Allergy

Question 1

CVID diagnosis

Answer 1

hypogammaglobulinemia

Question 2

complement deficiency clinical features

Answer 2

Recurrent neisseria (meningococcal meningitis)

Question 3

Management of refractory asthma

Answer 3

IF elevated IgE or sensitivity to allergies: omalizumab (binds IgE)
IF increased eosinophils: mepolizumab

Question 4

Other biologic approved for uncontrolled asthma

Answer 4

Dupilumab

Question 5

step up from albuterol in asthma

Answer 5

Daily low-dose ICS

Question 6

step up from daily low dose ICS

Answer 6

ICS-formoterol

Question 7

Safe

Answer 7

Budesonide

Question 8

long term SE to know of from chronic beta agonist (eg albuterol) overuse

Answer 8

tachyphylaxis (patients become refractory)

Question 9

Triad of aspirin-exacerbated respiratory disease

Answer 9

nasal polyps, asthma, aspirin sensitivity

Question 10

Allergic bronchopulmonary aspergillosis

Answer 10

asthma +

Question 11

Treatment of allergic bronchopulmonary aspergillosis

Answer 11

• steroids

- antifungals

Question 12

Person comes in with bee sting and diffuse hives management

Answer 12

do nothing

Question 13

Person comes in with bee sting and severe systemic reaction

Answer 13

• refer to AI + epi pen

- obtain baseline serum tryptase

Question 14

Fire ant clinical features

Answer 14

Sterile pustule 24 hours after sting

Question 15

potency of topical steroids

Answer 15

low = hydrocortisone
mid = triamcinolone
high = fluocinonide

Question 16

Treatment of refractory eczema

Answer 16

• topical calcineurin inhibitors

- dupilumab

Question 17

contact dermatitis treatment

Answer 17

• avoidance
• topical steroids
  IF severe – systemic steroids

Question 18

allergen in poison ivy

Answer 18

urushiol

Question 19

cause of hereditary angioedema

Answer 19

C1 esterase inhibitor deficiency

Question 20

management of ACEi angioedema

Answer 20

After 6 weeks, trial ARB

Question 21

chronic spontaneous urticaria and angioedema clinical features

Answer 21

• recurrent urticaria and or angiodedema without identifiable trigger

Question 22

Management of chronic spontaneous urticaria

Answer 22

• high dose antihistamines

- no lab workup

Question 23

Type 1 drug allergy

Answer 23

• IgE mediated

- anaphylaxis

Question 24

Type 2 drug allergy

Answer 24

• antibody mediated

- hemolysis

Question 25

Type 3 drug allergy

Answer 25

..

Question 26

Management of anaphylaxis if persistent after first epi shot

Answer 26

Repeat epi

Question 27

Fixed drug eruption clinical features

Answer 27

- pink/purple dusty plaque that occurs in the same spot the culprit med is taken

Question 28

Treatment of fixed drug eruption

Answer 28

- self limiting, no need to treat

Question 29

Acute generalized exanthematous pustulosis clinical features

Answer 29

pustular rash + fever

Question 30

Acute generalized exanthematous pustulosis clinical features

Answer 30

pustular rash + fever

Question 31

treatment of hypereosinophilia syndrome

Answer 31

- steroids | - imatinib

Question 32

treatment of eosinophilic esophagitis

Answer 32

- avoid culprit food | - swallowed budesonide or flonase

Question 33

how to differentiate allergic from acei/bradykinin induced angioedema

Answer 33

no urticaria, bronchospasm, or other symptoms of allergic reactions.

Question 34

workup of acromegaly

Answer 34

Serum IGF-1

Question 35

acromegaly clinical features

Answer 35

coarsening of facial features + macroglossa + increased hand and foot size

Question 36

acromegaly treatment

Answer 36

pituitary adenoma resection (typically caused by pituitary adenoma)

Question 37

CGD diagnosis

Answer 37

Abnormal neutrophil oxidative burst

Question 38

C1 esterase inhibitor deficiency presentation

Answer 38

Alexia with a sombrero on: her face is really edematous + she’s grabbing her stomach in agony + she’s choking and gasping for air/presentation = hereditary bradykinin-associated angioedema + recurrent episodes of abdominal pain + life-threatening laryngeal edema + pyogenic infections.

Question 39

Late or terminal complement (C5-C9) deficiency presentation

Answer 39

Hailing + Alexia hoola-hooping in middle: Serra’s from AK hanging from the ceiling topless/terminal complement deficiency increases susceptibility to recurrent Neisseria bacteremia (you can’t form MAC attack complex).

Question 40

Presentation of allergic contact dermatitis of the nails

Answer 40

- exposure to artificial nails | - edema or eczema + nail dystrophy + periungual hyperkeratosis + paresthesias + fingertip dermatitis

Question 41

Clinical features of psoriasis of the nail

Answer 41

- pittting + onycholysis (separation of the nail plate from the underlying nail bed)

Question 42

herpetic whitlow clinical features

Answer 42

- vesicular rash + paresthesias

Question 43

Initial management of parapneumonic effusion

Answer 43

IF less than 10 mm -- observe (likely to resolve with abx) | IF greater than 10 mm -- US to confirm, then thora

Question 44

Next step after US of parapneumonic effusion

Answer 44

IF high risk features (loculated, over half hemithorax, or thickened pleura --> chest tube for drainage IF no high risk features --> diagnostic thora

Question 45

Indications for chest tube following diagnostic thoracentesis

Answer 45

Complicated effusion (positive gram stain or culture OR pH less than 7.2)

Question 46

Management of mild anaphylaxis

Answer 46

*anaphylaxis can present with relatively mild manifestations initially so anyone with dyspnea + skin findings + hypotension + GI symptoms after exposure to an allergen should get IM epinephrine

Question 47

Initial treatment of chronic urticaria

Answer 47

- second generation antihistamines

Question 48

what are the second generation antihistamines?

Answer 48

- loratadine (claritin) - fexofenadine (allegra) - cetirizine (zyrtec)

Question 49

what is ranitidine?

Answer 49

H2 receptor blocker