Internal-Medicine

232 11: Immunology and Allergy
15. A 42-year-old man has an allergy to penicillin.
He is given cephalexin for a skin infection on
his finger after a cut became infected. He now
develops angioedema after drug exposure.
Which of the following physical findings is
characteristic of this syndrome?
(A) invariably severe itching
(B) prolonged nature of the edema
(C) fluid extravasation from subcutaneous
and intradermal postcapillary venules
(D) involvement of lips, tongue, eyelids,
genitalia, and dorsum of hands or feet
(E) fluid accumulation in the most dependent
areas of the body
16. A 47-year-old woman, with Type I diabetes of
30 years’ duration, is in the hospital for assessment
of atypical chest pain. While in the hospital,
she develops a true anaphylactic reaction.
Which of the following is the most likely cause
for the reaction?
(A)
(B)
(C)
(D)
(E)
radiographic contrast media
erythromycin
insulin
folic acid supplement
exposure to nuts
17. A 27-year-old long-time intravenous (IV) drug
user has recurrent infections and a low CD4 +
count. Which factor is true concerning this
immunosuppression?
(A)
(B)
(C)
(D)
(E)
qualitative defects in T lymphocytes follow
quantitative problems
the low CD4 count in advanced disease
is secondary to the direct cytotoxic
effects of virus infection
B-lymphocyte abnormalities do not
occur early in the disease
macrophages are important in viral
dissemination
circulating immune complexes are
rarely present
18. A 24-year-old man with known HIV infection
presents with a right hemiparesis that developed
over several days. Cognitive examination reveals
global impairment, and a computed tomography
(CT) scan reveals multiple cortical lesions that are
spherical and ring enhancing. Which of the following
is the most likely diagnosis?
(A) glioblastoma multiforme
(B) toxoplasmosis
(C) lymphoma
(D) progressive multifocal leukoencephalopathy
(E) cytomegalovirus (CMV)
19. A 23-year-old woman has had several episodes
of severe wheezing over the past 3 years. She is
a nonsmoker and feels well in between
episodes. She has no personal or family history
of atopy. The wheezing episodes are most
likely to occur in spring. Which of the following
is the most likely mechanism of wheezing
in this woman?
(A) elevated IgE levels
(B) mast cell instability
(C) nonspecific hyperirritability of the
tracheobronchial tree
(D) disordered immediate hypersensitivity
(E) disordered delayed hypersensitivity
20. A 45-year-old man with severe asthma is doing
well after a recent exacerbation requiring hospital
admission. He is interested in avoiding
any potential agents that might trigger his
asthma. Which of the following foods is most
likely to precipitate an asthmatic reaction in
this man?
(A)
(B)
(C)
(D)
(E)
red meat
egg whites
green salad
gluten
mayonnaise
DIRECTIONS (Questions 21 through 36): Each set
of matching questions in this section consists of a
list of lettered options followed by several numbered
items. For each numbered item, select the
appropriate lettered option(s). Each lettered
option may be selected once, more than once, or
not at all. EACH ITEM WILL STATE THE NUM-
BER OF OPTIONS TO SELECT. CHOOSE
EXACTLY THIS NUMBER.