NAECB Allergy & Asthma 2 — Questions and Answers
Question 1: A patient with allergic asthma is exposed to cat dander. Which mediator released by mast cells is primarily responsible for the immediate bronchoconstriction?
- Histamine (Correct answer)
- Interleukin-4
- Interferon-gamma
- Transforming growth factor-beta
Correct answer: Histamine
Histamine is the primary mast cell mediator responsible for immediate bronchoconstriction during an acute allergic reaction.
Question 2: Which spirometry pattern is most characteristic of asthma?
- Reduced FVC with normal FEV1/FVC ratio
- Reduced FEV1/FVC ratio with normal FVC (Correct answer)
- Proportionally reduced FEV1 and FVC
- Normal FEV1 and FVC with reduced TLC
Correct answer: Reduced FEV1/FVC ratio with normal FVC
Asthma produces an obstructive pattern with a reduced FEV1/FVC ratio while FVC remains relatively normal.
Question 3: An 8-year-old with moderate persistent asthma is well-controlled on inhaled corticosteroids. What is the recommended reassessment interval before stepping down therapy?
- 1 month
- 2–3 months (Correct answer)
- 6 months
- 12 months
Correct answer: 2–3 months
NAEPP guidelines recommend reassessing asthma control every 2–3 months before stepping down therapy in well-controlled patients.
Question 4: Which allergen is most strongly associated with year-round perennial allergic rhinitis in the United States?
- Grass pollen
- Ragweed pollen
- House dust mite (Correct answer)
- Mountain cedar
Correct answer: House dust mite
House dust mite is the most common cause of perennial allergic rhinitis because it is present year-round in household environments.
Question 5: A patient using a metered-dose inhaler without a spacer is likely depositing most of the medication in which location?
- Alveoli
- Terminal bronchioles
- Oropharynx (Correct answer)
- Trachea
Correct answer: Oropharynx
Without a spacer, large aerosol particles impact and deposit primarily in the oropharynx rather than reaching the lower airways.
Question 6: Which cytokine is most responsible for driving IgE class switching in B cells during allergic sensitization?
- IL-2
- IL-4 (Correct answer)
- IL-12
- IFN-gamma
Correct answer: IL-4
IL-4 is the principal cytokine that induces B cells to undergo class switching to IgE production during Th2-driven allergic sensitization.
Question 7: A patient with asthma reports nocturnal symptoms awakening her more than once per week. According to NAEPP classification, this indicates at least which level of severity?
- Mild intermittent
- Mild persistent
- Moderate persistent (Correct answer)
- Severe persistent
Correct answer: Moderate persistent
Nocturnal awakenings more than once per week but not nightly indicates moderate persistent asthma according to NAEPP criteria.
NAECB Allergy & Asthma 2
A patient with allergic asthma is exposed to cat dander.
Which mediator released by mast cells is primarily responsible for the immediate bronchoconstriction?