NMS Q&A Family Medicine

Atopic, Food, and Contact Allergies 22311 From the physiological point of view, which of the followingis the goal of immunotherapy in the treatmentof atopic allergies, for example, rhinitis and conjunctivitis,in regard to allergen-specific antibodies?(A) Increase IgE antibodies specific to the allergen(B) Decrease IgG antibodies specific to the allergen(C) Increase in IgE, decrease in IgG(D) Increase in IgG, decrease in IgE(E) Decrease in both IgG and IgE12 A 34-year-old man has noticed increasing incidentsof being stung by bees and increasingly severe reactionsfrom the stings. Instead of normal erythemaand swelling, when he was stung 2 weeks ago on theankle, the whole leg became swollen with an angryredness. At that time, he went to another doctor, whodiagnosed cellulitis and treated with antibiotics.Then, today he was stung on the arm with rapiddevelopment of the same type of response as lastweek, and this time, he is experiencing hives and havingsome shortness of breath. The sting occurred anhour ago. He appears to be in mild distress with thedyspnea and discomfort at the sting site. Auscultationof the lungs reveals bilateral wheezes with adequaterespiratory excursion. You opt for an intramuscularinjection of 1:1,000 epinephrine, and the patient’sdyspnea responds rapidly. Which of the followingis the best long-term management plan for thispatient?(A) Prescribe 5 years of specific venom immunotherapy(B) Prescribe epinephrine unit-dose syringes(EpiPen Auto-Injector) for use immediatelyafter he is stung(C) Prescribe prednisone in 2-week tapering dosagesfor initiation whenever he is stung(D) Prescribe 8 mg chlorpheniramine given orallywhenever he is stung(E) Prescribe cromolyn for inhalation at the time ofa bee sting(F) Prescribe diphenhydramine, 50 mg, for oral useimmediately upon being stung13 A 12-year-old boy has been followed for asthma forthe past 2 years. Until recently, he has been satisfiedwith self-treatment with albuterol inhalations onceor twice per week, and they are needed once or twiceper month at night. However, in the past 2 weeks, hehas required albuterol 3 or 4 times per week. Hisforced expiratory volume in 1 second (FEV 1 ) is measuredat 85% of normal. Which of the followingwould be an accepted therapeutic adjustment to thisdevelopment?(A) Increase albuterol inhalations to every 6 hoursas needed(B) Start oral albuterol at a dosage of 8 mg every12 hours(C) Start inhaled glucocorticoids(D) Start both inhaled cromolyn and inhaledglucocorticoids(E) Start long-acting beta-2 agonist, inhaledglucosteroids, and oral glucosteroids14 A teenaged boy with asthma has begun to requirealbuterol daily and once or twice weekly in the night.His FEV 1 and PEF have fallen to 65% of predictedlevels. In addition, the variability of the PEF rangesfrom 20% to 30% of predictability. What should bethe next therapeutic regimen?(A) Perform skin testing and prepare forimmunotherapy(B) Start oral albuterol at a dosage of 8 mg every12 hours(C) Start inhaled glucocorticoids(D) Start both inhaled glucocorticoids and along-acting beta-2 agonist(E) Start a long-acting beta-2 agonist, inhaledglucosteroids, and oral glucosteroids15 Considering infectious precipitants, which of the followingorganisms is thought to be most often implicatedin the initiation of an asthmatic diathesis?(A) Adenoviruses(B) Herpes viruses(C) Arboviruses(D) Respiratory syncytial virus(E) Streptococcus pneumoniae16 A 17-year-old with a long-standing history of asthma(since age 5) has been on short-acting beta-agonistinhalers or cromolyn inhalers (step 2) with fair daytimesymptom control, but he is now awakeningalmost every night with attacks of wheezing and dyspnea.The PEF is 75% of the predicted level. In keepingwith recategorizing the stage of asthma, hence thecare step, which of the following inhalers has the longestduration of action and thus specifically would bethe best choice to control his nocturnal symptoms?(A) Albuterol(B) Terbutaline(C) Pirbuterol(D) Ipratropium(E) Salmeterol