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These 10 free Otolaryngic Allergy questions are organized by exam domain, so you can see how each part of the Certification in Otolaryngic Allergy blueprint is tested. Reveal the answer and explanation under each question.
Watery rhinorrhea begins within minutes of eating hot, spicy food in a 68-year-old. It is not accompanied by itching, sneezing, urticaria, or nasal obstruction. Intranasal ipratropium substantially reduces the secretion without changing nasal airflow. Which physiologic action accounts for this selective effect?
Correct answer: C - Muscarinic receptor blockade reducing nasal gland secretion.
A 24-year-old has recurrent nonpruritic facial swelling and episodes of severe cramping abdominal pain dating from adolescence. Her father has similar swelling. There is no urticaria or ACE-inhibitor use. Two properly handled samples show low C4, a normal C1-inhibitor antigen concentration, markedly reduced C1-inhibitor function, and normal C1q. This pattern is most consistent with:
Correct answer: A - Hereditary angioedema caused by dysfunctional C1 inhibitor, type II.
An otolaryngologist and pulmonologist are comparing biologic mechanisms for a patient with asthma and nasal polyps. One proposed treatment blocks the shared receptor subunit used by both IL-4 and IL-13. Which drug-target pairing identifies this mechanism?
Correct answer: B - Dupilumab - IL-4 receptor alpha.
Despite eight weeks of daily intranasal fluticasone at the recommended adult dose, a teacher still has troublesome nasal obstruction, itching, and sneezing during confirmed grass-pollen exposure. Adherence and spray technique are satisfactory. Examination shows no polyps or structural obstruction, and the patient prefers another medication trial before immunotherapy. Which adjustment has the strongest evidence for improving the remaining nasal symptoms?
Correct answer: B - Add intranasal azelastine.
Eight minutes after a subcutaneous allergen injection, a patient abruptly develops a hoarse voice, inspiratory stridor, and diffuse wheezing. Blood pressure is 118/74 mm Hg, and the skin remains clear. Staff are activating the emergency response. Which medication should be given first?
Correct answer: A - Intramuscular epinephrine.
Peanut has not yet been introduced to a five-month-old with severe eczema who is already tolerating other pureed foods. Skin-prick testing on unaffected skin produces a 5-mm peanut wheal, a 0-mm saline wheal, and an adequate histamine response at 15 minutes. Under the 2017 NIAID peanut-prevention pathway, how should the first peanut exposure be approached?
Correct answer: D - Arrange specialist-supervised feeding or a graded oral food challenge.
An aeroallergen skin-prick report records 0-mm wheals to saline, histamine, and every allergen at the protocol-specified reading times. The patient took cetirizine that morning and reports recurrent exposure-related sneezing and ocular itching. What can be concluded from the negative allergen results?
Correct answer: D - These results cannot reliably exclude sensitization.
At follow-up, a patient's Rhinitis Control Assessment Test (RCAT) score has risen from 15 to 19 after treatment. Which interpretation respects both the instrument's control threshold and its validation-study estimate of a minimally important change?
Correct answer: C - Important improvement; inadequate current control.
During a routine injection visit, a patient reports that she is nine weeks pregnant. She has received the same effective maintenance subcutaneous immunotherapy dose for 18 months without systemic reactions. Her asthma is well controlled, and no dose increase is planned. After an individualized discussion of risks and benefits, she wishes to continue. How should pregnancy affect this regimen?
Correct answer: B - Continue the same maintenance dose without escalation.
Before dispensing a subcutaneous immunotherapy vial, a clinician reviews an order for a final volume of 5.0 mL containing enough standardized grass extract to deliver 600 BAU in each 0.30-mL injection. The available stock contains 20,000 BAU/mL. Which preparation and dose verification match the order, assuming additive volumes and a compatible diluent?
Correct answer: C - 0.50 mL stock plus 4.50 mL diluent; 600 BAU per injection.
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