1. A 45 year old woman with a 20 pack-year smoking history recently returned from Europe with her husband. During the flight she developed increasing back pain and thinks she has sciatica. She took three ibuprofen tablets yesterday with little relief and would like your opinion regarding her condition. She has never had a similar problem. There was no fever, chest pain, shortness of breath, abdominal pain, weight loss, nausea or vomiting. She has no bleeding conditions. She has a history of nasal polyps and allergic rhinitis for which she takes a corticosteroid inhaler and a cromolyn compound. She has no drug allergies but is allergic to seafood and certain types of nuts. Which of the following medication is contraindicated in this patient [11] ?

   A. Aspirin
   B. Naproxen Sodium
   C. Tylenol with Codeine
   D. Angiotensin converting enzyme (ACE) inhibitors
   E. Tramadol (Ultram®)

2. Which ONE of the following cytokines is NOT typically made by T helper type 2 lymphocytes [2] ?

   A. Interleukin 5
   B. Interleukin 10
   C. Interleukin 4
   D. Interleukin 13
   E. Interferon gamma

3. Elevated Interleukin 6 and C-Reactive Protein (CRP) are associated with all of the following EXCEPT [3]:

   A. Acute phase reactions
   B. Reduced erythrocyte sedimentation rate
   C. Increased mortality rates in elderly
   D. Anemia of chronic disease
   E. Systemic inflammation

4. All of the following are true concerning Hypersensitivity Reactions EXCEPT [4]:

   A. Type I Hypersensitivity Reactions are mediated primarily by IgE
   B. Type IV Hypersensitivity Reactions require antigen presentation to T helper cells
   C. Type III Hypersensitivity Reactions are due to immune complex deposition
   D. Type II Hypersensitivity Reactions are mediated by direct antibody effects
   E. Types I and III Hypersensitivity Reactions are T cell independent

5. All of the following are true concerning Interleukin 2 (IL-2) therapy EXCEPT [5]:

   A. IL-2 is a major T cell growth factor which can induce T cell proliferation
   B. IL-2 can be used in vitro to expand T cell clones as well as LAK and TIL cells
   C. Antibodies to IL-2 receptors (anti-CD25) can reduce rejection episodes in transplantation
   D. High dose infusions of IL-2 in humans are well tolerated but not very effective in cancer
   E. The toxicity of systemic IL-2 is mainly a severe pulmonary capillary leak syndrome

6. All of the following are important causes of lymphedema EXCEPT [6]:

   A. Following lymphadenectomy for breast cancer
   B. Infection due to filiarisis causing obstruction
   C. Congestive heart failure (CHF)
   D. Idiopathic primary lymphedema
   E. Yellow Nail Syndrome

7. All of the following are true anti-oxidants EXCEPT [7]:

   A. Superoxide Dismutase
   B. Glutathione S-Transferase
   C. Glutathione Peroxidase
   D. Reduced glutathione (GSH)
   E. Nitric oxide

8. All of the following substances play a prominant role in the sensation of pruritus EXCEPT [8]:

   A. Neuropeptide Y
   B. Prostaglandin E2 type, may potentiate histamine
   C. Substance P
   D. Histamine
   E. Opioid Peptides

9. All of the following cause splenomegaly EXCEPT [9]:

   A. Cirrhosis
   B. Late Stage Sickle Cell Disease
   C. Felty's Syndrome
   D. Infectious mononucleosis (Epstein-Barr Virus)
   E. Amyoloidosis

10. All of the following are true concerning the pathogenesis of multiple sclerosis EXCEPT [10]:

    A. T helper cell type 1 cytokines predominate
    B. Early disease is characterized by more inflammation than late stage disease
    C. Vaccination with hepatitis B virus vaccine or other vaccines increases the risk of MS
    D. Predominant cytokines include interleukin 2 (IL-2) and interferon gamma (IFNg)
    E. CD4+ T helper cells specific for myelin basic protein are commonly found

Answers

1. A (Aspirin is contraindicated in patients with possible "triad asthma" - nasal polyps,
2. allergies, and rhinitis or asthma)
3. E
4. B (ESR is elevated when CRP and IL6 are elevated)
5. E
6. D
7. C
8. E (Nitric oxide can perpetuate free radical formation, specifically reactive nitrogenous species.)
9. A (Neuropeptide Y is involved in eating behavior.)
10. B (Early stage sickle cell has splenomegaly; late stage with splenic infarction and shrinkage.)
11. C