ALLERGY DISORDERS

Question 1

Patients with decreased C6 levels are susceptible to:

Neisserial infections
Pneumococcal infections
Meningococcal infections
Pneumo and meningococcal infection

Answer 1

Neisserial infections

Question 2

It is the most common relapsing skin disease in infancy and childhood

Contact dermatitis
Psoriasis
Seborrheic dermatitis
Atopic dermatitis

Answer 2

Atopic dermatitis

Question 3

Patients with Bruton’s agammaglobulinemia usually can overcome common viral infections EXCEPT

Varicella Zoster
Rotavirus infection
Echovirus infection
Dengue fever

Answer 3

Echovirus infection

Viral infections are usually handled normally, with the exceptions of hepatitis viruses and enteroviruses. There were several examples of paralysis when live polio vaccine was administered to these patients, and chronic, eventually fatal, central nervous system (CNS) infections with various echoviruses and coxsackieviruses have occurred in a significant number of patients. An enterovirus-associated myositis resembling dermatomyositis has also been observed. Neutropenia, typically seen at diagnosis when infected, can be associated with Pseudomonas or staphylococcal infections.

Question 4

Which of the following is TRUE in the prevention of Food Allergy?

Introduce low-risk complementary foods altogether
Breastfeed exclusively for 4 months

Probiotic supplements may reduce the incidence and severity of eczema Avoid allergenic foods during pregnancy or nursing

Answer 4

Breastfeed exclusively for 4 months

Question 5

What is the MOST important predisposing factor for a child to develop allergies?

Presence or absence of other allergic diseases
Positive family history of allergies
Exposure to common allergens
Early onset of allergic disease in the patient

Answer 5

Positive family history of allergies

A family history of allergic disease is common and is one of the most important factors predisposing a child to the
development of allergies. The risk of allergic disease in a child approaches 50% when 1 parent is allergic and 66% when both parents are allergic, with maternal history of atopy having a greater effect than paternal history.

Question 6

You examined a patient that you are entertaining for Allergic rhinitis, one of the pertinent physical examination findings is a horizontal skin fold over the bridge of the nose. What do you call this presentation?

Allergic gape
Nasal crease
Allergic salute
Nasal bridge

Answer 6

Nasal crease

Children with AR often perform the allergic salute, an upward rubbing of the nose with an open palm or extended index finger. This maneuver relieves itching and briefly unblocks the nasal airway. It also gives rise to the nasal crease, a horizontal skin fold over the bridge of the nose. The diagnosis of AR is based on symptoms in the absence of an upper respiratory tract infection and structural abnormalities.

Question 7

What treatment option for patients with Allergic rhinitis should be considered if children have IgE-mediated allergic symptoms but cannot be adequately controlled by avoidance and medication, especially in the presence of comorbid conditions?

Systemic corticosteroids
Topical corticosteroids
Allergen-specific immunotherapy

Intranasal inhaled corticosteroids

Answer 7

Allergen-specific immunotherapy

Allergy immunotherapy is an effective treatment for AR and allergic conjunctivitis. In addition to reducing symptoms, it may change the course of allergic disease and induce allergen-specific immune tolerance. Immunotherapy administered by subcutaneous injection should be considered for children in whom IgE-mediated allergic symptoms cannot be adequately controlled by avoidance and medication, especially in the presence of comorbid conditions.

Question 8

It is a complication of Atopic dermatitis that presents with itching, burning, tearing and copious mucoid discharge; It involves the eyes and is usually bilateral with Tantras dots or Giant papillae may be present, this is a case of

Atopic keratoconjunctivitis
Keratoconus
Allergic conjunctivitis
Exfoliative dermatitis

Answer 8

Atopic keratoconjunctivitis

Question 9

One of the current goals of treatment in the latest Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines is to promote safe, effective prevention and relief of symptoms. Which of the following specific measure is a very helpful method to reduce the symptoms of allergic disease:

Keep windows open to facilitate exit of pollens and dust
Allow pets at home
Bed linens and blankets washed 3 times a week
Allergen proof encasings

Answer 9

Allergen proof encasings

Question 10

This immunodeficiency condition is considered an medical emergency right after birth as the neonate will need immune reconstitution to survive

DiGeorge syndrome
X-linked Agammaglobulinemia
Chronic Granulomatous disease
Severe Combined Immunodeficiency Disorder

Answer 10

Severe Combined Immunodeficiency Disorder

Question 11

It is a severe bilateral chronic inflammatory process of the upper tarsal conjunctival surface that occurs in a limbal or palpebral form. There is severe ocular itching exacerbated by exposure to irritants, light or perspiration. This condition is called

Vernal keratoconjunctivitis
Giant papillary conjunctivitis
Atopic keratoconjunctivitis
Contact allergy

Answer 11

Vernal keratoconjunctivitis

Question 12

Infants with eczema are predisposed to Atopic march which is comprised of:

Food allergy and asthma
Food allergy, Asthma, Allergic rhinitis
Contact dermatitis, Allergic rhinitis and Asthma
Allergic rhinitis and Asthma

Answer 12

Food allergy, Asthma, Allergic rhinitis

Question 13

A 15-month-old male child presented with thrombocytopenic purpura, atopic dermatitis, and recurrent infections caused by cytomegalovirus and P. jiroveci. Immunoglobulin assay revealed elevated IgE and IgA with decreased IgM levels. Of the following, the MOST likely diagnosis is

Wiskott-Aldrich syndrome
Hyper Ig E syndrome
Chediak-Higashi Syndrome
Lazy Leukocyte Syndrome

Answer 13

Wiskott-Aldrich syndrome

Question 14

Agnes an 6 month old infant was brought for consult due to erythematous fine rashes confined on the cheek area, neck area, arm pit, folded areas of the arms and legs. She was also noted to be slightly irritable This was noted a day after she was introduced with pureed brocolli as her complementary feeding. You managed this as a case of Mild Atopic Dermatitis, management for this patient will be by giving:

a. Application of emolients and Fluticasone propionate ointment
b. Daily bath with lukewarm water and use of moisturizers afterwards. Application of Betamethasone ointment as the anti-inflammatory treatment
c. Daily bath with lukewarm water, use of moisturizers as occlusive emolient and application with Hydrocortisone cream afterwards
d. Daily bath with cold water, use of moisturizers and application of Desonide cream afterwards

Answer 14

c. Daily bath with lukewarm water, use of moisturizers as occlusive emollient andapplication with Hydrocortisone cream afterwards

Moisturizers are first-line therapy. Lukewarm soaking baths or showers for 15-20 min followed by the application of an occlusive emollient to retain moisture provide symptomatic relief.
Occlusive ointments are sometimes not well tolerated because of interference with the function of the eccrine sweat ducts and may induce the development of folliculitis.
Topical corticosteroids are the cornerstone of antiinflammatory treatment for acute exacerbations of AD. Because of their potential adverse effects, the ultrahigh-potency glucocorticoids should not be used on the face or intertriginous areas and should be used only for very short periods on the trunk and extremities. Mid-potency glucocorticoids can be used for longer periods to treat chronic AD involving the trunk and extremities.

Question 15

Abigail, a 6 months old infant presented with intense itching on the face and neck more prominent at night time, no other associated symptoms were noted. Upon physical examinations, lesions were red, scaly, patchy like formation distributed on the cheek and neck area. You were entertaining Atopic dermatitis; to further strengthen your initial impression, what are the 3 major features that must be present for the said condition?

a. Pruritus; Positive family history of asthma, Chronic or chronically relapsing course
b. Eczematous dermatitis that fits the typical pattern of skin inflammation; Positive family history of asthma; Immediate skin test reactivity
c. Pruritus; Eczematous dermatitis that fits the typical pattern of skin inflammation; Chronic or chronically relapsing course
d. Family history of asthma, Chronic or chornically relapsing course; Pruritus

Answer 15

c. Pruritus; Eczematous dermatitis that fits the typical pattern of skin inflammation; Chronic or chronically relapsing course

Question 16

One of the closest differential diagnosis for infant patients presenting with colds, cough and wheezing that is often interpreted as bronchial asthma

Pediatric community acquired pneumonia
Foreign body aspiration
Viral bronchiolitis
Bronchopulmonary dysplasia

Answer 16

Viral bronchiolitis

Question 17

Tiffany, 6 months old infant has been having recurrent rashes that are quite reddish with skin thickening, confined on the neck area and folded areas of the skin. Mother also noted that her baby is fussy attempting to scratch the said affected areas. If you are to categorize the type of Eczema for this case, what will it be?

Mild Atopic dermatitis
Severe Atopic dermatitis
Moderate Atopic dermatitis
Clear

Answer 17

Moderate Atopic dermatitis

Question 18

Patients with decreased C2 levels are susceptible to :

Neisserial infections
Pneumococcal infections
Meningococcal infections
Meningococcal infections

Answer 18

Pneumococcal infections

Question 19

Dane, a 3 year old child came in for consult due to cough and colds associated with sneezing and nasal congestion more prominent at night, no febrile episodes noted, patient is not tachypneic. Condition started around 4 days prior to consult, and according to the mother she usually wakes up at night because of her nasal congestion. Based on her symptoms which ARIA classification does the patient belong?

Moderate to severe intermittent
Mild intermittent
Mild persistent
Moderate to severe persistent

Answer 19

Moderate to severe persistent

Question 20

Findings of pneumatocoeles, typical facies, “cold abscesses” will give you an impression of this deficiency.

DiGeorge Syndrome
Hyper IgE Syndrome
Selective Ig A deficiency
Wisckott Aldrich Syndrome

Answer 20

Hyper IgE Syndrome

Question 21

Technique in Allergen testing that utilizes an allergen extract and is injected in to the dermis of the skin:

Dermatographism
Puncture technique
Intradermal technique
Metacholine test

Answer 21

Intradermal technique

Question 22

This feature is found in 60% of allergic patients and is described as blue-gray to purple discolorations beneath the child’s lower eyelids.

Dennie lines
Allergic shiners
Allergic conjunctivitis
Allergic duck

Answer 22

Allergic shiners

Question 23

A 2 week old managed as sepsis neonatorum with oral candidiasis, with absent tonsils and with markedly decreased lymphocytes will give you an initial diagnosis of:

Common variable deficiency
Severe combined immunodeficiency
Leukocyte adhesion defects
Chronic Granulomatous disease

Answer 23

Severe combined immunodeficiency

Question 24

Emmanuel, 12 year old child is diagnosed for Allergic Rhinitis classified as Moderate-Severe Persistent disease.
Based on this classification what treatment is BEST for the patient?

a. Oral antihistamine alone
b. Oral antihistmaine + Leukotriene modifying agents
c. Intranasal antihistamine + Sympathomimetic + Intranasal Inhaled Corticosteroids
d. Intranasal antihistamine + Intranasal Inhaled Corticosteroids

Answer 24

Intranasal antihistamine + Intranasal Inhaled Corticosteroids

Question 25

Light microscopy of neutrophils for the presence of giant granules can help to diagnose chronic granulomatous disease Chédiak-Higashi syndrome hyperimmunoglobulin E (Job syndrome) lazy leukocyte syndrome

Answer 25

Chédiak-Higashi syndrome

Question 26

This type of vaccine will cause paralysis in patients 6-9 months old with absent tonsils and nonpalpable lymph nodes Polio Tetanus Varicella Measles

Answer 26

Polio

Question 27

Neonatal seizures secondary to this deficiency is associated with thymic hypoplasia Hypoglycemia Hypokalemia Hypocalcemia Hypogammaglobulinemia

Answer 27

Hypocalcemia

Question 28

Failure to thrive, diarrhea, malabsorption, and infections with opportunistic infections (i.e., fungi, Candida sp, Pneumocystis jiroveci [carinii]) suggest B-cell defects Complement defects T-cell defects neutrophil defects

Answer 28

T-cell defects

Question 29

This is one of the key elements of Allergic diseases which are likely involved in the induction of Asthma, Allergic rhinitis, Eosinophilic esophagitis and Atopic dermatitis? Innate Lymphoid cells (ILC) 2 T-Helper cells Antigen Presenting Cells (APCs) Immunoglobulin E (IgE)

Answer 29

Innate Lymphoid cells (ILC) 2

Question 30

Allergic diseases are characterized by peripheral blood and tissue eosinophilia, Of the many roles that Eosinophils play, which mechanism is the one that is responsible for the pathogenesis of Asthma? Induce airway hyperresponsiveness Cause degranulation of basophils and mast cells Causes bronchoconstriction Damage epithelial cells

Answer 30

Induce airway hyperresponsiveness

Question 31

Autosomal recessive inheritance; oculocutaneous albinism, neuropathy, giant neutrophilic cytoplasmic inclusions; malignancy, and neutropenia are features of one of the following phagocytic disorders chronic granulomatous disease Chédiak-Higashi syndrome Hyperimmunoglobulin E (Job syndrome) Lazy leukocyte syndrome

Answer 31

Chédiak-Higashi syndrome

Question 32

Stephen, a 4 year old child came in for difficulty of breathing associated with cough and colds of 2 days. He was noted also to be tachycardic (HR 110bpm), tachypneic (RR 40 cpm) with desaturations (O2sat 90%), O2 inhalation via nasal cannula was provided which improved 2 saturations to 92%. He prefers to sit and is able to talk in phrases when asked how he was. Other pertinent PE findings revealed: alar flaring, tight air entry, wheezes both lung fields on auscultation, subcostal and intercostal retractions. How would you categorize this patient based on Severity of Asthma exacerbation? Bronchial asthma in moderate exacerbation Bronchial asthma in severe exacerbation Bronchial asthma, respiratory arrest imminent Bronchial asthma in mild exacerbation

Answer 32

Bronchial asthma in moderate exacerbation

Question 33

Delayed separation of umbilical cord, absence of pus at site (s) of infection, and poor wound healing suggest B-cell defects complement defects T-cell defects neutrophil defects

Answer 33

neutrophil defects

Question 34

What is considered as a primary treatment for Ocular allergies? Avoidance of allergens, cold compresses and lubrication Oral or topical antihistamines Topical decongestants Topical tacrolimus or topical cyclosporine

Answer 34

**Avoidance of allergens, cold compresses and lubrication**

Question 35

Patrick, a 7 year old child came in for difficulty of breathing, flushing, intense pruritus, dry cough and hoarseness of voice. Symptoms manifested an hour after eating peanuts for snacks. You were entertaining Anaphylaxis secondary to food allergy (peanuts) for this patient. What will be your initial intervention? Give Epinephrine intramuscularly or intravenously (0.01mg/kg), supplemental oxygen and inhaled beta agonists and corticosteroids, IV fluids Give Oxygen, start IV fluids, give Epinephrine (0.1mg/kg) IM Give Epinephrine intramuscularly or intravenously (0.01mg/kg), supplemental oxygen and inhaled beta agonists and corticosteroids Give Epinephrine (0.01mg/kg) IM or IV and Oral Antihistamine

Answer 35

Give Epinephrine intramuscularly or intravenously (0.01mg/kg), supplemental oxygen and inhaled beta agonists and corticosteroids, IV fluids

Question 36

This is a common complication of Allergic rhinitis that is associated with purulent infection but with negative bacterial cultures despite marked mucosal thickening. Rhinitis medicamentosa Childhood asthma Chronic sinusitis Nasal polyposis

Answer 36

Chronic sinusitis

Question 37

It is the most common hypersensitivity response of the eye: Allergic conjunctivitis Vernal keratoconjunctivitis Atopic keratoconjunctivitis Giant papillary conjunctivitis

Answer 37

Allergic conjunctivitis

Question 38

This kind of physical urticaria results to localized pruritus, erythema and urticaria/angioedema after exposure to a cold stimulus: Aquagenic urticaria Solar urticaria Cholinergic urticaria Cold urticaria

Answer 38

Cold urticaria

Question 39

A 5-month-old infant presented with reluctance to feed, lethargy, abdominal distension, and severe gingivitis. The parents are healthy relatives and gave history of non-purulent omphalitis with separation of umbilical stump at the age of 2 months. His peripheral smear showed neutrophil count 24,000/mm3.Of the following, the MOST likely diagnosis is: Lazy leukocyte syndrome Hyperimmunoglobulin E (Job syndrome) Chronic granulomatous disease Chediak-Higashi syndrome

Answer 39

Lazy leukocyte syndrome

Question 40

This proposes that childhood exposure to germs and certain infections helps the immune system develop. This teaches the body to differentiate harmless substances from the harmful substances that trigger asthma. In theory, exposure to certain germs teaches the immune system not to overreact Atopic hypothesis Autoimmune hypothesis Hygiene hypothesis Immune enhancement hypothesis

Answer 40

Hygiene hypothesis

Question 41

One of the following is NOT a clinical features of Ataxia Telangiectasia Cerebral ataxia Ocular telangiectasia Chronic otitis media High incidence of Adenocarcinoma

Answer 41

Cerebral ataxia -CEREBELLAR ATAXIA DAPAT

Question 42

Patients with XLA usually starts having recurrent infections at this age? Birth 6 months 2 years old 3 years old

Answer 42

6 months

Question 43

Immunodeficiency disorders involving the cellular immunity usually occurs at this age: 2-6 months 6-9 months 9-12 months 2 years old

Answer 43

2-6 months

Question 44

Among the Early Childhood Risk Factors for developing Asthma, which is considered a major risk factor? Formula feeding Food allergy Male gender Parental asthma

Answer 44

Parental asthma

Question 45

Immunodeficiency disorders involving a T-cell defect will have increased susceptibility to what type of infectious agents? Gr. (+) organisms Pyogenic organisms Catalase (+) organisms Gm. (-) organisms, mycobacterium, viruses

Answer 45

Gm. (-) organisms, mycobacterium, viruses

Question 46

DiGeorge syndrome, also known as velocardiofacial syndrome or CATCH 22 syndrome. One of the following IS NOT a feature of this syndrome cardiac anomalies abnormal facies thymic hypoplasia cleft lip hypocalcemia

Answer 46

cleft lip -CLEFT PALATE DAPAT

Question 47

It is the cornerstone of anti-inflammatory treatment for acute exacerbations of AD: Ointments Topical corticosteroids Emollients Moisturizers

Answer 47

Topical corticosteroids

Question 48

Peak Expiratory Flow (PEF) is a less sensitive and reliable diagnostic method than spirometry to detect airflow obstruction. It is diagnostic for bronchial asthma if there is diurnal variation of PEF ≥ 20% less than 20% ≥ 30% less than 30%

Answer 48

less than 20%

Question 49

Majority of immunodeficiency disorders in the pediatric population involve this arm in the immune system Humoral Cellular Phagocytic Complement

Answer 49

Humoral

Question 50

Asthma is a chronic inflammatory condition of the lung airways resulting in episodic airflow obstruction. The etiology behind asthma is said to be: A. Associated with environmental factors such as living in rural areas and strongly linked to female gender B. Caused by exposure to indoor allergens such as house dust mites, animal danders, mice and cockroaches C. Always associated in the presence of having Allergic rhinitis D. A combination of environmental and genetic factors in early life shape how the immune system develops and responds to environmental exposures

Answer 50

D. A combination of environmental and genetic factors in early life shape how the immune system develops and responds to environmental exposures

Question 51

This kind of urticaria may accompany chronic urticaria or other physical urticaria. Diagnosis is by observing the skin after stroking with a tongue depressor. a. Pressure induced urticaria b. Aquagenic urticaria c. Cold urticaria d. Dermatographism

Answer 51

d. Dermatographism

Question 52

How would you categorize the Physical severity of Atopic Dermatitis for a patientpresenting with areas of dry skin and infrequent itching? a. Severe Atopic dermatitis b. Clear c. Mild Atopic dermatitis d. Moderate Atopic dermatitis

Answer 52

c. Mild Atopic dermatitis

Question 53

This IgE mediated immune response is characterized by edema of the skin,redness and induration. It is also associated with early infiltration of neutrophils and eosinophils. a. Acute allergic disease b. Early phase response c. Late phase response d. Chronic allergic disease

Answer 53

c. Late phase response

Question 54

What measures do we need to give to patients diagnosed with Bronchial Asthmaduring this time of pandemic? a. Continue use of spirometry even in patients with suspected Covid – 19 b. Continue the advise in the use of nebulizers c. Make sure that all patients have a written asthma action plan with instructions as to when to seek medical help d. Asthma medications may be discontinued once patient becomes asymptomatic

Answer 54

c. Make sure that all patients have a written asthma action plan with instructions as to when to seek medical help

Question 55

Which of the following can help lessen the risk of the occurrence of Allergic rhinitis? a. Exposure to dogs, cats and endotoxins early in childhood b. Serum IgE higher than 100 IU/mL before age 6 years c. Delivery by cesarean section d. Exclusive breastfeeding

Answer 55

a. Exposure to dogs, cats and endotoxins early in childhood

Question 56

What is the suggested initial controller treatment for Adolescents (>12yo) with adiagnosis of Asthma? a. Daily low dose ICS or as needed low dose ICS formoterol b. As needed low dose ICS formoterol c. Medium dose ICS-LABA d. Low dose ICS-LABA

Answer 56

b. As needed low dose ICS formoterol

Question 57

Ritz, is a 7 year old female, who was diagnosed as a case Bronchial Asthma - MildPersistent Asthma. What preferred controller will you give for this patient? a. Low dose ICS + leukotriene receptor antagonist (LTRA) b. Medium dose inhaled corticosteroid - long acting beta agonist c. Short acting beta agonist PRN d. Daily low dose inhaled corticosteroid (ICS)

Answer 57

d. Daily low dose inhaled corticosteroid (ICS)

Question 58

A 2 week old managed as sepsis neonatorum with oral candiadisis, with absent tonsils and with markedly decresaed lymphocytes will give you an initial diagnosis of: a. Common variable deficiency b. Severe combined immunodeficiency c. Leukocyte adhesion defects d. Chronic Granulomatous disease

Answer 58

b. Severe combined immunodeficiency ???

Question 59

Choose TRUE or FALSE on the statements on the warning signs of a Primary Immunodeficiency. 2 ear infections last year

Answer 59

FALSE

Question 60

Choose TRUE or FALSE on the statements on the warning signs of a Primary Immunodeficiency. 2 sinusitis last year

Answer 60

TRUE

Question 61

Choose TRUE or FALSE on the statements on the warning signs of a Primary Immunodeficiency. Admitted twice for Pneumonia in a month

Answer 61

TRUE

Question 62

Choose TRUE or FALSE on the statements on the warning signs of a Primary Immunodeficiency. family history of a secondary immunodeficiency disorder

Answer 62

FALSE

Question 63

Choose TRUE or FALSE on the statements on the warning signs of a Primary Immunodeficiency. 4 otitis media episodes last 6months

Answer 63

TRUE

Question 64

Stephen, a 4-year-old child came in for difficulty of breathing associated with cough and colds of 2 days. He was also noted to be tachypneic a night prior to consult. On physical examination he was tachycardeic (HR 110bpm), tachypneic (RR 40cpm), with desaturations (O2 sat at 90%). O2 inhalation via nasal cannula was provided which improved O2 saturations to 92%. He prefers to sit and is able to talk in phrases when he was asked how he was. Other pertinent PE findings revealed alar flaring, tight air entry wheezes both lung fields on auscultation, subcostal and intercostal retractions. What initial intervention(s) in the emergency room will you give for this patient? a. Provide O2 inhalation, give SABA nebulizations every 6 hours, start antibiotics b. Admit patient, provide O2 inhalation, monitor vital signs, start antibiotics, perform chest X-ray c. Admit patient, provide O2 inhalation, monitor vital signs, start IV fluids, give nebulization, SABA stat doses, re-evaluate d. Admit patient, provide O2 inhalation, give SABA nebulizations, start antibiotics

Answer 64

c. Admit patient, provide O2 inhalation, monitor vital signs, start IV fluids, give nebulization, SABA stat doses, re-evaluate

Question 65

After the patient was stabilized, further digging up in history revealed daytime symptoms lasting for > 2 days in a week with episodes of stat nebulization using Salbutamol especially during episodes of difficulty of breathing and frequent bouts of cough at nighttime at least once in a month. There were no maintenance medications as claimed by the mother. How would you further classify this patient? a. Bronchial asthma in intermittent b. Bronchial asthma mild persistent c. Bronchial asthma moderate persistent d. Bronchial asthma severe persistent

Answer 65

b. Bronchial asthma mild persistent

Question 66

You recently diagnosed a 3 year old child who presented with cough, wheezing and dyspnea having Bronchial Asthma, moderate persistent. With this working diagnosis, what treatment shall you give for this patient? a. Step 1: Short acting Beta Agonist (SABA) as needed b. Step 2: Low dose Inhaled Corticosteriods (ICS) c. Step 3: Medium dose ICS with SABA as needed d. Step 4: Medium dose ICS + Long Acting Beta Agonist (LABA) or Leukotiene Receptor Antagonist (LRTA)

Answer 66

d. Step 4: Medium dose ICS + Long Acting Beta Agonist (LABA) or Leukotiene Receptor Antagonist (LRTA) Preferred treatment for ALL patients with persistent Asthma is ICS therapy as MONOTHERAPY or in COMBINATION with ADJUNCTIVE THERAPY. Low dose ICS therapy treatment of choice for all children at Treatment 2 (Mild persistent asthma) Alternative medications: Leukotriene modifying agent: Montelukast NSAID: Cromolyn, Nedocromil Theophylline Treatment step 3: (Moderate persistent asthma) Medium dose ICS, combination low dose ICS and inhaled long acting beta agonist (LABA), leukotriene receptor antagonist (LTRA) or theophylline Treatment Step 4: (Moderate Persistent Asthma) Medium dose ICS/LABA combination Alternatives: medium dose ICS (Theophylline or an LTRA) Treatment Steps 5 and 6: (Severe Persistent Asthma) Combination high dose ICS + LABA Long term administration of oral corticosteroids as controller therapy is effective but is rarely required. Omalizumab can be used in children ≥6yo with severe allergic asthma Rescue course of systemic corticosteroids may be necessary at any step for very poorly controlled asthma

Question 67

Acute Atopic Dermatitis skin lesions are characterized by: a. Hyperplastic epidermis with hyperkeratosis and minimal spongiosis b. Predominantly IgE-bearing Langerhans cells in the epidermis and macrophages in the dermal mononuclear cell infiltrate c. Marked intercellular edema of the epidermis d. Mast cell and eosinophil numbers are increased contributing to skin inflammation

Answer 67

c. Marked intercellular edema of the epidermis

Question 68

Abigail, a six month old infant presented with intense itching on the face and neck more prominent at night time, no other associated symptoms were noted. Upon physical examination, lesions were red, dry, scaly, patchy like formation distributed on the cheek, and neck area. You were entertaining Atopic Dermatitis. To further strengthen your initial impression, what are the 3 major features that must be present with Atopic Dermatitis? a. Pruritus, Positive family history of Asthma, Chronic or chronically relapsing course b. Eczematous dermatitis that fits the typical pattern of skin inflammation, Positive family history of Asthma, immediate skin test reactivity c. Family history of asthma, Chronic or chronically relapsing course, Pruritus d. Pruritus, eczematous dermatitis that fits the typical pattern of skin inflammation; Chronic or chronically relapsing course

Answer 68

d. Pruritus, eczematous dermatitis that fits the typical pattern of skin inflammation; Chronic or chronically relapsing course

Question 69

Abigail, a six month old infant presented with intense itching on the face and neck more prominent at night time, no other associated symptoms were noted. Upon physical examination, lesions were red, dry, scaly, patchy like formation distributed on the cheek, and neck area. You were entertaining Atopic Dermatitis. To further strengthen your initial impression, what are the 3 major features that must be present with Atopic Dermatitis? How would you further categorize the Physical severity of Atopic Dermatitis for the above patient? a. Clear b. Mild atopic dermatitis c. Moderate atopic dermatitis d. Severe atopic dermatitis

Answer 69

c. Moderate atopic dermatitis

Question 70

The most common cause of chronic idiopathic urticaria is: a. Allergic condition b. Endocrine disorder c. Autoimmune disease d. Idiopathic

Answer 70

d. Idiopathic

Question 71

The predominant sites of involvement of Atopic Dermatitis in infants is/are: a. Chest and umbilical area b. Digits and armpits c. Flexor surface of the extremities d. Cheeks, extensor surface of extremities

Answer 71

d. Cheeks, extensor surface of extremities

Question 72

A 2 year old is known to have significant history of anaphylaxis after peanut intake on 2 occasions. Skin test to peanut showed significant results. What advice will you give to the parents? a. Eliminate peanut from family meals b. Advised peanut immunotherapy c. Pre-medicate with antihistamines prior to intake of peanuts d. Give small amounts of peanuts daily to induce tolerance

Answer 72

a. Eliminate peanut from family meals

Question 73

Patients with history of recurrent severe anaphylaxis should be instructed to inject epinephrine at what site and through what route? a. Sublingual b. Subcutaneous at deltoid c. Intramuscular at lateral thigh d. Subcutaneous at abdominal wall

Answer 73

c. Intramuscular at lateral thigh

Question 74

Patient with this condition is at risk for greater morbidity and mortality when they develop anaphylaxis a. Food allergies b. Bronchial asthma c. Atopic dermatitis d. Allergic rhinoconjunctivitis

Answer 74

b. Bronchial asthma

Question 75

A 5 year old reported recent history of developing angioedema, urticaria and difficulty of breathing after intake of Amoxicillin. He now needs antibiotic for his tonsillitis. What is the most rational thing to do? a. Desensitize to amoxicillin b. Do skin test to amoxicillin c. Do incremental dosing to amoxicillin d. Use alternative drug that does not cross react to amoxicillin

Answer 75

d. Use alternative drug that does not cross react to amoxicillin

Question 76

Answer 76

Question 77

A life threatening form of hemophagocytic lymphohistiocytosis is commonly associated with this deficiency. a. Chediak Higashi Syndrome b. Leukocyte Adhesion Defect c. Wisckott Aldrich Syndrome d. Severe Combined Immunodeficiency

Answer 77

a. Chediak Higashi Syndrome

Question 78

Bruton tyrosine kinase protein is commonly associated with this type of immunodeficiency. a. Chediak Higashi Syndrome b. Leukocyte Adhesion Defect c. Chronic Granulomatous Disease d. X-linked Agammaglobulinemia

Answer 78

d. X-linked Agammaglobulinemia

Question 79

Leukocyte adhesion defect will have a significant leukocytosis of: a. >22,000 b. >23,000 c. >24,000 d. >25,000

Answer 79

d. >25,000

Question 80

The accelerated phase in Chediak- Higashi Syndrome is characterized by the following features EXCEPT: a. High fever b. Thrombocytopenia c. Lympocytopenia d. Shortened bleeding time

Answer 80

d. Shortened bleeding time

Question 81

A severe case of Myositis caused by Echoviruses is commonly associated with this primary deficiency. a. Selective Ig A deficiency b. X-linked Agammaglobulinemia c. Common variable immunodeficiency- echovirus meningitis rare d. Severe combined Immunodeficiency

Answer 81

b. X-linked Agammaglobulinemia

Question 82

A finding of angioneurotic edema will possibly have a deficient defense system involving the: a. Antibodies b. Cellular immunity c. Phagocytosis d. Complement system

Answer 82

d. Complement system

Question 83

This immunodeficiency is commonly associated with phenytoin treatment. a. Selective IgA deficiency b. Hyper Ig E syndrome c. X linked hypogammaglobulinemia d. Ataxia Telangiectasia

Answer 83

a. Selective IgA deficiency

Question 84

The following are TRUE of Hyper IgE syndrome EXCEPT: a. Autosomal dominant b. Gene on Stat 3 c. Fine facial features d. Minimal trauma fractures

Answer 84

c. Fine facial features