Immunology and Allergy — Prometric Style Questions, Set 2

What this deck covers

Immunology and Allergy – Prometric Style Questions, Set 2 in 50 board-style clinical cases with worked explanations. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong, with the guideline or textbook it follows named on the answer.

Board-style teaching questions for paediatricians and trainees preparing for board, MRCPCH and Prometric examinations. Written from published guidelines and standard paediatric textbooks, with the source named on every answer.

The 50 cases, in order

1. Several attempts at a cannula
2. Still infected on treatment
3. A positive measles result
4. A headache the next day
5. Collapse minutes into the first
6. Eighteen months since the drug
7. Swollen legs, clear urine
8. Lymphopenia since the surgery
9. Abscesses and poor control
10. Twice ill since he recovered
11. Flagged low on the report
12. Normal levels, three pneumonias
13. Counted on a bad day
14. Two meningitis, tests clear
15. Taken on a Friday afternoon
16. Eczema on both forearms
17. Twenty foods off the menu
18. Hay fever and a positive result
19. One weal bigger than the other
20. Even the saline made a weal
21. The whole forearm swelled
22. Stung most summers on a farm
23. Something left in the skin
24. Weals but nothing worse
25. Tweezers or a card
26. Eleven operations already
27. Banana, then avocado
28. Draped, and no skin to see
29. Forty minutes into the case
30. A letter with no details
31. Found on screening, and well
32. Two brothers and both parents
33. Rash, diarrhoea, three weeks on
34. Why suppress it further
35. Well, and asking about children
36. Big nodes for three years
37. Diabetes at four months
38. Colitis at fourteen months
39. Platelets then red cells
40. Weak immunity, more autoimmunity
41. Planning another pregnancy
42. Two healthy, then one not
43. Well, and her brother is not
44. Pregnant again at nine weeks
45. Cured, and still testing
46. Raised even between attacks
47. She runs after a sandwich
48. Hours after the evening meal
49. Five attacks, nothing found
50. Dental work under general

Diagnoses and management options tested

Across the fifty cases you are asked to choose between options such as: Oral immunoglobulin, Aseptic meningitis from the infusion, Loss of protein and lymphocytes through the gut, Prolonged immune suppression following measles, Repeat it once he is well and off steroids, Skin prick testing today, It predicts likelihood, not severity, Referral for venom immunotherapy, Remove it immediately, however it is done, An urticarial rash, The precise genetic subtype, To make room in the marrow for donor cells, IPEX syndrome, Defer testing until she can decide for herself.

Clinical pearls from this deck

• Falling levels in the last week and a difficult cannula are the same answer. Weekly subcutaneous dosing flattens the curve and takes the vein out of the equation.
• There is no correct trough, only a trough that works for that child. Titrate against infections, and remember the dose has to grow with them.
• Never interpret serology in a child on replacement. You are measuring a thousand donors, not the patient in front of you.
• A stiff neck the day after immunoglobulin, with sterile fluid, is the infusion talking. Treat the headache, not the culture that was never going to grow.
• IgA deficiency alone is not a contraindication. It is the anti-IgA antibody that matters, and it changes the product rather than the infusion rate.
• Ask what the child was given a year ago, not just what they are on today. Rituximab keeps working long after everyone has stopped thinking about it.

Work through the deck once for recognition, then again a week later to test yourself — each question gives the answer and explains why every other option fails.

More from this system: all immunology and allergy case decks · pediatric reference values.