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Review Corner Archive
December 19 , 2007
Chapter 16 of Pediatric Allergy: Principles & Practices, edited by Donald Y.M. Leung, et al.
Chapter 16: Ebstein Barr Virus Infection
Prepared by Drs. Jennifer W. Mbuthia, Walter Reed Army Medical Center, and Thomas G. Sternberg, Le Bonheur Children’s Hospital.
1. Which of the following antibody tests is expected to be negative during the acute phase of a primary EBV infection:
A. Anti-VCA IgM (viral capsid antigen)
B. Anti-EBNA (Epstein-Barr nuclear antigen)
C. Anti-VCA IgG
D. Anti-EA (early antigens)
2. Infection with the Epstein-Barr virus begins with the binding of the virus to which receptor:
A. CR1
B. CR2
C. CR3
D. CR4
3. The percentage of adults over 30 years of age who are EBV seropositive is approximately
A. 5 percent
B. 15 percent
C. 50 percent
D. 90 percent
4. During its latent phase, the EBV viral DNA is in closed, circular extrachromosomal episomes. What cell type becomes a reservoir for the Epstein-Barr virus during this latent state?
A. B cells
B. M cells
C. NK cells
D. CD8+ T cells
5. Which of the following infections may present with infectious mononucleosis associated symptoms and a positive heterophil test?
A. HIV
B. Toxoplasmosis gondii
C. CMV
D. Parvovirus B19
6. EBV, CMV, HHV-6/7, adenovirus, Parvovirus B19, and HIV may all present with infectious mononucleosis-like symptoms. Which of the following statements is a correct about the differences between HIV and these other viruses?
A. HIV is a DNA virus.
B. The other viruses do not infect cells of the immune system.
C. Only HIV stimulates the production of the heterophil antibody.
D. HIV is a RNA virus.
7. The asymptomatic incubation period for EBV may last for what duration?
A. 3-5 days
B. 1-2 weeks
C. 4-6 weeks
D. 3 months
8. A five-year-old female with history of fever and acute otitis media returns to the office 5 to 9 days after starting amoxicillin for the ear infection with a diffuse blanching maculopapular rash. The patient also complained of a sore throat the day before. An exudative pharyngitis was noted on exam, but she had a negative rapid strep test. What is the likely etiology for this rash?
A. Scarlet Fever
B. Serum Sickness
C. Erythema multiforme minor
D. EBV related drug eruption.
9. X-linked lymphoproliferative disease is a disorder characterized by an inability to eliminate EBV, eventually leading to fulminant infectious mononucleosis, B cell lymphoma, and hypogammaglobulinemia. A defect in what protein is responsible for most cases of the disorder?
A. STAT 3
B. Tyk2
C. SLAM
D. SAP
Answers
1. B, page 179 (Table 16-3). Anti-EBNA appears once the active infection is under control.
2. B, page 178. CR2 (CD21) or C3d
3. D, page 177
4. A, page 177
5. B, page 179. All of these infections may have a similar presentation to EBV infection, but T. gondii will cause a positive heterophil test. Malaria, rubella and serum sickness may also trigger the production of this antibody.
6. D, page 179. The above-mentioned viruses may all cause EBV type symptoms; HIV is the only RNA virus.
7. C, page 178. The incubation period may last 4-6 weeks with little to no symptoms.
8. D, page 177 (Table 16-1). 5 percent of individuals will develop a rash with EBV infection. The rash is non-specific and may be macular, petechial, scarlatiniform, urticarial, or erythema-multiforme like. 90 to 95 percent of individuals receiving ampicillin or amoxicillin will develop an erythematous macular and papular rash. The rash results from ampicillin-antibody complexes resulting from B-cell activation (Hurwitz Clinical Pediatric Dermatology, 3rd edition. 2006).
9. D, page 177 (Table 16-1). About 80 percent of cases are due to mutations in the gene encoding an adaptor molecule called SLAM-associated protein (SAP). See also ‘Cellular and molecular immunology’, Abul Abbas et al., 6th ed p. 474.
October 10 , 2007
Chapter 11 of Pediatric Allergy: Principles & Practices, edited by Donald Y.M. Leung, et al.
Chapter 11: Complement Deficiencies
Prepared by Drs. Bret Haymore and Jiun Yoon, Walter Reed Army Medical Center.
1. Deficiency of early (C1-C4) components of the classical complement cascade are associated with susceptibility to:
A. Only autoimmune/immune complex disease
B. Only recurrent infections
C. Both autoimmune/immune complex disease and infection
D. Neither autoimmune/immune complex disease nor infection
2. Deficiency of late (C5-C9) components of the complement pathway are associated with susceptibility to:
A. Only autoimmune/immune complex disease
B. Only recurrent infections
C. Both autoimmune/immune complex disease and infection
D. Neither autoimmune/immune complex disease nor infection
3. Which of the following is an X-linked disorder:
A. C1 esterase inhibitor deficiency
B. Factor H deficiency
C. Factor I deficiency
D. Properdin deficiency
4. Which of the following is an autosomal dominant disorder:
A. C1 esterase inhibitor deficiency
B. Factor H deficiency
C. Factor I deficiency
D. Properdin deficiency
5. Which of the following is the most potent mediator of neutrophil chemotaxis:
A. C3b
B. C4a
C. C5a
D. C5b
6. Patients with which of the following deficiencies has the highest risk of developing systemic lupus erythematosus:
A. C1q
B. C1r
C. C2
D. C4
7. C1 esterase inhibits the enzymatic activity of:
A. C1q only
B. C1r only
C. C1s only
D. C1r & C1s
8. In addition to its role in inhibiting C1, C1 esterase is also the major inhibitor of:
A. C4
B. C9
C. Kallikrein
D. Factor H
9. Factor I inhibits which complement component(s):
A. C3b
B. iC3b
C. C4
D. C5-C9 (membrane attack complex)
10. In patients with hereditary angioedema which of the following has the least proven efficacy as prophylaxis for surgery or oral procedures:
A. Corticosteroids
B. Danazol
C. Fresh frozen plasma
D. C1 esterase concentrate
Answers
1. C, page 126
2. B, page 126
3. D, page 124
4. A, page 123, Table 11-1
5. C, page 118; Also see Abbas Cellular & Molecular Immunology, 6th ed, p.342
6. A, page 120
7. D, page 123
8. C, page 123
9. A, page 124
10. A, page 125
September 26, 2007
Chapter 10 of Pediatric Allergy: Principles & Practices, edited by Donald Y.M. Leung, et al.
Chapter 10: Pediatric Human Immunodeficiency Virus Infection
Prepared by Drs. Bret Haymore and Soo Hee Kim-Delio, Walter Reed Army Medical Center
1. Which of the following time periods accounts for the majority of cases of HIV transmission from mother to child:
A. During first trimester
B. During the second trimester
C. Around the time of delivery
D. Post-partum
2. The genome of HIV is:
A. Single-stranded RNA
B. Double-stranded RNA
C. Single-stranded DNA
D. Double-stranded DNA
3. Which HIV protein is most associated with allowing the virus to bind to the target cell surface co-receptors (CD4 and a chemokine receptor):
A. gp41
B. gp120
C. p17
D. p24
4. In HIV infection, the chemokine co-receptor associated with macrophage tropic virus is:
A. CXCR4
B. CXCR7
C. CCR5
D. CCR7
5. In HIV infection, the chemokine co-receptor associated with T-cell tropic virus is:
A. CXCR4
B. CXCR7
C. CCR5
D. CCR7
6. Which of the following tests is the most widely accepted for diagnosis of HIV in infants:
A. HIV DNA polymerase chain reaction
B. HIV RNA polymerase chain reaction
C. HIV culture
D. HIV ELISA followed by western blot
7. After what age can HIV ELISA and Western blot be used for the diagnosis of HIV infection?
A. 3 months
B. 6 months
C. 12 months
D. 18 months
8. What is the normal course of disease progression in regards to CD4+ T cell count in infants and children?
A. Lower in infants and children and increase to adult values by 6 years old
B. Higher in infants and children and decline to adult values by 6 years old
C. Lower in infants and children and increase to adult values by 12 years old
D. Higher in infants and children and decline to adult values by 12 years old
9. What is the normal progression of viral load in HIV infected infants?
A. Rising viral load in the first several months, peaking in the first year, then slowly declining over several years
B. Declining viral load in the first several months, peaking over the first several years, then declining slowly
C. No change until after the first year when it increases to adult levels
D. No change until after the first year when it decreases to adult levels
10. In children <12 months of age what CD4+ count indicates severe immunosuppression and risk for opportunistic infection:
A. <200/mm3
B. <500/mm3
C. <750/mm3
D. <1000/mm3
Answers
1. C, page 110, 112
2. A, page 112
3. B, page 112
4. C, page 112
5. A, page 112
6. A, page 113
7. D, page 113
8. B, page 113
9. A, page 113
10. C, page 11
September 12, 2007
Chapter 9 of Pediatric Allergy: Principles & Practices, edited by Donald Y.M. Leung, et al.
Chapter 9: T Cell Immunodeficiencies
Prepared by Drs. Bret Haymore and Soo Hee Kim-Delio at Walter Reed Army Medical Center.
1. Which of the following is the most common form of severe combined immunodeficiency?
A. Common gamma chain deficiency
B. Jak-3 deficiency
C. IL-7R alpha chain deficiency
D. Adenosine deaminase deficiency
2. The common gamma chain is a member of which interleukin receptors:
A. IL-2,4,6,9,15,21
B. IL-2,4,7,9,15,21
C. IL-2,4,7,11,15,21
D. IL-2,4,7,9,15,23
3. Which of the following is the feature most peculiar to SCID caused by ZAP-70 deficiency?
A. Decrease in circulating B cell count
B. Decrease in circulating NK cell count
C. Decrease in circulating CD4+ count
D. Decrease in circulating CD8+ count
4. An infant with generalized erythrodermia, alopecia, lymphadenopathy, hepatosplenomegaly, diarrhea, failure to thrive, and eosinophilia is most likely to have:
A. Ataxia telangiectasia
B. DiGeorge syndrome
C. Omenn’s syndrome
D. Hyper-IgE syndrome
5. Which of the following is not an X-linked disorder?
A. Ataxia telangiectasia
B. Wiskott-Aldrich syndrome
C. CD40 ligand deficiency
D. Common gamma chain deficiency
6. Which of the following is caused by mutations of the ATM gene on 11q22-23?
A. Ataxia telangiectasia
B. Wiskott-Aldrich syndrome
C. CD40 ligand deficiency
D. Common gamma chain deficiency
7. Which of the following is characterized by eczema, thrombocytopenia with small platelets, and immunodeficiency?
A. Ataxia telangiectasia
B. Wiskott-Aldrich syndrome
C. CD40 ligand deficiency
D. Common gamma chain deficiency
8. Which of the following is caused by a mutation at Xq26 which causes opportunistic infections, chronic diarrhea (particularly Cryptosporidium) and susceptibility to liver and gut disease?
A. Ataxia telangiectasia
B. Wiskott-Aldrich syndrome
C. CD40 ligand deficiency
D. Common gamma chain deficiency
9. For which of the following diseases is bone marrow transplant not indicated?
A. Ataxia telangiectasia
B. Wiskott-Aldrich syndrome
C. CD40 ligand deficiency
D. Common gamma chain deficiency
10. Which of the following is the most rapid and available tool used to diagnose SCID?
A. Complete WBC count looking for lymphopenia
B. Flow cytometry
C. Genetic evaluation
D. Liver function tests
Answers
1. A, page 99
2. B, page 99
3. D, page 101
4. C, pages 100-101
5. A, pages 106-107
6. A, page 106
7. B, page 107
8. C, page 107
9. A, pages 103-107
10. A, page 103
August 29, 2007
Chapter 8 of Pediatric Allergy: Principles & Practices, edited by Donald Y.M. Leung, et al.
Chapter 8: Antibody Deficiency
Prepared by Drs. Bret Haymore and Jiun Yoon, Walter Reed Army Medical Center
1. Which of the following immune deficiencies does not have a specific gene defect identified?
A. Bruton’s agammaglobulinemia
B. IgA deficiency
C. Hyper-IgM syndrome
D. Autosomal recessive agammaglobulinemia
2. Which of the following is true regarding X-linked agammaglobulinemia?
A. B cell development is stopped at the immature B cell stage
B. Defect gene is the signal transduction molecule CD179B
C. Opportunistic infections with Pneumocystis carinii are common
D. Only males are affected and they are often asymptomatic during infancy
3. Common variable immunodeficiency is characterized by:
A. A specific known gene defect
B. Presents most often in infancy with recurrent infections
C. Hypogammaglobulinemia and impaired specific antibody production
D. Treatment with IVIG is not effective
4. Which of the following is true regarding IgA deficiency and IgG subclass deficiency?
A. IgA is divided into four classes and IgG is divided into two classes.
B. A subset of patients can have both IgA deficiency and a IgG subclass deficiency.
C. IgG2 deficiency is more often found in adult women.
D. Most patients with a low IgA or IgG subclass are severely symptomatic.
5. Which of the following is true regarding transient hypogammaglobulinemia of infancy (THI)?
A. Maternal IgG is transported to the fetus mainly in the first trimester.
B. The physiologic nadir for serum IgG occurs at 12-14 months of age.
C. THI resolves spontaneously by the age of 5-6 in most patients.
D. The cause of the delay in rise of serum IgG is unknown.
6. Which of the following gene defects causes hyper-IgM syndrome?
A. AICDA
B. Btk
C. BLNK
D. IGHM
7. What is the cluster of differentiation (CD) maker for the defective molecule in hyper-IgM 1 (HIM1) or X-linked hyper-IgM syndrome?
A. CD 154
B. CD 40
C. CD 28
D. CD 95
8. Which of the following would be the best to determine an immune response to proteins and polysaccharides?
A. Tetanus and diphtheria vaccine titers
B. Tetanus and Conjugated Hemophilus influenza vaccine titers
C. Conjugated Streptocococcal pneumonia and diphtheria vaccine titers
D. Conjugated Neisseria menigititis vaccine titers and serum isohemagglutinins
9. Which of the following is true regarding IVIG treatment of primary humeral immunodeficiencies?
A. The average adult has a serum IgG level between 200-500
B. The usual replacement dose of IVIG is 300-500 mg/kg given every 2-4 weeks
C. IVIG is excellent prophylaxis against viral infections such as enteroviral meningoencephalitis
D. Trough levels of serum IgG should be maintained at less than 500 mg/dL
10. Which of the following is associated with an X-linked humoral immunodeficiency?
A. AICDA
B. TNFRSF5
C. Btk
D. CD179B
Answers
1. B, page 89
2. D, pages 88-89
3. C, page 89
4. B, page 90
5. D, page 91
6. A, page 89
7. A, page 91
8. D, page 93
9. B, pages 94-95
10. C, pages 89-9
August 15, 2007
Chapter 7 of Pediatric Allergy: Principles & Practices, edited by Donald Y.M. Leung, et al.
Chapter 7: Approach to the Child Recurrent Infections
Prepared by Drs. Bret Haymore and Soo Hee Kim-Delio at Walter Reed Army Medical Center.
1. Which of the following would be least likely to indicate an increased susceptibility to infections:
A. Four episodes of otitis media during the second year of life
B. Otitis associated with mastoiditis in a child
C. Osteomyelitis in a child
D. Pneumocystis jiroveci infection
2. What is the most common infection associated with IgA deficiency
A. Otitis media
B. Sinopulmonary infection
C. Conjunctivitis
D. Cellulitis
3. Which of the following diagnosis should be considered in any patient with recurrent sinupulmonary infection, especially with Pseudomonas, Staphylococcus, nontypable H. flu, or Burkholderia cepacia?
A. Ataxia telangiectasia
B. DiGeorge syndrome
C. Cystic fibrosis
D. Hyper-IgE syndrome
4. A child with coarse facies, eczematoid rash, retained primary teeth, bone fractures and recurrent pneumonia is most consistent with the presentation of:
A. DiGeorge syndrome
B. Ectodermal dysplasia-immunodeficiency (NEMO mutation)
C. Hyper-IgE syndrome
D. Wiskott-Aldrich syndrome
5. A young boy with recurrent sinopulmonary infections, eczema, and small platelets is most consistent with the presentation of:
A. DiGeorge syndrome
B. Ectodermal dysplasia-immunodeficiency (NEMO mutation)
C. Hyper-IgE syndrome
D. Wiskott-Aldrich syndrome
6. Neisserial infections are most associated with which type of primary immunodeficiency:
A. Hypogammaglobulinemia
B. Cell-mediated defects
C. Complement defects
D. Phagocytic defects
7. A young child presents with recurrent pyogenic infections and partial oculocutaneous albinism. You astutely suspect Chediak-Higashi syndrome and know the most important diagnostic test to perform is:
A. Serum immunoglobulin levels
B. Total hemolytic complement (CH50)
C. Lymphocyte count
D. Peripheral blood smear
Answers
1. A, page 81-82, Table 7-1
2. B, page 82
3. C, page 83
4. C, page 83, Table 7-3
5. D, page 83, Table 7-3
6. C, page 84, Table 7-4
7. D, page 84
August 1, 2007
Chapter 6 of Pediatric Allergy: Principles & Practices, edited by Donald Y.M. Leung, et al.
Chapter 6: The Developing Immune System and Allergy
Prepared by Dr. Soo Hee Kim-Delio at Walter Reed Army Medical Center.
1. At what time of gestational development can T-cells with TcR/CD3 be found in peripheral lymphoid organs?
A. Weeks 5-6
B. Weeks 10-12
C. Weeks 13-15
D. Weeks 16-18
2. At what time of gestational development does the fetus first have the ability to respond to polyclonal stimuli such as PHA (phytohemagglutinin)?
A. Weeks 5-6
B. Weeks 10-12
C. Weeks 13-14
D. Weeks 15-16
3. Which of the following is a true statement about T-cells in early life?
A. Total lymphocyte counts are lower in infancy than adulthood
B. Infant T-cells express CD1, PNA, and CD38 which indicate mature thymocytes
C. T-cell numbers decrease by 50 percent in the first 6 weeks of life
D. T-cell numbers quadruple in the first 6 weeks of life
4. Which of the following is the only chemokine receptor found on T-cells from cord blood?
A. CCR-1
B. CCR-2
C. CXCR-3
D. CXCR-4
Answers
1. C, page 69
2. D, page 69
3. B, page 70
4. D, page 71
July 19, 2007
Chapter 5 of Pediatric Allergy: Principles & Practices, edited by Donald Y.M. Leung, et al.
Chapter 5: Inflammatory Effector Cells/Cell Migration
Prepared by Drs. Bret Haymore and Soo Hee Kim-Delio at Walter Reed Army Medical Center.
1. The late-phase asthmatic response is best characterized by:
A. Release of histamine
B. Release of prostaglandin D2
C. Release of cysteinyl-peptide leukotrienes (LTC4, LTD4, LTE4)
D. Increased levels of eosinophils
2. The cytotoxic contents of eosinophil granules are primarily:
A. Eosinophil cationic protein, eosinophil neurotoxin, lymphotoxin
B. Eosinophil cationic protein, superoxide dismutase, eosinophil peroxidase
C. Eosinophil cationic protein, eosinophil peroxidase, eosinophil neurotoxin
D. Eosinophil cationic protein, eosinophil peroxidase, lymphotoxin
3. Which of the following is the most important stimulus for mast cell development in the bone marrow:
A. IL-5
B. IL-13
C. IL-17
D. Stem cell factor
4. The stem cell factor receptor on mast cells is called:
A. Transforming growth factor receptor
B. C-kit
C. Fc epsilon RI
D. CCR3
5. Which of the following cells completes its maturation outside of the bone marrow?
A. B cells
B. Basophils
C. Eosinophils
D. Mast cells
6. Which cytokine is most associated with pulmonary alveolar proteinosis:
A. Stem cell factor
B. GM-CSF
C. Lymphotoxin
D. RANTES
7. Which of the following is involved in the presentation of glycolipids to T cells?
A. CD1
B. CD4
C. CD8
D. CD80
8. Dendritic cells produce which chemokine receptor that binds MIP-3alpha and beta-defensin?
A. CCR3
B. CCR6
C. CCR7
D. CCR9
9. Which chemokine receptor appears to be the predominant eosinophil chemokine receptor?
A. CCR3
B. CCR6
C. CCR7
D. CCR9
10. Which of the following statements are true about CCR1 and CCR2?
A. They are induced on monocytes only after IL-2 stimulation.
B. They are induced on lymphocytes only after IL-2 stimulation.
C. They are constitutively expressed on lymphocytes.
D. They are induced on monocytes only after IL-10 stimulation.
Answers
1. D, page 51
2. C, page 53
3. C, page 54-55
4. B, page 55, box 5-3
5. D, page 54-55
6. B, page 56
7. A, page 57
8. B, page 57
9. A, page 63
10. B, page 61
July 5, 2007
Chapter 4 of Pediatric Allergy: Principles & Practices, edited by
Donald Y.M. Leung, et al.
Chapter 4: Regulation and Biology of Immunoglobulin E
Prepared by Drs. Bret Haymore and Soo Hee Kim-Delio at Walter
Reed Army Medical Center.
1. The two cytokines that are most important for IgE isotype
switching:
A. IL-4 & IL-10
B. IL-4 & IL-5
C. IL-4 & IL-13
D. IL-4 & IL-6
2. Which chain is shared by both the IL-4 and IL-13
receptors?
A. IL-4R-alpha chain
B. IL-13R-alpha1
C. IL-13R-alpha2
D. Common gamma chain
3. The transcription factors that are most associated with
Th2 differentiation:
A. T-bet & STAT-4
B. T-bet & STAT-6
C. GATA-3 & STAT-6
D. NFAT & STAT-4
4. The transcription factors that are most associated with
Th1 differentiation:
A. T-bet & STAT-4
B. T-bet & STAT-6
C. GATA-3 & STAT-6
D. NFAT & STAT-4
5. The second signal most important for IgE isotype switching
involves:
A. CD80/86 (on B cell) & CD28 (on T cell)
B. CD80/86 (on T cell) & CD28 (on B cell)
C. CD40 (on T cell) & CD154 (on B cell)
D. CD40 (on B cell) & CD 154 (on T cell)
6. Production of which cytokine is a critical distinguishing
feature of dendritic cell 1 (DC1)?
A. IL-4
B. IL-12
C. IL-10
D. GM-CSF
7. Which chain of the FcEpsilonRI binds IgE?
A. Alpha chain
B. Beta chain
C. Gamma chain
D. Delta chain
8. There are two isoforms of the FcEpsilonRI receptor, the
tetrameric alpha-beta-gamma2 forms is found on:
A. Mast cells & eosinophils
B. Mast cells & basophils
C. Mast cells & dendritic cells
D. Eosinophils, platelets, monocytes, dendritic cells
9. What is distinctive about CD23?
A. It’s common designation is as “the other high affinity” IgE
receptor
B. It has a low affinity for IgE with a Ka of about 1,000
C. It is only expressed on eosinophils
D. It is the only Ig receptor not in the Ig superfamily
10. Which of the following is a true statement about IgE
regulation of receptors?
A. It alters transcription of mRNA encoding CD23
B. It alters transcription of mRNA encoding the FcEpsilonRI subunit
C. It modulates receptor turnover and proteolytic shedding
D. It alters the transcription of mRNA of both CD23 and the
FcEpsilonRI subunit
Answers
1. C, page 40
2. A, page 40
3. C, page 43
4. A, page 43
5. D, page 41
6. B, page 44
7. A, page 45
8. B, page 45
9. D, page 45
10. C, page 46
June 20, 2007
Chapter 3 of Pediatric Allergy: Principles & Practices, edited
by Donald Y.M. Leung, et al.
Chapter 3: The Genetics of Allergic Diseases & Asthma
Prepared by Drs. Bret Haymore, Jiun Yoon and Soo Hee Kim-Delio at
Walter Reed Army Medical Center.
1. Which of the following is not encoded in chromosome region
5q?
A. ADAM33
B. IL-4
C. Beta2-adrenergic receptor
D. CD14
2. In what tissue is ADAM 33 expressed?
A. Bronchial epithelial cells
B. T-cells
C. Bronchial smooth muscle
D. Inflammatory leukocytes
3. Which of the following genes is most associated with
atopic dermatitis?
A. CD14
B. ADAM 33
C. MODY
D. SPINK5
4. Which of the following genes has the most evidence in
playing a role in airway remodeling?
A. Beta2-adrenergic receptor
B. CD14
C. A disintegrin and metalloprotease 33
D. SPINK5
5. Which of the following genes is most likely to reduce the
risk of atopy by promoting a Th1 differentiation through innate
responses?
A. A Disintegrin and Metalloprotease 33
B. IL-13
C. SPINK5
D. CD14
6. In seeking to identify genes that are causal of complex
genetic diseases such as asthma, what is the greatest challenge?
A. Finding linkage of genetic loci with atopy or asthma
B. Securing grant money
C. Identifying genes that underlie the linkages identified
D. Not enough researchers studying asthma
7. Which gene has been identified as the cause of Netherton’s
syndrome, a severe autosomal recessive disorder of congenital
icthyosis with defective cornification?
A. LEKT1
B. SPINK5
C. ADAM33
D. MODY
Answers
1. A, pages 29-30
2. C, page 30. It is also expressed myofibroblasts and fibroblasts.
3. D, pages 33-34
4. C, page 30
5. D, page 33
6. C, page 28
7. B, page 33, SPINK5 encodes the serine proteinase inhibitor LETK1
on Chromosome 5q32
June 6, 2007
Chapter 2 of Pediatric Allergy: Principles & Practices, edited
by Donald Y.M. Leung, et al.
Chapter 2: Natural History of Allergic Diseases & Asthma
Prepared by Drs. Bret Haymore, Walter Reed Army Medical Center and
Soo Hee Kim-Delio, Walter Reed Army Medical Center.
General Concepts:
• Allergy and asthma of earlier onset and greater severity are
generally associated with disease persistence. (p.10)
• 80 percent of asthmatics report symptoms before 6 years of age.
However, of all young children who experience recurrent wheezing,
only a minority will go on to have persistent asthma. (p.13)
• The most common form of recurrent wheezing in preschool children
occurs primarily with viral infections. These transient wheezers are
not at increased risk of having asthma in later life. (p. 13)
Questions:
1. What is the most likely order of development of atopic
disease from birth to young adulthood?
A. Asthma, food allergy, allergic rhinitis
B. Allergic rhinitis, atopic dermatitis, asthma
C. Cat allergen sensitization, asthma, atopic dermatitis
D. Food allergy, allergic rhinitis, asthma
2. What is the most common form of recurrent wheezing in
preschool children and is it associated with increased risk of
asthma in later life?
A. Transient wheezers; yes, an association
B. Persistent wheezers; no association
C. Transient wheezers; no association
D. Persistent wheezers; yes, an association
3. Which of the following is most likely to lead to asthma
based on data from cohort studies:
A. Male children who became overweight between age 6-11 years of age
B. Female children who became overweight between age 6-11 years of
age who had early-onset puberty
C. Female children who became overweight between age 6-11 years of
age who had late-onset puberty
D. Children with nasal polyposis and NSAID hypersensitivity
4. A history of atopy is a risk factor for anaphylaxis/anaphylactoid
reaction to which of the following:
A. Radiocontrast media
B. Penicillin
C. Insulin
D. Hymenoptera sting
5. Elevated serum IgE levels in infancy have been associated
with what disease?
A. Atopic dermatitis
B. Peanut allergy
C. Persistent asthma
D. Allergic rhinitis
6. What percentage of asthmatic patients report disease onset
before 6 years of age?
A. 20 percent
B. 40 percent
C. 60 percent
D. 80 percent
7. Which of the following statements is true?
A. In the Tucson cohort, breastfeeding generally increased the risk
of recurrent wheeze up to 2 years of age.
B. A Tucson subgroup of atopic kids exclusively breastfed for 4
months by asthmatic moms have increased risk of persistent asthma
between 6-13 years.
C. Infants breast fed by moms with high IgE had lower IgE levels.
D. Infants breast fed by moms with lower IgE had higher IgE levels.
8. Which of the following statements about atopic dermatitis
is true?
A. <50% of patients have clinical manifestations before the age of
7.
B. Lesions in the first 2 months of life are rare.
C. The greatest remission occurs between the ages of 12 and 16.
D. Parental history of AD is not an important risk factor.
9. When at-risk infants had restriction of common allergenic
foods, what resulted?
A. Reduced prevalence of atopic disease at 1 year only.
B. Reduced prevalence of atopic disease at 4 years.
C. Inhalant allergies was decreased at 4 years.
D. Allergic airway diseases were decreased at 4 years.
Answers
1. D, page10
2. C, page 13
3. B, page 17
4. A, page 19
5. C, page 12
6. D, page 13
7. B, page 16
8. B, page 17
9. A, page 19
May 23, 2007
Chapter 1 of Pediatric Allergy:
Principles & Practices, edited by Donald Y.M. Leung, et al.
Chapter 1: Epidemiology of Allergic Diseases
Questions prepared by Drs. Bret Haymore, Walter Reed Army Medical
Center and Soo Hee Kim-Delio, Walter Reed Army Medical Center.
1. Which of the following countries has the lowest prevalence
of asthma symptoms?
A. Brazil
B. Australia
C. South Africa
D. China
2. Which of the following would lead to the greatest risk of
developing asthma and atopy:
A. Growing up in Greece
B. Growing up on a farm
C. Growing up in an inner city in the U.S.
D. Growing up in Russia
3. Which of the following has been most associated with the
development of asthma?
A. Air pollution
B. Environmental tobacco smoke
C. Level of environmental allergen exposure
D. Family size
4. According to the Tucson, Ariz., birth cohort study, in
patients with proven RSV infections that were followed, what did they
note at age 13 with respect to risk of recurrent wheezing?
A. No difference in risk
B. Fourfold increased risk
C. Tenfold increased risk
D. Fourfold decreased risk
5. How is family size related to the prevalence of atopic
diseases?
A. As family size goes up, risk of atopy goes up
B. No difference
C. As family size goes up, risk of atopy goes down
D. As family size goes down, risk of atopy goes down
6. According to a longitudinal survey of infants in Denver,
Colo., exposure to high concentrations of endotoxin in dust showed
what results?
A. More likely to develop IgE antibodies to local allergens
B. Less likely to develop IgE antibodies to local allergens
C. Weaker cytokine response of the Th1 type
D. Stronger cytokine response of Th2 type
7. Growing up in what location appears to give the most
protective effect against the development of atopic diseases?
A. Rural areas of Western Europe
B. Urban Africa
C. Urban areas of Western Europea
D. Farms
8. What aspect of living on a farm appeared to be the most
protective from atopic disease?
A. Exposure to stables in the first year of life
B. Drinking pasteurized milk
C. Exposure to stables after the first year of life
D. Cleaning the henhouse
Answers
1. D, page 3 (Fig 1-2)
2. C, pages 4-5
3. B, pages 5-6
4. A, page 7
5. C, page 6
6. B, page 7
7. D, page 5
8. A, page 5
May 9, 2007
Chapter 93 of the 6th edition of
Middleton’s Allergy Principles and Practice, edited by N.
Franklin Adkinson, et al.
Questions prepared by Dr. Soo Hee Kim-Delio, Walter Reed Army Medical
Center.
Chapter 93: Sensitivity to Aspirin and Non-steroidal
Anti-inflammatory Drugs
1. Which is a true statement about AERD?
A. Aspirin induces the disease
B. Sensitivity refers to a single type of reaction
C. Avoidance of ASA/NSAIDs does not change the course of the
respiratory disease
D. A single type of NSAID may inhibits COX-1 and improves
respiratory symptoms
2. In which clinical setting should the clinician be most
suspicious of AERD?
A. An asthmatic patient with relentless formation of nasal polyps
and pansinusitis
B. Rhinosinusitis
C. Pan-sinusitis and asthma
D. Polyps alone
3. Which of the following statements about ASA/NSAIDs and
chronic idiopathic urticaria is true?
A. Avoidance of ASA/NSAIDs in patients with chronic idiopathic
urticaria does not eliminate the acute flares
B. Avoidance in patients with CIU appears to alter the course of the
disease
C. The more quiescent the underlying urticaria, the more likely it
is that ASA/NSAIDs will cause urticarial exacerbation
D. The more active the underlying urticaria, the more likely it is
that ASA/NSAIDs will cause urticarial exacerbation
4. What do leukotriene modifier drugs appear to do during
oral ASA challenges in patients with AERD?
A. Diminish the capacity of the challenges to induce nasoocular
reactions
B. Protect the lower respiratory tract without diminishing the
capacity of the challenges to induce nasoocular reactions
C. Increase the capacity of the challenges to induce nasoocular
reactions
D. Not affect the capacity of the challenges to induce nasoocular
reactions
5. Which of the following medications prevented most ASA induced
respiratory reactions, presumably by interfering with the
interaction of ASA and COX-1?
A. Clemastine
B. Sodium salicylate
C. Leukotriene modifier drugs
D. Systemic corticosteroids
6. Which of the following statements about ASA
desensitization is true?
A. All AERD patients can be desensitized to ASA
B. Desensitization to ASA in patients with chronic idiopathic
urticaria is possible to sustain
C. After desensitization, without any further meds, the desensitized
state lasts about seven days
D. After desensitization, without any further meds, full
sensitization returns after two to five days
7. BAL fluid from AERD asthmatics contained higher
concentrations of which substances compared to ASA tolerant
controlled asthmatics?
A. LTE4
B. LTD4 and TXB2
C. PGE2
D. LTC4 and TXB2
8. In nasal polyp tissue, which cells were found to have
delayed apoptosis in AERD patients compared to ASA tolerant
asthmatics?
A. Mast cells
B. PMNs
C. Eosinophils
D. T-cells
9. What are the most debilitating components of AERD?
A. Rhinosinusitis and nasal polyps
B. Asthma activity
C. Sinus infection
D. Ocular pruritis
10. ASA induced reactions require inhibition of which
substance based on cross-reactivity of AERD patients to structurally
distinct NSAIDs on first exposure?
A. Arachadonic acid
B. COX-2
C. COX-1
D. LTC4 synthase
Answers:
1. C, page 1697
2. A, page 1697
3. D, page 1697
4. B, page 1697
5. B, page 1697
6. A, page 1700
7. D, page 1701
8. C, page 1702
9. A, page 1706
10. C, page 1703
April 25, 2007
Chapter 92 of the 6th edition of
Middleton’s Allergy Principles and Practice, edited by N.
Franklin Adkinson, et al.
Questions prepared by Drs. Bret R. Haymore, Walter Reed Army Medical
Center, and Jiun Yoon, Walter Reed Army Medical Center
Chapter 92: Drug Allergy
1. Which of the following is most associated with anaphylactic
reactions in penicillin allergic patients:
A. Major determinant
B. Minor determinant
C. Penicilloyl epitope
D. Penicillenic acid
2. Which of the following are by themselves able to act as
immunogens (complete allergens):
A. Beta-lactam antibiotics
B. Quinidine
C. Antithyroid drugs
D. Insulin
3. Which of the following require haptenization in order to be
immunogenic:
A. Insulin
B. Protamine
C. Beta-lactam antibiotics
D. Succinylcholine
4. What percent of prior penicillin reactors, including those
with a history of anaphylaxis and urticaria, become skin test
negative:
A. 25 percent
B. 50 percent
C. 75 percent
D. 100 percent
5. Which of the following is most associated with hemolytic
anemia due to G6PD deficiency:
A. Penicillin
B. Tetracycline
C. Chloramphenicol
D. Primaquine
6. Which of the following is effective and often recommended as
pretreatment for aspirin desensitization:
A. Diphenhydramine
B. Cetirizine
C. Montelukast
D. Another NSAID
7. Which Gel-Coombs classes is associated with pencillin
immunopathologic reactions:
A. Type I
B. Type II
C. Type III
D. All of the above
8. Which of the following is most likely to produce a
lupus-like syndrome:
A. Penicillin
B. Halothane
C. Isoniazid
D. Quinine
9. Which of the following is true concerning reactions to
radiocontrast media:
A. Premedication with corticosteroids and antihistamines reduces risk
of anaphylactoid reactions
B. Premedication reliably prevents IgE mediated reactions
C. Hypertonic media is preferred over isotonic media
D. Patients should refrain from ingesting seafood rich in iodine
10. What percentage of history-positive patients have a
negative skin test to penicillin:
A. 5 percent
B. 20 percent
C. 50 percent
D. 80 percent
Answers
1. B, page1679
2. D, page 1681
3. C, page 1681
4. C, page 1684
5. D, page 1685
6. C, page 1689
7. D, page 1684
8. C, page 1683
9. A, page 1684
10. D, page 1687
April 11, 2007
Chapter 91 of the 6th edition of
Middleton’s Allergy Principles and Practice, edited by N.
Franklin Adkinson, et al.
Questions prepared by Dr. Soo Kim-Delio, Walter Reed Army Medical
Center.
Chapter 91: Adverse Reactions to Vaccines
1. Why was mercury use in vaccines reviewed by the FDA?
A. Hepatotoxicity
B. Neurotoxicity
C. Decreased effectiveness of vaccine
D. Autism
2. Which additive has 50-percent mercury by weight?
A. Thimerosal
B. Gelatin
C. Latex
D. Alum
3. What side effect to the rotavirus vaccine was reported in
the first several months of use in 1998 which led to its withdrawal?
A. IgE-mediated allergic reactions
B. Encephalitis
C. Intussusception
D. Nephritis
4. In regards to inactivated influenza vaccine, below what
level of egg protein content may it be safe to administer as a
two-dose protocol?
A. Less than 42 micrograms
B. Less than 4.2 microgram
C. Less than 12 microgram
D. Less than 1.2 micrograms
5. Which vaccine causes an unusual late onset urticarial and
angioedema reaction in as high as 1 percent of patients?
A. Anthrax
B. Yellow fever
C. Japanese Encephalitis
D. Smallpox
6. The most common tree nut allergy appears to be:
A. Almond
B. Walnut
C. Pecan
D. Pistachio
7. What is the most common complication of the vaccinia
(smallpox) vaccine?
A. Eczema vaccinatum
B. Progressive vaccinia
C. Auto-inoculation
D. Generalized vaccinia
8. In what situation is vaccinia immune globulin specifically
contra-indicated due to scar promotion?
A. Eczema vaccinatum
B. Vaccinia keratitis
C. Generalized vaccinia
D. Auto-inoculation of the eye or eye-lid
9. Which of the following is a live virus vaccine which, if
given to an immunocompromised patient, can lead to vaccine strain
induced disease?
A. Typhoid vi
B. Anthrax
C. Japanese Encephalitis virus
D. MMR
10. What is the recommended time interval to wait after
giving Hep A immune globulin (IG), tetanus IG, or Hep B IG before
giving another live virus vaccines?
A. 0 months
B. 3 months
C. 6 months
D. 12 months
Answers
1. B, page 1666
2. A, page 1666
3. C, page 1666
4. D, page 1667
5. C, page 1668
6. A, page 1671
7. C, page 1673
8. B, page 1673
9. D, page 1674
10. B, page 1675
March 28, 2007
Chapter 90 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin
Adkinson, et al.
Questions prepared by Dr. Soo Kim-Delio, Walter Reed Army Medical
Center.
Chapter 90: Adverse Reactions to Food and Drug Additives
1. “EAFUS” is published by the FDA periodically. What does it
stand for?
A. Eaten and Functional Unknown substances
B. Everything added to food in the United States
C. Everything about foods that’s used
D. Eats and Feed in the United States
2. What is the estimated occurrence of food additive allergy?
A. 0.01-0.24 percent
B. 0.5 percent
C. 1 percent
D. 2 percent
3. What component of some corticosteroid solutions has been
reported as a cause of anaphylactic shock?
A. Gums (Arabic and tragacanth)
B. Ethylenediamine
C. Carboxymethyl cellulose
D. Thermosol
4. What component of antihistamines and corticosteroid
tablets is an emulsifier that has caused urticaria?
A. Gums (Arabic and tragacanth)
B. Ethylenediamine
C. Carboxymethyl cellulose
D. Thermosol
5. Which of the following is a component of aminophylline,
but is primarily associated with contact dermatitis and cutaneous
sensitization?
A. Gums (Arabic and tragacanth)
B. Ethylenediamine
C. Carboxymethyl cellulose
D. Thermosol
6. Which preservative is often a contact sensitizer, but has
caused anaphylaxis when administered in IV heparin solution?
A. Gums (Arabic and tragacanth)
B. Ethylenediamine
C. Carboxymethyl cellulose
D. Thermosol
7. Which of the following natural food colorants is an
extract of the seeds of the fruit of the Bixa orellana tree?
A. Annatto
B. Carmine
C. Sulfites
D. Tartrazine
8. Which of the following is derived from dried female
insects of Dactlopius coccus Costa, a parasite on the prickly
pear cactus, and is used widely in cosmetics?
A. Annatto
B. Carmine
C. Sulfites
D. Tartrazine
9. Which of the following has </= 10 ppm of estimated total
sulfite level?
A. Dried fruit
B. Wine
C. Nonfrozen lemon and lime juice
D. Malt vinegar
10. Which of the following is sometimes used as a vaccine
expander?
A. Lactose
B. Beef and pork gelatin
C. Inulin
D. Wheat starch
Answers
1. C, page 1645
2. A, page 1646
3. C, page 1646
4. A, page 1646
5. B, page 1646
6. D, page 1646
7. A, page 1652
8. B, page 1652
9. D, page 1654
10. B, page 1660
March 14, 2008
Chapter 89 of the 6th edition of
Middleton’s Allergy Principles and Practice, edited by N.
Franklin Adkinson, et al.
Questions prepared by Drs. Bret Haymore, Walter Reed Army Medical
Center and Soo Kim-Delio, Walter Reed Army Medical Center.
Chapter 89: Adverse Reactions to Foods
1. About what percentage of infants with IgE-mediated cow’s
milk allergy still have this sensitivity in the second decade of
life?
A. 5 percent
B. 10 percent
C. 25 percent
D. 50 percent
2. About what percentage of children with moderate to severe
atopic dermatitis have IgE-mediated food allergy?
A. 10 percent
B. 20 percent
C. 30 percent
D. 40 percent
3. Which of the following is the major fish allergen?
A. Tropomysin
B. Ovalbumin
C. Profilin
D. Parvalbumin
4. In chicken-egg IgE mediated food allergy, which is the
dominant allergen?
A. Ovalbumin
B. Ovomucoid
C. Ovotransferrin
D. Profilin
5. Beyond age 4 years, the most common food allergen is:
A. Milk
B. Egg
C. Peanut
D. Tree nuts
6. The most common tree nut allergy appears to be:
A. Almond
B. Cashew
C. Pecan
D. Pistachio
7. The protein believed to be most responsible for the
food-pollen syndrome:
A. Vicilin
B. Casein
C. Conglutin
D. Profilin
8. What percentage of ingested foods are absorbed and
transported through the body in an immunologically intact form even
in the mature gut?
A. 0.1 percent
B. 2 percent
C. 5 percent
D. 10 percent
9. What factor has been shown to increase antigen absorption
in the GI system?
A. Alcohol ingestion
B. Increased stomach acidity
C. Other foods in the gut
D. Lack of alcohol ingestion
10. Which of the following peanut products does not retain
its allergenicity?
A. Pressed or extruded oil
B. Refined oil
C. Flour
D. Reprocessed peanuts
Answers:
1. C, page 1619
2. C, page 1619
3. D, page 1622
4. B, page 1623
5. C, page 1623
6. B, page 1624
7. D, page1625 & Table 89-2
8. B, page 1621
9. A, page 1621
10. B, page 1623
February 28, 2007
No review this issue.
February 14, 2007
Chapter 88 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N.
Franklin Adkinson, et al.
Chapter 88: Allergic Eye Diseases
1. The eye disease that is considered iatrogenic
A. Perennial allergic rhinitis
B. Bacterial conjunctivitis
C. Giant papillary conjunctivitis
D. Vernal conjunctivitis
2. The two allergic eye diseases considered
sight-threatening:
A. Bacterial conjunctivitis and perennial allergic rhinitis
B. Bacterial conjunctivitis and giant papillary conjunctivitis
C. Atopic keratoconjunctivitis and giant papillary conjunctivitis
D. Atopic keratoconjunctivitis and vernal keratoconjunctivitis
3. Which of the following is associated with vernal
conjunctivitis:
A. Peak incidence in third decade of life
B. Asian countries
C. Atopy
D. Most common in females
4. Two medications that have both antihistamine and mast
cell-stabilizing properties:
A. Olopatadine and levocabastine
B. Ketotifen and azelastine
C. Olopatadine and emedastine
D. Lodoxamide and pemirolast
5. The mast cell stabilizer that appears to be the most
efficacious in vernal keratoconjunctivitis:
A. Nedocromil
B. Cromolyn
C. Ketotifen
D. Pemirolast
6. In differentiating scleritis from episcleritis:
A. In episcleritis all redness will blanch shortly after
administration of 10 percent phenylephrine
B. Deep boring pain is characterisitic of episcleritis
C. Scleritis is non-sight-threatening
D. Episcleritis is associated with systemic conditions in 40 percent
of patients
7. Tears from allergic donors contain significantly less of
which anti-inflammatory cytokine?
A. IL-4
B. IL-5
C. IL-6
D. IL-10
8.Which of the following is a sight threatening inflammatory
process that generally starts before 10 years of age and resolves
with puberty, in patients with atopic backgrounds?
A. Giant papillary conjunctivitis
B. Vernal keratoconjunctivitis
C. Atopic keratoconjunctivitis
D. Seasonal allergic conjunctivitis
9. Which of the following allergic eye diseases is most often
associated with wearing contact lenses?
A. Giant papillary conjunctivitis
B. Vernal keratoconjunctivitis
C. Atopic keratoconjunctivitis
D. Seasonal allergic conjunctivitis
10.What is the treatment of choice for mild to moderate
allergic conjunctivitis?
A. Oral antihistamines
B. Dual-acting topical with both anti-histamine and mast cell
stabilizer
C. Topical NSAID
D. Topical corticosteroid
Answers:
1. C, page 1606
2. D, page 1602
3. C, page 1605
4. B, page 1609
5. A, page 1610 (see also Chapter 53)
6. A, page 1614
7. D, page 1604
8. B, page 1605
9. A, page 1606
10. B, page 1610
January 31, 2007
Chapter 87 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N.
Franklin Adkinson, et al.
Chapter 87: Contact Dermatitis
1. Which of the following conditions appear to have the least
risk of allergic contact dermatitis
A. Atopic dermatitis
B. Children >8 years old
C. Psoriasis
D. Ichthyosis
2. Patch testing has a sensitivity and specificity of
approximately:
A. 50 percent
B. 70 percent
C. 80 percent
D. 90 percent
3. Quaternium-15 has significant cross-reactivity on patch
testing with which of the following agents:
A. Thiuram mix
B. Tixocortol pivalate
C. Nickel sulfate
D. Formaldehyde
4. Most allergic contact dermatitis reactions to latex are
due to which of the following:
A. Carbamates
B. Mercapto compounds
C. Thiurams
D. Natural rubber
5. The most frequently encountered plant allergic contact
dermatitis is caused by:
A. Fragaria
B. Toxicodendron
C. Erythronium
D. Aconitum
6. What cells are the primary source of interleukin-1 alpha
in the epidermis?
A. Keratinocytes
B. Langerhans’ cells
C. Neurons
D. CD4+ helper T-lymphocytes
7. Inflammatory stimuli cause up-regulation of which
chemokine to direct migration of Langerhans’ cells to regional
draining lymph nodes?
A. CCR5
B. CCR6
C. CCR7
D. CXCR3
8. What area of the body is involved in more than half of all
cases of contact dermatitis?
A. Face
B. Hands
C. Feet
D. Genitals
9. What description is consistent with a 2+ reaction to patch
testing?
A. Vescicles or bullae
B. Papules with erythema and edema
C. Erythema and edema
D. No detectable change
10. Which of the following is an important occupational
sensitizer present in chrome plated metals, tanned leathers, and
construction materials?
A. Nickel
B. Carba mix
C. Colophony
D. Potassium dichromate
Answers:
1. A, page 1588
2. B, page 1589
3. D, page 1591
4. C, page 1592
5. B, page 1593
6. A, page 1584. Note: IL-1 beta is mainly produced by Langerhans’
cells in the epidermis
7. C, page 1587
8. B, page 1589
9. B, page 1593
10. D, page 1591
January 17, 2007
Chapter 86 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N.
Franklin Adkinson, et al.
Chapter 86: Atopic Dermatitis
1. Select the answer that correctly lists three of the five
major criteria for diagnosing atopic dermatitis according to the
Hafkin and Rajka criteria.
A. Pruritus, xerosis, chronic or relapsing dermatitis
B. Pruritus, elevated IgE level, chronic or relapsing dermatitis
C. Pruritus, positive immediate-type allergy skin tests, chronic or
relapsing dermatitis
D. Pruritus, personal or family history of atopic disease, chronic
or relapsing dermatitis
2. Organism associated with predominantly head and neck
distribution of atopic dermatitis.
A. Staphylococcus aureus
B. Trichophyton rubrum
C. Pityrosporum ovale
D. Streptococcus viridans
3. An adult who has eczematous dermatitis with no history of
childhood eczema and without other atopic features would benefit
from a skin biopsy to rule out this condition.
A. Scabies
B. Contact Dermatitis
C. Cutaneous T cell lymphoma
D. Seborrheic dermatitis
4. S. aureus toxin is thought to act as a superantigen
and binds to this region of the TCR, outside of the region involved
in antigen recognition.
A. Variable region of the alpha chain
B. Variable region of the beta chain
C. Constant region of the alpha chain
D. Constant region of the beta chain
5. Agent in topical corticosteroids that is frequently
implicated in causing contact dermatitis.
A. Thimerosol
B. Tixocortol pivalate
C. Quaternium-15
D. Nickel sulfate
6. What percentage of atopic dermatitis typically manifest
before the age of 5 years old?
A. 25 percent
B. 50 percent
C. 75 percent
D. 90 percent
7. What area is typically spared in atopic dermatitis during
infancy?
A. Face
B. Scalp
C. Diaper area
D. Extensor surfaces
8. As part of the immunoregulatory dysfunction found in
atopic dermatitis, Th2 cells have been found to have increased
secretion of which cytokines?
A. IL-10 and PGE2
B. IL-4, IL-5, and IL-13
C. IFN- gamma
D. CD80/CD86
9. T-cell derived IFN-gamma was shown to increase what
receptor on keratinocytes, leading to acantholysis?
A. CD80
B. CD86
C. CD23
D. CD95
Answers:
1. D, page 1562
2. C, page 1562
3. C, page 1562
4. B, page 1563
5. B, page 1570
6. D, page 1560
7. C, page 1561
8. B, page 1564
9. D, page 1565, also known as Fas receptor
January 3, 2007
Chapter 85 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N.
Franklin Adkinson, et al.
Chapter 85: Urticaria & Angioedema
1. Which of the following is thought to be non-IgE mediated
cause of urticaria?
A. Penicillin
B. Aspirin
C. Dog sensitivity
D. Hymenoptera sting
2. Sensitivity to this dye is reported in up to 15 percent of
patients with urticaria related to asthma
A. Yellow no. 40
B. Red no. 40
C. Red no. 5
D. Yellow no. 5
3. The antihistamine most effective for cold-induced urticaria
A. Diphenhydramine
B. Fexofenadine
C. Cyproheptadine
D. Hydroxyzine
4. Which of the following statements best describes a component
of exercise-induced anaphylaxis from cholinergic urticaria?
A. Lesions in exercise-induced urticaria are characterized by small
punctuate lesions.
B. Anxiety is a major component and trigger of exercise-induced
anaphylaxis.
C. Patients with exercise-induced anaphylaxis have a low incidence of
atopy compared to other physical urticarias.
D. Exercise is the precipitating stimulus in cholinergic urticaria and
exercise-induced anaphylaxis
5. The drug of choice for the management of cholinergic
urticaria
A. Diphenhydramine
B. Fexofenadine
C. Cyproheptadine
D. Hydroxyzine
6. Low levels of this complement component most help
distinguish between hereditary and acquired angioedema
A. C1
B. C2
C. C3
D. C4
7. Which 3 fragments of complement components act as
anaphylotoxins?
A. C3a, C4a, C5a
B. C3, C4, C5
C. C6, C7, C8
D. C2b, C4b, C5b
8. What form of urticaria occurs mainly in children, generally
on extremities at the site of insect bites?
A. Urticaria pigmentosa
B. Papular urticaria
C. Erythema multiforme
D. Solar urticaria
9. Which of these statements best characterizes chronic
urticaria?
A. Biopsy of lesions reveal evidence of increased vascular
permeability, edematous tissue and little or no cellular infiltrate.
B. Lesions appear quickly and usually disappear in 2 to 3 hours.
C. Biopsy typically reveals a non-necrotizing perivascular mononuclear
cell infiltrate.
D. Steroids are first-line treatment for chronic urticaria.
10. What is the test for the characteristic lesions of cholinergic urticaria?
A. Apply a test tube of warm water at 44 degrees Centigrade to the arm
for 4-5 minutes.
B. Immersion in a hot bath
C. Exercise while wearing an occlusive body suit
D. Intradermal injestion of 0.01 mg if methacholine in 0.1 ml saline
Answers:
1. B, page 1540
2. D, page 1540
3. C, page 1543
4. D, page 1544
5. D, page 1545
6. A, page 1549
7. A, page 1537
8. B, page 1542
9. C, page 1541
10. D, page 1545
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