FLORIDA BOARD OF MEDICINE ALLERGY
AND IMMUNOLOGY CERTIFICATION EXAM
WITH ACTUAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
Question 1
A 24-year-old woman develops generalized urticaria, wheezing, throat
tightness, hypotension, and dizziness within minutes of eating a dessert
containing peanuts. In the emergency department, she is tachycardic
with diffuse expiratory wheezing and blood pressure of 78/44 mm Hg.
Which of the following is the most appropriate initial pharmacologic
treatment?
A. Intravenous diphenhydramine
B. Intravenous methylprednisolone
C. Intramuscular epinephrine
D. Nebulized albuterol alone
E. Intravenous famotidine
Answer: C. Intramuscular epinephrine
Rationale: Anaphylaxis is a systemic, potentially fatal hypersensitivity
reaction involving airway, respiratory, cardiovascular, and/or severe
gastrointestinal manifestations. Intramuscular epinephrine
administered into the mid-anterolateral thigh is the first-line
treatment. Antihistamines and corticosteroids are adjunctive therapies
and must never delay epinephrine. Bronchodilators may treat
persistent bronchospasm but do not reverse airway edema or shock.
1
,Question 2
A 19-year-old college student has recurrent episodes of swelling of the
lips, hands, feet, and abdomen. The episodes are not associated with
urticaria or pruritus. His mother has experienced similar attacks.
Laboratory testing shows markedly reduced C4 and decreased C1
esterase inhibitor functional activity. Which diagnosis is most likely?
A. Histaminergic chronic urticaria
B. Hereditary angioedema due to C1 inhibitor deficiency
C. Acquired angioedema caused by food allergy
D. Mastocytosis
E. ACE-inhibitor-induced angioedema
Answer: B. Hereditary angioedema due to C1 inhibitor deficiency
Rationale: Hereditary angioedema classically causes recurrent
nonpruritic swelling without urticaria. Abdominal attacks may
produce severe pain, vomiting, and bowel-wall edema. Low C4 is an
important screening abnormality, while reduced C1 inhibitor quantity
and/or function confirms the diagnosis depending on the subtype.
Bradykinin, rather than histamine, is the major mediator, explaining
the poor response to antihistamines, corticosteroids, and epinephrine
in uncomplicated attacks.
Question 3
A 32-year-old woman has perennial nasal congestion, sneezing, clear
rhinorrhea, and intense nasal itching. Symptoms worsen when she cleans
a dusty basement. Skin-prick testing demonstrates a large wheal to
house-dust mite extract. Which immunologic mechanism best explains
her symptoms?
2
,A. IgG-mediated immune-complex formation
B. IgE-mediated activation of mast cells
C. CD8+ cytotoxic T-cell activation
D. IgM-mediated complement activation
E. Neutrophil-mediated phagocytosis
Answer: B. IgE-mediated activation of mast cells
Rationale: Allergic rhinitis is a classic type I hypersensitivity disorder.
Allergen-specific IgE binds high-affinity FcεRI receptors on mast cells
and basophils. Re-exposure causes cross-linking of cell-bound IgE,
resulting in rapid mediator release such as histamine, leukotrienes,
and prostaglandins. This produces sneezing, itching, rhinorrhea, and
congestion.
Question 4
A 7-year-old boy has severe eczema, recurrent sinopulmonary
infections, retained primary teeth, coarse facial features, and markedly
elevated serum IgE. Which primary immunodeficiency is most likely?
A. Selective IgA deficiency
B. X-linked agammaglobulinemia
C. Hyper-IgE syndrome
D. Common variable immunodeficiency
E. Chronic granulomatous disease
Answer: C. Hyper-IgE syndrome
Rationale: Hyper-IgE syndrome is characterized by eczema, recurrent
skin and pulmonary infections, markedly elevated IgE, and
characteristic skeletal/dental abnormalities in the STAT3-associated
form. Staphylococcal skin infections and pneumatoceles may occur.
The combination of severe eczema, recurrent infections, extremely
3
, elevated IgE, retained primary teeth, and skeletal findings strongly
favors this diagnosis.
Question 5
A 42-year-old woman has asthma, chronic sinusitis, recurrent nasal
polyps, and worsening wheezing after taking aspirin. Which mechanism
best explains this reaction?
A. IgE antibodies directed against aspirin
B. IgG-mediated hemolysis
C. Cyclooxygenase-1 inhibition with increased leukotriene production
D. Direct mast-cell destruction
E. Complement deficiency
Answer: C. Cyclooxygenase-1 inhibition with increased leukotriene
production
Rationale: Aspirin-exacerbated respiratory disease is associated with
asthma, chronic rhinosinusitis with nasal polyposis, and respiratory
reactions to aspirin and other COX-1 inhibitors. COX-1 inhibition
shifts arachidonic-acid metabolism toward cysteinyl leukotrienes,
contributing to bronchoconstriction, nasal symptoms, and airway
inflammation. This is generally not an IgE-mediated allergy to aspirin.
Question 6
A 5-year-old child has recurrent bacterial respiratory infections. Serum
testing reveals very low levels of all major immunoglobulin classes.
Flow cytometry demonstrates an absence of circulating CD19+ B cells.
Which diagnosis is most likely?
A. Selective IgA deficiency
B. X-linked agammaglobulinemia
4
AND IMMUNOLOGY CERTIFICATION EXAM
WITH ACTUAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
Question 1
A 24-year-old woman develops generalized urticaria, wheezing, throat
tightness, hypotension, and dizziness within minutes of eating a dessert
containing peanuts. In the emergency department, she is tachycardic
with diffuse expiratory wheezing and blood pressure of 78/44 mm Hg.
Which of the following is the most appropriate initial pharmacologic
treatment?
A. Intravenous diphenhydramine
B. Intravenous methylprednisolone
C. Intramuscular epinephrine
D. Nebulized albuterol alone
E. Intravenous famotidine
Answer: C. Intramuscular epinephrine
Rationale: Anaphylaxis is a systemic, potentially fatal hypersensitivity
reaction involving airway, respiratory, cardiovascular, and/or severe
gastrointestinal manifestations. Intramuscular epinephrine
administered into the mid-anterolateral thigh is the first-line
treatment. Antihistamines and corticosteroids are adjunctive therapies
and must never delay epinephrine. Bronchodilators may treat
persistent bronchospasm but do not reverse airway edema or shock.
1
,Question 2
A 19-year-old college student has recurrent episodes of swelling of the
lips, hands, feet, and abdomen. The episodes are not associated with
urticaria or pruritus. His mother has experienced similar attacks.
Laboratory testing shows markedly reduced C4 and decreased C1
esterase inhibitor functional activity. Which diagnosis is most likely?
A. Histaminergic chronic urticaria
B. Hereditary angioedema due to C1 inhibitor deficiency
C. Acquired angioedema caused by food allergy
D. Mastocytosis
E. ACE-inhibitor-induced angioedema
Answer: B. Hereditary angioedema due to C1 inhibitor deficiency
Rationale: Hereditary angioedema classically causes recurrent
nonpruritic swelling without urticaria. Abdominal attacks may
produce severe pain, vomiting, and bowel-wall edema. Low C4 is an
important screening abnormality, while reduced C1 inhibitor quantity
and/or function confirms the diagnosis depending on the subtype.
Bradykinin, rather than histamine, is the major mediator, explaining
the poor response to antihistamines, corticosteroids, and epinephrine
in uncomplicated attacks.
Question 3
A 32-year-old woman has perennial nasal congestion, sneezing, clear
rhinorrhea, and intense nasal itching. Symptoms worsen when she cleans
a dusty basement. Skin-prick testing demonstrates a large wheal to
house-dust mite extract. Which immunologic mechanism best explains
her symptoms?
2
,A. IgG-mediated immune-complex formation
B. IgE-mediated activation of mast cells
C. CD8+ cytotoxic T-cell activation
D. IgM-mediated complement activation
E. Neutrophil-mediated phagocytosis
Answer: B. IgE-mediated activation of mast cells
Rationale: Allergic rhinitis is a classic type I hypersensitivity disorder.
Allergen-specific IgE binds high-affinity FcεRI receptors on mast cells
and basophils. Re-exposure causes cross-linking of cell-bound IgE,
resulting in rapid mediator release such as histamine, leukotrienes,
and prostaglandins. This produces sneezing, itching, rhinorrhea, and
congestion.
Question 4
A 7-year-old boy has severe eczema, recurrent sinopulmonary
infections, retained primary teeth, coarse facial features, and markedly
elevated serum IgE. Which primary immunodeficiency is most likely?
A. Selective IgA deficiency
B. X-linked agammaglobulinemia
C. Hyper-IgE syndrome
D. Common variable immunodeficiency
E. Chronic granulomatous disease
Answer: C. Hyper-IgE syndrome
Rationale: Hyper-IgE syndrome is characterized by eczema, recurrent
skin and pulmonary infections, markedly elevated IgE, and
characteristic skeletal/dental abnormalities in the STAT3-associated
form. Staphylococcal skin infections and pneumatoceles may occur.
The combination of severe eczema, recurrent infections, extremely
3
, elevated IgE, retained primary teeth, and skeletal findings strongly
favors this diagnosis.
Question 5
A 42-year-old woman has asthma, chronic sinusitis, recurrent nasal
polyps, and worsening wheezing after taking aspirin. Which mechanism
best explains this reaction?
A. IgE antibodies directed against aspirin
B. IgG-mediated hemolysis
C. Cyclooxygenase-1 inhibition with increased leukotriene production
D. Direct mast-cell destruction
E. Complement deficiency
Answer: C. Cyclooxygenase-1 inhibition with increased leukotriene
production
Rationale: Aspirin-exacerbated respiratory disease is associated with
asthma, chronic rhinosinusitis with nasal polyposis, and respiratory
reactions to aspirin and other COX-1 inhibitors. COX-1 inhibition
shifts arachidonic-acid metabolism toward cysteinyl leukotrienes,
contributing to bronchoconstriction, nasal symptoms, and airway
inflammation. This is generally not an IgE-mediated allergy to aspirin.
Question 6
A 5-year-old child has recurrent bacterial respiratory infections. Serum
testing reveals very low levels of all major immunoglobulin classes.
Flow cytometry demonstrates an absence of circulating CD19+ B cells.
Which diagnosis is most likely?
A. Selective IgA deficiency
B. X-linked agammaglobulinemia
4
