Allergy and Immunology

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Chronic Spontaneous Urticaria

You are seeing a 26-year-old female-identifying patient in the office who has been previously diagnosed with chronic spontaneous urticaria (CSU). They are struggling with frequent appearance of wheals and would like to discuss treatment options. A stepwise approach to CSU management is recommended, beginning with the identification and elimination of potential underlying causes and triggers.

Volume 41.1 - Question 38

Managing Angioedema

Which one of the following statements regarding angioedema is false?

  • Histamine-mediated angioedema is the most common form.
  • Most patients with hereditary angioedema experience their first episode within the second decade of life.
  • In patients requiring an emergent airway intervention, surgical airway intervention is common.
  • Tranexamic acid has no role in treatment.
Volume 41.1 - Question 16

Penicillin Allergy

In low-risk patients, an oral challenge can safely be used to remove an incorrect label of penicillin allergy.

  • True
  • False
Volume 40.6 - Question 14

Reaction Risk to Direct Penicillin Challenges

A 23-year-old male suffers frequently from tonsillitis. You recall that his chart states that he is allergic to penicillin. This is based on what he heard from his mom: when he was around 6 years old, he developed a rash after taking amoxicillin for tonsillitis.

Volume 40.4 - Question 37

Chronic Urticaria

A 34-year-old patient presents to your office with a 3 month history of “hives”. There is a history of asthma but there are otherwise no medical concerns. After examination you diagnose chronic urticaria.

Volume 40.21 - Question 16

Food Allergies

A 30-year-old mother is at your office today because she suspects her 4 year-old daughter has food allergies. Her daughter experiences wheezing, diarrhea, and hives when she eats shellfish.

Volume 40.21 - Question 9

Food Allergy

You are seeing a 21-year-old patient with known peanut and shellfish allergy. Up until this age, they have strictly avoided food triggers, though unfortunately they have required the use of epinephrine via autoinjector a couple of times. They are seeing you today as they have heard there may be other treatment options available for their food allergies.

Volume 40.21 - Question 8

Chronic Urticaria

A 34-year-old patient presents to your office with a 3 month history of “hives”. There is a history of asthma but there are otherwise no medical concerns. After examination you diagnose chronic urticaria.

Volume 40.2 - Question 40

Food Allergy

You are seeing a 21-year-old patient with known peanut and shellfish allergy. Up until this age, they have strictly avoided food triggers, though unfortunately they have required the use of epinephrine via autoinjector a couple of times. They are seeing you today as they have heard there may be other treatment options available for their food allergies.

Volume 40.1 - Question 39

Omalizumab for the Treatment of Food Allergies

In persons as young as 1 year of age with multiple food allergies, omalizumab treatment for 16 weeks was superior to placebo in increasing the reaction threshold for peanut and other common food allergens.

  • True
  • False
Volume 39.6 - Question 11

Vaccination in Patients with Egg Allergy

Which one of the following statements regarding vaccinating patients with a history of egg allergy is false?

  • Measles, mumps and rubella vaccine can be administered in a routine manner.
  • Yellow-fever vaccine may be administered without any additional evaluation.
  • Influenza vaccine may be administered regardless of the severity of the patient’s previous reaction to egg.
  • For, rabies vaccination, inactivated human diploid vaccine is preferred.
Volume 39.6 - Question 9

Occupational Dermatitis

Which one of the following statements about occupational dermatitis is false?  

  • Up to 1/3 of health care workers develop occupational dermatitis.   
  • Hypoallergenic gloves are rubber accelerator-free.   
  • Allergies to metals such as chromium and cobalt contribute to dermatitis in certain industries such as construction.   
  • Fragrances and hair dyes are common causes. 
Volume 39.4 - Question 21

Eosinophilic Esophagitis

Which one of the following statements about eosinophilic esophagitis is false? 

  • Females are 3–4 times more likely than males to develop the condition.    
  • Patients often present initially with a food bolus obstruction in the esophagus.   
  • Topical corticosteroids are an effective treatment.   
  • Elimination of cows’ milk compared to a 6-food elimination diet shows similar symptom remission. 
Volume 39.4 - Question 20

DRESS Syndrome

A 54-year-old female presents to your rural emergency department with a complaint of a new rash. She has a history of gout and has been started on allopurinol over the last few months.  She has a diffuse morbiliform rash, is febrile, and is found to have elevated LFTs and eosinophils. You suspect drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. 

Volume 38.21 - Question 18

Paxlovid

Which one of the following statements about Paxlovid for treatment of COVID-19 infection is false? 

  • It can reduce rate of hospitalization.   
  • It can reduce the rate of death.   
  • It is contraindicated for use with drugs that are highly dependent on CYP3A for clearance.   
  • It can be started after 5 days of symptom onset.  
Volume 38.21 - Question 7

Tdap in Pregnancy 

Which one of the following statements is true regarding tetanus, diphtheria, and acellular pertussis (Tdap) vaccination during pregnancy? 

  • Maternal vaccination with Tdap does not affect the incidence of pertussis in infants.   
  • The National Advisory Committee on Immunization recommends that Tdap be administered in every pregnancy in Canada, regardless of preconception vaccination status.   
  • The majority of pregnant patients receive Tdap vaccination during their pregnancy.   
  • The primary reason for pregnant patients’ nonvaccination is not wanting to be vaccinated during pregnancy. 
Volume 38.21 - Question 2

Vaccine hesitancy

In strongly vaccine-hesitant adults, provision of information on collective benefits reduces hesitancy to a greater extent than information on personal benefit.

  • True
  • False
Volume 37.3 - Question 11

Pediatric Allergy Prevention

For infants at high risk of developing food allergies whose mothers cannot or choose not to breastfeed, hydrolyzed formulas are recommended to prevent food allergies.

  • True
  • False
Volume 37.3 - Question 7

Paxlovid

Which one of the following statements about Paxlovid for treatment of COVID-19 infection is false?

  • It can reduce rate of hospitalization.
  • It can reduce the rate of death.
  • It is contraindicated for use with drugs that are highly dependent on CYP3A for clearance.
  • It can be started after 5 days of symptom onset.
Volume 37.3 - Question 1

COVID-19 Vaccine for Adolescents

The risk of syncope is higher in adolescents than in adults following COVID-19 vaccination.

  • True
  • False
Volume 36.6 - Question 14

Allergic Conjunctivitis

Which one of the following statements about allergic conjunctivitis is false? 

  • Ophthalmic H1-antihistamines are at least as effective as oral second-generation H1 -antihistamines for treatment of ocular itching.  
  • Topical ketorolac is less effective in relieving ocular symptoms than an ophthalmic H1-antihistamine. 
  • Ophthalmic corticosteroids can be considered for use in patients that fails to respond to other drugs. 
  • Most ophthalmic products used in the treatment of allergic conjunctivitis contain the preservative benzalkonium chloride, which does not cause stinging. 
Volume 36.6 - Question 13

Meningococcal Vaccine

MenQuadfi is the only vaccine available in Canada for use in persons ≥ 56 years old for the prevention of invasive meningococcal disease caused by Neisseria meningitides serogroups A, C, W, and Y.  

  • True
  • False
Volume 36.6 - Question 12

The Treatment of Allergic Rhinitis

Which one of the following statements about the treatment of allergic rhinitis is false? 

  • Intranasal H1-antihistamines have a more rapid onset of action than oral H1-antihistamines.   
  • Intranasal H1-antihistamines are at least as effective as oral H1-antihistamines.   
  • An intranasal fixed -dose combination of azelastine (an H1-antihistamine) and fluticasone propionate has improved symptoms more than either drug alone in patients with seasonal allergic rhinitis.   
  • Cetirizine does not cause sedation in recommended doses. 
Volume 36.5 - Question 12

Hereditary Angioedema

Which one of the following statements about hereditary angioedema is false?

  • It is mediated by bradykinins. 
  • Urticaria is generally absent. 
  • It does not respond to antihistamines. 
  • It responds to corticosteroids. 
Volume 36.4 - Question 13

Cytokine Storm

Which one of the following statements about cytokine storm is false? 

  • Nearly all patients are febrile.   
  • Neurologic toxic effects occur early.    
  • Many patients have hypertriglyceridemia.    
  • Patients can develop a stress-related or takosubo-like cardiomyopathy. 
Volume 36.3 - Question 19

DRESS Syndrome

A 54-year-old female presents to your rural emergency department with a complaint of a new rash. She has a history of gout and has been started on allopurinol over the last few months.  She has a diffuse morbiliform rash, is febrile, and is found to have elevated LFTs and eosinophils. You suspect drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. 

Volume 38.1 - Question 37

Monkeypox

Post-exposure prophylaxis with monkeypox vaccination for recently exposed persons is recommended.

  • True
  • False
Volume 38.2 - Question 27

Antihistamines for Allergic Rhinosinusitis

In the treatment of allergic rhinosinusitis, oral antihistamines combined with intranasal corticosteroids provide better symptom relief than intranasal corticosteroids alone. 

  • True
  • False
Volume 38.1 - Question 11

Chronic Urticaria

Which one of the following statements about chronic urticaria is false? 

  • Most affected patients are men.
  • There is usually no identifiable cause.
  • A history of nonblanching lesions persisting for more than 24 hours that leave a residual bruise, suggests the alternative diagnosis of cutaneous vasculitis.
  • Up to 30% of patients have cutaneous exacerbations provoked by the use of NSAIDS.
Volume 38.1 - Question 10

Tdap in Pregnancy 

Which one of the following statements is true regarding tetanus, diphtheria, and acellular pertussis (Tdap) vaccination during pregnancy? 

  • Maternal vaccination with Tdap does not affect the incidence of pertussis in infants. 
  • The National Advisory Committee on Immunization recommends that Tdap be administered in every pregnancy in Canada. 
  • The majority of pregnant patients receive Tdap vaccination during their pregnancy. 
  • The primary reason for pregnant patients’ nonvaccination is not wanting to be vaccinated during pregnancy. 
Volume 38.1 - Question 2

Long COVID Diagnosis

Autonomic dysfunction (dysautonomia) such as postural orthostatic tachycardia syndrome commonly occurs in long COVID.

  • True
  • False
Volume 38.4 - Question 12

Food Allergies

A 30-year-old mother is at your office today because she suspects her 4 year-old daughter has food allergies. Her daughter experiences wheezing, diarrhea, and hives when she eats shellfish.

Volume 39.2 - Question 43

Allergic Rhinitis

Which one of the following statements about allergic rhinitis is false?

  • If allergy testing is needed, skin testing should be performed instead of blood serum testing.
  • Children who were breastfed as infants do not have lower rates (at age 6) of allergic rhinitis than those who were not breastfed.
  • Intranasal corticosteroids are first-line treatment for allergic rhinitis.
  • High-efficiency particulate air filters are effective at decreasing symptoms.
Volume 39.2 - Question 19

Peanut Allergy Desensitization

Peanut oral immunotherapy should be considered a treatment option for infants age less than 12 months with peanut allergies. 

  • True
  • False
Volume 39.1 - Question 10

Vaccines for Prevention of RSV Disease

Vaccination for prevention of respiratory syncytial virus (RSV) reduces the incidence of RSV-associated lower respiratory tract disease in adults ≥ 60 years old. 

  • True
  • False
Volume 39.1 - Question 7

Allergic Rhinitis

A 23-year-old mother of a newborn baby, is at your office today because she has been experiencing nasal congestion, runny nose, itchy nose, and sneezing for the past few weeks.  She does not have a cold or the flu or COVID-19 infection.  Her twin sister has a history of allergic rhinitis, asthma, and atopic dermatitis. Your patient has been diagnosed with asthma and atopic dermatitis in the past. You suspect that she has allergic rhinitis.

Volume 38.5 - Question 43

RSV Vaccination in Pregnancy

Which one of the following statements about vaccination in pregnancy to prevent respiratory syncytial virus (RSV) illness in infants is false?

  • There is an increased risk of spontaneous abortion in subsequent pregnancies in vaccinated women.
  • Serious adverse events are rare in the newborns of vaccinated women.
  • It reduces the incidence of severe RSV-associated lower respiratory tract illness in infants within 90 days after birth.
  • It is a single dose vaccine.
Volume 38.5 - Question 9

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