- Email: [email protected]
Answers for July CME examination
VOLUME NUMBER
160. 161. 162. 163. 164. 165. 166. 167. 168. 169. 170. 171. 172. 173.
72 2
July
man factor dependent pathways. Fourth International Congress of Immunology, Paris, 1980, p. 13.5.10. Meier HL, Newball HH, Berninger RW, Talamo RC, Lichtenstein LM: J ALLERGY CLIN IMMLJNOL 63:191, 1979. Schechter NM, Fraki JE, Geesin JC, Lazarus GS: J Biol Chem 258:2973, 1983. Newball HH, Beminger RW, Talamo RC, Lichtenstein LM: J Clin Invest 64:457, 1979. Yurt RW, Austen KF: J Exp Med l&1405, 1977. Schwartz LG. Riedel C, Caulfield JP, Wasserman SI, Austen KF: J lmmunol 126:207 1, 198 1. Woodbury RG, Neurath H: Biochemistry 17:4298, 1978. Schwartz LB. Austen KF, Wasserman SI: J Immunol 1231445, 1979. Wasserman SI, Austen KF: J Biol Chem 252:7074, 1977. Weller PF, Lewis RA, Corey EJ, Austen KF: Fed Proc 40:1023, 1981. Henderson WR, Kaliner M: J Clin Invest 61:187, 1978. Henderson WR, Kaliner M: J Immunol 122:1322, 1979. Metcalfe DD, Lewis RA, Silbert JE, Rosenberg RD. Wasserman SI, Austen KF: J Clin Invest 64:1537, 1979. Metcalfe DD, Soter NA, Wasserman SI, Austen KF: J Invest Dermatol 74:210, 1980. Yurt RW, Leid RW, Austen KF, Silbert JE: J Biol Chem 252:518, 1977.
Answers
ALLERGY
Identification
refer to journal
pages.
answers
No. 078302
CLIN IMMUNOL 72:1-14, 1983.
1. b (pp. l-2*) Mononuclear cells are more prominent than eosinophils. Ig and C are seen in the exceptional cases of urticarial vasculitis. 2. d (p. 2) IgM and IgG would be more commonly present. 3. d (p. 3) Ampicillin does not release histamine from normal skin. 4. c (p. 3) Some types of solar u&aria are related to IgE. 5. d (p. 6) Nail polish commonly causes type IV hypersensitivity. 6. e (p. 12) Penicillin urticaria is not related to atopy or the autosomal dominant forms of urticaria. 7. b (p. 4) Cold may tend to protect (the nonsensitive patient) because of its vasoconstrictive effect. 8. c (p. 3) Alternative pathway and late C components are normal in these cases.
*Page numbers
examination
174. Weiler JM, Yurt RW, Fearon DT, Austen KF: J Exp Med 147:409, 1978. 175. Razin E, Stevens RL, Akiyama F, Schmid K, Austen KF: J Biol Chem 257:7229, 1982. 176. Dolovitch J, Hargreaves FE, Chalmers R, Skiar KJ, Gauldie J,BrenenstockJ:J ALLERGY CLIN IMMUNOL 5238, 1973. 177. Solley GO, Gleich GJ, Jordon RE, Schroeter AL: J Clin Invest 58:408, 1976. 178. Ting S, Dunsky EH, Lavker RM, Zweiman B: J ALLERGY CLIN IMMUNOL~~:~~~, 1980. 179. Ting S, Zweiman B, Lavker RM, Dunsky EH: J Immunol 127:5577, 1981. 180. Booj-Noord H, Orie NGM, DeVries K: J ALLERGY CLIN IMMUNOL 48:344, 1971. 181. Metzger WJ, Henriksen RA, Zaleski T, Donnelly A: Clin Res 31:164, 1983. 182. Knauer KA, Lichtenstein LM, Adkinson NF, Fisk JE: N Engl J Med 304:1404, 1981. 183. Cockcroft DW, Ruffin RE, Dolovitch J, Hargreaves FE: Clin Allergy 7:503, 1977. 184. Eady RAJ, Graves MW: Lancet 1:336, 1978. 185. Eady RAJ, Keahey TM, Sibbold RG, Kobza-Black A: Clin Exp Dermatol 6:355, 198 1.
for July CME examination
Mathews KP: Urticaria and angioedema. J
CME
9. e (p. 11) An impression of decreasing spontaneous remissions with increasing duration has recently been documented. 10. b (p. 2) NCF, ECF-A, and eosinophil chemotactic oligopeptides with and without chemotactic activity for monocytes have been described in these venous effluents. 11. a, b, c, d, e (pp. 3, 7-8, 9) All have been demonstrated. 12. b, c, e (pp. 7, 8, 9) Passive transfer of cholinergic urticaria has not been confirmed, and it has not been reported in aquagenic urticaria. 13. a, c (p. 1) Chronic urticaria is defined as in option A. Although some types occur more frequently in atopic persons, the majority of cases are in nonatopic individuals. 14. a, b, d (p. 2) As expected, increased mast cells are associated with increased histamine content, but human mast cells are devoid of serotonin. 15. b, d (pp. 2-3) Evidently there may be a partial “desensitiza115
116
16.
17.
18.
19.
20.
21.
22.
Instructions
for category
J. ALLERGY
I credit
tion” in vivo which results in decreased release of histamine and ECF in vitro with anti-IgE stimulation but not with a pharmacologic histamine releaser (48/80). a, b, e (p. 8) Delayed pressure urticaria often is associated with systemic symptoms and frequently is quite refractory to treatment. a, c, d, e (p. 8) Combinations of physical urticarias occur with significant frequency, but there is no reported association with HAE. a, c, d (p. 12) In addition to inhibiting Cls, Ci INH inhibits Clr, kallikrein, activated Hagemanfactor, XIa, and plasmin. e (p. 3) C4a recently has been shown to be an anaphylatoxin (as well as C5a and C3a). b (p. 4) SCPN is the only known anaphylatoxin inactivator. c (p. 4) SubstanceP is a vasodilator peptide presentin the nervous system and gastrointestinaltract. c (p. 4) Aquagenic urticaria lesions are produced by water at body temperature.
INSTRUCTIONS
23. d (p. 4)
Urticarial vasculitis tends to occur on the lower extremities like other forms of vasculitis. 24. d (p. 4) Children tend to get these insect bites on their legs. 25. c (p. 7)
26.
27.
28.
29.
30.
C4 will be low when Ci INH levels are low for any reason. b (p. 7) Low Clq is present with the acquired but not hereditary form of Ci INH deficiency. b (p. 7) The acquired form of deficiency has been observed in association with lymphomas, other neoplasms , and autoimmune conditions. c (p. 9) Pruritus often is prominent early in attacks of exercise-inducedanaphylaxis. a (p. 9) Heat is a prominent precipitant of cholinergic urticaria, but generally exercise is neededto initiate this type of anaphylaxis. b (p. 9) Cholinergic urticaria characteristically features small wheals.
FOR EARNING SELF-ASSESSMENT
Certification. As an organizationaccreditedfor continuing medicaleducation,The AmericanAcademyof Allergy and Immunology certifies that when the self-assessment program is used as directed, it meets the criteria for 2 hours of credit in Category I of the Physician’s Recognition Award of the American Medical Association. Instructions. Category I credit can be earned by: 1. Reading the lead CME article in each issue of the Journal. 2. Recording the answers on the perforated answer sheet as directed 3. Returning the answer sheet (by the 15th of the month following the Journal’s publication month) to: The American Academy of Allergy and Immunology Continuing Medical Education Coordinator 611 East Wells St. Milwaukee, WI 53202
CLIN. IMMUNOL. AUGUST 1983
CATEGORY I CREDIT
In marking the answer sheet, use a No. 2 or soft lead pencil. Corrections can be made, but must be erased completely in order to prevent computer reading errors. Your medical education number (ME#), which can be found on your AMA membership card, and the quiz identification number, which is provided at the beginning of the quiz, will be used to develop cumulative results and group statistics. To ensure anonymity, after group statistics have been developed, individual answer sheets will be destroyed. No records of individual performance will be maintained. Those who send in answer sheets will be sent a computer analysis of each exam that will include item analysis, mean, standard deviation, frequency distribution, and a continuing medical education certificate for maintaining credit records. Answers to each quiz will be published in the following issue of the JOURNAL.
160. 161. 162. 163. 164. 165. 166. 167. 168. 169. 170. 171. 172. 173.
72 2
July
man factor dependent pathways. Fourth International Congress of Immunology, Paris, 1980, p. 13.5.10. Meier HL, Newball HH, Berninger RW, Talamo RC, Lichtenstein LM: J ALLERGY CLIN IMMLJNOL 63:191, 1979. Schechter NM, Fraki JE, Geesin JC, Lazarus GS: J Biol Chem 258:2973, 1983. Newball HH, Beminger RW, Talamo RC, Lichtenstein LM: J Clin Invest 64:457, 1979. Yurt RW, Austen KF: J Exp Med l&1405, 1977. Schwartz LG. Riedel C, Caulfield JP, Wasserman SI, Austen KF: J lmmunol 126:207 1, 198 1. Woodbury RG, Neurath H: Biochemistry 17:4298, 1978. Schwartz LB. Austen KF, Wasserman SI: J Immunol 1231445, 1979. Wasserman SI, Austen KF: J Biol Chem 252:7074, 1977. Weller PF, Lewis RA, Corey EJ, Austen KF: Fed Proc 40:1023, 1981. Henderson WR, Kaliner M: J Clin Invest 61:187, 1978. Henderson WR, Kaliner M: J Immunol 122:1322, 1979. Metcalfe DD, Lewis RA, Silbert JE, Rosenberg RD. Wasserman SI, Austen KF: J Clin Invest 64:1537, 1979. Metcalfe DD, Soter NA, Wasserman SI, Austen KF: J Invest Dermatol 74:210, 1980. Yurt RW, Leid RW, Austen KF, Silbert JE: J Biol Chem 252:518, 1977.
Answers
ALLERGY
Identification
refer to journal
pages.
answers
No. 078302
CLIN IMMUNOL 72:1-14, 1983.
1. b (pp. l-2*) Mononuclear cells are more prominent than eosinophils. Ig and C are seen in the exceptional cases of urticarial vasculitis. 2. d (p. 2) IgM and IgG would be more commonly present. 3. d (p. 3) Ampicillin does not release histamine from normal skin. 4. c (p. 3) Some types of solar u&aria are related to IgE. 5. d (p. 6) Nail polish commonly causes type IV hypersensitivity. 6. e (p. 12) Penicillin urticaria is not related to atopy or the autosomal dominant forms of urticaria. 7. b (p. 4) Cold may tend to protect (the nonsensitive patient) because of its vasoconstrictive effect. 8. c (p. 3) Alternative pathway and late C components are normal in these cases.
*Page numbers
examination
174. Weiler JM, Yurt RW, Fearon DT, Austen KF: J Exp Med 147:409, 1978. 175. Razin E, Stevens RL, Akiyama F, Schmid K, Austen KF: J Biol Chem 257:7229, 1982. 176. Dolovitch J, Hargreaves FE, Chalmers R, Skiar KJ, Gauldie J,BrenenstockJ:J ALLERGY CLIN IMMUNOL 5238, 1973. 177. Solley GO, Gleich GJ, Jordon RE, Schroeter AL: J Clin Invest 58:408, 1976. 178. Ting S, Dunsky EH, Lavker RM, Zweiman B: J ALLERGY CLIN IMMUNOL~~:~~~, 1980. 179. Ting S, Zweiman B, Lavker RM, Dunsky EH: J Immunol 127:5577, 1981. 180. Booj-Noord H, Orie NGM, DeVries K: J ALLERGY CLIN IMMUNOL 48:344, 1971. 181. Metzger WJ, Henriksen RA, Zaleski T, Donnelly A: Clin Res 31:164, 1983. 182. Knauer KA, Lichtenstein LM, Adkinson NF, Fisk JE: N Engl J Med 304:1404, 1981. 183. Cockcroft DW, Ruffin RE, Dolovitch J, Hargreaves FE: Clin Allergy 7:503, 1977. 184. Eady RAJ, Graves MW: Lancet 1:336, 1978. 185. Eady RAJ, Keahey TM, Sibbold RG, Kobza-Black A: Clin Exp Dermatol 6:355, 198 1.
for July CME examination
Mathews KP: Urticaria and angioedema. J
CME
9. e (p. 11) An impression of decreasing spontaneous remissions with increasing duration has recently been documented. 10. b (p. 2) NCF, ECF-A, and eosinophil chemotactic oligopeptides with and without chemotactic activity for monocytes have been described in these venous effluents. 11. a, b, c, d, e (pp. 3, 7-8, 9) All have been demonstrated. 12. b, c, e (pp. 7, 8, 9) Passive transfer of cholinergic urticaria has not been confirmed, and it has not been reported in aquagenic urticaria. 13. a, c (p. 1) Chronic urticaria is defined as in option A. Although some types occur more frequently in atopic persons, the majority of cases are in nonatopic individuals. 14. a, b, d (p. 2) As expected, increased mast cells are associated with increased histamine content, but human mast cells are devoid of serotonin. 15. b, d (pp. 2-3) Evidently there may be a partial “desensitiza115
116
16.
17.
18.
19.
20.
21.
22.
Instructions
for category
J. ALLERGY
I credit
tion” in vivo which results in decreased release of histamine and ECF in vitro with anti-IgE stimulation but not with a pharmacologic histamine releaser (48/80). a, b, e (p. 8) Delayed pressure urticaria often is associated with systemic symptoms and frequently is quite refractory to treatment. a, c, d, e (p. 8) Combinations of physical urticarias occur with significant frequency, but there is no reported association with HAE. a, c, d (p. 12) In addition to inhibiting Cls, Ci INH inhibits Clr, kallikrein, activated Hagemanfactor, XIa, and plasmin. e (p. 3) C4a recently has been shown to be an anaphylatoxin (as well as C5a and C3a). b (p. 4) SCPN is the only known anaphylatoxin inactivator. c (p. 4) SubstanceP is a vasodilator peptide presentin the nervous system and gastrointestinaltract. c (p. 4) Aquagenic urticaria lesions are produced by water at body temperature.
INSTRUCTIONS
23. d (p. 4)
Urticarial vasculitis tends to occur on the lower extremities like other forms of vasculitis. 24. d (p. 4) Children tend to get these insect bites on their legs. 25. c (p. 7)
26.
27.
28.
29.
30.
C4 will be low when Ci INH levels are low for any reason. b (p. 7) Low Clq is present with the acquired but not hereditary form of Ci INH deficiency. b (p. 7) The acquired form of deficiency has been observed in association with lymphomas, other neoplasms , and autoimmune conditions. c (p. 9) Pruritus often is prominent early in attacks of exercise-inducedanaphylaxis. a (p. 9) Heat is a prominent precipitant of cholinergic urticaria, but generally exercise is neededto initiate this type of anaphylaxis. b (p. 9) Cholinergic urticaria characteristically features small wheals.
FOR EARNING SELF-ASSESSMENT
Certification. As an organizationaccreditedfor continuing medicaleducation,The AmericanAcademyof Allergy and Immunology certifies that when the self-assessment program is used as directed, it meets the criteria for 2 hours of credit in Category I of the Physician’s Recognition Award of the American Medical Association. Instructions. Category I credit can be earned by: 1. Reading the lead CME article in each issue of the Journal. 2. Recording the answers on the perforated answer sheet as directed 3. Returning the answer sheet (by the 15th of the month following the Journal’s publication month) to: The American Academy of Allergy and Immunology Continuing Medical Education Coordinator 611 East Wells St. Milwaukee, WI 53202
CLIN. IMMUNOL. AUGUST 1983
CATEGORY I CREDIT
In marking the answer sheet, use a No. 2 or soft lead pencil. Corrections can be made, but must be erased completely in order to prevent computer reading errors. Your medical education number (ME#), which can be found on your AMA membership card, and the quiz identification number, which is provided at the beginning of the quiz, will be used to develop cumulative results and group statistics. To ensure anonymity, after group statistics have been developed, individual answer sheets will be destroyed. No records of individual performance will be maintained. Those who send in answer sheets will be sent a computer analysis of each exam that will include item analysis, mean, standard deviation, frequency distribution, and a continuing medical education certificate for maintaining credit records. Answers to each quiz will be published in the following issue of the JOURNAL.