81. A 10-year-old girl has had asthma for 18 months. She typically complains of asthma symptoms 3 times per week on the average, with daily symptoms when she has a URIs. She has never been hospitalized for asthma but has had 2 ED visits for wheezing with URIs. She complains of cough and shortness of breath with strenuous exercise. Her FEV1 and PEFR are both >80% predicted. Her treatment to date has been an albuterol inhaler prn. At this point, the one clearly inadequate therapy for this patient is:
A. Start a leukotriene antagonist daily, albuterol inhaler prn and before exercise
B. Start an inhaled corticosteroid at low to moderate dose, continue albuterol prn and before exercise
C. Start the patient on a combined controller inhaler with inhaled steroid and long acting bronchodilator
D. Start the patient on an inhaled steroid and leukotriene antagonist, and albuterol inhaler before exercise and prn
E. All therapy strategies listed are adequate for this patient
Ans: D
82. A 52-year-old male with known asthma for 27 years is seen in your office for a follow up of his asthma. He states his asthma has been in good control on his low dose of inhaled corticosteroid. But when asked about albuterol use, he says he uses it 2-3 times daily. When asked about nighttime awakening due to asthma, he states he awakes because of asthma 3 times per month. He also tells you his asthma has been in good control and that he has not missed a day of work. A PFT indicates he has an FEV1 of 81% predicted. You would characterize his asthma as:
A. Mild intermittent
B. Mild persistent
C. Moderate persistent
D. Severe persistent
E. Well controlled asthma
Ans: B
83. 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
E. Anti-leukotriene receptor antagonist
Ans: D
84. An 18-year-old teenager with a history of asthma as a young child, which she “outgrew” by the time she was in first grade, presents to her primary care physician in November 4 months pregnant, with wheezing and cough for the last month. On questioning, she admits to ragweed hayfever and frequent heartburn. On exam, she is coughing at frequent intervals. Chest is clear to auscultation with fair breath sounds throughout. There is slightly prolonged expiratory phase. What is the most appropriate treatment for this patient:
A. Prn albuterol inhaler, loratadine and calcium carbonate antacid.
B. Prn albuterol inhaler, beclomethasone inhaled corticosteroid and ranitidine.
C. Prn albuterol inhaler, budesonide inhaled corticosteroid, ranitidine and oral steroid burst.
D. Prn albuterol inhaler, oral steroid burst and proton pump inhibitor.
E. Prn albuterol inhaler, course of erythromycin for possible mycoplasma infection, calcium carbonate antacid.
Ans: A
85. Complement activation is a part 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
Ans: B
86. 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
E. SLE; Type V reaction
Ans: C
87. Skin 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
Ans: E
88. Rh disease & Goodpasture's syndrome are which type of hypersensitivity reaction?
A. Type I
B. Type II
C. Type III
D. Type IV
E. Type V
Ans: B
89. Megakaryocytes are minimally immunoresponsive. What type of cell do megakaryocytes give rise to?
A. RBC
B. Platelets
C. Leukocytes
D. Monocytes
E. Mast cells
Ans: B
90. A latent, measles-like viral infection &, presumably, a defect in cellular immunity is associated with which of the following diseases?
A. Hereditary angioedema
B. Systemic lupus erythematous (SLE)
C. Subacute sclerosing panencephalitis (SSPE)
D. DiGeorge syndrome
E. Bruton disease
Ans: C
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A. Start a leukotriene antagonist daily, albuterol inhaler prn and before exercise
B. Start an inhaled corticosteroid at low to moderate dose, continue albuterol prn and before exercise
C. Start the patient on a combined controller inhaler with inhaled steroid and long acting bronchodilator
D. Start the patient on an inhaled steroid and leukotriene antagonist, and albuterol inhaler before exercise and prn
E. All therapy strategies listed are adequate for this patient
Ans: D
82. A 52-year-old male with known asthma for 27 years is seen in your office for a follow up of his asthma. He states his asthma has been in good control on his low dose of inhaled corticosteroid. But when asked about albuterol use, he says he uses it 2-3 times daily. When asked about nighttime awakening due to asthma, he states he awakes because of asthma 3 times per month. He also tells you his asthma has been in good control and that he has not missed a day of work. A PFT indicates he has an FEV1 of 81% predicted. You would characterize his asthma as:
A. Mild intermittent
B. Mild persistent
C. Moderate persistent
D. Severe persistent
E. Well controlled asthma
Ans: B
83. 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
E. Anti-leukotriene receptor antagonist
Ans: D
84. An 18-year-old teenager with a history of asthma as a young child, which she “outgrew” by the time she was in first grade, presents to her primary care physician in November 4 months pregnant, with wheezing and cough for the last month. On questioning, she admits to ragweed hayfever and frequent heartburn. On exam, she is coughing at frequent intervals. Chest is clear to auscultation with fair breath sounds throughout. There is slightly prolonged expiratory phase. What is the most appropriate treatment for this patient:
A. Prn albuterol inhaler, loratadine and calcium carbonate antacid.
B. Prn albuterol inhaler, beclomethasone inhaled corticosteroid and ranitidine.
C. Prn albuterol inhaler, budesonide inhaled corticosteroid, ranitidine and oral steroid burst.
D. Prn albuterol inhaler, oral steroid burst and proton pump inhibitor.
E. Prn albuterol inhaler, course of erythromycin for possible mycoplasma infection, calcium carbonate antacid.
Ans: A
85. Complement activation is a part 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
Ans: B
86. 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
E. SLE; Type V reaction
Ans: C
87. Skin 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
Ans: E
88. Rh disease & Goodpasture's syndrome are which type of hypersensitivity reaction?
A. Type I
B. Type II
C. Type III
D. Type IV
E. Type V
Ans: B
89. Megakaryocytes are minimally immunoresponsive. What type of cell do megakaryocytes give rise to?
A. RBC
B. Platelets
C. Leukocytes
D. Monocytes
E. Mast cells
Ans: B
90. A latent, measles-like viral infection &, presumably, a defect in cellular immunity is associated with which of the following diseases?
A. Hereditary angioedema
B. Systemic lupus erythematous (SLE)
C. Subacute sclerosing panencephalitis (SSPE)
D. DiGeorge syndrome
E. Bruton disease
Ans: C
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