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Review Corner Archive
December 21, 2005 Chapter 59 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 59: Primary Immunodeficiency Diseases – Part II 1. Which of the following laboratory findings is usually normal or increased in patients with Ataxia-Telangiectasia? a. IgA concentration b. IgE concentration c. CD8+ T cell concentration d. Proliferative response to mitogens 2. Which of the following conditions is notable for radiologic findings of scalloping and sclerotic or cystic changes in the metaphyses? a. Ataxia-Telangiectasia b. Cartilage-Hair Hypoplasia c. DiGeorge Syndrome d. Chediak-Higashi Syndrome 3. A young girl with recurrent pneumonia has elevated IgM and low to undetectable levels of IgG, IgA, and IgE. What is most likely the defective gene? a. Activation-Induced Cytidine Deaminase b. Purine Nucleoside Phosphorylase c. CD154 (CD40Ligand) d. CD11/CD18 4. Which of the following statements about DiGeorge Syndrome is the most accurate? a. There appears to be an excess of 22q11.2 deletions of paternal origin b. Proportions of CD4+ and CD8+ cells are normal. c. Most T lymphocytes present are intrinsically abnormal. d. CD3+T cell numbers are increased 5. The patient presents with delayed separation of the umbilical cord and recurrent severe bacterial infections. You plan to order cytofluorography with monoclonal antibody to: a. Ig-alpha b. CD80/86 c. Sialyl-LewisX d. CD18 6. GDP-fucose transporter deficiency is a cause of which of the following immunodeficiencies? a. Leukocyte Adhesion Deficiency Type 1 b. Leukocyte Adhesion Deficiency Type 2 c. Severe Combined Immunodeficiency d. Wiskott-Aldrich Syndrome 7. Which of the following conditions is characterized by oculocutaneous albinism and susceptibility to recurrent respiratory tract infections? a. Ataxia-Telangiectasia b. Cartilage-Hair Hypoplasia c. Chediak-Higashi Syndrome d. Hyperimmunoglobulinemia E Syndrome 8. Serum concentrations of other immunogloblulins are usually normal in patients with Selective Immunoglobulin A Deficiency. However, which of the following IgG subclass deficiencies may be present? a. IgG1 b. IgG2 c. IgG3 d. IgG4 9. A patient presents with course facial features, recurrent severe staphylococcal abscesses of the skin and lung, and pneumatoceles on chest x-ray. Which of the following lab findings will most likely be significantly elevated? a. IgE b. IgM c. Serum neutrophils d. Gamma-delta T cells 10. What is the most common inherited complement deficiency? a. C2 b. C3 c. C5 d. Properdin Answers 1. c, page 1028 2. b, page 1028 3. a, page 1029 4. b, page 1029 5. d, page 1030 6. b, page 1030 7. c, page 1031 8. b, page 1032 9. a, page 1035 10. a, pages 1035-36 November 23, 2005 Chapter 58 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 58: Immune Complexes and Allergic Diseases 1. Which of the following skin eruptions is the most common in patients with serum sickness? a. Angioedema b. Exfoliative rash c. Vesiculo-bullous lesions d. Urticaria 2. Immune complexes tend to be large at: a. Equivalence (number of available antigenic sites is equal to the number of available antibody-combining sites) b. Antibody excess c. Antigen excess d. Only when monovalent antigens are present 3. Which of the following antibody isotypes activates complement by the alternative pathway? a. IgG1 b. IgG2 c. IgM d. IgA 4. Which of the following receptors has a high affinity for IgG and can bind monomeric IgG? a. Fc gamma receptor I b. Fc gamma receptor II c. Fc gamma receptor III d. Fc epsilon receptor I 5. Binding of the C3 degradation fragment (C3d) to which of the following complement receptors promotes B cell activation and proliferation? a. CR1 b. CR2 c. CR3 d. CR4 6. Which of the following cell adhesion molecules is up-regulated by histamine? a. P-selectin (GMP-140) b. E-selectin (ELAM-1) c. Intracellular adhesion molecule-1 (ICAM-1) d. Vascular cell adhesion molecule-1 (VCAM-1) 7. Presence of which of the following substances can lead to a false-positive result in the 125I-C1q binding assay used in the detection of circulating immune complex? a. Bacterial endotoxin b. Bacterial DNA c. Heparin d. Ethylenediaminetetraacetic acid (EDTA) 8. Serum sickness occurs how many days after starting the culprit drug in a patient not previously sensitized? a. 1-2 days b. 7-21 days c. 30-60 days d. 90-180 days 9. Which of the following lab findings is observed in a patient with serum sickness. a. Low levels of IgG and IgM b. Low titers of immune complex c. Low levels of serum C3 and C4 d. Significantly elevated CH50 10. Patients with systemic lupus erythematosus have decreased numbers of which of the following receptors on their erythrocytes? a. Complement receptor 1 b. Fc gamma receptor 1 c. P-selectin d. Neoantigen receptors 11. Which of the following laboratory findings is suggestive of membranoproliferative glomerulonephritis? a. Decreased C4 and C3 b. Decreased C3, decreased factor B, or decreased properdin c. Increased levels of decay-accelerating factor (DAF) d. C1q inhibitor deficiency Answers: 1. d, page 997 2. a, page 998 3. d, page 998 4. a, page 999 5. b, page 1000 6. a, page 1001 7. c, page 1005 8. b, page 1006 9. c, page 1007 10. a, page 1008 11. b, page 1010 November 9, 2005 No review this issue. October 26, 2005 Chapter 57 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 57:Cell-Mediated Immunity in Health and Disease 1. A 5 millimeters tuberculin skin test is considered positive in which of the following groups of patients? a. Intravenous drug abusers b. Patients who reside in a nursing home c. Patients who have close contact with persons with tuberculosis (TB) d. Patients with no identified risk factors for TB 2. Which of the following agents can be used to test for the ability to develop a new (primary) delayed type hypersensitivity reaction? a. Trichophyton b. Keyhole limpet hemocyanin c. Candida antigen d. Tetanus toxoid 3. Antigraft antibodies play a major pathogenic role in which of the following patterns of graft rejection? a. Hyperacute rejection b. Ischemic injury c. Acute rejection d. Chronic rejection 4. Which of the following factors enhances T cell responses to tumor cells? a. Failure to express co-stimulatory molecule by T cell b. Anti-tumor necrosis factor (anti-TNF) c. Interleukin (IL)-10 d. Presentation of tumor antigen in an MHC-restricted manner by dendritic cells 5. Langerhans’ cells express receptors for the Fc portions of which of the following immunoglobulins? a. IgG b. IgA c. IgD d. IgM 6. Which of the following cytokines plays a major role in Langerhans’ cell activation and migration to the local lymph nodes? a. IL-4 b. IL-12 c. IL-1beta d. IL-2 7. Antibodies to ganglioside GM1 may be present in a patient with which of the following diseases? a. Acute disseminated postinfectious encephalomyelitis (ADEM) b. Guillain-Barre syndrome c. Dermatomyositis d. Graft-verses-host reaction 8. Which of the following antibodies is associated with polymyositis/ dermatomyositis? a. Anti-myelin antibody b. Myeloperoxidase antibody c. Anti-Jo-1 (histidyl tRNA synthetase) d. Anti-gliadin 9. Autoantibody against mitochondrial antigen is seen in which of the following autoimmune diseases? a. Primary biliary cirrhosis b. Ulcerative colitis c. Crohn’s disease d. Primary pernicious anemia 10. Type I diabetes (IDDM) is characterized by the production of which of the following autoantibodies? a. Microsomal antibodies b. Anti-transglutaminase c. Anti-21-hydroxylase d. Anti-glutamic acid decarboxylase 11. Transient depression of cell-mediated immunity can be seen in: a. Puberty b. Zinc deficiency c. Hypereosinophilic syndrome d. Lead poisoning 12. Prolonged depression of cell-mediated immunity is often observed in which of the following diseases? a. Chronic lyme disease b. Infectious mononucleosis c. Sarcoidosis d. Glomerulonephritis 13. Serum level of which of the following cells is increased within hours of corticosteroid administration? a. CD4+ T cells b. Monocytes c. CD8+ T cells d. Neutrophils 14. Which of the following immunosuppressive drugs is considered an alkylating agent? a. Cyclophosphamide b. Cyclosporine c. 6-Mercaptopurine d. Mycophenolate mofetil Answers: 1. c, page 974 (Table 57-1) 2. b, page 975 3. a, page 977 4. d, page 978 5. a, page 978 6. c, page 979 7. b, page 981 8. c, page 982 9. a, page 983 10. d, page 984 11. b, page 985 12. c, page 987 13. d, page 989 14. a, page 999 October 12, 2005 No review this issue. September 28, 2005 Chapter 56 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 56:Immunomodulators 1. Which of the following statements best describes methotrexate’s (MTX) mechanism of action? a. MTX binds to amino-imidazole-carboxy-amido-ribonucleotide (AICAR) transformylase, resulting in inhibition of adenosine release. b. MTX activates thymidylate synthetase. c. MTX binds to the active site of dihydrofolate reductase, blocking the reduction of folic acid. d. MTX enhances the methylation of homocysteine to methionine. 2. Which of the following is considered a common adverse effect associated with methotrexate therapy? a. Methotrexate pneumonitis b. Alopecia c. Myelosuppression d. Oral ulcerations 3. Which of the following statements is correct about the use of methotrexate (MTX)? a. MTX is considered a teratogen and is strictly contraindicated in pregnancy. b. Folic acid, even at low dosages (e.g., 1 mg/day), can significantly decrease the efficacy of MTX. c. Serum homocysteine levels often decrease during MTX therapy. d. Monitoring of liver function is unnecessary since hepatic fibrosis is an uncommon adverse effect. 4. Which of the following is structurally distinct, but shares its mechanism of action with cyclosporine (CsA)? a. Methotrexate b. Tacrolimus c. Rapamycin d. Sirolimus 5. Which of the following statements about CsA is most accurate? a. Typical intravenous doses of CsA are about 1/2 of the oral preparations of CsA. b. CsA is hydrophilic. c. CsA is primarily eliminated through renal metabolism. d. Advancing age does not appear to be an important factor affecting the pharmacokinetics of CsA. 6. Which of the following immunologic effects is associated with the use of cyclosporine and tacrolimus? a. Up-regulation of the expression of the high-affinity receptor for immunoglobulin E b. Up-regulation of fas-ligand expression on mast cells and basophils, promoting their apoptosis c. Block degranulation of mast cells and basophils d. Increase the transcriptional activation of genes encoding IL-2, IL-3 and IL-5 in T-cells 7. Which of the following intervals represents the half-life of intravenous immunoglobulins (IVIG) in patients with humoral immunodeficiencies? a. 10-14 days b. 14-24 days c. 26-35 days d. 40-60 days 8. A patient complains of chills and flushing while receiving IVIG. Your next step is to: a. Do a lumbar puncture to obtain cerebral spinal fluid to evaluate for aseptic meningitis. b. Draw blood to check for immunoglobulin A deficiency. c. Add methylprednisolone to the IVIG infusion. d. Interrupt the infusion and resume at a slower rate. 9. CpG-rich (cytosine guanosine) immunostimulatory DNA sequences up-regulate the expression of which of the following cytokines? a. IL-5 b. IL-10 c. IL-12 d. IL-13 10. CpG-rich (cytosine guanosine) immunostimulatory DNA sequences inhibit the production of which of the following cytokines? a. IL-5 b. IL-18 c. Interferon-gamma d. Interferon-alpha 11. Antisense oligodeoxynucleotide therapy prevents which of the following? a. Transcription of DNA sequence into mRNA b. Translation of the mRNA into a protein c. Degradation of the mRNA sequence, consequently enhancing protein production d. Unwinding of the DNA double helix by helicases Answers 1. c, pages 957-958 2. d, page 958 3. a, page 959 4. b, page 960 5. d, page 960 6. c, pages 960-961 7. c, page 963 8. d, page 963 9. c, pages 966-967 10. a, page 967 11. b, pages 968-969 September 14, 2005 Chapter 55 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 55: Antileukotriene Therapy in Asthma 1. Which of the following leukotrienes is a potent chemoattractant for both neutrophils and eosinophils? a. LTB4 b. LTC4 c. LTD4 d. LTE4 2. Primarily which of the following cells produces LTC4? a. Endothelial cells b. Neutrophils c. Airway smooth muscle d. Mast cells 3. LTD4 and LTC4 have equal affinity for which of the following receptors? a. BLT1 b. BLT2 c. CysLT1 d. CysLT2 4. Which of the following drugs has the highest binding affinity to the cysLT1 receptor in biologic receptor binding models? a. Zafirlukast b. Montelukast c. Pranlukast d. Zileuton 5. Zileuton is a: a. Cysteinyl leukotriene receptor antagonist (cysLTRA) b. Phospholipase A2 inhibitor c. 5-Lipoxygenase inhibitor d. LTC4 synthase inhibitor 6. Which of the following statements about the role of cysLTRAs is most correct? a. CysLTRAs have been shown to inhibit bronchoconstriction associated with exercise. b. Treatment with cysLTRAs in chronic asthma decreases blood eosinophils and significantly improves FEV1 (forced expiratory volume at 1 second). c. Abrupt discontinuation of cysLTRAs results in rebound airway hyperreactivity. d. The inhibition of aspirin-induced bronchoconstriction by cysLTRAs is independent of the dose of aspirin given. 7. Which of the following statements about intravenous (IV) montelukast is correct? a. IV montelukast has a lower maximal bronchodilating effect than oral montelukast b. IV montelukast and inhaled beta-agonist have equivocal but not additive effect on bronchodilation c. IV montelukast has a more rapid onset of action (bronchodilation) than oral montelukast d. The IV formulation of montelukast has the same clinical efficacy when administered intramuscularly 8. Liver function test monitoring during the first year of therapy is suggested for which of the following anti-LTs? a. Zafirlukast b. Montelukast c. Pranlukast d. Zileuton 9. Which of the following agents has the greatest potential for interaction with warfarin? a. Zafirlukast b. Montelukast c. Pranlukast d. Zileuton 10. Food interferes with the absorption of which of the following anti-LTs? a. Zafirlukast b. Montelukast c. Pranlukast d. Zileuton Answers 1. a, page 943 2. d, page 944 3. d, page 944 4. b, page 945 5. c, page 945 6. a, pages 946-947 7. c, page 948 8. d, page 952 9. a, page 952 10. a, page 952 August 31, 2005 Chapter 54 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 54: Cholinergic Mechanisms and Anticholinergic Therapy in Respiratory Diseases 1. Bronchoconstriction is partially mediated by acetylcholine release from parasympathetic nerves. Which of the following statements is true regarding parasympathetic control of the airways? a. Cholinergic innervations are densest below the terminal bronchi. b. Cutting the parasympathetic supply causes bronchospasm. c. Stimulating parasympathetic nerves leads to bronchodilation. d. Acetylcholine increases ciliary beat frequency. 2. Five subtypes of muscarinic receptors (M1-M5) have been described. Choose the true statement regarding muscarinic receptors. a. Activation of neuronal M2 receptors increases vagally induced bronchoconstriction. b. Viral neuraminidase can directly damage M2 receptors on parasympathetic nerve endings. c. Airway smooth muscles contain M4 and M5 receptors. d. M3 receptors mediate smooth muscle relaxation. 3. Which of the following statements regarding major basic protein (MBP) released from eosinophils is correct? a. MBP is an agonist for all 5 subtypes of muscarinic receptors. b. MBP binding to neuronal M2 receptors inhibits acetylcholine release. c. MBP binds to M3 receptors with the highest affinity. d. Heparin removes MBP from M2 receptors and restores receptor function. 4. Atropine is a naturally occurring anticholinergic. Which of the following statements best describes atropine? a. It is poorly absorbed from the gastrointestinal tract and respiratory mucosa. b. It cannot cross the blood-brain barrier. c. Dry mouth and urinary retention are common side effects. d. It is a selective M3 receptor antagonist. 5. Which of the following statements regarding ipratropium is correct? a. In patients with chronic obstructive pulmonary disease (COPD), anticholinergics such as ipratropium are considered first-line bronchodilator therapies. b. Ipratropium selectively binds M2 receptors. c. Inhaled ipratropium is dosed every 12 hours. d. Ipratropium is an effective treatment for nasal polyps. 6. Which of the following medications has a long duration of action and slow dissociation from M1 and M3 receptors, leading to less paradoxical bronchoconstriction? a. Atropine b. Ipratropium c. Tiotropium d. Revatropate 7. Fifty-percent maximum bronchodilation is achieved in 7.6 minutes after inhalation of ipratropium. How many minutes after inhalation of tiotropium is 50-percent maximum bronchodilation achieved? a. 2 minutes b. 10 minutes c. 30 minutes d. 60 minutes 8. The most common side effect of tiotropium is: a. Fever b. Dry mouth c. Nervousness d. Urinary retention Answers 1. d, pages 929-930 2. b, pages 931-933 3. d, page 931 4. c, pages 932-934 5. a, page 934 6. c, page 935 7. c, page 935 8. b, page 935 August 17, 2005 Chapter 53 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 53: Chromones 1. Which of the following statements concerning cromolyn and nedocromil is true? a. Cromolyn but not nedocromil is water soluble b. Both nedocromil and cromolyn are highly fat soluble c. Both nedocromil and cromolyn are ionized at physiologic pH d. 75% of an inhaled cromolyn dose is cleared by the lungs within 2 minutes 2. Which of the following statements concerning cromolyn and nedocromil is correct? a. Both inhibit the release of histamine from human skin mast cells, but fail to inhibit histamine release from mast cells at other anatomic sites b. Both cromolyn and nedocromil block the activation of human blood eosinophils c. Cromolyn but not nedocromil has been shown to inhibit the release of prostaglandin D2 from human mast cells d. Nedocromil and cromolyn have been shown to enhance neutrophil activation, chemotaxis, and mediator release 3. Which of the following statements about cromolyn is correct? a. Cromolyn fails to inhibit bronchoconstriction induced by irritants such as sulfur dioxide b. Cromolyn reduces the size of wheals induced in human skin with intradermal histamine c. Cromolyn can inhibit angiotensin-converting enzyme inhibitor-induced cough in patients receiving enalapril or captopril d. Cromolyn enhances neurokinin-P release in human skin 4. Single doses of nedocromil and cromolyn have been shown to protect against bronchoconstriction from which of the following stimuli? a. Sulfur dioxide b. Histamine c. Methacholine d. Direct acting spasmogens 5. For which of the following bronchoconstrictor agents is treatment with cromolyn and nedocromil ineffective (not protective) in the acute situation? a. Exercise/ cold air b. Hypertonic saline c. Substance P d. Methacholine 6. The anti-inflammatory effects of cromolyn and nedocromil are demonstrated by: a. Decreased sputum neutrophils with cromolyn treatment when compared with placebo b. Significant reduction of neutrophils in bronchial biopsy after 12 weeks of treatment with cromolyn c. Nedocromil reduces the numbers of eosinophils in bronchoalveolar lavage at 48 hours after antigen challenge d. Biopsy studies revealed that the number of activated macrophages is significantly reduced in the bronchial mucosa after 16 weeks of treatment with nedocromil 7. Which of the following is the recommended starting dose frequency for cromolyn and nedocromil? a. One time per day b. Two times per day c. Three times per day d. Four times per day 8. Using a spacer can increase the effective delivered dose from nedocromil sodium metered dose inhalers by: a. Does not increase the delivered dose. A spacer only helps with the overall coordination of the inhalation b. 2-5% c. 10-15% d. 20-50% 9. Nedocromil is more efficacious than cromolyn in which of the following ocular conditions? a. Vernal keratoconjunctivitis b. Acute seasonal conjunctivitis c. Chronic allergic conjunctivitis d. Bacterial conjunctivitis Answers 1. c, page 916 2. b, pages 917-918 3. c, page 919 4. a, page 919 5. d, page 919 6. c, page 921 7. d, page 924 8. d, page 924 9. a, page 924 August 3, 2005 Chapter 52 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 52: Glucocorticoids (part 2) 1. For patients in
status asthmaticus, intravenous (IV) methylprednisolone (mPn) is
preferred over IV hydrocortisone because: July 20, 2005 Chapter 52 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 52: Glucocorticoids (part 1) 1. Hydrocortisone secreted from the adrenal glands reaches peak levels in the: a. Early morning hours b. Early afternoon hours c. Late evening hours d. Both early morning and late evening hours 2. Transcortin is a(n): a. Cell-surface receptor for glucocorticoids (GCs) b. Cytoplasmic protein that translocates GCs into the nucleus c. Plasma-protein with a high-affinity, but low binding capacity for GCs d. Inactive metabolite of cortisol 3. Drugs that induce liver mixed-function oxidases: a. Can prolong the plasma half-life (t1/2) of GCs b. Does not impact the metabolism of cortisol since it is excreted unchanged in the urine c. Can increase the rate of metabolism of GCs and shorten their half-lives d. Often prolong the activity of GCs 4. The relative potency of oral hydrocortisone to oral prednisone is: a. 1:4 b. 1:10 c. 1:12 d. 1:25 5. For a given amount of antiasthmatic efficacy, the development of systemic side effects is greater with oral versus inhaled steroids. Which of the following best describes this relative increase in systemic side effects with oral steroids? a. Two-fold b. Four-fold c. Eight-fold d. Ten-fold 6. You are making a novel GC to be used with a dry powder inhaler device. You would like the oral bioavailability to be: a. <1% b. 10-20% c. 45-50% d. >99% 7. After the GC binds to the glucocorticoid receptor, which of the following is the next step? a. Binding with transcortin and phosphorylation of the GC receptor b. Dissociation of heat shock proteins (HSPs) and phosphorylation of the GC receptor c. Dimerization of the GC-receptor complex and translocation to the nucleus d. Binding of the GC-receptor complex to the glucocorticoid response element and activation of the ribonucleic acid polymerase 8. GCs induce the gene expression of which of the following groups of inflammatory mediators? a. Interleukins b. Proinflammatory cytokines c. Metalloproteases d. Soluble interleukin receptors 9. Beta2-adrenergic receptor agonists do which of the following? a. Induce and potentiate translocation of the glucocorticoid receptor (GR) to the nucleus b. Activate protein kinases that dephosphorylates GR c. Inhibit the dissociation of heat shock proteins from GR d. Increase expression of GR on the cell surface 10. Circulating numbers of which of the following cells are significantly decreased after oral or intravenous GC administration? a. CD8 T-cells b. Neutrophils c. Eosinophils d. Natural killer cells 11. Which of the following is true about GC effects on cells in allergic inflammation? a. GC inhibits mast cell degranulation b. GC inhibits eosinophil chemotaxis, adhesion and degranulation c. GC increases the number of lymphocytes bearing the low-affinity IgE receptor d. GC inhibits the emigration of lymphocytes to the site of antigen challenge and inhibits the production of lymphocyte growth and activating factors 12. Glucocorticoids enhance induction of which of the following cytokines? a. IL-2 b. IL-3 c. IL-10 d. IL-16 13. Which of the following is an effect of corticosteroid treatment? a. Increased lysozyme release by macrophages b. Impaired intracellular killing of organisms by macrophages c. Decreased phagocytic activity of macrophages d. Decrease in the number of bronchoalveolar macrophages 14. Which of the following integrins is responsible for the binding of eosinophils and lymphocytes to vascular cell adhesion molecule-1 (VCAM-1) and fibronectin? a. CD49d, CD29 (heterodimer of alpha4/beta1) b. Very late antigen-4 (VLA-4) c. Mucosal addressin cell adhesion molecule (MAdCAM) d. Eselectin 15. Studies demonstrate that steroids affect the expression of which of the following aquaporins? a. 1 b. 3 c. 4 d. 5 Answers 1. a, page 870 2. c, page 871 3. c, page 871 4. a, page 872 5. b, page 873 6. a, pages 873-874 7. b, page 875 8. d, page 877, Box 52-1 9. a, page 878 10. c, page 879 11. d, page 881 12. c, page 882 13. b, page 882 14. a, page 883 15. a, page 885 July 6, 2005 Chapter 51 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 51: Antihistamines 1. Through which of the following receptors does histamine cause sensory nerve stimulation that leads to pruritus and sneezing? a. H1 b. H2 c. H3 d. H4 2. Through which of the following receptors does histamine down-regulate the responses of type 1 and 2 helper T cells a. H1 b. H2 c. H3 d. H4 3. Which of the following statements is true about the H1 receptor? a. Peripheral and central H1 receptors differ from each other in structure and function. b. H1 is a G-protein-coupled receptor. c. The majority of H1 receptors are soluble (i.e., not membrane-bound). d. In the vasculature, histamine has a higher affinity for H2 than H1 receptor. 4. Which of the following antihistamines is best described as lipophobic with a relatively high molecular weight? a. Chlorpheniramine b. Diphenhydramine c. Loratidine d. Dimethindene 5. H3 receptors are predominantly found in: a. Histaminergic nerve terminals in the central nervous system, presynaptically b. Enterochromaffin cells c. Lymphocytes d. Parietal cells 6. Currently available H1 antihistamines are best described as: a. Agonists b. Competitive antagonists c. Inverse agonists d. Noncompetitive inhibitors 7. Antidepressants, antipsychotics, and local anesthetics with a substituted ethylamine group are similar to H1 antihistamines in which of the following ways? a. They all act as inverse agonists on the H1 receptor. b. They can prevent the release of preformed mediators from mast cells and basophils. c. They directly down-regulate the expression of adhesion proteins on epithelial cells. d. They are not recognized by the P-glycoprotein reflux pump. 8. Which of the following is a receptor-dependent anti-inflammatory effect of H1 antihistamines? a. Inhibition of release of preformed chemical mediators of inflammation b. Upregulation of expression of adhesion proteins c. Down-regulation of nuclear factor kappa B expression d. Generation and release of superoxide radicals 9. Which of the following H1 antihistamines is dependent on transport proteins for absorption and elimination? a. Acrivastine b. Fexofenadine c. Levocetirizine d. Desloratadine 10. More than 80 percent of which of the following antihistamines is eliminated unchanged in the feces after biliary excretion? a. Loratidine b. Fexofenadine c. Cetirizine d. Azelastine 11. Which of the following statements about H1 antihistamines is true? a. They are more effective than intranasal glucocorticoids for the relief of allergic nasal itching, sneezing, and rhinorhea. b. They significantly shorten the duration of viral upper respiratory infections. c. Their use in acute otitis media has been shown to significantly improve tympanic membrane compliance. d. They are more effective than decongestants for the relief of nasal itching, sneezing, and rhinorhea. 12. Which of the following statements about antihistamine in the treatment of urticaria is correct? a. First-generation H1 antihistamines have a better benefit-to-risk ratio than second-generation H1 antihistamines. b. There is a relatively steep dose-response curve for H1 antihistamine in the treatment of urticaria. c. Doxepin has greater activity at the H1 receptor than either hydroxyzine or diphenhydramine. d. Adding an H2 antihistamine will significantly increase the adverse effects of an H1 antihistamine. 13. Which of the following antihistamines has been shown to have a topical glucocorticoid-sparing effect in atopic dermatitis? a. Cetirizine b. Hydroxyzine c. Loratadine d. Diphenhydramine 14. Which of the following antihistamines is considered a Pregnancy Category B drug by the U.S. FDA? a. Cetirizine b. Fexofenadine c. Olopatadine d. Hydroxyzine Answers: 1. a, page 834 2. b, page 838 3. b, page 838 4. c, page 839 5. a, page 839 6. c, page 842 7. b, page 843 8. c, page 843, Box 51-1 9. b, page 845 10. b, pages 845-846 11. d, page 851 12. c, page 854 13. a, page 855 14. a, page 863 June 22, 2005 Chapter 49 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 49: Beta-Adrenergic Agonists 1. Terbutaline is a: a. Short-acting non-selective beta-agonist b. Complete agonist for the beta-adrenergic receptors c. Short-acting selective beta-agonist that produces a similar degree of bronchodilation as albuterol d. Long-acting beta-agonist 2. Which of the following statements about formoterol is correct? a. When given orally, formoterol has prolonged bronchodilator action over 12 hours b. After inhalation, formoterol onset of action is similar to that of albuterol c. When given orally, formoterol is a non-selective beta2-agonist d. Formoterol and salmeterol are both long-acting selective beta2-agonists with similar onset and duration of action 3. The following aerosolized beta-agonist is best described by the onset of 75% of maximum bronchodilation within 5 minutes, peak bronchodilation after 4 hours, and duration of bronchodilation greater than 12 hours? a. Metaproterenol b. Terbutaline c. Salmeterol d. Formoterol 4. Which of the following statements about the delivery of medication from a jet nebulizer is correct? a. Jet nebulizer is a more efficient delivery system than the metered-dose inhaler (MDI) b. The delivery rate of medication varies over a sevenfold range among commercially available nebulizers. c. In a typical jet nebulizer, approximately 75% of a 2-ml volume leaves the nebulization chamber d. More bronchodilation is produced from the same beta-agonist dose when delivered by a pressure-driven nebulizer than by a fluorocarbon-propelled MDI 5. With excellent MDI technique, how much of the dose can be deposited in the lungs? a. 2-5% b. 6-10% c. 12-14% d. 20-25% 6. In addition to relaxation of bronchial smooth muscle, other actions of beta2-adrenergic agonists include: a. Increasing the microvascular permeability b. Excitation of cholinergic neurotransmission c. Preventing the translocation of the glucocorticoid receptor into the nucleus d. Increasing mucociliary clearance 7. Which of the following is decreased on bronchoalveolar lavage (BAL) examination after 4-8 weeks of regular treatment with salmeterol? a. Total number of cells b. Activation markers on lymphocytes c. Eosinophil cationic protein levels d. Number of eosinophils 8. Which of the following is a side effect of beta2-adrenergic therapy? a. Prolonged QTc interval b. Stimulation of gastric acid secretion c. Hypoglycemia d. Hyperkalemia 9. Which of the following is correct about subsensitivity (or tolerance) to beta-agonist? a. Subsensitivity has only been observed in the use of non-selective beta-agonists b. Subsensitivity to beta-agonist has a greater affect on the duration of action than the peak affect of the drug c. There is strong evidence that chronic use of long-acting beta-agonists will blunt the response to short-acting beta-agonists d. With chronic administration, subsensitivity to formoterol develops much more rapidly and often than salmeterol 10. For beta-agonists, as a whole, increased use is associated with an increased risk of death. At what level of use does the risk of death begin to rise? a. 0.4 canisters per month b. 1.4 canisters per month c. 2.4 canisters per month d. 3.4 canisters per month Answers: 1. c, page 804 2. b, page 805 3. d, page 806 4. b, page 806 5. c, page 807 6. d, page 808 7. c, page 808 8. a, page 809 9. b, page 810 10. b, page 813 June 8, 2005 May 25, 2005 Chapter 48: Principles of Pharmacotherapeutics 1. Synthetic beta2-agonists exist as racemic mixtures of two optical isomers. Which of the following is correct about (R)-albuterol and (S)-albuterol? a. Beta-agonist receptors are stereoselective for the (S)-albuterol b. (S)-albuterol inhibits the affect of (R)-albuterol by competitive inhibition c. (R)-albuterol is 100 times more potent than (S)-albuterol d. (R)-albuterol increases the responsiveness of the bronchial smooth muscle 2. Which of the following describes the therapeutic index of a drug? a. The ratio of the dose that produces toxicity to the dose that produces therapeutic effect b. The dose that produces toxicity minus the dose that produces therapeutic effect c. The ratio of the dose that produces therapeutic effect to the dose that produces toxicity d. The dose that produces therapeutic effect minus the dose that produces toxicity 3. Which of the following is true about parenteral administration of glucocorticosteroids (GCs)? a. GCs administered parenterally are direct-acting agonists b. Parenteral administration of GC results in a more intense clinical response than oral adminstration c. Parenteral administration of GC results in faster systemic absorption, and therefore, a faster therapeutic response d. There is no evidence of either a more rapid or intense response with parenteral administration compared to oral administration of GCs 4. A specific spacer device may increase the delivery of respirable particles of one product while reducing the delivery of respirable particles of another product. Which of the following statement is correct? a. Aerochamber provides increased delivery of flunisolide pressurized metered dose inhalers (pMDI) and decreased delivery of beclomethasone pMDI b. Aerochamber provides increased delivery of beclomethasone pMDI and decreased delivery of flunisolide pMDI c. Aerochamber provides greater delivery of both beclomethasone and flunisolide pMDIs d. Aerochamber reduces the delivery of both beclomethasone and flunisolide pMDIs 5. Which of the following is true about the therapeutic range of systemically administered drugs? a. The therapeutic range is based on the tissue concentration of the drug b. The therapeutic range is a combination of the probability curves for therapeutic response and unacceptable toxicity c. The lower limit of the therapeutic range is a result of the flat-dose response d. The therapeutic range is defined by the in vitro biopharmaceutic characteristics of the drug 6. The Food and Drug Administration (FDA) primarily uses the results of bioavailability studies rather than therapeutic efficacy studies to determine the equivalence of generic drugs, with the exception of drugs delivered by which of the following methods? a. Nebulizer b. Inhaler c. Intravenous injection d. Intramuscular injection 7. First pass metabolism is stereoselective. Which of the following statements about orally administered beta2-agonists is correct? a. (S)-albuterol is more rapidly metabolized by the liver than (R)-albuterol b. (R)-albuterol is more rapidly metabolized by the liver than (S)-albuterol c. Oral administration of (R, S)-albuterol results in higher concentration of (R)-albuterol d. (R)-terbutaline is more rapidly metabolized by the gastrointestinal tract than (S)-terbutaline 8. The newer beta2-agonists, such as formoterol and salmeterol, have a longer duration of action secondary to their greater: a. Stimulation of first pass metabolism b. Hydrophilicity c. Lipophilicity d. Absorption by the large surface area of the lung 9. How much of a drug administered either by metered dose inhalation (MDI) or dry power inhalation (DPI) is delivered to the lung? a. 10-30% b. 30-50% c. 50-70% d. 70-80% 10. Which of the following drugs is relatively water-soluble and is excreted unchanged? a. Montelukast b. Hydroxyzine c. Cetirizine d. Fluoxetine 11. Enzymatic drug metabolism (e.g., by the P450 system) is most rapid between which of the following ages? a. 2-36 weeks old b. 1-9 years old c. 24-40 years old d. 55-68 years old 12. After 5 half-lives of a drug, how much of it remains in the body? a. 2.5% b. 3.125% c. 5% d. 6.25% 13. Montelukast is dosed at bedtime because: a. The maximal drug concentration is reached in the late night/early morning hours b. Bronchial hyperresponsiveness peaks between 7 p.m. and 10 p.m. c. Leukotriene excretion is highest between 6 a.m. and 9 a.m., and maximal drug concentration is reached 12 hours after the dose d. Bedtime dosing improves patient compliance 14. Which of the following drugs will inhibit the metabolism of theophylline? a. Fluoxetine b. Rifampin c. Erythromycin d. Phenobarbital Answers: 1. c, page 791 2. a, page 792 3. d, page 792 4. a, page 793 5. b, page 793 6. b, page 794 7. b, page 794: Note error in Middleton, pg 794. (R)-terbutaline is the eutomer (1000x more potent than the distomer (S)-terbutaline). Metabolism of the (S)-terbutaline is more rapid than (R)-terbutaline. Kalstone BL, et al. Steric aspects of formoterol and terbutaline. Chirality, 1996; 8(8): 567-73. 8. c, page 794 9. a, page 794 10. c, page 795 11. b, page 796 12. b, page 797 13. a, page 798 14. c, page 800 May 11, 2005 April 27, 2005 Chapter 46 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 46: Aerosols 1. Peripheral airway deposition is reduced and central airway deposition is increased when the aerosolized particle’s diameter is greater than which of the following? a. 0.5 micrometers b. 3 micrometers c. 4.5 micrometers d. 8 micrometers 2. Which breathing pattern can facilitate deposition of aerosolized particles to the peripheral portions of the lung? a. Slow inspiratory flow rate b. Rapid expiratory flow rate c. Rapid inspiratory flow rate d. Minimize the time in which the breath is held after inspiration 3. Spacer devices have been shown to decrease oropharyngeal deposition of aerosolized medications and compensate in part for the delay in inhalation after actuation of the device. Which of the following is also true about spacer devices? a. With coordinated use, parenchymal deposition of drug within the lung is similar with or without a spacer. b. Spacers with two-way valves can improve compliance due to greater ease-of-use. c. Enhanced drug delivery is obtained with spacer chambers of 75-100 mL volume. d. A spacer with sonic feedback will “whistle” if the patient inhales too slowly. 4. Which of the following devices requires rapid inhalation to generate the aerosol? a. CFC (chlorofluorocarbons) pressurized metered-dose inhaler (pMDI) b. HFA (1,1,1,2, tetrafluoroethane) pMDI c. Dry-powder inhaler (DPI) d. Nebulizer 5. Oral bioavailability of a drug is defined as: a. The level of drug activity that remains after it is ingested b. The percentage of an oral dose that reaches the systemic circulation c. The initial dose of the inhaled drug minus the amount of alveolar deposition d. The percentage of the aerosolized drug that is deposited on the oropharynx 6. With respect to most pMDI, which of the following ratios best describes the amount of medication deposited in the oropharynx, as compared to the lung? a. 1/4 oropharynx: 1 lung b. 1/2 oropharynx: 1 lung c. 2 oropharynx: 1 lung d. 4 oropharynx: 1 lung 7. The oral bioavailability of which of the following corticosteroids, if aerosolized, approaches 100 percent? a. Dexamethasone b. Budesonide c. Flunisolide d. Triamcinolone 8. Which of the following corticosteroids, when given by pMDI or DPI, has the lowest oral bioavailability? a. Beclamethasone b. Budesonide c. Fluticasone d. Triamcinolone 9. Beyond which age are children generally able to use a DPI device? a. 3 years b. 4 years c. 5 years d. 6 years 10. Which of the following statements about mucociliary clearance is the most accurate? a. Beta agonists and theophylline decrease rates of mucociliary clearance. b. Corticosteroids improve mucociliary clearance acutely. c. In healthy subjects, mucociliary clearance is usually completed within 3-5 days of deposition. d. In healthy subjects, the fastest rate of mucociliary transport is in the trachea. Answers: 1. c, page 759 2. a, pages 759-760 3. a, page 761 4. c, page 762 5. b, page 767 6. d, page 767 7. a, page 767 8. c, page 768 9. b, page 769 10. d, pages 771-772 April 13, 2005 Chapter 44 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 44: Development, Structure, and Physiology in Normal and Asthmatic Lung 1. In fetal lung development, airway branching and development are completed by 16 weeks of gestation. During which week of gestation does the development of the alveoli begin? a. 18 b. 24 c. 28 d. 36 2. Which of the following statements regarding structural changes in the asthmatic lung is correct? a. Only moderate to severe asthmatics have structural alterations in their airways. b. Using high-resolution computed tomography, airway wall thickening has been found to the greatest extent in the large airways. c. Airway wall thickening has been correlated with the degree of airway hyperresponsiveness, as assessed by methacholine challenge. d. Airway wall thickening has only been observed in cases of fatal asthma. 3. Which of the following statements regarding airway remodeling in the asthmatic lung is true? a. Epithelial hyperplasia is limited to the central airway. b. Subepithelial fibrosis has been observed only in severe asthmatics and is not reversible with corticosteroid therapy. c. Smooth muscle atrophy is a common finding in the asthmatic airway. d. Fatal cases of asthma of short duration, unlike the nonfatal cases, have significantly increased number of mucous glands. 4. Which of the following statements is correct? a. The forced expiratory volume at one second (FEV1) tends to be decreased to a greater degree than the peak expiratory flow (PEF) in patients with asthma. b. PEF is significantly decreased, whereas FEV1 remains normal, in cases of upper airway obstruction. c. Forced expiratory flow at 25% to 75% of forced vital capacity (FEF25-75) is more reproducible than FEV1. d. PEF is a reflection of airflow in the distal airways. 5. Which of the following statements about the FEV1/FVC ratio is true? a. The ratio reflects the airflow resistance in the larger central airways, not the distal airways. b. A ratio less than 0.8 is a sensitive indicator of airflow limitation. c. A ratio greater than 0.8 rules out airflow limitation. d. A falsely low FEV1/FVC can be observed in cases of mild asthma with air trapping (secondary to the increased FVC). 6. Which of the following plethysmography findings is most consistent with the diagnosis of mild asthma? a. Total lung capacity (TLC) is decreased. b. Residual volume (RV) is increased. c. Functional reserve capacity (FRC) is decreased. d. Expiratory reserve volume (ERV) is increased. 7. According to a study on inhaled budesonide, how many hours after the first dose of the inhaled corticosteroid is a reduction in bronchial reactivity noted? a. 4 hours b. 6 hours c. 8 hours d. 12 hours 8. A clinically significant bronchodilator response on pulmonary function testing is currently defined as: a. A greater than 26% change in FEV1 or FVC b. A greater than 20% change in FEV1/FVC c. A greater than 12% change in FEV1 or FVC d. A greater than 8% change in FEV1/FVC 9. A decrease in which of the following indices of lung volume is the major predictor of morbidity and mortality? a. Forced vital capacity (FVC) b. TLC c. RV d. FRC 10. Which of the following statements regarding the diffusing capacity of carbon monoxide (DLCO) is the most accurate? a. DLCO correlates with gas exchange. b. DLCO is decreased in asthmatic patients. c. Measurement of DLCO can determine the alveolar volume (VA). d. In normal subjects, the alveolar volume is less than the TLC. Answers: 1. c, pg. 727 2. c, pg. 728 3. d, pg. 729 4. a, pg. 731 5. b, pg. 732 6. b, pg. 732 7. b, pg. 733 8. c, pg. 737 9. a, pg. 737 10. c, pg. 738 March 30, 2005 Chapter 41 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 41: Structural and Functional Cutaneous Immunology 1. Which of the following statements regarding epidermal cells is true? a. Intradermal T cells make up 1% of the epidermal cell population and are typically CD8+/CD45RA+ b. Langerhans cells make up 5% of the epidermal cell population and have MHC II on the surface c. Keratinocytes make up 70% of the epidermal cell population and can prime naïve-T cells d. B cells make up 15% of the epidermal cells in normal skin 2. Which of the following layers of the dermal-epidermal junction is the most easily disrupted? a. Lamina lucida b. Lamina densa c. Anchoring fibril layer d. Stratum germinativum 3. Which of the following statements is correct? a. Mast cells of the skin have granules containing tryptase vs. mast cells of the lung have granules containing chymase. b. Intestinal mast cells have granules containing tryptase vs. mast cells of the lung have granules containing chymase. c. Mast cells of the skin and the intestinal mucosa have granules containing both chymase and tryptase. d. Mast cells of the skin have granules containing chymase. 4. Which of the following distinguishes dermal macrophages within the skin? a. CD68 b. CD34 c. CD14 d. CD24 5. Which of the following molecules, stored in the cytoplasm of keratinocytes, is a key initiator of cutaneous inducible innate immunity? a. IL-1-alpha b. IL-1-beta c. IL-8 d. Nitric oxide synthase 6. Constitutive innate immunity of the skin consists of: a. Microorganisms such as Streptococcus pyogenes and Pseudomonas aeruginosa b. Polypeptides such as beta-defensin-1, iron-binding proteins, and natural IgM c. High pH d. Skin temperature cooler than normal core body temperature, as a consequence of evaporation 7. Pathogen associated molecular patterns (PAMPs) are important in innate immunity. Which is a true statement regarding PAMPs? a. PAMPs are actual parts of pathogens b. PAMPs are found on the surface of dendritic cells and are involved in the endocytosis of pathogens c. PAMPs are host molecules that recognize pathogens d. PAMPs are cell surface molecules that can be secreted under proper circumstances 8. Which of the following is correct about pattern-recognition receptors (PRRs)? a. Mannose is recognized by CD1a b. CD14 is expressed by neutrophils and macrophages and mediate lipopolysaccharide-sensitive killing c. Unmethylated CpGs are examples of PRR d. Macrophage scavenger receptor is an example of a secreted PRR 9. Which of the following represents the earliest infiltrating leukocyte in a typical cutaneous immune response? a. Monocyte b. Eosinophil c. B lymphocyte d. Neutrophil 10. Which of the following contributes to the down-regulation of the cutaneous inflammatory response? a. IL-1ra b. TNF-alpha c. IFN-alpha d. IL-8 11. For which of the following immunobullous skin diseases is desmocollin-1 the antibody-targeted protein? a. Pemphigus foliaceous b. Paraneoplastic pemphigus c. IgA pemphigus d. Pemphigus vulgaris 12. In drug-induced lupus erythematosus, autoantibodies are directed to which of the following nuclear antigens? a. SS-A/Ro b. Double-stranded DNA c. Jo-1 d. Histones Answers: 1. b, pages 671-673 2. a, page 673 3. c, page 674 4. a, page 674 5. a, page 676 6. b, page 676 7. a, page 677 8. b, page 677 9. d, page 677 10. a, page 679 11. c, page 681 12. d, page 682
March 16, 2005 March 2, 2005 February 16, 2005 Chapter 37 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 37: Laboratory Tests for Allergic and Immunodeficiency Diseases 1. Which of the following is correct about immunoglobulin E (IgE)? a. There is an age-dependent increase of serum IgE levels after 45 years of age b. IgE is elevated in patients with atopic dermatitis, with a mean around 1000 kU/L c. Increased IgE levels are observed in chronic GVHD d. The serum IgE level decreases progressively until the age of 10 years 2. Which of the following IgG subclasses is found in the greatest concentration in the peripheral blood? a. IgG1 b. IgG2 c. IgG3 d. IgG4 3. After immunotherapy, which of the following IgG subclasses has been observed to block antigen-induced basophil histamine release in vitro? a. IgG1 b. IgG2 c. IgG3 d. IgG4 4. After which of the following ages can the diagnosis of a primary or secondary immunodeficiency be made if the total serum IgG concentration is less than 30 percent of the individual’s age-adjusted normal range? a. 1 year b. 2 years c. 3 years d. 4 years 5. Which of the following laboratory techniques has the lowest analytic sensitivity? a. Precipitation in gel b. Nephelometry c. Enzyme-linked immmunoassay d. Flow Cytometry 6. In which of the following assay configurations is the amount of the unlabeled antigen (ligand) the rate-limiting component of the binding reaction? a. Equilibrium dialysis assay b. Two-site immunoenzymetric assay c. Radioimmunoprecipitation assay d. Precipitin-based assay 7. Which of the following statements is true regarding tests for IgG antibodies? a. Specific IgG can be useful in monitoring the response to Hymenoptera immunotherapy b. Specific IgG is useful in the diagnosis of food allergy c. Radioimmunoprecipitation assay is a qualitative test used to measure non-specific IgG d. Radioimmunoprecipitation assay is a superior test compared to solid-phase radioimmunoassay in detecting IgG antibodies 8. Which of the following is true regarding tryptase? a. Beta tryptase is constitutively secreted by all mast cells b. Beta tryptase levels are a measure of mast cell activation c. Alpha tryptase levels peak at 10-30 minutes after a sting in venom anaphylaxis d. Total serum tryptase greater than 5 ng/ml is indicative of systemic mastocytosis 9. Which of the following specimen types is the specimen of choice for measurement of cotinine levels? a. Tears b. Saliva c. Urine d. Serum 10. Which of the following statements is true regarding measurement of indoor aeroallergens? a. The threshold for sensitization for cat allergen Fel d 1 is 10,000 ng per gram of fine dust b. Molds produce the same variety of protein when indoor versus when they are outdoors c. Amounts of Der p 1 greater than 2000 ng per gram of fine dust are associated with increased symptoms in sensitized patients d. The thresholds for sensitization are similar for cockroaches and cats 11. Which of the following is an accurate match of the lymphocyte subpopulations and their cell surface markers? a. B-cells: CD8, CD19 b. Cytotoxic suppressor T-cells: CD3, CD8, CD45 c. NK cells: CD20, CD56 d. Monocytes: CD2 12. In order to evaluate the NK cell population, which of the following monoclonal antibody panels would likely be utilized? a. CD3, CD19, CD45 b. CD3, CD8, CD45 c. CD3, CD4, CD45 d. CD3, CD16, CD56 Answers: 1. b, page 611 2. a, page 612 3. d, page 612 4. b, page 612 5. a, pages 617-627 6. b, page 618 7. a, page 623 8. b, page 624 9. d, page 625 10. c, page 626 11. b, page 628 12. d, page 628 February 2, 2005 By Thao N. Tran, M.D., Stony Brook University Hospital- SUNY; Karla Lowe, M.D., Walter Reed Medical Center; and Todd Levin, M.D., Medical College of Georgia Chapter 36 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N.
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