71. Which of the following would not suggest a FISH (Fluorescence In Situ Hybridization) test to identify DiGeorge syndrome?
A. Recurrent otitis media in a 3-year-old
B. Neonatal tetany
C. Pervasive developmental delay in a 6-year-old female
D. Recurrent/persistent otitis and diarrhea in a 6-month-old
E. None of the above
Ans: C
72. 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
Ans: B
73. 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
Ans: D
74. 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
Ans: A
75. The most common cause of contact dermatitis in general is:
A. Latex
B. Poison ivy, poison oak and poison sumac
C. Nickel
D. Dark-colored pigments in shoes and clothing
E. None of the above
Ans: B
76. A 2-year-old with wheezing, persistent cough, a history of vomiting with cough, as well as hives and angioedema and increased cough after milk products comes to your office for evaluation. He drinks soy and grandma is not feeding him any milk products. He has been treated with prn albuterol nebulizer treatments with benefit in the past. On exam he has frequent congested cough, p = 112, r =26, shiners and Dennies lines. On chest exam he has transmitted upper airway rhonchi and coarse breath sounds but no wheezes or rales. Nasal exam reveals swollen pale nasal mucosa without any visible discharge. CXR shows increased bronchovascular markings without infiltrate but with hyperexpansion. What diagnostic lab information do you want to obtain?
A. CBC and diff, IgE and IgG RAST to milk and soy
B. CBC and diff, total IgE, IgG RAST to milk
C. CBC and diff, total IgE, and skin or RAST testing to milk, casein and soy
D. CBC, milk precipitins, IgE RAST to milk and casein
E. B and D
Ans: C
77. The one true statement about anaphylaxis is
A. There are always skin findings—rash, angioedema, etc.
B. People with recurrent anaphylaxis with no identifiable cause (idiopathic)
are the most likely to carry adrenalin
C. After adrenalin, the most important medication to administer immediately
is steroids
D. After adrenalin, the most important medication to administer promptly is
an H2 blocker
E. The most likely patient to die of anaphylaxis has underlying asthma
Ans: C
78. A 5-year-old boy lives in a smoking household and has a history of RSV bronchiolitis in infancy. He has been diagnosed with bronchitis at least once, and sometimes twice, every winter. He has sneezing and allergic salute in spring and fall. When he runs in kindergarten he often coughs but has no obvious shortness of breath. He wakes at night coughing only when he has bronchitis. He is unable to do full pulmonary functions. The historical information most suggestive of asthma in this child is:
A. Cough at night when ill
B. His allergic symptoms
C. RSV bronchiolitis in infancy
D. Cough with exercise
E. He has been living in a smoking household
Ans: D
79. 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
Ans: B
80. An 8-year-old male has asthma symptoms about three times per month requiring the use of an albuterol inhaler, despite adequate inhaled steroid treatment. These episodes typically occur at night. The child is not allergic to his guinea pig or dust mites, and there is no smoking in the home. He has no problems with exercise and rarely needs albuterol during the day except when he has an upper respiratory tract viral infection. His FEV1 and PEFR are both >80% predicted. Based on this history, the most likely trigger for his nighttime asthma is:
A. Allergic rhinitis
B. Obstructive sleep apnea
C. Gastro-esophageal reflux disease (GERD)
D. Drop in endrogenous corticosteroid levels at night
E. None of the above
Ans: C
A. Recurrent otitis media in a 3-year-old
B. Neonatal tetany
C. Pervasive developmental delay in a 6-year-old female
D. Recurrent/persistent otitis and diarrhea in a 6-month-old
E. None of the above
Ans: C
72. 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
Ans: B
73. 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
Ans: D
74. 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
Ans: A
75. The most common cause of contact dermatitis in general is:
A. Latex
B. Poison ivy, poison oak and poison sumac
C. Nickel
D. Dark-colored pigments in shoes and clothing
E. None of the above
Ans: B
76. A 2-year-old with wheezing, persistent cough, a history of vomiting with cough, as well as hives and angioedema and increased cough after milk products comes to your office for evaluation. He drinks soy and grandma is not feeding him any milk products. He has been treated with prn albuterol nebulizer treatments with benefit in the past. On exam he has frequent congested cough, p = 112, r =26, shiners and Dennies lines. On chest exam he has transmitted upper airway rhonchi and coarse breath sounds but no wheezes or rales. Nasal exam reveals swollen pale nasal mucosa without any visible discharge. CXR shows increased bronchovascular markings without infiltrate but with hyperexpansion. What diagnostic lab information do you want to obtain?
A. CBC and diff, IgE and IgG RAST to milk and soy
B. CBC and diff, total IgE, IgG RAST to milk
C. CBC and diff, total IgE, and skin or RAST testing to milk, casein and soy
D. CBC, milk precipitins, IgE RAST to milk and casein
E. B and D
Ans: C
77. The one true statement about anaphylaxis is
A. There are always skin findings—rash, angioedema, etc.
B. People with recurrent anaphylaxis with no identifiable cause (idiopathic)
are the most likely to carry adrenalin
C. After adrenalin, the most important medication to administer immediately
is steroids
D. After adrenalin, the most important medication to administer promptly is
an H2 blocker
E. The most likely patient to die of anaphylaxis has underlying asthma
Ans: C
78. A 5-year-old boy lives in a smoking household and has a history of RSV bronchiolitis in infancy. He has been diagnosed with bronchitis at least once, and sometimes twice, every winter. He has sneezing and allergic salute in spring and fall. When he runs in kindergarten he often coughs but has no obvious shortness of breath. He wakes at night coughing only when he has bronchitis. He is unable to do full pulmonary functions. The historical information most suggestive of asthma in this child is:
A. Cough at night when ill
B. His allergic symptoms
C. RSV bronchiolitis in infancy
D. Cough with exercise
E. He has been living in a smoking household
Ans: D
79. 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
Ans: B
80. An 8-year-old male has asthma symptoms about three times per month requiring the use of an albuterol inhaler, despite adequate inhaled steroid treatment. These episodes typically occur at night. The child is not allergic to his guinea pig or dust mites, and there is no smoking in the home. He has no problems with exercise and rarely needs albuterol during the day except when he has an upper respiratory tract viral infection. His FEV1 and PEFR are both >80% predicted. Based on this history, the most likely trigger for his nighttime asthma is:
A. Allergic rhinitis
B. Obstructive sleep apnea
C. Gastro-esophageal reflux disease (GERD)
D. Drop in endrogenous corticosteroid levels at night
E. None of the above
Ans: C
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