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The Allergy & Immunology exam has 225 questions and runs 7 hours.
These 10 free Allergy & Immunology questions are organized by exam domain, so you can see how each part of the Certification in Allergy & Immunology blueprint is tested. Reveal the answer and explanation under each question.
Fluticasone has controlled a 46-year-old man's nasal itching, sneezing, and congestion, but not the profuse clear rhinorrhea that begins with hot meals or cold air. He has no facial pain, fever, or loss of smell. Which add-on treatment most directly targets the remaining symptom?
Correct answer: A - Intranasal ipratropium
At follow-up for chronic spontaneous urticaria, a 35-year-old reports taking cetirizine 10 mg daily for four weeks without sedation. Wheals still appear most days, disappear within eight hours, and leave no bruising. Her Urticaria Control Test score is 9 out of 16. Renal function is normal. Which interpretation and treatment adjustment fit these findings?
Correct answer: D - Control is inadequate; increase cetirizine, up to 20 mg twice daily.
Recurrent hand and facial swelling began at age 15 in a now 23-year-old woman. Episodes last two to three days and sometimes accompany severe abdominal pain. There are no hives, and antihistamines have not helped. She has never taken an ACE inhibitor and has no affected relatives. Repeat testing while well shows C4 of 6 mg/dL (reference 10-40), C1-inhibitor antigen of 31 mg/dL (reference 21-39), C1-inhibitor function of 18% (reference at least 68%), and C1q of 17 mg/dL (reference 12-22). Which form of angioedema does this profile support most strongly?
Correct answer: C - Type II hereditary angioedema
A 52-year-old woman with asthma has recurrent episodes of coughing up thick mucus plugs. Chest CT shows central bronchiectasis and mucus impaction. She completed prednisone one week earlier. Total IgE is 720 IU/mL, Aspergillus fumigatus-specific IgE is 4.1 kUA/L (positive at 0.35 or higher), Aspergillus-specific IgG is positive, and blood eosinophils are 90/µL. There is no neuropathy, purpura, or renal abnormality. Under the revised 2024 ISHAM criteria, which diagnosis is best supported?
Correct answer: C - Allergic bronchopulmonary aspergillosis
Eight minutes after eating cashew-containing pesto, a 19-year-old with known cashew allergy develops a hoarse voice, persistent cough, and diffuse wheezing. Oxygen saturation is 91% on room air and blood pressure is 118/72 mm Hg. There are no hives or visible facial swelling. He has not yet received treatment. While emergency assistance is called, which medication should be given first?
Correct answer: B - Intramuscular epinephrine
An orthopedic surgeon asks whether cefazolin can be used for prophylaxis before a 67-year-old woman's knee arthroplasty. Two years earlier, amoxicillin caused generalized urticaria, bronchospasm, and hypotension within 20 minutes. She has never reacted to a cephalosporin and has no history of a severe delayed drug eruption or drug-related organ injury. What should the allergist recommend regarding cefazolin?
Correct answer: D - Give cefazolin routinely without prior penicillin allergy testing.
Two episodes of meningococcal meningitis in a previously healthy 18-year-old prompt complement testing. CH50 is within the reference interval, whereas AH50 is undetectable. The same pattern is found on a second, freshly processed specimen. Serum C3 and C4 concentrations are normal. Deficiency of which protein best fits these results?
Correct answer: A - Properdin
Before treatment, esophageal biopsies from a 29-year-old with intermittent solid-food dysphagia show 42 eosinophils per high-power field proximally and 36 distally. Endoscopy shows rings and furrows, and evaluation finds no alternative cause of esophageal eosinophilia. After eight weeks of high-dose proton pump inhibitor therapy, dysphagia resolves and repeat biopsies show 3 eosinophils per high-power field. A colleague argues that the PPI response excludes eosinophilic esophagitis (EoE). Which conclusion is most accurate?
Correct answer: B - The findings support EoE that responds to PPI therapy.
An abnormal newborn T-cell receptor excision circle (TREC) screen is followed by flow cytometry. CD3-positive T cells and CD16/56-positive natural killer cells are nearly absent, while CD19-positive B cells are preserved in age-appropriate numbers. The combined absence of T and natural killer cells most strongly implicates failure of which process?
Correct answer: C - Common gamma-chain cytokine-receptor signaling
At 10 weeks' gestation, a 31-year-old asks whether she must stop allergy shots. She has received unchanged maintenance house-dust-mite immunotherapy for 18 months with marked relief of rhinitis, no systemic reactions, and no missed doses. Her asthma is well controlled. After discussion of the maternal anaphylaxis risk, she prefers to continue. Which plan is appropriate?
Correct answer: A - Continue the established maintenance dose without increasing it.
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