NAECB Allergy & Asthma 5 β Questions and Answers
Question 1: Which immunoglobulin class mediates Type I (immediate) hypersensitivity reactions such as allergic asthma and anaphylaxis?
- IgA
- IgG
- IgM
- IgE (Correct answer)
Correct answer: IgE
IgE is the immunoglobulin responsible for Type I immediate hypersensitivity; it binds to FcΞ΅RI receptors on mast cells and basophils, triggering degranulation upon allergen crosslinking.
Question 2: A patient with poorly controlled asthma has a total serum IgE of 450 IU/mL and weight of 80 kg. Which biologic is approved and dosed based on both IgE level and body weight?
- Mepolizumab
- Benralizumab
- Omalizumab (Correct answer)
- Dupilumab
Correct answer: Omalizumab
Omalizumab dosing is uniquely determined by both baseline serum IgE level and body weight using a dosing table.
Question 3: Which occupational exposure is the most common cause of occupational asthma in the United States?
- Latex
- Flour dust (baker's asthma)
- Isocyanates (Correct answer)
- Animal dander
Correct answer: Isocyanates
Isocyanates, found in polyurethane foam, paints, and coatings, are the leading cause of occupational asthma in the US.
Question 4: Peak flow monitoring in asthma management uses a traffic-light system. A reading in the 'red zone' (below 50% personal best) indicates:
- Continue current therapy and recheck in 1 week
- Use rescue inhaler and proceed to the yellow zone protocol
- Medical alert β use rescue bronchodilator and seek emergency care (Correct answer)
- Increase inhaled corticosteroid dose and monitor at home
Correct answer: Medical alert β use rescue bronchodilator and seek emergency care
A peak flow below 50% of personal best is a medical alert indicating a severe exacerbation requiring immediate bronchodilator use and emergency evaluation.
Question 5: Which finding would differentiate vocal cord dysfunction (VCD) from asthma in a patient with refractory wheeze?
- Wheeze that worsens with cold air
- Symptom relief with albuterol
- Variable extrathoracic obstruction on flow-volume loop (Correct answer)
- Elevated FeNO (fractional exhaled nitric oxide)
Correct answer: Variable extrathoracic obstruction on flow-volume loop
VCD shows a characteristic truncated inspiratory loop (variable extrathoracic obstruction) on flow-volume loop, whereas asthma affects the expiratory loop.
Question 6: A patient on high-dose inhaled corticosteroids (ICS) complains of hoarseness and white patches in the oropharynx. What is the most likely complication and the appropriate action?
- Allergic reaction β switch to a different ICS formulation
- Oropharyngeal candidiasis β instruct patient to rinse mouth after each ICS use (Correct answer)
- Viral laryngitis β prescribe antiviral therapy
- Steroid-induced myopathy β reduce ICS dose
Correct answer: Oropharyngeal candidiasis β instruct patient to rinse mouth after each ICS use
Oropharyngeal candidiasis is a common local side effect of ICS; rinsing the mouth and gargling after each use prevents fungal overgrowth.
Question 7: According to the NAECB scope of practice, which activity is within the role of the Certified Asthma Educator (CAE)?
- Prescribing controller medications
- Performing pulmonary function tests independently without physician supervision
- Developing and delivering asthma self-management education plans (Correct answer)
- Diagnosing asthma using bronchoscopy findings
Correct answer: Developing and delivering asthma self-management education plans
The CAE role is centered on developing individualized asthma action plans and delivering evidence-based self-management education to patients and caregivers.
NAECB Allergy & Asthma 5
Which immunoglobulin class mediates Type I (immediate) hypersensitivity reactions such as allergic asthma and anaphylaxis?