MRCPH/FCPS PEDIATRIC MCQS: IMMUNOLOGY

MRCPH/FCPS PEDIATRIC MCQS: IMMUNOLOGY 

 1. An 8-year-old boy with Elevated IgE with normal levels of IgG, IgA, and IgM; What is the diagnosis? 

2. A 7 -year-old boy presents with generalized maculopapular rash, hepatomegaly, headache, neutropenia, thrombocytopenia, and hyperlipidemia: What is the diagnosis? 

3. A 14-year-old girl with large tonsils, splenomegaly, and pernicious anemia: How will you treat this child? 

4. A 14-year-old boy presents with progressive debilitating unbalanced gait, making ambulation extremely difficult: What is the mode of inheritance? 

5. A 3-year-old boy with known hemoglobin SS sickle cell disease: What is the most common organism causing infection in this disease?

Quiz

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1. An 8-year-old boy presents following a dentist visit in which he was told several of his permanent teeth are coming in and yet he has not lost any of his primary teeth. On examination, both the patient and his mother have a broad forehead, widely spaced eyes, a protruding mandible,
   and rough, excoriated skin. On further history, his mother states he has been hospitalized on several occasions for multiple skin boils, septic arthritis, and several pneumonias.
   Of the following, which set of laboratory results is most likely for this patient?
   1.   Low serum complement levels
   2.   Elevated immunoglobulin (Ig)A with normal levels of IgG, IgM,
      and IgE
   3.   Elevated IgE with normal levels of IgG, IgA, and IgM
   4.   Elevated IgG with normal levels of IgA, IgM, and IgE
   5.   Elevated IgM with normal levels of IgG, IgA, and IgM
2. A 7 -year-old boy presents to the emergency department with fevers, fatigue, severe exudative tonsillitis, posterior cervical lymphadenopathy, and splenomegaly.
   Of the following, which set of symptoms is most consistent with a reactive hemophagocytic lymphohistiocytosis (HLH) process?
   1.   History of recent treatment of the patient's sore throat with amoxicillin followed by a generalized maculopapular rash after initiating the antibiotic
   2.   Fever for 5 days consecutively, erythematous lips and a fissured tongue, cracked peeling skin on the patient's palms and soles
   3.   Generalized maculopapular rash, hepatomegaly, headache, neutropenia,
      thrombocytopenia, and hyperlipidemia
   4.   Severe headache, photophobia, and stiff neck
   5.   Generalized lymphadenopathy, pancytopenia, and persistent fevers
3. A 14-year-old girl with large tonsils, splenomegaly, and pernicious anemia is seen for follow-up in clinic. She reports a recent history of several pneumonias with Streptococcus pneumoniae. Quantitative immunoglobulins (Igs) reveal pan-hypogammaglobulinemia.
   Of the following, what is the best treatment option for this patient?
   1.   Stem cell transplant
   2.   Intravenous immunoglobulin (IVIG)
   3.   Chronic prophylaxis with trimethoprim-sulfamethoxazole (TMPSMX)
   4.   Bi-weekly infusions with infliximab
   5.   Social services care
4. A 14-year-old boy presents with progressive debilitating unbalanced gait, making ambulation extremely difficult. He is noted to have a proliferation of blood vessels on his skin and eyes, and his past medical history reveals frequent antibiotic use for recurrent sinus infections.
   Of the following, which is the inheritance pattern for this patient's
   most likely diagnosis?
   1.   X-linked recessive
   2.   X-linked dominant
   3.   Autosomal recessive
   4.   Autosomal dominant
   5.   Mitochondrial
5. A 3-year-old boy with known hemoglobin SS sickle cell disease presents to the emergency department with 1 day of fever to 104 °F, lethargy, and abdominal pain. He quickly deteriorates with a blood pressure of 70/30 mmHg, capillary refill in his lower extremities of 4 seconds, and
   a white blood cell count of 30 X 103 I llL. On further history, his mother states that he does take a medication daily, but he ran out a month ago and she has not had a chance to refill it. Of the following, what is the most likely organism to grow from his blood culture?
   1.   Aspergillus fumigatus
   2.   Candida albicans
   3.   Streptococcus pneumoniae
   4.   Escherichia coli
   5.   Listeria monocytogenes