|
Review Corner Archive
Dec. 20, 2006 December 6, 2006 Chapter 83 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 83: Anaphylaxis and Anaphylactoid Reactions 1. Anaphylaxis associated with which of the following agents occurs more frequently in men than in women? A. Aspirin B. Intravenous muscle relaxants C. Latex D. Stinging insects 2. Atopic individuals have an increased incidence of anaphylaxis to which of the following? A. Hymenoptera stings B. Insulin C. Latex D. Muscle relaxants 3. Which of the following statements regarding factors affecting the incidence or severity of anaphylaxis and anaphylactoid reactions is the most accurate? A. Females are affected more frequently than males in all age groups. B. The incidence of anaphylaxis is increased in urban, as compared with rural, environments. C. The likelihood of a second episode of anaphylaxis decreases as the time between the original event and readministration of the antigen increases. D. Anaphylactic reactions to penicillin are more common in atopic individuals. 4. Which mediator is capable of converting angiotensin I to angiotensin II? A. Carboxypeptidase B. Cathepsin G C. Chymase D. Tryptase 5. Cardiac effects of histamine are mediated through H1 and H2 receptors. Which of the following effects is produced by H1 receptor stimulation? A. Increased force of ventricular contraction B. Increased force of atrial contraction C. Increased rate of atrial contraction D. Hastened diastolic depolarization at the sinoatrial node 6. Multiple mediators are recruited during anaphylaxis and anaphylactic events, activating multiple inflammatory pathways. Which of the following has been demonstrated to be increased in patients with severe anaphylactic reactions? A. C3 B. C3a C. Factor V D. Fibrinogen 7. Nitric oxide is synthesized from L-arginine through the activity of nitric oxide synthase (NOS). Of the options listed below, where is inducible nitric oxide synthase (iNOS) found? A. Endothelium B. Platelets C. Smooth muscle D. Skeletal muscle 8. Signs and symptoms of anaphylaxis may vary in individual patients. Overall, the most frequent manifestations of anaphylaxis ranked from most common to least common are which of the following? A. Cutaneous, Gastrointestinal, Respiratory, Hypotension B. Cutaneous, Respiratory, Hypotension, Gastrointestinal C. Cutaneous, Respiratory, Gastrointestinal, Hypotension D. Respiratory, Cutaneous, Hypotension, Gastrointestinal 9. Which of the following best describes the time course of histamine elevation in association with an anaphylactic episode? A. Begins to rise in 5-10 minutes, remains elevated for 30-60 minutes B. Begins to rise in 5-10 minutes, peaks in 60-90 minutes C. Begins to rise in 5-10 minutes, remains elevated for as long as 5 hours D. Begins to rise in 30-60 minutes, remains elevated for 60-90 minutes 10. What is the appropriate dose and route of administration for Epinephrine for initial management of an adult with anaphylaxis? A. 0.01 mg/kg of a 1:1000 solution IM in the deltoid B. 0.1 mg of 1:1000 aqueous solution diluted in 10mL Normal Saline IV C. 0.1-0.3 mL of a 1:1000 solution IM in the lateral thigh D. 0.3-0.5 mL of a 1:1000 solution IM in the lateral thigh Answers: 1. D, page 1499 2. C, page 1500 3. C, pages 1500-1501 4. C, page 1504 5. D, page 1505 6. B, page 1505 7. C, page 1506 8. B, page 1508 9. A, page 1512 10. D, pages 1514-1516 Nov. 21, 2006 Chapter 82 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 82: Natural Rubber Latex Allergy 1. Many natural rubber latex proteins function as allergens. Health care workers are likely to be sensitized to which of the following proteins? A. Hev b 1 B. Hev b 3 C. Hev b 5 D. Hev b 7 2. Structural homologies exist between Hev b 5 and which of the following foods? A. Avocado B. Banana C. Kiwi fruit D. Potato 3. Which of the following fruits is most likely to cause clinical symptoms in a latex-allergic person? A. Papaya B. Passion fruit C. Pear D. Pineapple 4. Contact dermatitis to rubber is most frequently attributed to which of the following rubber product components? A. Amine derivatives B. Carbamate group C. Thiourea group D. Thiuram group 5. What is the most common early manifestation of rubber allergy? A. Allergic contact dermatitis B. Asthma C. Contact urticaria D. Rhinitis 6. Surgical and household gloves produced by different manufacturers contain different compounds. Patients with sensitivity to which of the following foods may experience glove-related reactions due to the food allergen compounded into gloves? A. Egg B. Milk C. Peanut D. Shrimp 7. Many natural rubber latex proteins function as allergens. Which is a rubber elongation factor (REF)? A. Hev b 1 B. Hev b 3 C. Hev b 5 D. Hev b 7 8. What is the most common reaction to latex products? A. Anaphylaxis B. Asthma C. Irritant contact dermatitis D. Rhinitis 9. Which of the following products is a synthetic elastomer, which poses no risk to persons who are sensitized to natural rubber proteins? A. Balloons B. Condoms C. Neoprene D. Surgical Gloves 10. Which of the following Hospital/Clinic areas has been demonstrated to have the highest latex aeroallergen concentration, based on high-volume air sampling studies? A. Bone marrow transplant unit B. Orthodontics outpatient surgery C. Spirometry laboratory D. Virus serology laboratory Answers: 1. C, page 1487 2. C, page 1488 3. A, page 1489 4. D, page 1490 5. C, page 1490 6. B, page 1487 7. A, page 1487 8. C, pages 1489-1490 9. C, page 1487 10. B, page 1492 November 8, 2006 Chapter 81 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 81:Insect Allergy 1. You are evaluating a 10-year-old boy for seasonal allergic rhinitis. As part of your history, you inquire about a history of reactions to stinging insects. The family reports that the child was stung approximately two years ago. The reaction was a small local reaction, which resolved within several hours. The child had no associated respiratory or cardiovascular symptoms. The family feels that the attack was likely provoked by the patient, who was poking a stick at a nest located in the eaves of the family home. The child’s mother is unsure of what type of insect stung the boy. She inquires if you can make an educated guess. Which of the following insects do you suspect? A. Honeybee B. Paper wasp C. White-faced hornet D. Yellow jacket 2. You are counseling a new patient about the risks and benefits associated with venom immunotherapy. You feel strongly that the patient would benefit from immunotherapy, given his past history of a systemic reaction involving cutaneous and respiratory symptoms. Which of the following statements is the most accurate? A. Venom immunotherapy can be up to 85 to 95 percent effective in preventing systemic reactions to stings. B. Adverse reactions to venom immunotherapy are more common than adverse reactions during inhalant allergen immunotherapy. C. Systemic reactions to venom injections occur more frequently in patients treated with honeybee venom than in those treated with yellow jacket venom. D. Systemic symptoms occur in 25 percent of patients during the initial weeks of venom immunotherapy, regardless of the regimen used. 3. Honeybee venoms are standardized for their content of which of the following antigens? A. Alkaloid toxins B. Antigen-5 C. Hyaluronidase D. Phospholipase A 4. For evaluation of patients with a history of very severe reactions to insect stings, epicutaneous skin testing may be used initially. Which venom concentration is recommended for epicutaneous testing? A. 0.001 micrograms per milliliter B. 0.01 micrograms per milliliter C. 0.1 micrograms per milliliter D. 1.0 micrograms per milliliter 5. Systemic allergic reactions to insect stings are reported by up to what percent of adults? A. 1 percent B. 3 percent C. 10 percent D. 40 percent 6. Treatment recommendations for venom immunotherapy in children are the same as those for adults in which of the following age groups? A. 2 years or older B. 3 years or older C. 4 years or older D. 5 years or older 7. Approximately what percentage of fatal reactions to insect stings occurs in persons with no prior history of allergic reactions to stings? A. 5 percent B. 25 percent C. 50 percent D. 75 percent 8. After a large local reaction, what percent of children are at risk for having a subsequent systemic reaction? A. 5 percent B. 10 percent C. 15 percent D. 25 percent 9. Allergy to which of the following predicts an increased chance of relapse after discontinuation of venom immunotherapy? A. Honeybee B. Paper wasp C. Yellow hornet D. Yellow jacket 10. The frequency of large local reactions to insect stings in adults is estimated at which of the following? A. 1 percent B. 3 percent C. 5 percent D. 10 percent Answers: 1. B, pages 1475-1476 2. C, page 1481 3. D, page 1477 4. B, page 1479 5. B, page 1478 6. B, page 1482 7. C, page 1478 8. B, page 1480 9. A, page 1482 10. D, page 1478
October 25, 2006 October 11, 2006 Chapter 79 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 79: Otitis Media 1. At one month following the first episode of acute otitis media, what percent of children still have a middle ear effusion? A. 10 percent B. 20 percent C. 40 percent D. 7 percent 2. Which of the following host-related factors is associated with a higher incidence of acute otitis media? A. African American ethnicity B. Birth at less than 33 weeks estimated gestational age C. Female gender D. Onset of first episode of acute otitis media after 12 months of age 3. Which of the following occurs more frequently in children with recurrent acute otitis media than in healthy controls? A. HLA-A2 B. HLA-A3 C. Active opening function of the Eustachian tube D. High tubal resistance of the Eustachian tube 4. Which of the following has been associated with an increased risk for ear disease in early childhood? A. Bacterial colonization of pacifiers B. Birth order: firstborn child status C. Breastfeeding D. Increased saliva cotinine 5. What is the most common intratemporal complication of Otitis Media? A. Meningitis B. Hearing loss C. Facial nerve paralysis D. Cholesteatoma 6. Viruses may play a role in secondary bacterial infections and otitis media. Which of the following viruses has been shown to depress granulocytic function and cell-mediated immunity? A. Coxsackie A virus B. Influenza virus C. Rhinovirus D. Respiratory syncytial virus 7. What is the most common complication associated with tympanostomy tubes? A. Tympanosclerosis B. Persistent perforation C. Cholesteatoma D. Otorrhea 8. A 3-year-old child presents with otalgia, fever, postauricular erythema, tenderness, and swelling. What diagnosis should you be most concerned about? A. Meningitis B. Coalescent mastoiditis C. Infected cholesteatoma D. Perforated tympanic membrane 9. What is the major human rhinovirus receptor? A. VLA-1 B. ICAM-1 C. ICAM-3 D. E-Selectin 10. Which is the most common intracranial complication of otitis media? A. Epidural abscess B. Facial nerve paresis C. Mastoiditis D. Meningitis Answers: 1. C, page 1437 2. B, page 1438 3. A, page 1439 4. D, page 1440 5. B, page 1450 6. B, page 1445 7. D, page 1450 8. B, page 1450 9. B, page 1443 10. D, pages 1450-1451 September 27, 2006 Chapter 78 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 78: Nasal Polyps and Sinusitis 1. Which of the following percentages best approximates the number of patients with nasal polyps that have aspirin sensitivity? A. 5 percent B. 15 percent C. 40 percent D. 80 percent 2. Most nasal polyps emerge from which of the following locations? A. Maxillary sinuses B. Clefts of the middle nasal meatus and ethmoidal cells C. Sphenoid and Frontal sinuses D. Middle and superior turbinates 3. Mycetomas or “fungus balls” most commonly affect which of the following? A. Ethmoidal cells B. Frontal Sinus C. Maxillary Sinus D. Sphenoid Sinus 4. Acute, fulminant, necrotizing, invasive fungal sinusitis is primarily caused by which of the following, in immunocompromised hosts? A. Aspergillus flavus B. Aspergillus fumigatus C. Bipolaris specifera D. Curvularia 5. Which of the following cytokines is thought to influence the predominance and activation of eosinophils in nasal polyps, independent of atopy? A. GM-CSF B. IL-3 C. IL-4 D. IL-5 6. Nasal polyp eosinophilic infiltration and activation correlates with increased gene expression of which of the following chemokines? A. Eotaxin B. MCP-3 C. MCP-4 D. RANTES 7. Corticosteroid treatment for nasal polyps appears to increase which of the following, based on protein levels in tissue homogenates of polyp patients? A. Albumin B. ECP C. IL-5 D. TGF-beta1 8. How many episodes of rhinosinusitis per year are required for the definition of chronic rhinosinusitis in a child? A. 4 B. 6 C. 8 D. 10 9. In the sinus fluid of patients with chronic sinusitis undergoing surgery, which of the following are the predominant cells? A. Basophils B. Eosinophils C. Mast cells D. Neutrophils 10. Which of the following cytokines is significantly increased in chronic sinusitis mucosa? A. IL-3 B. IL-4 C. IL-5 D. IL-8 11. A 1980 study evaluated children from 4 to 16 years of age, presenting with nasal polyps. What percentage of these children had Cystic Fibrosis? A. 20 percent B. 35 percent C. 50 percent D. 70 percent 12. What is the most frequent cystic fibrosis transmembrane conductance regulator (CFTR)-mutation found in patients with Cystic Fibrosis? A. R553X B. R347P C. F508 D. F805 13. What is the recommended treatment for Allergic Fungal Sinusitis? A. Surgical intervention only B. Surgical intervention and the use of systemic and long-term topical steroids C. Systemic and long-term topical steroids only D. Systemic anti-fungals and the use of systemic and long-term topical steroids Answers: 1. B, page 1421 2. B, page 1422 3. C, page 1426 4. B, page 1427 5. D, page 1428 6. A, page 1428 7. D, page 1429 8. B, page 1431 9. D, page 1432 10. A, page 1432 11. C, page 1425 12. C, page 1425 13. B, page 1426
September 13, 2006 August 30, 2006 Chapter 76 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 76 Questions: Allergic and Nonallergic Rhinitis 1. At which of the following ages does peak prevalence for allergic rhinitis occur in the United States? A. 10 years B. 19 years C. 24 years D. 35 years 2. Which of the following neurotransmitters has vasodilatory properties and has been shown to stimulate serous cell secretion in human nasal mucosal explants? A. Acetylcholine B. Peptide histidine isoleucine C. Substance P D. Vasoactive intestinal peptide 3. What is the dominant determinant of exudation of extravasated plasma in the nasal mucosa? A. Gaps in endothelial cells at postcapillary venules B. Endothelial cell behavior C. Arteriolar tone D. Decreased capillary vascular pressure 4. Which of the following chemokines is a chemoattractant for T cells, basophils, mast cells, and eosinophils? A. IL-8 B. IL-8 sIgA C. MIP-1 alpha D. RANTES 5. Which of the following constitutes approximately 55 percent of the granular protein content of eosinophils? A. Eosinophil cationic protein B. Eosinophil derived neurotoxin C. Eosinophil peroxidase D. Major basic protein 6. Studies of nasal allergen challenge reveal an early increase in eosinophils 30 to 60 minutes after challenge in recovered nasal lavage fluid and a second increase 6 to 10 hours after challenge, which is sustained for up to 24 hours. This change in eosinophils is paralleled by changes in nasal lavage levels of which of the following? A. Eosinophil cationic protein B. Eosinophil derived neurotoxin C. Eosinophil peroxidase D. Major basic protein 7. The development of basophil-specific antibodies has allowed a detailed evaluation of the localization of basophils within the nasal mucosa. Which of the following is a basophil-specific antibody? A. BB1 B. BB2 C. BB7 D. 2D1 8. Basophils and mast cells generate comparable amounts of which of the following after immunologic activation? A. Chondroitin sulfate A B. LTC4 C. PGD2 D. Tryptase 9. In patients with aspirin-sensitive rhinitis, which of the following is increased in the nasal mucosa? A. IL-2 B. IFN-gamma C. IL-4 mRNA-positive cells D. IL-5 mRNA-positive cells 10. Which of the following is an excitatory stimulus that influences substance P release and its ability to act on different neurokinin receptors within the nose? A. Cannabinoid agonists B. Opiates C. Purines D. Theophylline 11. What is the predominant nasal effect of PGD2, LTC4, and LTD4? A. Rhinorrhea B. Nasal blockage C. Nasal itch D. Sneezing Answers: 1. C, page 1394 2. D, page 1397 3. C, page 1396 4. D, page 1401 5. D, page 1402 6. C, page 1402 7. A, page 1403 8. B, page 1403 9. D, page 1405 10. C, page 1406 11. B, page 1404 August 16, 2006 Chapter 75 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 75: Hypersensitivity Pneumonitis 1. Thermophiles have been studied extensively by in vitro antigenic analysis. Gel precipitation and subfractionation studies have suggested that the major antigens are which of the following? A. Protein complexes B. Polysaccharide complexes C. Acidic glycoproteins D. Basic glycoproteins 2. The most common form of Hypersensitivity Pneumonitis in the pediatric population is related to the inhalation of which of the following? A. Medications B. Insect proteins C. Avian proteins D. Rodent urinary proteins 3. What percentage of pigeon breeders develops Hypersensitivity Pneumonitis? A. 0-5 percent B. 6-21 percent C. 22-34 percent D. 35-50 percent 4. Which antigens are capable of inducing Hypersensitivity Pneumonitis? A. Bacteria, rodent products, plant products, and prions B. Bacteria, viruses, low molecular weight chemicals, and certain drugs C. Fungi, amoebae, avian products, and certain drugs D. Prions, viruses, bacteria, and fungi 5. In the acute form of Hypersensitivity Pneumonitis, arterial blood gases (ABGs) typically demonstrate which of the following? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis 6. Which of the following best represents CD4 and CD8 lymphocyte numbers found in bronchoalveolar lavage samples of patients with Hypersensitivity Pneumonitis vs. normal controls? A. Increased CD4, increased CD8, decreased CD4/CD8 ratio B. Decreased CD4, decreased CD8, decreased CD4/CD8 ratio C. Decreased CD4, increased CD8, decreased CD4/CD8 ratio D. Decreased CD4, decreased CD8, increased CD4/CD8 ratio 7. Which of the following is a major criterion for the diagnosis of Hypersensitivity Pneumonitis? A. Bibasilar dry rales B. Decreased diffusing capacity C. Arterial hypoxemia D. Lung lavage fluid lymphocytosis 8. Which of the following pulmonary diseases is characterized by areas of active collagen synthesis on histopathology studies? A. Primary pulmonary histiocytosis B. Sarcoidosis C. Asthma D. Usual interstitial pneumonia 9. Which of the following groups of symptoms are common in the chronic form of Hypersensitivity Pneumonitis? A. Progressive dyspnea, cough, fever B. Malaise, weakness, fever C. Cough, malaise, anorexia D. Cough, weakness, myalgias 10. Which of the following chemicals, associated with Bathtub refinisher’s lung and Paint refinisher’s lung, is found in varnishes and lacquer? A. Diphenylmethane diisocyanate (MDI) B. Toluene diisocyanate (TDI) C. Phthalic anhydride D. Trimellitic anhydride 11. Which type of Hypersensitivity Pneumonitis has been associated with exposure to amoebae? A. Oyster shell lung B. Tap water lung C. Summer-type/summer house Hypersensitivity Pneumonitis D. Ventilation pneumonitis 12. Which of the following is associated with Farmer’s lung? A. Histoplasmosis B. Cryptococcus C. Thermophilic actinomycetes D. Aspergillus fumigatus Answers 1. C, page 1376-1377 2. C, page 1373 3. B, page 1373 4. C, page 1373 5. B, page 1378 6. A, page 1381 7. D, page 1385 8. D, page 1387 9. C, page 1377 10. B, page 1375 11. D, page 1374-1375 12. C, page 1374 August 2, 2006 Chapter 74 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 74: Allergic Bronchopulmonary Aspergillosis 1. Which of the following clinical or laboratory features is essential for the diagnosis of Allergic Bronchopulmonary Aspergillosis (ABPA)? A. Chest roentgenographic infiltrate B. Elevated total serum immunoglobulin E (IgE) >2,000 ng/mL C. Immediate cutaneous reactivity to Aspergillus D. Peripheral blood eosinophilia 2. Which of the following stages of Allergic Bronchopulmonary Aspergillosis (ABPA) is most likely to be associated with a normal chest roentgenogram? A. I (Acute) B. II (Remission) C. III (Exacerbation) D. IV (Corticosteroid-dependent asthma) 3. Describe the role of Aspergillus fumigatus in complement activation. A. Aspergillus fumigatus is not known to activate complement B. Aspergillus fumigatus activates the alternative pathway of complement C. Aspergillus fumigatus activates the classical pathway of complement D. Aspergillus fumigatus activates the lectin pathway of complement 4. Which of the following is a common presenting finding of an Aspergilloma? A. Dyspnea B. Hemoptysis C. Hypoxia D. Retractions 5. Most of the radiographic findings of Allergic Bronchopulmonary Aspergillosis (ABPA) occur in the dilated central bronchi. In which segments of the lung are they most likely to occur? A. Anterior segments, upper lobes B. Posterior segments, upper lobes C. Anterior segments, lower lobes D. Posterior segments, lower lobes 6. Which of the following describes the most common plain film finding in patients with Allergic Bronchopulmonary Aspergillosis (ABPA)? A. Homogeneous consolidation B. Infiltrates C. Parallel-line shadows D. Ring shadows 7. Aspergillus precipitins occur in patients with asthma who do not have Allergic Bronchopulmonary Aspergillosis (ABPA). Which of the following best represents the number of patients with asthma that have Aspergillus precipitins? A. 1 percent B. 5 percent C. 10 percent D. 15 percent 8. Which of the following statements regarding Aspergillus species is the most accurate? A. Aspergillus species are thermosensitive and are not capable of growing at temperatures from 15 degrees to 53 degrees Celsius. B. Aspergillus flavus is the species of Aspergillus that most frequently infects humans, followed by Aspergillus fumigatus. C. Hyphae from Aspergillus species are too small to be visualized on microscopic examination of sputum. D. Aspergillus spores are 2.0 to 3.5 micrometers in diameter, which permits penetration to the smaller airways. 9. Which of the following glycoproteins of Aspergillus fumigatus is a member of the mitogillin family of cytotoxins (ribotoxins)? A. Asp f 1 B. Asp f 2 C. Asp f 6 D. Asp f 16 10. Which of the following glycoproteins of Aspergillus fumigatus, when used together, are of value in distinguishing Allergic Bronchopulmonary Aspergillosis (ABPA) from asthma? A. Asp f 1, Asp f 2, Asp f 3 B. Asp f 1, Asp f 3, Asp f 5 C. Asp f 2, Asp f 4, Asp f 6 D. Asp f 1, Asp f 2, Asp f 5 Answers: 1. C, page 1355 2. B, page 1355 3. B, page 1359 4. B, page 1354 5. B, page 1361 6. B, page 1361 7. C, page 1365 8. D, page 1353 9. A, page 1367 10. C, page 1367 July 19, 2006 Chapter 73 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 73: Occupational Asthma 1. Which of the following agents is (are) most commonly associated with Irritant-Induced Asthma (IrIA)? A. Acrylate B. Amines C. Ammonia D. Anhydrides 2. Which of the following agents, associated with occupational asthma (OA), is a high molecular weight agent? A. Choramine-T B. Formaldehyde C. Latex D. Wood dust 3. Which of the following low molecular weight agents induces specific IgE antibodies, probably by acting as a hapten and binding with proteins to form a functional antigen? A. Gum B. Latex C. Seafood D. Trimellitic anhydride 4. Which of the following agents can act as a complete antigen? A. Flour B. Persulfate C. Platinum Salt D. Trimellitic anhydride 5. Which of the following cell types plays a central role in occupational asthma without the production of IgE antibodies? A. CD4+ T cells B. CD8+ T cells C. Gamma-delta T cells D. Double-negative T cells 6. Which of the following agents associated with occupational asthma can activate complement in high concentrations? A. Anhydrides B. Diisocyanates C. Persulfate D. Plicatic acid 7. Cigarette smoking influences sensitization and asthma resulting from exposure to which of the following compounds? A. Colophony B. Diisocyanates C. Platinum D. Western Red Cedar 8. The presence of which of the following alleles is thought to be protective in both Western red cedar and diisocyanate-induced occupational asthma? A. DQB1*0104 B. DQB1*0301 C. DQB1*0302 D. DQB1*0501 9. Which of the following statements regarding the diagnosis of occupational asthma is the most accurate? A. A negative methacholine challenge test when the patient is off work and symptom-free excludes the diagnosis of occupational asthma. B. Specific challenge testing for occupational asthma has not been demonstrated to yield either false-positive or false-negative results. C. Serial peak expiratory flow (PEF) monitoring should be conducted every 2 hours for at least 2 weeks while at work and 2 weeks away from work in order to achieve the greatest sensitivity and specificity for the diagnosis of occupational asthma. D. Patients with occupational asthma demonstrate an increase in sputum eosinophils and eosinophil cationic proteins during periods of work exposure, as compared to periods away from work. 10. Which of the following statements regarding occupational asthma and diisocyanates is the most accurate? A. Atopy and smoking are risk factors for the development of Toluene diisocyanate (TDI)-induced occupational asthma. B. Approximately 5 to 10 percent of workers exposed to diisocyanates develop occupational asthma. C. Specific IgE antibodies to Toluene diisocyanate (TDI) are found in the majority of patients with documented disease by specific challenge tests. D. Patients with occupational asthma due to Methylene diphenyl diisocyanate (MDI) have a better prognosis than those with occupational asthma due to either Hexamethylene diisocyanate (HDI) or Toluene diisocyanate (TDI). Answers: 1. C, Pages 1333-1334 2. C, Page 1334 3. D, Pages 1334-1335 4. A, Page 1335 5. B, Page 1335 6. D, Page 1335 7. C, Page 1342 8. D, Page 1342 9. D, Page 1345 10. B, Pages 1347-1348 July 6, 2006 Chapter 72 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 72: Exercise-Induced Airway Narrowing 1. Which of the following statements regarding exercise-induced asthma (EIA) is the most accurate? A. EIA is more common in adults than children. B. EIA is more common in children than adults. C. EIA is more apparent clinically in adults. D. EIA is equally common in adults and children. 2. The upper airways act as a thermal reservoir that enables large volumes of frigid or dry air to be inhaled for prolonged periods without having a material impact on the status of the mucosal surface fluid in the lower airways. Which percentage best represents the contribution of the central airways (glottis to segmental bronchi) to heat and water exchange during hyperpnea? A. 15 percent B. 35 percent C. 50 percent D. 75 percent 3. Which of the following has been linked to respiratory heat exchange and thermally induced asthma? A. Histamine B. Nitric Oxide C. Neutrophil Chemotactic Factor D. Tryptase 4. Receptor antagonists for which of the following leukotrienes blunt thermally induced airflow limitation? A. Leukotriene A4 B. Leukotriene B4 C. Leukotriene C4 D. Leukotriene D4 5. Peak obstruction during exercise-induced asthma (EIA) occurs at which time point during exercise? A. Prior to the start of exercise B. 5 to 10 minutes after the start of exercise C. 5 to 10 minutes after completion of exercise D. 30 minutes after completion of exercise 6. Spontaneous resolution of obstruction during exercise-induced asthma (EIA) occurs at which time point related to exercise? A. 30 minutes after the start of exercise B. 5 to 10 minutes after completion of exercise C. 30 minutes after completion of exercise D. 45 minutes after completion of exercise 7. Inspiration of which of the following minimizes obstruction in patients with exercise-induced asthma (EIA)? A. Cold and dry air B. Cold and humid air C. Warm and dry air D. Warm and humid air 8. Which of the following precipitants of asthma induces tachyphylaxis? A. Aspirin B. Beta-blockers C. Exercise D. Viral infection 9. Exercise-induced asthma (EIA) is confirmed by a recorded fall in the peak expiratory flow rate or FEV1 after thermal challenge of which of the following percentages? A. 10 percent B. 12 percent C. 15 percent D. 20 percent 10. Bronchial narrowing progressively decreases when bouts of exercise are repetitively performed within which of the following intervals? A. 40 minutes of one another B. 60 minutes of one another C. 80 minutes of one another D. 100 minutes of one another Answers: 1. D, page 1323 2. A, page 1324 3. B, pages 1325-1226 4. D, page 1326 5. C, page 1327 6. C, page 1327 7. D, page 1327 8. C, page 1328 9. C, page 1329 10. A, page 1328 June 21, 2006 Chapter 71 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 71: Asthma and Allergic Diseases During Pregnancy 1. Which of the following increases during pregnancy? A. Expiratory reserve volume B. Functional residual capacity C. Residual volume D. Tidal volume 2. Which of the following is preserved during pregnancy? A. Expiratory reserve volume B. Functional residual capacity C. Residual volume D. Total lung capacity 3. Numbers of which of the following cells are reduced during pregnancy? A. CD4 lymphocytes B. CD8 lymphocytes C. Natural killer cells D. Polymorphonuclear neutrophil leukocytes 4. Use of which of the following asthma medications during pregnancy has been associated with severe unusual cardiac congenital malformations? A. Albuterol B. Ipratropium C. Salmeterol D. Theophylline 5. Use of which of the following antihistamines during pregnancy has been associated with an increase in oral cleft congenital malformations in a case-control study? A. Cetirizine B. Dexchlorpheniramine C. Diphenhydramine D. Loratadine 6. Which class of antibiotics should be used to treat bacterial complications of asthma or allergic diseases during pregnancy or lactation? A. Penicillins B. Quinolones C. Sulfonamides D. Tetracyclines 7. Which vaccine could theoretically potentiate AO hemolytic disease of the newborn infant when given during an AO incompatible pregnancy? A. Influenza B. Hepatitis B C. Pneumococcal D. Yellow fever 8. If a high-dose inhaled corticosteroid is needed during pregnancy, which of the following medications is recommended? A. Beclomethasone B. Budesonide C. Fluticasone D. Flunisolide 9. Avoidance of which of the following leukotriene modifiers is recommended during pregnancy? A. Montelukast B. Pranlukast C. Zafirlukast D. Zileuton 10. In the management of a pregnant woman with acute asthma, an arterial blood gas should be obtained for a pulse oximetry measurement of less than which of the following? A. 99 percent B. 95 percent C. 90 percent D. 88 percent Answers: 1. D, page 1303 2. D, page 1303 3. C, pages 1305-1306 4. D, page 1309 5. C, page 1308 6. A, page 1311 7. C, page 1311 8. B, page 1313 9. D, page 1313 10. B, page 1314 June 7, 2006 Chapter 70 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 70: Asthma Guidelines and Outcomes 1. Diurnal variation of expiratory flows has been suggested for the diagnosis of asthma, as well as for asthma control and severity assessment. Diurnal variability greater than which of the following is suggested to be significant? A. 12 percent B. 15 percent C. 20 percent D. 25 percent 2. According to the 1998 revised Global Initiative for Asthma (GINA) Guidelines, peak expiratory flow (PEF) variability of 20-30 percent would fall into which category of asthma severity? A. mild intermittent B. mild persistent C. moderate persistent D. severe persistent 3. What is the single most effective method to reduce exposure to house dust mite allergen? A. maintaining relative humidity below 50 percent B. removal of carpeting C. use of a high-efficiency particulate air (HEPA) filter D. encasing mattresses in mite allergen-impermeable covers 4. According to the 1998 revised Global Initiative for Asthma (GINA) Guidelines, peak expiratory flow (PEF) variability of less than 30 percent would fall into which category of asthma severity? A. mild intermittent B. mild persistent C. moderate persistent D. severe persistent 5. According to the 1998 revised Global Initiative for Asthma (GINA) Guidelines, peak expiratory flow (PEF) between 60 and 80 percent of predicted would fall into which category of asthma severity? A. mild intermittent B. mild persistent C. moderate persistent D. severe persistent 6. According to the 1998 revised Global Initiative for Asthma (GINA) Guidelines, night-time asthma symptoms more than two times per month would fall into which category of asthma severity? A. mild intermittent B. mild persistent C. moderate persistent D. severe persistent 7. According to the 1995 Global Initiative for Asthma (GINA) Guidelines, asthma treatment should be reviewed regularly. A gradual stepwise reduction in treatment may be possible if control is sustained for which of the following time periods? A. at least 1 month B. at least 2 months C. at least 3 months D. at least 6 months 8. Practical recommendations on environmental control measures for house dust mite allergic patients include maintaining relative humidity in the home below which of the following? A. 90 percent B. 70 percent C. 50 percent D. 30 percent 9. Asthma guidelines suggest which of the following as a target of therapy, rather than for use in guiding treatment? A. peak expiratory flow (PEF) B. forced expiratory volume in 1 second (FEV1) C. symptoms D. airway inflammation 10. According to the 1995 Global Initiative for Asthma (GINA) Guidelines, addition of a long-acting bronchodilator is first recommended for asthma treatment at which of the following categories of asthma severity? A. mild intermittent B. mild persistent C. moderate persistent D. severe persistent Answers: 1. C, Page 1286 2. B, Page 1287 3. D, Page 1288 4. C, Page 1287 5. C, Page 1287 6. B, Page 1287 7. C, Page 1289 8. C, Page 1288 9. D, Page 1287 10. B, Page 1289 May 24, 2006 Chapter 69 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 69: Asthma in Adults: Evaluation and Management 1. Which of the following statements regarding the role of air pollution and asthma is true? A. Diesel exhaust particles can enhance human IgE production, and have been implicated in the worldwide increased prevalence of allergic asthma. B. Endotoxin is not an important factor contributing to asthma exacerbations. C. Nitrogen dioxide at 0.3 ppm (six times the National Ambient Air Quality Standard) will have an effect on exercising individuals with stable asthma. D. Asthma severity correlates better with levels of dust mite allergen in house dust than endotoxin in house dust, in dust mite-sensitive asthmatics. 2. Pulmonary function tests (PFTs) can be used to establish the diagnosis of asthma, to quantify the severity of the disease, and to monitor the course of the disease and response to therapy. Which of the following statements regarding PFTs and asthma is correct? A. Greater than 15 percent improvement of forced expiratory volume in 1 second (FEV1) after inhalation of a beta2-adrenergic agonist is required to make the diagnosis of asthma. B. Greater than 20 percent diurnal (evening to morning) fall in peak expiratory flow (PEF) is indicative of asthma. C. The presence of airway obstruction is pathognmonic for asthma. D. Reversibility of obstruction with bronchodilators is pathognmonic for asthma. 3. When do the majority of in-hospital sudden deaths and episodes of ventilatory arrest from asthma occur? A. Morning B. Afternoon C. Evening D. Night 4. Which of the following decreases in diurnal (evening to morning) peak expiratory flow (PEF) is indicative of asthma? A. Greater than 10 percent B. Greater than 12 percent C. Greater than 20 percent D. Greater than 30 percent 5. A flow-volume loop demonstrating a rapid fall of flow rate and a marked prolongation of expiration is most consistent with which of the following disease states? A. Asthma B. Fixed airway obstruction C. Emphysema D. Vocal cord dysfunction 6. Which of the following statements regarding methacholine bronchoprovocation is the most accurate? A. A decrease in forced expiratory volume in 1 second (FEV1) of greater than 20 percent after inhalation of methacholine is seen only in asthma patients. B. Infants and young children do not exhibit airway reactivity to methacholine, unless they have asthma. C. Approximately 5 percent of the apparently normal population exhibits airway reactivity to methacholine. D. In non-asthmatic patients with airway reactivity to methacholine, there is a plateau in the bronchoconstrictive response. 7. Creola bodies include which of the following cell types? A. Eosinophils B. Epithelial cells C. Mast cells D. Neutrophils 8. Which of the following is a common side effect related to theophylline? A. Hypocalcemia B. Hypokalemia C. Hypercalcemia D. Hyperkalemia 9. Which of the following statements regarding eosinophils and asthma is the most accurate? A. Peripheral blood eosinophil numbers and eosinophilic cationic protein levels in bronchoalveolar lavage (BAL) fluids correlate with severity of disease. B. Serum ECP is a good indicator of disease activity in chronic asthma. C. Treatment with anti-IL-5 antibody reduces circulating and sputum eosinophil numbers with a corresponding improvement in clinical symptoms. D. Sputum eosinophils are more readily reduced with corticosteroid therapy than are blood eosinophils. 10. The improvement seen in forced expiratory volume in 1 second (FEV1) with the use of leukotriene modulators, as compared with inhaled corticosteroids, is best described as? A. Less, sooner B. More, sooner C. Less, later D. More, later Answers: 1. A, page 1259 2. B, page 1261 3. D, page 1259 4. C, page 1260 5. C, page 1260 6. D, page 1262 7. B, page 1264 8. C, page 1270 9. A, page 1264 10. A, page 1273 May 10, 2006 Chapter 68 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 68: Asthma in Infancy and Childhood 1. Which of the following best represents the percentage of children who experience only transient wheezing prior to 2 years of age? A. 10% B. 15% C. 20% D. 25% 2. Which of the following best represents the percentage of children with asthma who develop symptoms within their first year of life? A. 10% B. 30% C. 50% D. 80% 3. Prenatal and perinatal risk factors for the development of asthma in inner-city African American children have been evaluated using obstetric, perinatal, and pediatric records. Which of the following is the strongest independent predictor of asthma? A. Maternal smoking during pregnancy B. Low maternal weight gain C. Positive-pressure ventilation at birth D. Maternal history of asthma 4. Cord blood mononuclear cells from children destined to be at increased risk of developing allergic diseases or asthma produce decreased quantities of which of the following cytokines as compared with nonatopic control children? A. IL-4 B. IL-5 C. IL-6 D. INF-gamma 5. Which of the following represents the duration of significant bronchodilation following administration of salmeterol? A. 3-6 hours B. 6-10 hours C. 10-12 hours D. 12-18 hours 6. Which of the following medications is a 5-lipoxygenase inhibitor? A. Montelukast B. Zafirlukast C. Zileuton D. Pranlukast 7. Which of the following best represents the percentage of children who wheeze as infants who will go on to develop persistent wheezing after age 3 years? A. 5 percent B. 15 percent C. 25 percent D. 30 percent 8. Increasing asthma symptoms and reductions in home peak expiratory flow rates have been temporally associated with which of the following infections in school-age children? A. Respiratory syncytial virus (RSV) B. Influenza virus C. Coronavirus D. Rhinovirus 9. Which of the following statements is most accurate? A. Dog allergen exposure in early life is linked to decreased risk of recurrent wheezing in children with no family history of asthma. B. Early exposure to cat allergen increases the incidence of asthma as early as age 4. C. Hospitalization rates for asthma in urban environments do not correlate with low median family income. D. Hospitalization rates for children with asthma decreased from 1980-1999. 10. Which of the following statements is most accurate regarding asthma and linear growth? A. Delays in height attainment correlate with the severity of asthma. B. Comparison of asthmatic children with their pubertal peers demonstrates a decreased growth potential. C. Comparison of asthmatic children with their pubertal peers demonstrates a decreased eventual adult height attained. D. Comparison of asthmatic children with their pubertal peers demonstrates a temporary relative slowing of growth velocity. Answers: 1. C, page 1225 2. B, page 1226 3. D, page 1226 4. D, page 1229 5. D, page 1246 6. C, page 1249 7. B, page 1251 8. D, page 1227 9. A, page 1228 10. D, page 1235 April 26, 2006 Chapter 67 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 67: Pathology of Asthma Compared with Chronic Obstructive Pulmonary Disease 1. Which of the following statements regarding chronic obstructive pulmonary disease (COPD) and asthma is true? A. In COPD, the small airways are the major source of the hypersecretion associated with the production of sputum. B. Bronchial asthma and COPD are chronic inflammatory disorders of the conducting airways and lung parenchyma. C. The predominant anatomic zone affected by asthma is confined to the large airways. D. The large airways are considered the main site responsible for airflow limitation in COPD. 2. A characteristic feature found in sputum obtained from asthmatic, but not bronchitic patients, is a corkscrew-shaped twist of condensed mucus. This is referred to as a: A. Curschmann’s spiral B. Creola body C. Charcot-Leyden crystal D. Clara cell complex 3. Which of the following cell types is most characteristically found in the sputum of patients with chronic obstructive pulmonary disease (COPD)? A. Eosinophils B. Metachromatic cells C. Macrophages D. Creola bodies 4. Which of the following changes in mucus-secreting elements is found in chronic obstructive pulmonary disease (COPD), rather than in both chronic obstructive pulmonary disease (COPD) and in asthma? A. Submucosal gland enlargement B. Excessive production of mucus C. Change in proportion of serous and mucous acini D. Goblet cell hyperplasia 5. Which of the following cluster of differentiation (CD) markers is typically found in the cellular infiltrate of chronic obstructive pulmonary disease (COPD), rather than in both chronic obstructive pulmonary disease (COPD) and asthma? A. CD3 B. CD25 C. CD4 D. CD68 6. Which of the following ratios best describes the CD4/CD8 ratio in inflammatory cells of subjects with atopic asthma? A. 1:2 B. 1:4 C. 3:1 D. 3:2 7. In symptomatic asthma, which of the following cytokines has been reported to increase during the late-phase response to allergen A. IL-2 B. IL-6 C. GM-CSF D. TNF-alpha 8. Which of the following cytokines encourages the selective recruitment of eosinophils by up-regulating vascular cell adhesion molecule-1 (VCAM-1) on bronchial epithelial cells? A. IL-4 B. IL-5 C. GM-CSF D. TGF-beta 9. Which of the following ratios best describes the CD4/CD8 ratio in inflammatory cells of subjects with chronic bronchitis and chronic obstructive pulmonary disease (COPD)? A. 3:1 B. 1:4 C. 1:2 D. 2:2 10. Which of the following features of the epithelial basement membrane is highly characteristic of asthma? A. Thickening of the “true” epithelial basement membrane B. Focal and variable thickening of the lamina reticularis C. Homogeneous and hyaline thickening of the lamina reticularis D. Thickening of the lamina basalis Answers 1. B, page 1209 2. A, page 1211 3. C, page 1210 4. C, page 1212 5. D, page 1210 6. C, page 1219 7. C, page 1218 8. A, page 1217 9. C, page 1219 10. C, page 1211 April 12, 2006 Chapter 66 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 66: Asthma Pathogenesis 1. Which cells are resident cells of the airways, rather than recruited from the circulation to the lungs? A. Eosinophils B. Mast cells C. T-lymphocytes D. Neutrophils 2. A 47-year-old man presents at the request of his employee-health physician for evaluation of possible occupational asthma. Which of the following statements regarding occupational asthma is most correct? A. Occupational asthma is universally a progressive condition. B. Occupational asthma is potentially curable with early removal of the worker from exposure to the sensitizing agent. C. Occupational asthma is invariably due to a usual aeroallergen exposure. D. Occupational asthma always occurs due to a hapten-induced specific IgE response. 3. After a documented case of Respiratory Syncytial Virus (RSV) bronchiolitis, approximately which percentage of patients will demonstrate persistent wheezing after 5 years? A. 10% B. 40% C. 60% D. 75% 4. Curschmann’s spirals are found within mucus plugs in asthmatic airways. Which cell type is often arranged in a spiral pattern, composing Curschmann’s spirals? A. Dendritic cells B. Eosinophils C. Macrophages D. Neutrophils 5. Which cells are considered to be the predominant and most characteristic cells in asthma? A. Dendritic cells B. Eosinophils C. Macrophages D. Neutrophils 6. Which of the following is the predominant cell found during virus-induced exacerbations of asthma? A. Eoinophil B. Mast cell C. Lymphocyte D. Neutrophil 7. Which of the following cytokines is thought to have regulatory functions, and contributes to fibroblast generation of extracellular matrix (ECM) proteins in asthma? A. IL-1 B. IL-6 C. IFN-alpha D. IL-11 8. Which of the following cytokines enhances the synthesis of collagens I and III, fibronectins, tenascin, and proteoglycans? A. Insulin-like growth factor (IGF) B. Platelet-derived growth factor (PDGF) C. Transforming growth factor beta (TGF-beta) D. Tumor necrosis factor (TNF) 9. You are asked by a concerned parent about a possible association of wheezing with allergy and viral airway infection. Which of the following is most correct? A. Evidence of allergy in combination with the presence of virus in nasal secretions synergistically increases the odds ratio for wheezing. B. It is unlikely that there is any increased risk for wheezing in allergic patients with viral airway infection versus non-allergic patients. C. Common viral infections have no impact on lower airway function and wheezing. D. Allergy alone accounts for virtually all cases of wheezing. 10. Neonatal T cells produce relatively low levels of which of the following cytokines? A. IL-4 B. IL-5 C. IL-10 D. IFN-gamma 11. For low-molecular-weight chemicals implicated in occupational asthma, specific IgE or IgG antibodies have generally not been clearly implicated. For which of the following low-molecular-weight chemicals is an increased role of CD8+T cells in the absence of IgE suspected in occupational sensitization? A. Acid anhydrides B. Ethanolamines C. Toluene isocynate D. Plicatic acid 12. Eosinophil secondary granules contain four principal basic proteins. Which protein is believed to function as a parasitic toxin, may produce many of the deleterious effects on the airway tissue seen in asthma, and has been found in high concentrations near areas of desquamated epithelium in asthmatic airways? A. Major basic protein (MBP) B. Eosinophil cationic protein (ECP) C. Eosinophil peroxidase (EPO) D. Eosinophil-derived neurotoxin (EDN) 13. Which of the following prostanoids has bronchodilator and anti-inflammatory activity? A. PGD 2 B. PGF 2 alpha C. PGE 2 D. Thromboxane A2 14. Nonallergic asthma patients have a cytokine profile that includes predominant increased expression of which of the following cytokines? A. IL-3 B. IL-4 C. IL-5 D. GM-CSF 15. A potential role for Chlamydia pneumoniae has been described in the pathogenesis of asthma and asthma exacerbations in some patients. With regard to these associations, which of the following statements is most correct? A. C. pneumoniae induces a profound and universal Th2-type response in all patients regardless of HLA phenotype. B. Intracellular bacteria such as C. pneumoniae down-regulate all cytokine production. C. C. pneumoniae may stimulate Th2-type cytokines when presented in the context of HLA-DR15, while it may stimulate Th1-type cytokines when presented by cells expressing HLA-DR4. D. An association between C. pneumoniae antibody titers and wheezing has not been demonstrated. Answers 1. B, page 1178 2. B, page 1189 3. B, page 1183 4. C, page 1177 5. B, page 1178 6. D, page 1193 7. D, page 1189 8. C, page 1180 9. A, page 1187 10. D, page 1182 11. C, page 1189 12. A, page 1192 13. C, page 1194 14. C, page 1195 15. C, page 1188 March 29, 2006 Chapter 65 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 65: Natural History, Development, and Prevention of Allergic Disease in Childhood 1. Which of the following study designs is able to identify risk factors associated either with the new onset of a disease or with the severity of an illness? A. Cross-sectional B. Retrospective C. Quasi-experimental D. Longitudinal 2. Specific IgE antibodies to food allergens are detectable in up to which percentage of 1-year-old children? A. 5% B. 10% C. 15% D. 25% 3. Sensitization against inhalant allergens generally develops in children at which of the following ages? A. The first months of life B. The first year of life C. Between 1 and 2 years of life D. After 3 years of life 4. Atopic eczema is primarily related to IgE responses to which of the following? A. Dietary allergens B. House dust mites C. Pollens D. Molds 5. Cohort studies of children with asthma in Germany, Australia and the United States have shown that early sensitization is a characteristic feature of childhood asthma. Which of the following has been most closely associated with an increased risk of asthma? A. Sensitization to inhalant allergens after 8 years of age B. Paternal history of asthma C. Elevated concentration of total serum IgE at birth D. Food sensitization before age 1 to 2 years 6. Different mechanisms may determine allergic sensitization during childhood. Which of the following statements with regard to allergen sensitization and development of asthma is the most accurate? A. Sensitization related to asthma occurs at low doses, with no dose-response association with the degree of exposure to the corresponding allergen. B. Sensitization related to asthma occurs at low doses and has a strong dose-response association with the degree of exposure to the corresponding allergen. C. Sensitization related to asthma occurs at very high doses of allergen exposure. D. The development of allergic sensitization is not different among specific allergen exposures; such as cat, dog, and house dust mite. 7. Environmental exposure to which of the following, as assessed in mattress dust levels, significantly decreases the risk of hay fever, atopic sensitization, and atopic asthma in childhood? A. Fungi B. Mold C. Endotoxin D. Gram-positive germs 8. There is evidence of a dose-response relationship between allergen exposure and atopic sensitization to the specific allergen for which of the following allergens? A. Dog B. Dust mite C. Cockroach D. Ragweed 9. Contact with which of the following is thought to explain the relationship between farming and atopy? A. Rodents B. Smog-free air C. Livestock D. Silos 10. By the school-age years, which percentage of children in a Western population will be sensitized to one of the following environmental allergens: house dust mites, animal dander, various pollens, and molds? A. 0-25% B. 5-15% C. 15-25% D. 25-65% Answers: 1. D, page 1169 2. B, page 1169 3. D, page 1169 4. A, page 1169 5. D, page 1170 6. A, page 1171 7. C, page 1172 8. B, page 1170 9. C, page 1172 10. D, page 1169 March 15, 2006 Chapter 64 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 64, Part B (pages 1148-1168): Epidemiology of Asthma and Allergic Disease 1. Which of the following statements with regard to airway reactivity in patients with a history of bronchopulmonary dysplasia (BPD) is the most accurate? A. Airway reactivity in patients with a history of BPD in infancy is strongly associated with a family history of asthma. B. Airway reactivity in patients with a history of BPD is associated with an increased prevalence of atopy. C. Most patients with a history of BPD during infancy do not have pulmonary dysfunction as adolescents and young adults. D. Airway reactivity in patients with a history of BPD in infancy is not associated with a more frequent family history of asthma. 2. Occupational asthma is caused by exposure to a specific agent or conditions in a particular occupational setting. Which of the following groups of agents is correctly paired with the suspected pathogenic mechanism? A. High-molecular-weight agents: induce occupational asthma by nonimmunologic mechanisms B. Low-molecular-weight agents: induce specific IgE antibodies C. Irritant gases, fumes and chemicals: induce specific IgE antibodies D. High-molecular-weight agents: induce specific IgE antibodies 3. Studies have investigated the possible role of specific air pollutants in the development of asthma. Which of the following, related to road traffic, has been associated with an increased prevalence in physician-diagnosed asthma (after adjusting for potential confounders)? A. Benzene B. Sulfur dioxide C. Nitrogen dioxide D. Carbon monoxide 4. In 2000, The Institute of Medicine, Committee on the Assessment of Asthma and Indoor Air, published “Clearing the air: asthma and indoor air exposures.” According to data from the Institute of Medicine, for which of the following indoor exposures is there significant evidence of a causal relationship in the development of asthma? A. Cat B. Dog C. House dust mite D. Cockroach 5. Which of the following statements regarding determinants in childhood asthma is the most accurate? A. Asthma occurs more frequently in girls than boys. B. Smoking during adolescence has been associated with decreased risk for the persistence of symptoms. C. Treatment of asthma in childhood alters the natural history of the disease. D. Persistence of eczema has been associated with persistence of asthma. 6. The 1996 National Health Interview Survey (NHIS) estimated that about 24 million Americans have allergic rhinitis. In which area of the country was the highest prevalence of seasonal allergic rhinitis reported? A. South B. West C. Midwest D. Northeast 7. Which of the following risk factors for allergic rhinitis is best supported by current epidemiologic studies? A. Very young age B. Air pollution C. Low socioeconomic status D. Parental history 8. In 2000, The Institute of Medicine, Committee on the Assessment of Asthma and Indoor Air, published “Clearing the air: asthma and indoor air exposures.” According to data from the Institute of Medicine, for which of the following biological agents is there sufficient evidence of a causal relationship for exacerbation of asthma in sensitive individuals? A. Chlamydia trachomatis B. Cow C. Houseplants D. Cockroach 9. In 2000, The Institute of Medicine, Committee on the Assessment of Asthma and Indoor Air, published “Clearing the air: asthma and indoor air exposures.” According to data from the Institute of Medicine, for which of the following chemical agents is there sufficient evidence of a causal relationship for exacerbation of asthma in sensitive individuals? A. Environmental tobacco smoke in preschool children B. Formaldehyde C. Environmental tobacco smoke in school-aged children D. Pesticides 10. Which of the following statements regarding tobacco smoking and asthma is the most accurate? A. Young smokers have greater lung function and a lesser degree of underlying airway responsiveness than nonsmokers. B. Smokers report wheezing less frequently than do nonsmokers. C. Active cigarette smoking has been directly linked to asthma as a cause. D. Active smoking decreases nonspecific airway responsiveness. 11. The Tucson study by Martinez et al. described the natural history of wheezing beginning before age 3 years. Continued wheezing up to age 6 years was associated with which of the following? A. Maternal history of asthma B. Diminished airway function in early life C. Decreased IgE levels D. Paternal history of asthma Answers: 1. D, page 1148 2. D, page 1149 3. A, page 1152 4. C, page 1154 5. D, pages 1159-1160 6. B, page 1162 7. D, page 1163 8. D, page 1155 9. A, page 1155 10. A, pages 1154-55 11. A, page 1156 March 1, 2006 Chapter 64 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al. Chapter 64, Part A: Epidemiology of Asthma and Allergic Disease 1. The National Health Interview Survey (NHIS) is a population-based interview survey of United States households. The NHIS is a key source of longitudinal information on the prevalence of asthma. Based on the 1996 NHIS estimates, approximately what percentage of United States residents have asthma? A. 3.5% B. 5.5% C. 7.5% D. 9.5% 2. Which of the following groups had the highest asthma mortality rate from 1980 to 1998 for United States residents less than 35 years old, by race and age? A. Whites, age 15-24 years B. Blacks, age 15-24 years C. Whites, age 25-34 years D. Blacks, age 25-34 years 3. Asthma incidence rates are the highest in which of the following age and gender groups? A. Young boys B. Young girls C. Young-adult men D. Young-adult women 4. Ambulatory care visits due to asthma demonstrate one aspect of asthma morbidity. Two ambulatory care surveys were conducted in the United States in 1999. According to these 1999 ambulatory care surveys, which of the following statements about ambulatory care visits for asthma is the most accurate? A. Persons older than 18 years had higher rates of health care utilization than did persons younger than 18 years B. Rates for Emergency Department visits were highest among the elderly C. Race is not significantly associated with Emergency Department use D. Rates for Emergency Department visits were highest among children younger than 4 years 5. Among Hispanic Americans, asthma mortality rates between 1990 and 1995 differed by region of the country. Which area of the country had the highest mortality rates? A. Southwest B. Southeast C. Midwest D. Northeast 6. Data from epidemiologic studies consistently reveal male gender to be a risk factor for asthma in children. The statement that most accurately describes this risk is: A. Before age 14 years, asthma prevalence in boys is as much as 1.5 times that in girls B. Before age 14 years, asthma prevalence in boys is as much as 2 times that in girls C. Before age 14 years, asthma prevalence in boys is as much as 5 times that in girls D. Before age 14 years, asthma prevalence in boys is as much as 10 times that in girls 7. Intake of which of the following has been negatively associated with asthma risk? A. Sodium B. Micronutrients C. Apples D. Trans fatty acids 8. The association of obesity with asthma has been investigated in both adults and children. In the Tucson Children’s Respiratory Study, girls becoming overweight or obese between ages 6 and 11 years were at an increased risk for asthma. This increased risk is best represented by: A. Fivefold B. Sevenfold C. Tenfold D. Fifteenfold 9. A community-based study in Tecumseh, Mich., estimated the frequency of lower respiratory tract infections (LRI) in children in the first year of life. Which of the following numbers best approximates the average number of LRIs experienced by children in the first year of life, according to the study? A. 2 B. 3 C. 4 D. 5 10. Which of the following is a risk factor for asthma? A. Female gender B. Rural living C. Low dietary intake of sodium D. Maternal smoking 11. In adult patients, chronic obstructive pulmonary disease (COPD) overlaps with asthma. Which symptom, listed below, is the cardinal clinical manifestation of COPD? A. Cough B. Wheezing C. Nocturnal cough D. Dyspnea Answers: 1. B, page 1130 2. D, page 1142 3. A, page 1136 4. D, page 1138 5. D, page 1142 6. B, page 1145 7. C, page 1146 8. B, page 1147 9. A, page 1147 10. D, page 1130 11. D, page 1128 February 15, 2006 |