JACI PRIMER EXAM 2023-2024 ACTUAL EXAM 120 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (100% VERIFIED ANSWERS) |ALREADY GRADED A+||BRAND NEW!!!

JACI PRIMER EXAM 2023-2024 ACTUAL EXAM 120

QUESTIONS AND CORRECT DETAILED ANSWERS WITH

RATIONALES (100% VERIFIED ANSWERS) |ALREADY

GRADED A+||BRAND NEW!!!

Question 1. Which of the following processes involved during natural allergen

sensitization through the nasal mucosa in patients with allergic rhinitis is most

specific for dust mite antigen?

A. elaboration of thymic stromal lymphopoietin by nasal epithelial cells

B. local and systemic production of allergen-specific IgE

C. enhancement through induction of Toll-like receptor 4 (TLR4) signaling

D. interaction of dust mite antigen with interepithelial and

subepithelial dendritic cells - ANSWER- 1. Answer: C

Rationale : The dust mite antigen has proteolytic activity that cleaves tight

junctions in the airway epithelium. Activated epithelial cells produce thymic

stromal lymphopoietin, a protein that interacts with interepithelial and subepithelial

dendritic cells to skew T-cell development toward TH2 allergic sensitization. The

house dust mite allergen Der p 2 has a unique property, namely that it mimics MD2, the LPS-binding component of the TLR4 signaling complex, and facilitates

TLR4 signaling and airway TH2-type inflammation. In the nose allergens are

processed by antigen-presenting cells (dendritic cells expressing CD1a and CD11c

and macrophages) in the nasal epithelial mucosa, with subsequent presentation of

allergenic peptides by MHC class II molecules to T-cell receptors on resting CD41

T lymphocytes in regional lymph nodes.

Question 2. Which of the following subtypes of nonallergic rhinitis is most likely

to be associated with eosinophilia?

A. irritant-induced rhinitis

B. cold-induced rhinitis

C. vasomotor rhinitis

D. rhinitis associated with aspirin sensitivity (aspirinexacerbated respiratory disease) - ANSWER- 2. Answer: D

Rationale : Nonallergic rhinitis often occurs without eosinophilia. The terms

nonallergic rhinitis without eosinophilia and idio- pathic rhinitis are used

interchangeably. Irritant-induced rhinitis, cold-induced rhinitis, and vasomotor

rhinitis are all considered subsets of this condition. Vasomotor rhinitis is

sometimes used synonymously with nonallergic rhinitis without eosinophilia, but it

sometimes can more specifically connote nasal symptoms that occur in response to

environmental conditions, such as changes in temperature or relative humidity,

odors (eg, perfume or cleaning materials), passive tobacco smoke, alcohol, sexual

arousal, and emotional factors. Nonallergic rhinitis with aspirin sensitivity is

usually associated with marked tissue eosinophilia (ie, nonallergic rhinitis with

eosinophilia).

Question 3. Which of the following pathologic processes impli- cated in the

pathogenesis of CRS is most specific for CRS with nasal polyposis?

A. TH2-type immune hyperresponsiveness (production of IL-5 and IL-13) directed

toward colonizing fungi in sinus secretions

B. glandular hyperplasia

C. formation of bacterial biofilm on sinus mucosal tissue

D. local production of IgE directed against staphylococcal enterotoxins (ie,

superantigens) from Staphylococcus aureus - ANSWER- 3. Answer: D

Rationale : TH2-type immune hyperresponsiveness in sinus tissue is an important

feature of CRS without distinction for the pres- ence of nasal polyps. Patients with

CRS typically have fungi, such as Alternaria species, in the mucus secretions and

in vitro hyper- responsiveness to Alternaria species, with production of IL-5 and

IL-13. Local production of IgE against staphylococcal enterotoxins (superantigens)

has been found in homogenates of nasal polyps and is regarded as specific for CRS

with nasal polyps. Pro- duction of bacterial biofilm on sinus mucosal tissue has

been demonstrated in several studies without distinction for the presence of nasal

polyps. Glandular hyperplasia is a feature of CRS without nasal polyps.

Question 4. In patients with CRS, the sinus CT scan might reveal hyperdensities

within an opacified sinus cavity. Which of the following statements best describes

the significance of hyperdensities?

A. They are pathognomonic of allergic fungal rhinosinusitis.

B. They are suggestive of the presence of necrotizing infection (abscess

formation).

C. They are often associated with mucocele formation.

D. They are suggestive of the presence of thick inspissated secretions containing

large numbers of degranulated eosinophils (allergic mucin) and possibly colonizing

fungi. - ANSWER- 4. Answer: D

Rationale : Opacified sinus cavities might contain inspissated mucus that produces

an inhomogeneous hyperdense pattern on sinus CT scanning. Hyperdensities

suggest the presence of allergic mucin. They are a classic feature of allergic fungal

rhinosinusitis (in which case the allergic mucin also contains fungal hyphae), but

they can be seen in both patients with CRS without nasal polyps and patients with

CRS with nasal polyps.

Question 1. Which of the following most accurately describes an epidemiologic

feature of food allergy?

A. Allergy to fish/shellfish is more prevalent among children than among adults.

B. On the basis of studies from a referral center in the United States, allergy to

milk and egg might be more persistent than noted in past decades, with fewer than

20% resolving these allergies by age 4 years.

C. Food allergy has approximately doubled in children over the past decade.

D. Peanut allergy resolves by school age for 35% of children given diagnoses at

less than 2 years of age. - ANSWER- 1. Answer: B

Rationale : Studies of a referral population in the United States indicated that only

11% resolved egg and 19% resolved milk allergy by age 4 years; however, about

80% resolved these allergies by age 16 years. Allergy to fish/shellfish is reported

more often in adults compared with children. Although several studies showed an

increase, approximately doubling, in peanut allergy among children in the past 10

to 15 years, there are no data to indicate a general doubling of food allergy. Peanut

allergy resolves for about 20% of young children by school age.

Question 2. A 27-year-old atopic man experienced mild oral pruritus when eating

raw apples but tolerates apple juice and baked apple. Which of the following is

most likely to be true?

A. He has an increased IgE level that binds lipid transfer protein in apple.

B. He has positive skin test results to commercial extract of apple.

C. He has an increased IgE level to Bet v 1.

D. The Maillard reaction during heating apple results in a change in conformation

that abrogates IgE binding for this subject. - ANSWER- 2. Answer: C

Rationale : The symptom complex of having mild oral pruritis to raw apple but

tolerating cooked apple is consistent with a diagnosis of oral allergy

syndrome/pollen-food syndrome, in which initial sensitization to pollen results in

reactions to homologous proteins in a raw food. Here there was likely sensitization

to birch pollen protein in this ''atopic'' man; the birch pollen protein Bet v 1 is

homologous to Mal d 1 in apple. Lipid transfer protein is more stable to heat and

less likely to result in mild symptoms. Although he might have a positive skin test

result to commercial apple extract, the birch-related protein is less stable, and

testing with fresh raw juice of an apple is more likely to show a positive result in

this scenario. Although heating apple reduces the Mal d 1 protein level and

generally results in a form of the food that does not trigger symptoms in persons

with birch pollen-related allergy, this is not a Maillard reaction. High heat resulting

in a Maillard reaction, a chemical reaction between an amino acid and a reducing

sugar, has been proposed to increase the allergenicity of some foods (roasted

peanut) by increasing the stability of allergens.

Question 3. Which of the following clinical descriptions is most likely to represent

a food allergy?

A. A 3-year-old experiences acute, transient, nonpruritic erythema over the left

cheek minutes after she ingests, on separate occasions, lemonade, spicy potato

chips, and sour candy.

B. A breast-fed 5-month-old infant experiences severe vomiting, lethargy, and an

increased white blood cell count with bandemia 2 hours after she is fed rice cereal.

Skin test results to rice are negative.

C. An 18-year-old experiences cramps and diarrhea after ingesting a large milk

shake.

D. A 47-year-old experiences facial flushing and a tingling sensation in the mouth

after ingesting tuna in a restaurant. He previously tolerated all fish. - ANSWER- 3.

Answer: B

Rationale : Food allergy requires an adverse immune response. This description

fits rice-induced enterocolitis syndrome. This is a non-IgE-mediated food allergy,

and results of skin testing are expected to be negative. Choice A describes

auriculotemporal syndrome, which is a neurologic response to the spicy or tart

triggers for the child described. Choice C describes lactose intolerance, which is

dose dependent. Choice D most likely describes an episode of scombroid fish

poisoning.

Question 4. An infant experienced urticaria and angioedema when introduced to

egg, and the egg-specific IgE concentration was 4.7 kIU/L. At age 2 years, she

accidentally ingested a bite of egg and experienced wheezing and generalized

urticaria and around that time had an egg IgE level of 1.7 kIU/L. At age 3 years,

she accidentally ingested a small amount of egg and ex- perienced generalized

urticaria. At age 31⁄2 years, she presents for evaluation, and the serum egg IgE

level was less than

0.35 kIU/L. Which of the following would be the most reason- able next step

toward diagnosis?

A. Perform an open oral food challenge to egg.

B. Perform a double-blind, placebo-controlled oral food challenge to egg.

C. Perform a skin prick test to egg.

D. Allow the child to add egg to the diet. - ANSWER- 4. Answer: C