Block 10 Board Review Part 1 of 4

1. Block 10 Board ReviewPart 1 of 4 Allergy/Immunology 14March2014 Chauncey D. Tarrant, M.D. Chief of Residents 13-14

2. 3.5% of Initial Certifying Exam!!!

3. Pediatrics In Review Articles • Asthma • Atopic Dermatitis

4. PIR Quizzes

5. 1. An 11-month-old boy presents with fever, runny nose, and difficulty breathing for 1 day. Physical examination shows an axillary temperature of 37.8°C, respiratory rate of 32 breaths/min, and heart rate of 110 beats/min. Diffuse expiratory wheezes are audible bilaterally. He had similar illness 2 months ago. The mother is concerned about her son developing asthma during his childhood. Which of the following is the most appropriate response to her concerns about her son? A. If he has two more episodes of wheezing during the next year, his chances of having asthma during childhood are greater than 80%. B. If he responds to bronchodilators such as albuterol, there is a greater than 80% risk that he will have asthma during childhood. C. If the respiratory infection is due to RSV, he should have less than a 20% risk of developing asthma during childhood. D. More than 80% of infants who have a history of wheezing after respiratory infection in the first postnatal year do not wheeze after age 3 years. E. More than 80% of infants younger than 1 year of age who have respiratory tract infections wheeze during their illness.

6. 1. An 11-month-old boy presents with fever, runny nose, and difficulty breathing for 1 day. Physical examination shows an axillary temperature of 37.8°C, respiratory rate of 32 breaths/min, and heart rate of 110 beats/min. Diffuse expiratory wheezes are audible bilaterally. He had similar illness 2 months ago. The mother is concerned about her son developing asthma during his childhood. Which of the following is the most appropriate response to her concerns about her son? A. If he has two more episodes of wheezing during the next year, his chances of having asthma during childhood are greater than 80%. B. If he responds to bronchodilators such as albuterol, there is a greater than 80% risk that he will have asthma during childhood. C. If the respiratory infection is due to RSV, he should have less than a 20% risk of developing asthma during childhood. D. More than 80% of infants who have a history of wheezing after respiratory infection in the first postnatal year do not wheeze after age 3 years. E. More than 80% of infants younger than 1 year of age who have respiratory tract infections wheeze during their illness.

7. 2. A 3-year-old boy who has a previous history of allergic rhinitis and eczema presents to your office with cough and wheezing for 2 days. The symptoms started after he visited his uncle’s house and played with a cat. Which of the following statements about his current state is true? A. Airway inflammation has occurred due to action of cytokines and chemokines. B. Airway remodeling has occurred, characterized by mucous gland hyperplasia and bronchial smooth muscle hypertrophy. C. Current illness represents the early phase of mast cell activation, causing bronchospasm. D. Eosinophils have been activated by IgE, causing IL-4 release. E. Th1 lymphocyte activation by IgA has caused airway hyperreactivity.

8. 2. A 3-year-old boy who has a previous history of allergic rhinitis and eczema presents to your office with cough and wheezing for 2 days. The symptoms started after he visited his uncle’s house and played with a cat. Which of the following statements about his current state is true? A. Airway inflammation has occurred due to action of cytokines and chemokines. B. Airway remodeling has occurred, characterized by mucous gland hyperplasia and bronchial smooth muscle hypertrophy. C. Current illness represents the early phase of mast cell activation, causing bronchospasm. D. Eosinophils have been activated by IgE, causing IL-4 release. E. Th1 lymphocyte activation by IgA has caused airway hyperreactivity.

9. 3. A 6-year-old girl is brought in for evaluation of nighttime cough and wheezing after being exposed to secondhand smoke. A pulmonary function test (PFT) using a forced expiratory maneuver to display a flow volume curve is ordered. Which of the following statements is most accurate regarding PFT in this situation? A. Flattening of the inspiratory portion of the flow volume loop and decreased forced vital capacity suggest the presence of asthma. B. Increase in FEV1 by at least 12% after administration of a bronchodilator is indicative of asthma. C. Normal PFT indicates that the patient does not have airway hyperresponsiveness and, therefore, retesting with a bronchodilator is unnecessary. D. PFT assessment in those younger than age 8 years is unreliable due to lack of patient cooperation. E. PFT should be performed after challenging the patient with secondhand smoke and retesting after administration of a bronchodilator.

10. 3. A 6-year-old girl is brought in for evaluation of nighttime cough and wheezing after being exposed to secondhand smoke. A pulmonary function test (PFT) using a forced expiratory maneuver to display a flow volume curve is ordered. Which of the following statements is most accurate regarding PFT in this situation? A. Flattening of the inspiratory portion of the flow volume loop and decreased forced vital capacity suggest the presence of asthma. B. Increase in FEV1 by at least 12% after administration of a bronchodilator is indicative of asthma. C. Normal PFT indicates that the patient does not have airway hyperresponsiveness and, therefore, retesting with a bronchodilator is unnecessary. D. PFT assessment in those younger than age 8 years is unreliable due to lack of patient cooperation. E. PFT should be performed after challenging the patient with secondhand smoke and retesting after administration of a bronchodilator.

11. 4. A 15-year-old girl who has a known history of asthma is hospitalized for exacerbations of cough, wheezing, and shortness of breath. Her asthma has become increasingly unresponsive to bronchodilators and corticosteroids in the past 5 years. Flow-volume loop using a forced expiratory maneuver shows flattening of the inspiratory loop. Flexible fiberoptic laryngoscopy shows adduction of vocal cords and narrowing of the subglottic area during inspiration. Which of the following is the most likely diagnosis? A. Laryngomalacia. B. Subglottic hemangioma. C. Subglottic stenosis. D. Tethered vocal cord. E. Vocal cord dysfunction.

12. 4. A 15-year-old girl who has a known history of asthma is hospitalized for exacerbations of cough, wheezing, and shortness of breath. Her asthma has become increasingly unresponsive to bronchodilators and corticosteroids in the past 5 years. Flow-volume loop using a forced expiratory maneuver shows flattening of the inspiratory loop. Flexible fiberoptic laryngoscopy shows adduction of vocal cords and narrowing of the subglottic area during inspiration. Which of the following is the most likely diagnosis? A. Laryngomalacia. B. Subglottic hemangioma. C. Subglottic stenosis. D. Tethered vocal cord. E. Vocal cord dysfunction.

13. 5. Infants who have atopic dermatitis often have clinical features that are different from those of older affected children. Which of the following areas of the body is more likely to be affected in infants? A. Antecubital fossae. B. Cheeks. C. Eyelids. D. Genitals. E. Neck.

14. 5. Infants who have atopic dermatitis often have clinical features that are different from those of older affected children. Which of the following areas of the body is more likely to be affected in infants? A. Antecubital fossae. B. Cheeks. C. Eyelids. D. Genitals. E. Neck.

15. 6. You are evaluating a 4-year-old boy who has a history of atopic dermatitis that usually affects his feet and popliteal fossae. He complains of itching and increased rash on his feet for several weeks. His mother feels that his atopic dermatitis is flaring up. Which of the following features makes a diagnosis of tinea pedis more likely than an exacerbation of atopic dermatitis? A. Erythema. B. Lesions in web spaces. C. Plaques without central clearing. D. Pruritus. E. Scaling.

16. 6. You are evaluating a 4-year-old boy who has a history of atopic dermatitis that usually affects his feet and popliteal fossae. He complains of itching and increased rash on his feet for several weeks. His mother feels that his atopic dermatitis is flaring up. Which of the following features makes a diagnosis of tinea pedis more likely than an exacerbation of atopic dermatitis? A. Erythema. B. Lesions in web spaces. C. Plaques without central clearing. D. Pruritus. E. Scaling.

17. 7. Which of the following treatments is recommended for all patients who have atopic dermatitis? A. Complete avoidance of eggs and peanuts. B. Daily prophylactic topical antibiotic cream. C. Emollient application after a bath or shower. D. Frequent bathing with hot water. E. Periodic oral corticosteroid courses.

18. 7. Which of the following treatments is recommended for all patients who have atopic dermatitis? A. Complete avoidance of eggs and peanuts. B. Daily prophylactic topical antibiotic cream. C. Emollient application after a bath or shower. D. Frequent bathing with hot water. E. Periodic oral corticosteroid courses.

19. 8. You are evaluating a 4-month-old boy during a health supervision visit. His mother complains that he is “always sick,” and she is concerned about his constant “dry skin.” She describes three upper respiratory tract infections and one episode of pneumonia that required hospitalization in the past 2 months. On physical examination, you note numerous scaly, erythematous patches on the infant’s face and the extensor surfaces of his arms and legs. In addition, an erythematous diaper rash with satellite lesions is visible. You obtain a complete blood count, which reveals eosinophilia but no other abnormalities. Which of the following is the most likely diagnosis? A. Allergic contact dermatitis. B. Hyper-immunoglobulin E syndrome. C. Lamellar ichthyosis. D. Tinea corporis. E. Wiskott-Aldrich syndrome.

20. 8. You are evaluating a 4-month-old boy during a health supervision visit. His mother complains that he is “always sick,” and she is concerned about his constant “dry skin.” She describes three upper respiratory tract infections and one episode of pneumonia that required hospitalization in the past 2 months. On physical examination, you note numerous scaly, erythematous patches on the infant’s face and the extensor surfaces of his arms and legs. In addition, an erythematous diaper rash with satellite lesions is visible. You obtain a complete blood count, which reveals eosinophilia but no other abnormalities. Which of the following is the most likely diagnosis? A. Allergic contact dermatitis. B. Hyper-immunoglobulin E syndrome. C. Lamellar ichthyosis. D. Tinea corporis. E. Wiskott-Aldrich syndrome.

21. CONTENT SPECS!!!

22. Asthma

23. What are the characteristics of exercise induced asthma?

24. What are the characteristics of exercise induced asthma? • Coughing and wheezing after 5-6mins of exercise • Gradual improvement after 20-30mins of rest

25. Smog increases the severity of exercise induced asthma. True or False?

26. Smog increases the severity of exercise induced asthma. True or False?

27. What are some asthma triggers?

28. What are some asthma triggers? • Exercise • Viral URI • Allergen Exposure • Weather Changes • Smoke Pollutants/other irritants • Aspirin • Beta Blockers

29. Children with early onset asthma (<3yo), parental history of asthma, diagnosed atopic dermatitis, or sensitization to aeroallergens are least likely to outgrow asthma. • True or False?

30. Children with early onset asthma (<3yo), parental history of asthma, diagnosed atopic dermatitis, or sensitizations to aeroallergens are least likely to outgrow asthma. • True or False?

31. What does IgE mediated allergen challenge in an asthmatic induce?

32. What does IgE mediated allergen challenge in an asthmatic induce? • Immediate obstruction • Resolves and is followed in 4-12hrs by persistent late phase obstruction

33. Asthmatic patients have bronchial hyperresponsiveness with exaggerated bronchial response to environmental changes. • True or False?

34. Asthmatic patients have bronchial hyperresponsiveness with exaggerated bronchial response to environmental changes. • True or False?

35. The pathology of asthma is characterized by….

36. The pathology of asthma is characterized by…. • Inflammation with predominance of eosinophils • Epithelial Destruction • Glandular Hyperplasia • Collagen deposition in the submucosa

37. Atelectasis associated with AAE requires bronchoscopy, antibiotics, and CPT • True or False?

38. Atelectasis associated with AAE requires bronchoscopy, antibiotics, and CPT • True or False?

39. What are the signs of severe obstruction in AAE?

40. What are the signs of severe obstruction in AAE? • Severe retractions • Inability to speak whole phrases • Cyanosis • Quiet breath sounds • Peak Expiratory flow rates <30% of predicted

41. Mild persistent asthma is characterized by….

42. Mild persistent asthma is characterized by…. • Symptoms >2x/week but <1x/day • Nighttime cough >2x/month • Exacerbations of variable intensity

43. The majority of asthmatic school age children have positive immediate type allergy skin tests • True or False?

44. The majority of asthmatic school age children have positive immediate type allergy skin tests • True or False?

45. Severe persistent asthma is characterized by….

46. Severe persistent asthma is characterized by…. • Daily symptoms • Limited physical activity • Frequent nighttime symptoms • Frequent exacerbations • Abnormal PE or PFTs

47. Mild Intermittent asthma is characterized by….

48. Mild Intermittent asthma is characterized by…. • Symptoms <2x/week • Long periods without symptoms • Normal PFTs • Exacerbations last hours to days

49. EIA is a sign of poorly controlled asthma • True or False?

50. EIA is a sign of poorly controlled asthma • True or False?