the course of the disease and response to therapy. Which of the following statements regarding PFTs and asthma is correct?

A. Greater than 15 percent improvement of forced expiratory volume in 1 second (FEV1) after inhalation of a beta2-adrenergic agonist is required to make the diagnosis of asthma.
B. Greater than 20 percent diurnal (evening to morning) fall in peak expiratory flow (PEF) is indicative of asthma.
C. The presence of airway obstruction is pathognmonic for asthma.
D. Reversibility of obstruction with bronchodilators is pathognmonic for asthma.

3. When do the majority of in-hospital sudden deaths and episodes of ventilatory arrest from asthma occur?

A. Morning
B. Afternoon
C. Evening
D. Night

4. Which of the following decreases in diurnal (evening to morning) peak expiratory flow (PEF) is indicative of asthma?

A. Greater than 10 percent
B. Greater than 12 percent
C. Greater than 20 percent
D. Greater than 30 percent

5. A flow-volume loop demonstrating a rapid fall of flow rate and a marked prolongation of expiration is most consistent with which of the following disease states?

A. Asthma
B. Fixed airway obstruction
C. Emphysema
D. Vocal cord dysfunction

6. Which of the following statements regarding methacholine bronchoprovocation is the most accurate?

A. A decrease in forced expiratory volume in 1 second (FEV1) of greater than 20 percent after inhalation of methacholine is seen only in asthma patients.
B. Infants and young children do not exhibit airway reactivity to methacholine, unless they have asthma.
C. Approximately 5 percent of the apparently normal population exhibits airway reactivity to methacholine.
D. In non-asthmatic patients with airway reactivity to methacholine, there is a plateau in the bronchoconstrictive response.

7. Creola bodies include which of the following cell types?

A. Eosinophils
B. Epithelial cells
C. Mast cells
D. Neutrophils

8. Which of the following is a common side effect related to theophylline?

A. Hypocalcemia
B. Hypokalemia
C. Hypercalcemia
D. Hyperkalemia

9. Which of the following statements regarding eosinophils and asthma is the most accurate?

A. Peripheral blood eosinophil numbers and eosinophilic cationic protein levels in bronchoalveolar lavage (BAL) fluids correlate with severity of disease.
B. Serum ECP is a good indicator of disease activity in chronic asthma.
C. Treatment with anti-IL-5 antibody reduces circulating and sputum eosinophil numbers with a corresponding improvement in clinical symptoms.
D. Sputum eosinophils are more readily reduced with corticosteroid therapy than are blood eosinophils.

10. The improvement seen in forced expiratory volume in 1 second (FEV1) with the use of leukotriene modulators, as compared with inhaled corticosteroids, is best described as?

A. Less, sooner
B. More, sooner
C. Less, later
D. More, later

Answers:
1. A, page 1259
2. B, page 1261
3. D, page 1259
4. C, page 1260
5. C, page 1260
6. D, page 1262
7. B, page 1264
8. C, page 1270
9. A, page 1264
10. A, page 1273