Allergy and Immunotherapy Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Allergy and Immunotherapy. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Allergy and Immunotherapy Indian Medical PG Question 1: Under the Stepwise Approach to the management of Bronchial Asthma, which one of the following is the correct initial treatment at Step 1 for a patient diagnosed with Asthma?
- A. Low dose inhaled corticosteroid plus leukotriene antagonist
- B. Low dose inhaled corticosteroid only (Correct Answer)
- C. Low dose inhaled corticosteroid plus long acting anti-muscarinic agents
- D. Low dose inhaled corticosteroid plus oral corticosteroid
Allergy and Immunotherapy Explanation: ***Low dose inhaled corticosteroid only***
- For newly diagnosed asthma patients requiring daily controller therapy (Step 1 or 2 as per GINA 2021+), a **low-dose inhaled corticosteroid (ICS)** is the recommended initial monotherapy [1].
- ICS addresses the underlying inflammation in asthma, which is crucial even in mild persistent cases.
*Low dose inhaled corticosteroid plus leukotriene antagonist*
- This combination is typically considered at **higher steps** (e.g., Step 3 or 4) if control is not achieved with low-dose ICS alone or if there are specific indications like **aspirin-exacerbated respiratory disease** [1].
- Initiating with two controller medications at Step 1 is generally not recommended as per guideline.
*Low dose inhaled corticosteroid plus long acting anti-muscarinic agents*
- **Long-acting muscarinic antagonists (LAMAs)** are primarily used in **severe asthma** that remains uncontrolled despite ICS/LABA therapy, usually at Step 4 or 5.
- They are not considered a first-line addition to ICS at Step 1.
*Low dose inhaled corticosteroid plus oral corticosteroid*
- **Oral corticosteroids** are reserved for asthma **exacerbations** or very severe, uncontrolled asthma, used for short periods due to significant systemic side effects [1].
- They are never used as initial daily maintenance therapy at Step 1 due to their high side effect profile.
Allergy and Immunotherapy Indian Medical PG Question 2: Match List-I with List-II and select the correct answer using the code given below the Lists:
- A. A→4 B→3 C→1 D→2 (Correct Answer)
- B. A→3 B→4 C→1 D→2
- C. A→2 B→1 C→4 D→3
- D. A→1 B→2 C→3 D→4
Allergy and Immunotherapy Explanation: ***A→4 B→3 C→1 D→2***
- **Oral polio vaccine (OPV)** is a live attenuated vaccine, and a rare but serious adverse effect is vaccine-associated paralytic poliomyelitis (VAPP), which manifests as **paralysis**.
- **BCG vaccine** (Bacillus Calmette-Guérin) is used against tuberculosis. A known adverse effect, particularly in immunocompromised individuals, is **suppurative lymphadenitis**, where regional lymph nodes become inflamed and may form abscesses.
- **Pertussis vaccine** (whole-cell DTP) can cause reactions such as persistent inconsolable screaming, high fever, and, very rarely, encephalopathy. **Persistent inconsolable screaming** is a recognized adverse reaction to the pertussis component.
- **Measles vaccine** is a live attenuated vaccine. While generally safe, rare severe adverse effects include **encephalopathy** (or encephalitis).
*A→3 B→4 C→1 D→2*
- This option incorrectly associates oral polio vaccine with suppurative lymphadenitis and BCG with paralysis, contradicting established vaccine adverse effects.
- Oral polio has a risk of paralysis, not lymphadenitis, whereas BCG can cause lymphadenitis.
*A→2 B→1 C→4 D→3*
- This option incorrectly links oral polio to encephalopathy and BCG to persistent inconsolable screaming.
- Encephalopathy is associated with measles or pertussis, and persistent screaming with pertussis, not oral polio or BCG.
*A→1 B→2 C→3 D→4*
- This option incorrectly attributes persistent inconsolable screaming to oral polio and encephalopathy to BCG.
- Paralysis is a known complication of oral polio, and suppurative lymphadenitis is a key adverse effect of BCG.
Allergy and Immunotherapy Indian Medical PG Question 3: A patient with chronic sinusitis has nasal polyps, aspirin sensitivity, and asthma. Most appropriate treatment is:
- A. Early polypectomy
- B. Aspirin desensitization (Correct Answer)
- C. Antibiotics
- D. Topical steroids
Allergy and Immunotherapy Explanation: Aspirin desensitization
- The combination of **nasal polyps**, **aspirin sensitivity**, and **asthma** is characteristic of **Aspirin-Exacerbated Respiratory Disease (AERD)**, also known as Samter's triad.
- **Aspirin desensitization** is the most effective treatment for AERD as it addresses the underlying inflammatory pathway, leading to improved asthma control, reduced polyp recurrence, and decreased need for oral corticosteroids.
*Early polypectomy*
- While polypectomy can temporarily relieve symptoms by removing the polyps, it does not address the underlying inflammatory process of **AERD**.
- Polyps in AERD patients have a **high recurrence rate** after surgical removal if the underlying aspirin sensitivity is not managed.
*Antibiotics*
- Antibiotics are used to treat **bacterial infections**, but they do not address the **chronic inflammatory condition** of AERD or the formation of nasal polyps.
- Chronic sinusitis in AERD is often an inflammatory, not primarily infectious, process.
*Topical steroids*
- **Topical nasal steroids** can help manage chronic rhinosinusitis symptoms and may slow polyp growth but are generally insufficient as a sole treatment [1] for patients with established **AERD** and significant symptoms.
- They provide **symptomatic relief** but do not modify the disease course in the same comprehensive way as aspirin desensitization.
Allergy and Immunotherapy Indian Medical PG Question 4: Which of the following statements is true regarding omalizumab?
- A. Anti-IgE
- B. Given subcutaneously
- C. Used as add-on therapy in moderate to severe asthma prophylaxis
- D. All of the options (Correct Answer)
Allergy and Immunotherapy Explanation: ***All of the options*** is correct because each statement is true:
**Anti-IgE**
- Omalizumab is a **humanized monoclonal antibody** that specifically targets and binds to **free IgE** in the circulation
- By binding free IgE, it prevents IgE from attaching to **high-affinity receptors** on mast cells and basophils
- This reduces the allergic cascade and prevents release of inflammatory mediators
**Given subcutaneously**
- Omalizumab is administered via **subcutaneous injection** only
- Dosing is typically every **2 to 4 weeks** based on patient's body weight and baseline IgE levels
- Not available in oral or intravenous formulations for asthma treatment
**Used as add-on therapy in moderate to severe asthma prophylaxis**
- FDA approved as **add-on maintenance treatment** for patients aged ≥6 years with **moderate to severe persistent allergic asthma**
- Indicated when asthma is **inadequately controlled** with inhaled corticosteroids
- Reduces frequency of asthma exacerbations and improves asthma control
- Also approved for chronic spontaneous urticaria
All three statements accurately describe omalizumab's mechanism, administration route, and clinical indication, making **"All of the options"** the correct answer.
Allergy and Immunotherapy Indian Medical PG Question 5: A young boy came to OPD with complaints of difficulty in breathing. On examination, bilateral polyps were found. On aspiration, bleeding was seen. What will be the initial management?
- A. Septoplasty
- B. I and D
- C. Topical corticosteroids (Correct Answer)
- D. Antihistaminic
Allergy and Immunotherapy Explanation: ***Topical corticosteroids***
- **Topical corticosteroids** are the **first-line medical management** for **nasal polyps**, helping to reduce inflammation and shrink polyp size.
- They work by reducing local inflammation and edema, improving nasal airway patency and breathing.
- **Important note**: The presence of **bleeding on aspiration** suggests a **vascular lesion** (such as juvenile nasopharyngeal angiofibroma in young males), which would require **imaging (CT/MRI) before any intervention** and **no biopsy** due to hemorrhage risk. However, if these are inflammatory polyps, topical steroids remain the initial medical management.
*Antihistaminic*
- **Antihistamines** are not first-line treatment for nasal polyps, as polyps are primarily an **eosinophilic inflammatory condition** rather than a simple IgE-mediated allergic reaction.
- While antihistamines may help with associated allergic rhinitis symptoms, they do **not shrink polyps** or address the underlying inflammatory pathology.
*Septoplasty*
- **Septoplasty** is a surgical procedure to correct a **deviated nasal septum**, not for treating nasal polyps.
- This would not address the bilateral polyps causing difficulty in breathing.
*I and D*
- **Incision and drainage (I&D)** is performed for abscesses or pus collections, which is not the presentation here.
- Nasal polyps are benign inflammatory masses, not infectious collections requiring drainage.
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