1.

Immediate allergy reaction (type I allergic reaction) is:

+A) An allergic or immune response that begins within a period lasting from a few minutes to about
an hour after exposure to an antigen to which the individual has been sensitized

B) An allergic reaction that becomes apparent only hours after contact

C) An allergic reaction that results from the formation of antigen antibody complexes between a
foreign antigen and IgM or IgG immunoglobulins.

D) An allergic reaction that is due to the presence of elevated levels of antigen antibody complexes
that cause tissue damage

E) It occurs during blood transfusion reactions and in hemolytic disease of the newborn.

2. Immunodeficiency:

A) A localized protective reaction of tissue to irritation, injury, or infection, characterized by pain,

redness, swelling, and sometimes a loss of function

+B) A disorder or deficiency of the normal immune response

C) A disease resulting from an immune reaction produced by an individual's white blood cells or
antibodies acting on the body's own tissues or extracellular proteins

D) A disease caused by immune system when the drug passes 1st pass effect and damage the liver.

E) It is an immunity disorder which is genetically transferred.

3. Delayed allergy reaction (type IV allergic reaction) is:

A) An An allergic or immune response that begins within a period lasting from a few minutes to
about an hour after exposure to an antigen to which the individual has been sensitized

+B) An allergic reaction that becomes apparent only hours after contact

C) An allergic reaction that results from the formation of antigenantibody complexes between a
foreign antigen and IgM

D) allergic reaction that is due to the presence of elevated levels of antigenantibody complexes that
cause tissue damage

E) An allergic disorder which is transferred genetically.

4. Which one of the following statements is false? Allergic asthma is characterized by:

A) Is characterized by reversible airways obstruction.

B) T2 cells are found in bronchoalveolar lavage fluid.

C) Affects 5% of the population.

+D) Is diagnosed routinely by use of ELISA

5. Hypersensitivity refers to undesirable reactions produced by

A) circulatory system

B) Respiratory system

+C) Immune System

D) Endocrine system

E) Autonomic nervous system

6. Which of these is more likely to be a sign that the acute urticaria observed may be life
threatening?

a) Dermatographism

+b) Angioedema of the lips

c) Blanching, palpable wheals

d) Lesions that persist for 12 hours

7. Which is most accurate about physical examination findings associated with urticaria?

a) typically lasts 6-8 weeks and often causes residual scarring

b) Tiny pinpoint hives are commonly associated with cold-induced lesions

+c) Angioedema of the face, hands, and feet occurs in the vast majority of patients

d) Permanent hyperpigmentation or hypopigmentation is often caused by excessive

dermatographism

8. Which of these helps distinguish contact dermatitis (CD) from contact urticaria (CU)?

+A) CD develops hours to days after contact with the agent, whereas CU is immediate yet transient

b) CD lesions are more likely than CU lesions to appear arcuate (serpiginous)

c) Patch testing is the only way to definitively exclude CD if both CU and CD are possible

d) Corticosteroid response confirms that lesions are caused by CD as opposed to CU

9. Which of these is a first-line, single-agent treatment for most cases of acute urticaria?

A) Diphenhydramine

+ B) Fexofenadine

C) Famotidine

d) Epinephrine
10. Which statement about the workup for severe asthma is correct?

A) Chest radiography has little clinical utility in the management of severe asthma

B) Inflammatory endotype characterization is not clinically relevant to the management of severe

asthma

+ C) Confirmation of reversible airflow limitation should be obtained

D) Allergen-inhalation challenges are recommended for most patients

11. Which statement about the management of severe asthma is correct?

A) Overuse of short-acting beta2 agonists (SABAs) has no impact on asthma severity

B) Current use of inhaled corticosteroids is associated with increased risk for asthma-related death

C) Absence of oral corticosteroid use has been shown to increase asthma-related mortality

+ D) Overuse of SABAs has been shown to increase the risk for asthma-related death

12. Which statement about the management of severe asthma is accurate?

A) Macrolide therapy should be avoided in patients with severe uncontrolled asthma

B) Measurement of blood eosinophil level has little predictive value when initiating anti-IgE therapy

C) Anti-IL-5 and anti-IL-5Rα therapies reduce hospitalizations but not exacerbations in patients with
severe eosinophilic asthma

+ D) In patients with uncontrolled severe asthma, the addition of a long-acting muscarinic agent may
reduce use of as-needed SABAs

13. Which statement is true regarding risk factors for Atopic dermatitis development?

A) Infants who were not breastfed are at a higher risk for moderate to severe AD

+ B) Filaggrin (FLG) gene mutation is associated with the development of AD

C) Cat-sensitized children are at decreased risk for inflammatory skin conditions

D) Cesarean birth increases risk for AD

14. Which sign indicates that allergic asthma is well controlled?

A. Symptoms limited to 2-3 days per week

+ b. No nocturnal awakenings

c. Short-acting beta-agonist use (rescue inhaler) limited to 3-4 days per week

d. Limited to two to three exacerbations per year requiring oral systemic corticosteroid therapy
15. Which statement is most accurate about the medical management of allergic asthma?

A. Anti-inflammatory medications (eg, inhaled corticosteroids) are recommended for all patients
with allergic asthma, including those with mild intermittent allergic asthma

B. Allergen immunotherapy is not effective for allergy-induced asthma

+ C. Sublingual immunotherapy is safe for home administration

D. Biologic (monoclonal anibodies) therapy is associated with reductions in asthma exacerbations

but no improvement in the frequency of oral corticosteroid use

16. The ED physician prescribed the patient a 5-day course of oral steroids and 60 g triamcinolone
0.1% ointment twice daily for 2 weeks; discussed gentle skin care (including short showers and daily
moisturizer); and instructed her to follow up with her primary care provider or dermatologist within
1 week.

Which of these is a potential adverse effect of oral steroids?

A. Hypotension
B. Accelerated growth
C. Hypoglycemia
D. growth suppression

17. Which FEV1 threshold is used to define severe persistent asthma according to the National
Asthma Education and Prevention Program (NAEPP)?

A. ≤ 70% predicted

B. ≥ 60% predicted

C. ≤ 80% predicted

+ D. ≤ 60% predicted

18. According to the Global Initiative for Asthma (GINA) guidelines, control of severe asthma
requires:

A. High-dose inhaled corticosteroids (ICS) alone

+ B. High-dose ICS/long-acting beta2-agonists (LABA)

C. As-needed reliever medication alone

D. Low-dose ICS/LABA

19. Which class of drugs might be considered as add-on therapy in patients with moderate to
severe or severe eosinophilic phenotype asthma?

+ A. Monoclonal antibodies
B. Beta2 agonists

C. Mast cell stabilizers

D. Leukotriene modifiers

20. Patients with bronchial asthma should not be treated with

+ a. Beta blockers

b. Calcium antagonists

c. Diuretics

d. Hydralazine

21. If a patient with pollen allergic rhinitis or bronchial asthma receiving allergen-specific
immunotherapy develops an anaphylactic shock

a. Allergen specific immunotherapy continues under the protection of corticosteroids

b. Allergen-specific immunotherapy is stopped after 30 days and then continued

+c. Allergen specific immunotherapy is discontinued

22. When pressing the weals

a. Change their size

b. Permanent disappearance

+c. Disappears briefly

23. The principle of allergen specific immunotherapy is

+a. Production of allergen-specific blocking IgG4 antibodies

b. Blocking of mast cell IgE receptors

c. Blocking extracellular histamine

d. Inhibition of phospholipase A2

24. In case of persistence of urticaria complaints for more than 6 weeks, it is

a. Mastocytosis

+b. Chronic spontaneous urticarial

c. Acute spontaneous urticaria

 d. Churg-Strauss syndrome

25. Which group of drugs should not be used alone in the treatment of bronchial asthma

a. Methylxanthine drugs (theophylline, novphylline)

b. Leukotriene antagonists

+c. Beta 2 agonists with prolonged action

d. Systemic corticosteroids

26. The diagnosis of food allergy is made on the basis of

+ a. Sequential four-step protocol: positive skin tests, elimination diet, single-blind challenge
test, double-blind challenge test

b. Medical history

c. Skin tests with food allergens

d. Physical examination

27. FEV1 is

+a. The volume of exhaled air for the first season in forced expiration

b. The maximum velocity of the exhaled air

c. The maximum volume of exhaled air

d. Forced vital capacity

28. Which of the following antigen-presenting cells APC are actively phagocytic and reside in
peripheral sites such as the skin, intestinal lamina propria, and lungs?

a. Eosinophils

+b. Dendritic cells

c. Mast cells

d.Th2 cellse.

29. The allergence on first contact function as mild antigen this process is called

(a) vaccination

(b) immunization

+(c) sensitisation
(d) histamine

30. Histamine is a chemical formed from

(a) platelet

(b) RBC

(c) Macrophages

+(d) histidine

31. Which of the following is most accurate regarding symptoms of allergic reactions to food?

A. Constipation is more commonly associated with food allergy than is nausea, vomiting, or diarrhea

B. In most cases of fatal food anaphylaxis, respiratory failure is secondary to cardiovascular

compromise

+C. Cutaneous reactions are the most common clinical manifestations of an allergic reaction to a
food or food additive

E. Seizure is commonly associated with food anaphylaxis and is often accompanied by

hypertension

32. Which of the following is considered the best and most reliable method for diagnosing peanut
allergy?

+ A. Oral food challenge

B. Skin-prick test

C. Serum-specific IgE testing

D. Basophil histamine-release assay

33. What is the minimum serum eosinophil level that is generally accepted as an indicator of
eosinophilia?

A. > 100-200 cells/μL

+b. > 300-400 cells/μL

c. > 500-600 cells/μL

d. > 700 cells/Μl

34. Which of the following is recognized as a common factor that can contribute to asthma or airway
hyperreactivity?
+ a. Gastroesophageal reflux disease (GERD)

b. Lymphangitis

c. Hyperaldosteronism

d. Thalassemia

35. All of the following statement regarding Type III hypersensitivity reaction is true, EXCEPT:

a) Antigen-antibody forms a large complex and is deposited in the nearby tissue

b) Immune complex activate the complement system and anaphylatoxins

b) The anaphylatoxin such as C3a, C3b recruits neutrophils at the site of immune complex deposition

+c) Neutrophils and macrophages clear the immune complexes and tissue damage

36. CD4+ cells recognize antigen displayed on MHC ____ molecules and CD8+ cells recognize
antigen displayed on MHC ____ molecules. ____ has TH1 and TH2 cell populations.
a) Class I; Class II; CD4+
b) Class I; Class II; CD8+
+ c) Class II; Class I; CD4+
d) Class II; Class I; CD8+

37. Dust mite would most likely evoke which type of hypersensitivity response:
a. Cytotoxic (Type II)
b. Immune complex (Type III)
c. Cell-Mediated (Type IV)
+d. Immediate type (Type I)
e. latent (Type V)

38. 2. A 10-year-old boy presents to the emergency department with sudden shortness of
breath. He was playing in the school garden and suddenly started to complain of abdominal
pain. He then vomited a few times. An hour later in the hospital, he slowly developed a rash
on his chest, arms, and legs. His breathing became faster with audible wheezing. On physical
examination, his vital signs are as follows: the temperature is 37.0°C (98.6°F), the blood
pressure is 100/60 mm Hg, the pulse is 130/min, and the respiratory rate is 25/min. A rash is
on his right arm, as shown in the image. After being administered appropriate treatment,
the boy improves significantly, and he is able to breathe comfortably. Which of the following
is the best marker that could be measured in the serum of this boy to help establish a
definitive diagnosis?

A. Prostaglandin D2
B. Serotonin
C. Histamine
+D. Tryptase
F. Leukotrienes
39. You are treating an adult patient you suspect is having a severe allergic reaction. He
has an EpiPen on him for situations like this. The recommended location for injection with
the epinephrine autoinjector is the:
a. Center of the back
+b. Lateral middle thigh
c. Buttocks
d. Biceps

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

41. The effects on the cardiac system of an allergic reaction for the patient described in the
previous question could include __________ heart rate and ____________ blood pressure.
a. Decreased; decreased
b. Increased; increased
c. Decreased; increased
+d. Increased; decreased
42. A 12-year-old female presents to her pediatrician with an asthma exacerbation. Upon
physical examination, the physician notes the finding shown in Figure A. This presentation is
a common side effect of which of the following pharmacologic agents used in the treatment
of asthma?

A) Salmetero
B) Albuterol
C) + Budesonide
D) Ipratropium
E) Theophylline

43.Which of the following symptoms is commonly associated with true food allergy?
+A) Urticaria
B) Vomiting
C) Heartburn
D) Gas/bloating
44. Due to cross-reactivity, an individual with allergy to natural rubber latex may also have
allergy to
A) honey.
B) parsley.
+ C) avocado.
D) egg yolk.

45. Positive intradermal tests are those with a papule diameter above
+a. 7 mm
b. 2 mm
c. 3 mm
d. 10mm

46. The classification of allergic rhinitis according to ARIA

a. Light, medium-heavy and heavy
b. Viral, bacterial, pollen, caused by household allergens
+ c. Intermittent and persistent
d. Acute, subacute and chronic

47. The size and shape of the rashes in chronic spontaneous urticaria
a. Depends on concomitant diseases
b. Differ in size and shape from those in acute spontaneous urticaria
c. Depends on the duration of the urticarial
d. There is no difference

48. The size and shape of the rashes in chronic spontaneous urticaria
a. Depends on concomitant diseases
b. Differ in size and shape from those in acute spontaneous urticaria
c. Depends on the duration of the urticarial
+d. There is no difference

49. The diagnosis of food allergy is made on the basis of

+a. Sequential four-step protocol: positive skin tests, elimination diet, single-blind challenge
test, double-blind challenge test
b. Medical history
c. Skin tests with food allergens
d. Physical examination

50. Anaphylactic shock is characterized by symptoms of the following 4 systems

a. Cardiovascular, nervous, respiratory and gastrointestinal
b. Cardiovascular, respiratory, skin and nervous
c. Cardiovascular, skin, gastrointestinal, nervous
+d. Cardiovascular, respiratory, gastrointestinal and skin

51. Angioedema can develop

a. Only in the mucosal area
b. Skin only
c. In the area of connective tissue
+ d. All over the skin and mucous membranes

52. The most severe clinical manifestation of insect allergy are caused by insects of the
genus
a. Hemiptera (bedbugs, etc.)
+ b. Hymenoptera (bees, wasps, etc.)
c. Phthiraptera-lice
d. Wingless blood-sucking insects (siphonaptera – fleas)

53. Patients with bronchial asthma should not be treated with

+a. Beta blockers
b. Calcium antagonists
c. Diuretics
d. Hydralazine

54. If a patient with pollen allergic rhinitis or bronchial asthma receiving allergen-specific
immunotherapy develops an anaphylactic shock
a. Allergen specific immunotherapy continues under the protection of corticosteroids
b. Allergen-specific immunotherapy is stopped after 30 days and then continued
+c. Allergen specific immunotherapy is discontinued
55. Which kind of patients with bronchial asthma are expected to have best effect from
allergen-specific immunotherapy
a. Adult monoallergic patient without concomitant diseases
b. A young patient with polyallergy
+c. A young patient with monoallergy to pollen
d. Adult patient with concomitant diseases and monoallergy to house dust mites

56. The principle of allergen specific immunotherapy is

+a. Production of allergen-specific blocking IgG4 antibodies
b. Blocking of mast cell IgE receptors
c. Blocking extracellular histamine
d. Inhibition of phospholipase A2

57. In case of persistence of urticaria complaints for more than 6 weeks, it is

a. Mastocytosis
+b. Chronic spontaneous urticarial
c. Acute spontaneous urticaria
d. Churg-Strauss syndrome

58. Which group of drugs should not be used alone in the treatment of bronchial asthma
a. Methylxanthine drugs (theophylline, novphylline)
b. Leukotriene antagonists
+c. Beta 2 agonists with prolonged action
d. Systemic corticosteroids

59. In the nasal Cytology of a patient with allergic rhinitis are found
a. Neutrophils
b. Segmental lymphocytes
c. Mast cells
+d. Eosinophils
60. The peak expiratory flow (PEF) is
a. 50% of the volume of exhaled air
+b. Maximum exhaled air velocity
c. The maximum volume of exhaled air
d. The volume of exhaled air for the first second of expiration

61. Dry skin patients with atopic dermatitis is due to

a. The action of histamine
b. Broken connection between the keratocytes
c. The action of TNF action
+d. Increased transepidermal waterloss (TWL)

61. In asthma diagnosis the bronchodilator test is positive with a result above
+a. 12%
b. 20%
c. 8%
d. 10%

62. The non-specific bronchial challenge test with methacholine is positive in

a. Increase of the initial FEV1 by 20%
b. Reduction of the initial FEV1 by 40%
c. Increase of the initial FEV1 by 10%
+d. Reduction of the initial FEV1 by 20%

63. Atopic bronchial asthma is often preceded by

+a. Allergic rhinitis
b. Food allergy
c. Urticaria
d. Contact allergic dermatitis
64. The clinical manifestations of atopic dermatitis in different age groups
a. Depend on gender
+b. Usually have different predilection zones
c. There is no difference in the different ages
d. Depend on concomitant diseases

65. The late phase of the anaphylactic reaction is caused by

a. TNF-beta
b. Late effect of protease enzymes
+c. De newly synthesized mediators – prostaglandins and leukotrienes
d. De newly synthesized histamine

66. Itching in urticaria is due to

a. Of local edema
b. Of increased permeability of blood vessels
c. The action of the released protease inhibitors
+ d. Activation of H1 receptors by histamine

67. The first steps in the treatment of anaphylactic shock are

a. Removal of the allergen, placing the patient in the Trendelenburg position, parenterally
high doses of H1 (antihistamines) and H2 blockers, infusion of aqueous saline and oxygen
delivery
b. Removal of the allergen, placing the patient in the Trendelenburg position, intravenous
infusion of high-dose corticosteroids, infusion of aqueous saline solutions, oxygen delivery
+c. Removal of the allergen, placing the patient in the Trendelenburg position,
subcutaneous or intramuscular adrenaline, infusion or aqueous saline solutions, oxygen
supply
d. Removal of the allergen, placing the patient in the Trendelenburg position, parenterally
high-dose corticosteroids and antihistamines, infusion of aqueous saline solutions, oxygen
delivery

68. Pathophysiological changes in anaphylaxis are expressed in

a. Spasm of blood vessels and smooth muscle
+b. Dilation of smooth blood vessels, increase of their permeability and spasm of smooth
muscle
c. Dilatation of blood vessels and smooth muscle
d. Dilation of smooth blood vessels, reduction of their permeability and spasm of smooth
muscle

69.. FVC is
a. The volume of exhaled air for the first second of expiration
+ b. The maximum volume of exhaled air in forced expiration
c. The maximum speed of exhaled air in forced expiration
d. 50% of the volume of exhaled air

70. With the skin tests – scarification, prick and intradermal we find a reaction to
+a. Type 1 hypersensitivity reaction
b. Type 4 hypersensitivity reaction
c. Hypersensitivity reaction type 3
d. Type 2 hypersensitivity reaction

71.Which of the following groups of drugs most often cause drug allergy
a. Tricyclic antidepressants
b. Antihypertensive drugs from the group of sartans
+c. Antibiotics of the penicillin group
d. Antibiotics from the macrolide group

72.Atopic dermatitis is
a. Due to a spontaneous genetic mutation
b. The etiology is unknown
c. Autoimmune disease
+d. Family genetically determined
73. Nasal decongestants
a. Can be used for a long time
b. Should not be used in the treatment of allergic rhinitis
+c. Can be used only in the period of exacerbation, for no more than 3-5 days

74. Drug allergy occurs in:

a. by type 1 hypersensitivity reaction
b. by type 2 hypersensitivity reaction
c. by type 4 hypersensitivity reaction
+ d. may occur by any of the above mechanisms

75. Your patient is having a sudden and severe anaphylactic reaction to a medication. You
immediately stop the medication and call a rapid response. The patient's blood pressure is
80/52, heart rate 120, and oxygen saturation 87%. Audible wheezing is noted along with
facial redness and swelling. As the nurse you know that the first initial treatment for this
patient's condition is?
A. IV Diphenhydramine
B. IV Normal Saline Bolus
+C. IM Epinephrine
D. Nebulized Albuterol

76. A 25-year-old female is admitted to the ER in anaphylactic shock due to a bee sting.
According to the patient's mother, the patient is severely allergic to bees and was recently
stung by one. This type of anaphylactic reaction is known as a?
+ A. Type I Hypersensivity Reaction
B. Type II Hypersensivity Reaction
C. Type III Hypersensivity Reaction
D. Type IV Hypersensivity Reaction
77. Your patient is started on an IV antibiotic to treat a severe infection. During infusion, the
patient uses the call light to notify you that she feels a tight sensation in her throat and it's
making it hard to breathe. You immediately arrive to the room and assess the patient. While
auscultating the lungs you note wheezing. You also notice that the patient is starting to
scratch the face and arms, and on closer inspection of the face you note redness and
swelling that extends down to the neck and torso. The patient's vital signs are the following:
blood pressure 89/62, heart rate 118 bpm, and oxygen saturation 88% on room air. You
suspect anaphylactic shock. Select all the appropriate interventions for this patient:
A. Slow down the antibiotic infusion
B. Call a rapid response
C. Place the patient on oxygen
+ D. Prepare for the administration of Epinephrine

78. Which of the following is a predictable cause of most adverse drug reactions (ADRs)?
A. Nonadherence
B. Allergic reactions
+ C. Dosage issues
D. Idiosyncratic causes

79. Which of these is not an antihistamine drug?

A. Dimenhydrinate
B. Levocetirizine
C. cetirizine
+D. Piroxicam

80. Common triggers of asthma in children include all of the following except:
a.Secondary tobacco smoke
b.Ozone
c.Cold air
d.Exercise
+e.Gelatin
 81. The parents of a 3-yr-old girl with a history of several previous coughing and wheezing
exacerbations are wondering if their toddler is likely to develop persistent asthma. Which of
the following is a strong risk factor for persistent asthma in toddlers with recurrent
wheezing?
+a. Eczema
b. Colic
c. Living on a farm
d. Female gender

82. When investigating a patient following anaphylaxis during anaesthesia, the test most
widely applicable and least likely to produce false positive results, in identifying the
responsible drug or drugs is:
+ A. skin prick testing
B. radiommunoassay (RIA) to specific circulating IgE
C. RIA inhibition
D. intradermal skin testing
E. assessment of basophil degranulation and histamine release from leukocytes

83. Latex allergy may present with:

A. Bronchospasm
B. Urticaria
C. Pruritis
+D. All of the above

84. In acute anaphylaxis, hypotension results from

1. decreased peripheral resistance
2.hypovolaemia
3. increased venous capacity
4. medullary depression by histamine
A. if options 1, 2 & 3 are correct
+ B. if options 1 & 3 are correct
C. if options 2 & 4 are correct
D. if option 4 only is correct
E. if all options are correct

85. Tryptase
1. Is a neutral protease and 99% is located primarily within the mast cell
2. Half-life of 2 to 3 hours
3. A level > 10ng/ml indicates anaphylaxis

+A. if options 1, 2 & 3 are correct

B. if options 1 & 3 are correct
C. if options 2 & 4 are correct
D. if option 3 only is correct

86. The leading cause of anaphylaxis during anaesthesia is:

(a) antibiotics
(b) induction drugs
(c) latex
+(d) muscle relaxants

87. Mastocytosis may result in elevation of serum:

a) LDH
d) creatine kinase
c) troponin
+d) tryptase

88. The commonest initial presenting feature in anaphylaxis is

A. coughing
B. desaturation
+ C. hypotension
D. rash
E. wheeze

89. Your 45-year-old female patient with atopic dermatitis comes for follow-up evaluation.
Her condition has not improved with adequate trials of emollients and topical
corticosteroids. Which of these is the most appropriate next step in management?
Topical permethrin
a. Oral corticosteroid
+ b. Topical calcineurin inhibitor
b. Systemic immunomodulator
c. Intramuscular corticosteroid

67. Your 18-year-old female patient with hereditary angioedema is undergoing evaluation
prior to initiation of oral contraception. Which of these counseling points is most
appropriate for this patient?

+It may lead to more frequent angioedema attacks

It will likely decrease the severity of angioedema attacks
The drug’s effectiveness at preventing pregnancy will be decreased
A higher dose will be required to regulate her hormonal levels

68. Your 6-week-old patient is brought for evaluation because of colic, diarrhea, a runny
nose, and hives. After further questioning and examination, you suspect a cow’s milk allergy.
Which of these is the most appropriate first step in establishing the diagnosis?

A. Skin prick testing

B. Specific IgE testing
+C. Dietary elimination and challenge
D. Patch testing

69. Your 42-year-old female patient is evaluated because of a 5-day history of dry, cracked,
irritated skin on her hands. She started a new job last week, and her symptoms have
worsened during the past several days. She does not have itchiness, dyspnea,
lightheadedness, or gastrointestinal symptoms. On examination, the irritated skin is limited
to her hands; there are no vesicles or blisters present. On further questioning, a reaction to
latex products is suspected. Which of these types of reaction is most likely present in this
patient?

A. + Irritant contact dermatitis

B. Type I hypersensitivity reaction
C. Delayed hypersensitivity
D. Allergic dermatitis
70. Your patient is undergoing evaluation because of a reaction to an insect sting.
Prescription of epinephrine for self-administration is most appropriate if the patient’s
history includes which of these reactions to stings?

Swelling to 5 cm in diameter surrounding the site

Possible involvement of a joint
+ Bronchospasm
Local erythema
Increase in reaction size for 24 hours

71. Your 35-year-old female patient has a 2-week history of rhinorrhea, sneezing, and
intermittent nasal obstruction and pruritus. Which of this is the most appropriate first step
in management of this patient's symptoms?
Serum-allergen–specific IgE testing
anti-leukotriene
Referral to ENT specialist
+ Oral H1-antihistamine+ intranasal corticosteroid
Testing for asthma
72. Your 25-year-old male patient is undergoing evaluation because of persistent allergic
rhinitis. Which of these criteria is most likely to disqualify this patient from being a
candidate for immunotherapy?

Concurrent diagnosis of allergic asthma

Poor response to oral corticosteroids in the past
Severe symptoms that are present most days of the week
+ Serum testing that is negative for IgE antibodie

73. Your patient with hemolytic anemia, thrombocytopenia, and granulocytopenia as a

result of penicillin administration is undergoing evaluation in the emergency department.
Which of these types of drug reaction is most likely taking place in this patient?

Hypersensitivity vasculitis
IgE mediated
+ Cytotoxic
Immune complex
Delayed-type hypersensitivity

74. Your patient is undergoing evaluation at the urgent care clinic because of flushing of the
face, neck, and upper chest. He reports itchiness; erythema is noted over the upper body.
He recently started a new medication, but he can’t remember the name. Which of these
drugs is the most likely cause of these symptoms?

+ Vancomycin
Penicillin
Bleomycin
Allopurinol

75. Your 30-year-old female patient reports difficulty breathing during exercise. Pulmonary
function testing shows a fall in her forced expiratory volume (FEV1) from baseline of 15%
following exercise. Which of these is the most appropriate management?
++ A short-acting β2-agonist before exercising
A daily long-acting β2-agonist
An inhaled corticosteroid before exercising
Discontinuation of exercise

76. Your patient with a known peanut allergy is undergoing evaluation because of shortness
of breath, wheezing, and lightheadedness. Initial examination shows hypoxia and
angioedema. Which of these additional findings is most likely to strongly suggest
anaphylaxis rather than a vasovagal reaction in this patient?

Pale skin
Bradycardia
Hypotension
+ Urticaria
Vomiting

77. Anaphylaxis is diagnosed in the previous patient, and administration of epinephrine is

planned. Which of these dilutions of aqueous epinephrine is most appropriate?

1:10
1:100
+ 1:1000
1:10,000

78. Your 22-year-old female patient who is a college student reports dry, itchy skin on her
arms. Atopic dermatitis is suspected. She has been using a moisturizer consistently and tries
to take lukewarm showers. Which of these is the most appropriate management at this
time?

Discontinue use of moisturizers

+ Prescribe a topical corticosteroid
Prescribe a topical antimicrobial
Add a non-soap cleanser to her bathing regimen
Prescribe a topical antihistamine

79. Measurement of the previous patient’s airway responsiveness using a methacholine

challenge test shows the concentration of methacholine needed to cause a 20% fall in
forced expiratory volume in one second (FEV1) is 0.5 mg/mL. The test is repeated after
several days away from his worksite. Which of these methacholine concentrations is most
likely to indicate a significant improvement when away from the work exposure in this
patient?

+4 mg/mL
1 mg/mL
0.25 mg/mL
0.125 mg/mL

80. In which of these populations is allergen immunotherapy CONTRAINDICATED?

Patients taking an ACE inhibitor

+ Patients with uncontrolled or severe asthma
Patients with comorbid hepatic disease
Elderly patients

81. Your previously healthy 48-year-old patient is undergoing evaluation because of signs
and symptoms of asthma and COPD. The presence of which of these features is most likely
to suggest a diagnosis of asthma instead of COPD?

Hyperinflation on chest x-ray

Daily symptoms
Dyspnea preceded by chronic cough
+ Normal lung function between symptoms
82. Your patient with allergic rhinitis is undergoing evaluation. Patient education regarding
the risk of rebound congestion should take place when prescribing which of these
medications in this patient?

Cromolyn
+Pseudoephedrine
Ipratropium
Cetirizine
Loratadine

83. Your 55-year-old female patient is undergoing evaluation at the urgent care clinic
because of a several-hour history of a "puffy" face, tongue, and lips. She has a history of
hypertension. Physical examination shows edema of the face, tongue, and neck. There is no
urticaria. Which of these medications is the most likely cause of this patient's symptoms?

+ Lisinopril
Hydrochlorothiazide
Furosemide
Metoprolol
Amlodipine

84. An adult patient with a known bee venom allergy is stung by a bee. Which of these
findings is likely to indicate anaphylaxis if it occurs within minutes of the sting, without the
presence of other signs or symptoms?

Generalized hives
Heart rate >120 beats per minute
Oxygen saturation <90%
+Systolic blood pressure <70 mm Hg
Wheezing
85. A patient is being treated in the emergency department for anaphylaxis. Current
medications include metoprolol. On examination, he has hypotension and bradycardia
refractory to epinephrine. Which of these is the most appropriate treatment?

Atropine
Calcium chloride
+Glucagon
Insulin
Vasopressin

86. A patient presents with acute allergic contact dermatitis caused by an occupational
allergen. Which of these is the most appropriate initial approach to corticosteroid treatment
for this patient?

Low potency topical steroid as long as allergen exposure continues

Low potency topical steroid as long as symptoms continue
+Short course of high potency topical steroid followed by tapering
Short course of oral steroid

87. A patient reports burning, redness, and scaling on his hands. Which of these findings is
likely to be more suggestive of a diagnosis of irritant contact dermatitis vs allergic contact
dermatitis?
Generalized erythema beyond the contact area
Intensely pruritic lesions
Lichenification
Presence of vesicles and blistering
+Well-demarcated rash in the area of exposure

88. Pulmonary function tests assess an individual's _____, which is simply the movement of
air into the lungs, known as _____ and the movement of air out of the lungs, known as
_____.
+A) breathing; inspiration; expiration
B) Respiration; inspiration; exhale
C) Breathing; inhale; exhale
D) Ventilation; inspiration; expiration

89. A defect in which of the following has been identified as an important component of the
cause of atopic dermatitis?
+A) Filaggrin
B) Blood urea nitrogen
C) Phospholipase B3
D) Arachadonic base

90. Which of the following best describes penicillin, a hapten?

a) Large in size and can induce an immune response alone
b) Large in size and needs to be coupled to induce an immune response
c) Small in size and can induce an immune response alone
+d) Small in size and needs to be coupled to induce an immune response

91. . Delayed allergy reaction (type IV allergic reaction) is:

(A) An An allergic or immune response that begins within a period lasting from a few
minutes to about an hour after exposure to an antigen to which the individual has been
sensitized
+B) An allergic reaction that becomes apparent only hours after contact
C) An allergic reaction that results from the formation of antigen¬-antibody complexes
between a foreign antigen and IgM
D) An allergic disorder which is transferred genetically.

92. Which of the following factors can pre-dispose you to having allergies?
A. A family history of allergies
B. Environmental Conditions
C. Number and type of Exposures
D. Emotional factors
+E. All of the above

93. Which of the following factors can pre-dispose you to having allergies?
A. A family history of allergies
B. Environmental Conditions
C. Number and type of Exposures
D. Emotional factors
+E. All of the above

94. Which of the following is the most commonly prescribed treatment for Urticaria?
+A. Oral antihistamines
B. Oral corticosteroids such as prednisone
C. Epinephrine (adrenaline)
D. Aspirin
E. Immunotherapy

95. a 28-year-old female presents with angioedema of the face, including eyelids and lips.
She has had two previous similar episodes. She always has associated gas and diarrhea with
the angioedema. She was previously skin tested and found to have sensitivities to milk,
ragweed and molds. Which diagnosis is suggested?

A. Hereditary angioedema
+B. Food allergy
C. Enterovirus infection
D. Idiopathic angioedema
E. An ACE inhibitor was prescribed by her internist for hypertension
96. As part of the work up of adult asthma, which of the following reproducible, pre and
post bronchodilator pulmonary function test results would be interpreted as showing
significant reversibility?
A. a 15% increase in FEF 25-75%
+B. a 12% increase in FEV1
C. a 20% increase in FEV1
D. a 15% increase in FEV1/FVC ratio
E. a 15% increase in FVC

97. The major advantage of second generation antihistamines is:

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

98. All of the following except one can be useful in managing atopic dermatitis:
A. Skin lubrication/moisturization
B. Controlling pruitus to reduce scratching
+C. Immunotherapy (allergy injections)
D. Avoiding specific food allergy triggers
E. Topical therapy with steroid or non-steroid immune modulating agent(pimecolimus,
tacrolimus)

99. The two most common superinfections in atopic dermatitis are due to:
+A. Staph aureus and Herpes simplex
B. Staph epidermidis and cutaneous viral infections
C. Staph aureus and Candida
D. Staph epidermidis and Candida
E. Acinetobacter and Herpes simplex

100. In treating allergic rhinitis, which of the following medication or medications control
the symptoms of congestion, rhinorrhea and itching.
A. Antihistamine
B. Anticholinergic
C. Decongestant
+D. Nasal corticosteroid

101. After playing in the bushes during a camping trip, a 7-year-old girl complains of intense
itching & blistering of the hands, arms, & legs. What is the most likely condition & what type
of
hypersensitivity reaction is she displaying?
A. Hives; Type I reaction
B. Hives; Type IV reaction
+C. Contact Dermatitis; Type IV reaction
D. Contact Dermatitis; Type I reaction

102. Skin (Prick, patch) testing is useful in the diagnosis of which type of hypersensitivity
reaction?
A. Type I
B. Type II and Type III
C. Type IV
D. Type III and IV
+E. Type I and IV

103. What's a specific term for a bacterial or other foreign protein that initiates antibody
production by the body?
A. Peptide
B. MHC II molecule
C. Complement
+D. Antigen
E. Allergen

104. Five week old boy who after introduction of normal adapted cow’s milk base formula
became uneasy with colic, vomiting x 2-4 daily, development of exanthema/urticaria, and
also nasal itching.
The symptoms are suggestive of:
a) Lactose intolerance
b) Gastroenteritis
c) Constipation
d) Pyloric stenosis
+ e) Cow’s milk protein allergy

105. Which of the following is NOT a recommended diagnostic test for food allergy?
A) Skin prick test
B) Elimination diet
+ C) Atopy patch test
D) Food allergen-specific IgE

106. A 6-month old girl presented with a 5-month history of itchy rashes affecting the face,
trunk and the limbs. Her hands and feet as well as the buttocks and intertriginous sites were
not affected . She had visited general practitioners on two separate occasions and was
treated with miconazole 1% cream and hydrocortisone 1% cream, with no significant
improvement. Her parents had a history of atopic dermatitis. She had no significant history
of allergic rhinitis or asthma. Her developmental milestones were normal and she had been
breastfed with recent introduction of fruit and vegetable puree into her diet. The patient
was otherwise healthy, with no oral thrush, nail changes, petechiae, ecchymosis or bleeding
diathesis. Estimated body surface area involvement was 10%.
Which one of the following genetic mutations or histocompatibility antigens (HLA) is most
likely associated with this condition?
+ A. FLG gene mutation
B. HLA-Cw6 allele
C. AIRE gene mutation
D. SLC39A4 gene mutation
E. WAS gene

107.With regard to comorbidities in atopic dermatitis, which of the following best

characterizes the “atopic march”?
+A. Development of AD followed by, allergic rhinitis and asthma
B. Development of allergic rhinitis, followed by AD and asthma
C. Development of asthma, followed by AD and allergic rhinitis
D. Development of asthma, followed by AD and food allergy
E. Development of AD, followed by allergic rhinitis and food allergy

108. A 12-month old girl was referred to our center with an extensive rash developed
around her mouth that spread to her chest and swollen eyelids. She was well without any
history of any allergic reaction. The parents mentioned that her problems started a few
minutes ago after she was given a few bites of peanut butter cookie
What is the probable diagnosis in this case?
A. Atopic dermatitis
B. Celiac disease
+C. Food Allergy;
E. Inflammatory bowel disease

109. The following statements are true regarding peanut allergy, except:
A. Atopy is a risk factor in peanut allergy
+B. IgM has the main role in anaphylaxis to peanut antigens
C. Peanut allergy is an example of immediate hypersensitivity
D. The child should avoid tree nuts in addition to peanut
110. All of the following sentences are correct in type I hypersensitivity, except:
A. Activated T helper cells produce cytokines, which stimulate B cells to proliferate and
differentiate into plasma cells capable of producing IgE
B. IgE molecules attach to mast cells through their constant region
C. Two bound IgE molecules on a mast cell must react with a specific antigen for the mast
cell to degranulate
+ D. Histamine released by mast cells leads to capillary dilation and airway constriction on
first exposure to allergen

111. A 22 year-old atopic man with recurrent urticaria and collapse during or shortly after
physical activity correlates the symptoms to the consumption of pizza with tomatoes,
cheese, ham and mushrooms (button mushrooms). Usually he tolerates pizzas of the same
brand without any symptoms. Which is the most likely diagnosis for this patient?
A) Allergy to tomato
+B) Food-dependent exercise-induced anaphylaxis
C) Allergy to lupine flour
D) Allergy to pork-albumin
E) Mushroom allergy (button mushrooms)

112. A 19-years old boy is looking for you help as he suffers from urticaria since more than a
years. He reports that the wheals and flares are persisting long. Marking the lesions with a
pen, in fact the wheals do not move within 24 hours. The most likely diagnosis in this patient
is
A) Cold urticaria
B) Delayed pressure urticaria
+C) Urticarial vasculitis
D) Contact urticaria
E) Cholinergic urticarial
113. In addition to removing the offending food, which of the following has been found
helpful for long-term use in patients with chronic food allergies?
+a) Oral cromolyn
b) Oral antihistamines
c) Oral corticosteroids
d) Oral vitamin C

114. Skin tests for immediate-type (IgE-mediated) hypersensitivity help identify reactions to
β-lactam antibiotics, foreign (xenogeneic) serum, and some vaccines and polypeptide
hormones. For patients who have a history of an immediate hypersensitivity reaction and
who must take a penicillin, which of the following statements is correct?
a) Any form of penicillin can be used for initial skin testing.
b) If prick tests are negative, intradermal testing is unnecessary.
c) The penicillin skin test may induce a de novo sensitivity reaction in patients.
+d) If tests are negative, a serious reaction is less likely but not excluded.

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

116. Jewelry made with which metal is most likely to cause an allergic reaction?
a) Gold;
b) Silver;
+ c) Nickel;
d) Copper;

117. Which of the following is the initial intervention for Atopic Dermatitis?
a) Topical corticosteroid creams
+b) Skin moisturizers
c) Targeted biologic therapies
d) Immunomodulator medication

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

119. Some people with atopic dermatitis develop:

a) Thick, leathery skin
b) Red, scaling skin
c) Small raised bumps on the skin
+d) All of the above

120. Which of the following downstream inflammatory markers are produced with a Th2
inflammatory response?
a) IFN-ɣ and IL-2
+b) IL-4, IL-5, and IL-13
c) IL-17 and IL-22
d) TGF-β

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

A. LABA
B. Oral Corticosteroids
C. Immunomodulators
+ D. Inhaled Corticosteroids
E. SABA
122. Allergy of Penicillin is an example of:
+ a) Type 1 hypersensitivity
b) Type 2 hypersensitivity
b) Type 3 hypersensitivity
d) Type 4 hypersensitivity

123. Which of the following factors is characteristic of an Atopic response?

a) Th1 release of cytokines prompting phagocytosis;
b) Th1 release of cytokines prompting synthesis of opsonizing antibodies;
c) Th1 and Th2 release of cytokines prompting synthesis of (only Th1) complement-fixing
antibodies;
+d) Th2 release of cytokines prompting synthesis of IgE antibodies;

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

125. A child stung by a bee experiences respiratory distress within minutes and lapses into
unconsciousness. This reaction is probably mediated by:
+ A. IgE antibody
B. IgG antibody
C. Sensitized T cells
D. Complement
E. IgM antibody

126. The sum of the four primary lung volumes (tidal volume, inspiratory reserve volume,
expiratory reserve volume, and residual volume) equals

a) The functional residual capacity (FRC);

b) The vital capacity (VC);
+c) The total lung capacity (TLC);
d) The maximum ventilatory volume (MVV);

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

128.Which of the following features is characteristic of serum sickness?

a) Immediate anaphylactoid reaction;
+b) Presents 7 to 14 days after antigen exposure;
c) IgE mediated hypersensitivity reaction;
d) Type 4 cell mediated immunity reactions;

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

130 .Which of the following is most accurate concerning physical findings during an acute
asthma exacerbation?
+a) Lung findings may include wheezing, rhonchi, hyperinflation, or a prolonged expiratory
phase
B) Nasal flaring, grunting, accessory muscle use, and cyanosis are not seen during acute
asthma exacerbations
c) A heart murmur is a common finding during an acute exacerbation of allergic asthma
d) Edema is a common finding in patients with an acute exacerbation of allergic asthma

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

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

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

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

a) Seasonal allergic rhinoconjunctivitis;
b) Allergic asthma;
+c) Allergic urticaria;
d) Perennial Allergic conjunctivitis;

134. Recognition by T cells is a very important tool for any response to a certain antigen.
How does the T cell recognize antigen?
A) The T cell recognizes antigen via pattern recognition receptors.
B) The T cell receptor recognizes antigens via the CD3 structure
+ C) The T cell recognizes antigen via the T cell receptor for antigen (TCR), which has a high
diversity generated at the level of DNA.
A) The T cell receptor recognizes antigens via binding to membrane-bound IgD
antibodies.

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

136. A 16 years old female patients with a six month history of recurrent urticaria with
residual discoloration occasionally. She also has arthralgias. Erythrocyte sedimentation rate
is 80mm_hour. Which of the following procedures would yield the diagnosis?
a) Patch testing;
b) Measurement of C1 esterase inhibitor activity;
+c) Skin biopsy;
d) Allergy skin testing;

137. What is the etiology of hereditary angioedema?

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

138. Common causes of acute urticaria include all of the following except:
A. Food allergy
B. Drug allergy
C. Viral infection
+ D. Inhalant allergy
E. Hymenoptera stings

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

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

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

141. An abnormal reaction from the human body as a result of ingestion of food is termed
food allergy if the cause is
A) A high histamine content in the food.
B) Tyramine in aged cheese
+C) An IgE or cellular mediated immunological hypersensitive reaction.
D) Excessive alcohol ingestion.
142. The practical steps to diagnosing food allergy are careful history taking, physical
examination, skin prick test and exclusion diet. Which of the following is also practical?
A) Test for food specific IgG.
B) Determination of food-antigen complexes in the blood.
C) Intradermal test with allergen.
+D) Specific IgE determination.
F) None of the above
.
143. Which of the following is a relative contraindication to immunotherapy for allergic
rhinitis?
A) Pregnancy.
B) Autoimmune disease.
C) On beta-blockers.
D) Unstable coronary artery disease.
+E) All of the above.
144. Treatment with omalizumab decreases serum levels of which of the following
immunoglobulins?
a) IgM
b) IgG
+c) IgE
d) IgA

145. Which of the following is not a risk factor for asthma persisting in a child?
a) Onset prior to 12 months;
+b) Recurrent viral illnesses;
c) Other allergic conditions such as allergic rhinitis or atopic dermatitis;
d) Family history;

146. Which of the following drugs can be used to treat Atopic Dermatitis?
a) Omalizumab;
b) Abciximab;
c) Imatinib;
+d) Dupilumab;

147. Which of the following is accurate regarding pharmacologic treatment of urticaria?

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

148. Children with eczema are more likely to get:

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

149. A patient with chronic atopic dermatitis is found to have elevated IgE levels. Which
cytokine promotes isotype switching to IgE?
A. + IL-4
B. IL-6
C. IL-5
D. Interferon-gamma
E. IL-23

150. Rhinitis medicamentosa or rebound rhinitis is due to the prolonged use of:
A) Sodium cromoglycate.
B) Corticosteroids.
C) Antihistamines.
+D) Nasal decongestants.
E) Anti-cholinergics.

151. In the treatment of hereditary angioedema:

a) Epinephrine, corticosteroids and antihistamines play an important role.
+b) Infusion of plasma-derived C1 esterase inhibitor concentrates is recommended.
c) Fresh frozen plasma is likely to aggravate an acute attack.
d) Anabolic androgens are the agents of choice for long-term
Prophylaxis in children.

152. Which one of the following statements is true regarding of the oral allergy syndrome in
this patient?
+A. The oral allergy syndrome in this patient results from primary sensitization to inhalant
allergens that cross react with food allergens
B. The oral allergy syndrome results from primary sensitization to food allergens that cross
react with inhalant allergens
C. The oral allergy syndrome never produces anaphylaxis
D. The oral allergy syndrome always produces anaphylaxis
E. The oral allergy syndrome is only present with allergic rhinitis

153. A 19-year-old boy presented to our clinic with copious nasal secretions since early
childhood. He has suffered from nasal stuffiness, frequent need to clear secretions, nasal
speech, and difficulty sleeping throughout the year. There is no exacerbation with seasonal
changes and any change following environmental exposures. He also had suffered from
atopic eczema during infancy. He had no history of recurrent wheezing or airway hyper
reactivity. Evidence of food allergy was not detected. He was well nourished and had no
history of recurrent infections. What is the least possible diagnosis in this patient?
A. Chronic rhinosinusitis
+B. Intermittent allergic rhinitis
C. Persistent allergic rhinitis
D. Sino-nasal polyposis
154. All of the following immunological changes are seen after initiation of immunotherapy,
except:
A. Decreases in mast cell and basophil activity and degranulation
B. Early increase in allergen-specific IgE levels, which later decreases
C. Increase in allergen-specific IgG4 levels
D. Increase in allergen-specific regulatory T cells with increase in secretion of IL-10 and TGF-
β
++E. Transition from Th1 to Th2 cytokine response

155. Which one of the following is the most appropriate medical aid in case his allergic
reaction progresses to systemic symptoms, such as dyspnea and loss of consciousness?
A. Topical antihistamine ointment
B. Oral non-sedative antihistamine
C. Systemic corticosteroid
D. Oral cyclosporine
+E. Intramuscular injection of epinephrine

156. Which one of the following genetic mutations or histocompatibility antigens (HLA) is
most likely associated with Atopic Dermatitis ?
+A. FLG gene mutation
B. HLA-Cw6 allele
C. AIRE gene mutation
D. SLC39A4 gene mutation
E. WAS gen

157. About the progression from atopic dermatitis to other allergic disorders (atopic
march), specify which of the following statements is true?
A. The impaired skin barrier allows an epicutaneous sensitization to allergens
B. Early AD and food sensitization is considered a risk factor on other allergic diseases
C. The atopic march could be considered as the natural history of allergic diseases
+D. All the statements are true

158. Which statement is correct regarding atopic dermatitis treatment?

+ A. Emollients represent the first step to improve skin barrier function in AD and reduce
skin susceptibility to irritants
B. Tacrolimus is not useful as proactive treatment
C. Topical corticosteroids must be applied only as reactive therapy
D. Systemic immunosuppression with CsA is only a treatment options to adults

159. All of the following should be suspected as an associated condition of chronic urticaria,
except:
A. Autoimmune disease
B. Helicobacter pylori infection
C. Malignancies
+D. Hereditary angioedema

160. Which one is the first-line therapy for chronic urticaria?

A. Low dose oral corticosteroid
B. Combination of H1- and H2-antihistamine
+C. Non-sedating H1-antihistamine
D. Omalizumab

161. The reason of eczema exacerbation might be:

A. Late reaction induced by a food
B. Skin exposure to pollens
C. Skin exposure to dust mite
+ D. All of the above

162. To confirm the diagnosis of asthma and exclude other differential diagnoses, which of
the following procedures do you order first?
A. Arterial blood gasses
B. Computerized tomography scan
+ C. Pulmonary function test
D. Chest X-Ray

163. Which of the below options can be used to detect asthma in a bronchoprovocation test
in these patients?
A. Cold air
B. Methacholine
C. Exercise
+D. All of the above

164. Beta-2 agonist is administered before repeating the pulmonary function test. What
percentage of reversibility in FEV1 -from baseline level- is significant and diagnostic for
asthma?
A. 6%
B. 8%
C. 10%
+D. 12%

165. Which one of the following classifications are applicable in asthma?

A. Classification based on severity of asthma
B. Classification based on level of control of asthma
C. Classification of asthma exacerbation
+D. All of the above

166. Which one of the following features defines the airway remodeling in asthma?
A. Hypertrophy and hyperplasia of smooth muscle cells
B. Subepithelial fibrosis and sub-basement membrane thickening
C. Angiogenesis and mucus hypersecretion
+D. All of the above

167. The severity of asthma crisis is established based on?

A. Peripheral cyanosis with SaO2 90%
B. Heart rate with QT segment elevation
+C. Heart rate, respiratory rate and pulse oximetry
D. Respiratory frequency and wheezing
E. Blood gas with PaO2 > 90%

168. Which one of the following is a factor that increases the risk of asthmarelated death in
this patient?
+A. Not currently using inhaled corticosteroids
B. Hospitalization or emergency care visit for asthma at 7 years old
C. Use of SABA in the last 15 days
D. Age of the patient
E. History of viral pharyngitis

169. A 5-year-old boy with a history of asthma from 2 years of age is on treatment with
daily montelukast since one month ago. His symptoms are not under control and disturb his
daily activity and sleep. What is the best treatment for him?
A. Add inhaler corticosteroid to montelukast
+B. Use inhaler corticosteroid instead of montelukast
C. Add short curse corticosteroid to montelukast
D. Use inhaler corticosteroid and Long acting bronchodilator

170. Which type of hypersensitivity is responsible for peanut allergy?

+A. Type I
B. Type II
C. Type III
D. Type IV
171. In type I hypersensitivity, all of the following cells have a contribution, except:
A. B cells
B. Antigen presenting cells
C. Mast cells
+D. Neutrophils

172. All of the following sentences are correct in type I hypersensitivity, except:
A. Activated T helper cells produce cytokines, which stimulate B cells to proliferate and
differentiate into plasma cells capable of producing IgE
B. IgE molecules attach to mast cells through their constant region
C. Two bound IgE molecules on a mast cell must react with a specific antigen for the mast
cell to degranulate
+ D. Histamine released by mast cells leads to capillary dilation and airway constriction on
first exposure to allergen

173. The following statements are true regarding peanut allergy, except:
A. Atopy is a risk factor in peanut allergy
+ B. IgM has the main role in anaphylaxis to peanut antigens
C. Peanut allergy is an example of immediate hypersensitivity
D. The child should avoid tree nuts in addition to peanut

174. a 45-year-old male with Type I HAE. He called your office saying he woke up this
morning with hand swelling. Due to the frequent and disabling nature of Mike's HAE
symptoms, you discuss treatment options with him. Which of the following has been
demonstrated most effective for long term-prophylaxis in HAE in clinical trials?
A) Icatibant;
B) Intravenous C1-inhibitor

+C) Subcutaneous C1-inhibitor

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

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

177. In a patient with CSU, what duration of antihistamine treatment is recommended

before escalating therapy?

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

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

a) A family history of allergies;

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

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

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

181. Eosinophilia in allergic diseases such as allergic rhinitis or asthma is driven by allergen
activated Th2 cells. Which cytokine is the most critical cytokine mediating increased
eosinophils differentiation, activation and survival?
(A) IL-4
(B) IL-13
(C) INF-gamma
+(D) IL-5
(E) Eotaxin

182. Which of the following features is characteristic of serum sickness?

a) Immediate anaphylactoid reaction;
+b) Presents 7 to 14 days after antigen exposure;
c) IgE mediated hypersensitivity reaction;
d) Type 4 cell mediated immunity reactions;

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

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

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

1) Phagocytosis and bacteriocidal mechanisms, antigen presentation

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

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

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

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

188. A 65-year-old woman with a strong family history of both allergies and glaucoma
presents with frequent red eyes that sometimes itch, sometimes feel dry and sometimes
water. On exam, bulbar conjunctivae are injected, palpebral conjunctiva are normal in color.
Nasal mucosa is moderately swollen and pale. Which of the following is the most likely
diagnosis?
A. Vernal conjunctivitis
+ B. Allergic conjunctivitis
C. Glaucoma
D. Dryness from hormone replacement
E. Behcet’s disease

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

190 . Which of the following is accurate regarding the workup for urticaria?
a) Imaging studies are routinely indicated to confirm diagnosis of urticaria
+b) Cholinergic urticaria can be diagnosed using exercise testing
c)Autologous serum skin testing for allergy is routinely indicated in patients with chronic
urticaria
d)A skin biopsy is required for confirmation before conclusive urticaria diagnosis

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

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

192. A 6-year-old is brought into the emergency department for trouble breathing. He was
at a family picnic playing when his symptoms began. The patient is currently struggling to
breathe and has red, warm extremities. The patient has an unknown medical history and his
only medications include herbs that his parents give him. His temperature is 99.5°F (37.5°C),
pulse is 112/min, blood pressure is 70/40 mmHg, respirations are 20/min, and oxygen
saturation is 82% on 100% O2. Which of the following is the best initial step in
management?

a) Albuterol

+ b) Epinephrine- 150 micrograms (0.15 mL) intramuscularly;

c) Epinephrine- 500 micrograms (0.5 mL) intramuscularly;
d) Magnesium;
193. The following are examples of 2nd Generation H1 antihistamines:

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

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

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

B It is commonly due to urticarial vasculitis.

C It can be triggered by IgE antibodies to aspirin.

+ D It can be associated with autoantibodies to FcepsilonRI.

E Systemic steroids are usually required to suppress attacks

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

A) Innate responds quickly and adaptive adaptive responds slowly;

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

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

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

generation antihistamines?
a) Second-generation antihistamines are often less expensive;
b) Second-generation antihistamines are more frequently available in oral preparations;
c) Second-generation antihistamines has less of a sedative effect and produce less
cognitive impairment;
d) +++Second-generation antihistamines are generally more effective than firs-
generation antihistamines;
198 . Boy 8 years old, with continuous snoring and a tendency to sleep apnoea, nasal
stuffiness, morning headache and worsening of asthma symptoms previous history: Family
history: Mother atopic dermatitis and asthma since early childhood. The boy has suffered
from atopic dermatitis and recurrent wheezing since 12 months of age. Skin prick test at 4
years of age showed positive reaction against house dust mites Since four years of age
treated with inhaled steroids and inhaled beta-2-agonists on demand..
Which tests would you perform/consider?

a) Autologous skin serum test (ASST)

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

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

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

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

Which diagnosis seems more probable?

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

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

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

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

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

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

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

a) Seasonal allergic rhinoconjunctivitis;

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

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

+a) dust mite;

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

207. Recognition by T cells is a very important tool for any response to a certain antigen.
How does the T cell recognize antigen?
(A) The T cell recognizes antigen via pattern recognition receptors.
(B) ) The T cell receptor recognizes antigens via the CD3 structure
+ (C) The T cell recognizes antigen via the T cell receptor for antigen (TCR), which has a high
diversity generated at the level of DNA.
(D) The T cell receptor recognizes antigens via binding to membrane-bound IgD antibodies.
208. A 38 year old woman was referred to the clinic with a history of three episodes of lip
swellings for the last year. There is no obvious trigger for her swellings. The swellings lasted
for 2-4 days. She was not on any regular medications apart from oral combined
contraceptive for the last year. Her mother had recurrent angioedema since puberty. On
examination, she had normal concentration and normal functional activity of C1 inhibitor
(C1-INH). Allergy screening tests were not revealing any IgEmediated sensitization. Which is
the probable diagnosis in this patient?

(A) Drug allergy to oral contraceptives

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

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

210. Treatment with omalizumab decreases serum levels of which of the following
immunoglobulins?
a) IgM
b) IgG
+c) IgE
d) IgA
211. A young female patients with a six month history of recurrent urticaria with residual
discoloration occasionally. She also has arthralgias. Erythrocyte sedimentation rate is
80mm_hour. Which of the following procedures would yield the diagnosis?
a) Patch testing;
b) Measurement of C1 esterase inhibitor activity;
+c) Skin biopsy;
d) Allergy skin testing;

212. What is the etiology of hereditary angioedema?

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

213. Humoral immunity is mediated by antibodies from____ and is involved in the

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

214. If you are at risk for anaphylaxis, the best way to manage your condition is:
a) Avoid allergens that trigger symptoms
b) Carry autoinjectable epinephrine
c) Know how to use epinephrine
d) Develop an anaphylaxis action plan
+e) All of the above
215. One of your adult patients with severe chronic asthma recently was placed on two
inhalations of salmeterol bid 3 months ago in addition to four inhalations of
beclomethasone bid and as needed albuterol. He states that he has never felt better. On
questioning him, he states that he occasionally awakens at night, although only once or
twice per week, and that he did require a 7-day burst of prednisone for an upper respiratory
tract infection last month. He is in to refill his albuterol, which was filled last month. This
patient should.
a) Continue with current therapy because he is improving.
+b) consider increasing inhaled corticosteroid dose.
c) Consider adding regular inhaled ipratropium bromide.
d) Consider increasing salmeterol dose.

216. Type I hypersensitivity reactions are called:

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

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

a) FEV1 or peak flow > 60%-80% predicted/personal best
b) Symptoms two or fewer days per week
c) Two or more exacerbations per year requiring oral systemic corticosteroids
+ d) Nighttime awakenings one to three times per week

218. Common causes of acute urticaria include all of the following except:

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

219. The major advantage of second generation antihistamines is:

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

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

221. A 24-year-old female presents with angioedema of the face, including eyelids and lips.
She has had two previous similar episodes. Her father has also had recurrent angiodema of
the face and extremities. Neither has associated pruritis with the angioedema. Which
diagnosis is suggested?
+ A. Hereditary angioedema
B. Food allergy
C. Enterovirus infection
D. Idiopathic angioedema
E. An ACE inhibitor was prescribed by her internist for hypertension
22. The first time a person is exposed to an allergen, the person's immune system:
a. Reacts violently
b. Shuts down
+c. Forms antibodies
d. Ignores the allergen

223. 18 y/o male has episodic wheezing, and dyspnea. His mother tells you that he wakes up
about twice a week coughing. He is unable to keep up with the rest of the kids on the
baseball team because of shortness of breath. You perform a PFT, and find out the FEV1 is
77%. How would you classify his asthma?
A. Intermittent
B. Mild Persistent
+C. Moderate Persistent
D. Severe Persistent

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

225. A 3-year-old girl is brought to the emergency department by her father for acute-onset
shortness of breath and wheezing. The rash shown in Figure A is found upon brief
examination of the patient; the patient reports that the rash itches. While in the emergency
department, the patient vomits and has an episode of diarrhea. Her vital signs are as
follows: T 38.2, HR 155, BP 75/45, RR 38, and SpO2 99%. Examination is significant for the
rash mentioned previously and rapid breathing, but there is no facial or oral swelling noted.
On further discussion with the father, he relates that she has been otherwise healthy,
except for an ear infection that developed a few days ago. She was seen by her pediatrician
yesterday and started on her first dose of a course of amoxicillin this morning. The father
relates that she took this medication for a previous ear infection without any issue. Which of
the following best describes the pathophysiology of the skin lesions seen in this patient?
A) Histamine- and leukotriene-induced subscutaneous smooth muscle contraction;
B) Type IV hypersensitivity reaction
+C) Histamine-mediated vasodilatation with increased vascular permeability resulting in
dermal fluid accumulation
D) Acquired anti-desmoglein antibodies disrupt keratinocyte adherence, leading to
epidermal bullae

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

227. Ig unit is composed of:

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

228. The radioallergosorbent tests (RAST) determines:

a) Bronchial reactivity to subcutaneous serotonin;
b) Bronchial reactivity after inhalation bronchial provocation test;
c) The proportion of total allergic immunoglobulin;
d) ++Allergen-specific serum IgE concentration;
229. Which of the following types of cells are distributed throughout connective tissues,
often, adjacent to blood vessels and below epithelial surfaces that are exposed to the
external environment, and release a diverse array of mediators of allergic inflammation?

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

230.An 18 year old female presents with an acute exacerbation of asthma associated with a
chest infection. She is unable to complete a sentence and her peak flow rate was 35% of her
normal level. She is treated with high flow
oxygen, nebulised bronchodilators and oral steroids but this is associated with little change
in her condition.
Which of the following treatments, given intravenously, would be the most appropriate for
this patient?

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

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

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

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

232. A 78-year-old man reports a 5-month history of recurrent swelling of the orbits, lips,
and tongue. The swelling occurs every 2 to 3 weeks and lasts for 3 days. There is no
associated pruritus or hives. He denies the use of any blood pressure medications. He also
reports fatigue and a 4.5-kg weight loss. He
cannot relate the swelling episodes to food ingestion, over-thecounter medication
ingestion, or environmental changes.

What is the most likely underlying cause of the angioedema?

+a. Hereditary C1 esterase inhibitor deficiency

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

233. Patients with hay fever:

+ a- may develop asthma

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

234. Which of the following arecharacteristic of allergens?

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

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

a. Th1 release of cytokines promoting phagocytosis (activate)
b. Th1 release of cytokines promoting synthesis of opsonizing. antibodies
c.Th1 and Th2 release of cytokines promoting synthesis of (only Th1) complement-
fixingantibodies
d .Th2 release of cytokines promoting phagocytosis
+e. Th2 release of cytokines promoting synthesis of IgE antibodies

236. Which of the following types of cells are distributed throughout connective tissues,
often adjacent to blood vessels and below epithelial surfaces that are exposed to the
external environment, and release a diverse array of mediators of allergic inflammation?
a. Eosinophils
b. Basophils
+c.Mast cells
d. Th2 cells
e. Dendritic cells

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

238.Which of the following statements best describes the relationship between allergic
disorders and a possible genetic basis?
a. Allergic disorders are a response to only environmental factors
b. Allergic disorders are a response to only environmental factors and infectious agents
c. Asthma and allergic rhinitis are the only allergic disorders with a familial predisposition
+d. Any familial predisposition is related to polymorphisms of a single gene located on
chromosome 10
e. Any familial predisposition is related to many genetic loci and also many polymorphisms

239. All of the following may be signs of moderate to severe airway obstruction resulting
from allergic response except:
+a. Dennie lines (Dennie-Morgan folds)
b. Supraclavicular and intercostal retractions
C. Cyanosis
d. Pulsus paradoxus
e. Respiratory distress with minimal wheezing and a few crackles

240. The radioallergosorbenttest (RAST)determines:

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