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Flashcards in Allergy & Immunology Deck (86):
1

Hypersensitivity rxns

Type I: Immediate, IgE
Type II: Cytotoxic, IgG/M
Type III Immune complex IgG, M
Type IV: Cell Medidiated

2

Type I Hypersensitivity

Immediate, IgE
Weed, pollen, dust, grass, mold cat or Dog progeins (atopic), hives, utricaria, peanuts, shellfish, bee stings, drugs

3

Tyope II - Cytotoxic

Antibody mediated (no ab/ag complexes)
Hemolytic rxn, goodpastrure's
hyperacute graft rejection

4

Type III Immune complex IgG/M

Serum sickness, SLE, Post Strep Glomerulonephritis, PAN, RA, Arthus rxn, hypersensitive Pneumonitis

5

Type IV Cell medicated

PPD, Poison Ivy, Nicketl, Type I DM, acute and chronic graft rejection, Latex

6

IgE

Type I

7

Cytotoxic cell mediated (Ab nwsuRWS XTRIRIZUX EZB(

Type II

8

Immune complex mediated

Type III

9

Cell mediated/delayed

Type IV

10

ABPA

Type I (mold)

11

Hyperseitivity pneumonitis

Type III

12

Rh incompatibility

Type II

13

ABO incomaptiblity

Type II

14

Arthus rxn

Type III (Immune complex dep mediated)

15

Serum Sickness

Type III

16

SLE, PAN, RA, Hep B

Type III (Hep C low complement)

17

PPD, Poison Ivy, Nickel, Latex

Type IV

18

Hyperacute graft rejection

Type II

19

Acute or chronic graft rejection

Type IV

20

Allergic Rhinitis/Urticaria

Type I

21

Wheal and flare

Type I

22

Pt with sore throat - hematuria _-> Pre-renal azotemia

Antigen-ab rxn (type III)

23

Pt receiving IV abx for endocarditis - pt c/o arthralgias - mechanism of arthralgia is....

immune complex depeostion - serum complement low

24

RAST (radioallergosorbent test

measures IgE in serum (quantitiative immunoglobulins)

25

Skin testing (pin prick test)

more specific and sensitive

26

Pt with rhinitis, occular itching exacerbated by pollen best test?

Pin Prick test

27

Can you do skin testing if pt on anti-histamine

No - reduces sensitivity for 7 days

28

Nursing student started using latex glove for first time and pw hives - best test to confirm?

RAST for allergy to latex

29

Can yo give allergy injections to ABPA?

NO!! will make it worse

30

Can you give allergy injections to prevent contrast dye rxn or hypersensivity pneumonitis

No not IgE mediated....

31

How can you dx ABPA

Serum IgE level

32

Effetive immunotherapy causes increas in what ab type

IgG

33

What med will you NOT use during immunotherapy

BB - will interfere with epi tx

34

Pt on BB - receives immunotx and gets anaphylactic rxn - in addition to epi what else to give?

glucagon to reverse BB effect

35

Pt has allergy to ASA 0 what NSAID can you use?

Salicylate

36

Best way to reduce rxn in pt allergic to radiocontrast media

Diphenyhydramine, steroids, lower osmolar radiocontrast

37

HLA I ag

most tissues EXCEPT RBCs
presented to T8 cells
responsible for TRANSPLANT rejection and destroying tumor cells

38

HLA II ag

B cells, macrophages, langerhan cells, dendritic cells - presented to T4 helper cells - > responsible for cell mediated immunity

39

Pt gets utricaria when exposed to COLD

cold cryoglobulin - IgE mediated

40

All the following are T cell mediated

Nickel
Poison IVY
PPD
Cosmetics/hair dyes
(NOT NSAIDS)

41

Which anti inflamm drug contraindicated with sulfa allergy

Celecoxib (has sulfa)

42

Pt with latex allergy while using condoms

polyurethane condoms

43

Pt after seeing needle or blood - becomes anxious, pale diaphoretic and passes out BP 80/60, HR 40 dx?

Vasovagal syncope

44

Pt post IWMI gets TPA - 30min later HR 35, BP 70/40 wtd?

atropine to inc vagal tone

45

Pt gets utricaria when exposed to heat or hot shower

Cholinergic utricaria

46

You suspect allergic rhinitis wtd?

nasal secretions - smear for eosinophils

47

What is effetive in any type of rhinits including perennial allergic rhinitis?

Nasal glucocorticoids
(Cromolyn on good with allergic rhinitis)

48

Pt stung by bee pw broncospasm, utricaria, flusing BP 94/60 HR 100 IVF started wtd?

SQ Epinephrine

49

Whic of follwing would benefit from immunotx?

Bee keeper
(not ABPA, not hypersensitiveity pneumonits)

50

Pt with wasp sting, local wheal, burnign sensation wtd?

cool compress, antihitamine, topical calamine, elevate for local rxn

51

Young man was picking apples and was stung by bee - next day presents to you with large wheal on R arm - itch wtd?

reassurethat this is normal rxn to insect bite

52

Bee stings on face, neck throat ->

swelling lips, tongue largngeal edema

53

Bee sting to other parts of body

local rxn

54

Immune defiicenices

dec'd ab (immunoglobulins
MM
AIDS
Asplenia
ALL/CLL
CVID
All inc'd risk for capsulated bugs - S pneumo, H flu, Meningiococcus

B cells -> plasma cells -> Ab's (HLA II)

55

MOst common Immunoglobulin def

IgA def

56

Does IVIG help in IgA deficieny?

No - causes anaphylaxis

57

IN IGA nephropathy what is complement level?

Normal

58

Pt with severe IgA deficiency which is contraindicated

IVIG - anaphylaxis
(HAV vacc, HBV vacc, FFP, plts all ok)

59

32yo Pt with recurrent sinusitis for 5 years - nasal endoscopic surgery done couple years ago now pw facial pain and xray shows total opacification of maxillary sinuses

Immunoglobulin titers

60

Pt with recurrent bronchitis x 25 years - when he takes TMP-SMZ infxn resolves CXR normal wtd?

Immunoglobulin titers

61

Neutropenia

Bacterial: Pseudomonas, corynebacterium jeikeium
Fungal: andida, aspergillus (halo sign), Mucor
Tx: INc'd count with G=-CSF and tx infection

62

Phagocytic deficit

Staph aureus, Gram neg, fungal, nocardia
Able to INGEST , but UNABLE to DIGEST - recurrent infections, fhx for recurrent infexns, NBT abnormal failure to produce O2 super radicals
dx: Chronic granulomatous dz, NADPH oxidase deficiency
Tx: Interferon gamma and abx

63

Chronic mucocutaneous candidiasis

Candidiasis of skin and MM
severe, recurrent thrush, onychomyosis, vaginitis, chronic skin lesions
maylook hyperkeratotic, crusted on face, scalp, hands

64

Solitary furuncle infection 4x in past 5 years - easily tx with incision and drainage

DX: Nasal colonization with staph (under finger nails)
Can eradicate with mupirocin ointment and rifampin

65

Complement C1 esterase inhibitor deficiency

Hereditary angioedema
responds to FFP
no response to Epi

66

Type I hereditary angioedema

dec'd C4, dec'd C1 inhibitor (total)

67

Type II hereditary angioedema

Dec'd C4, NORMAL C1 inhibitor total but dec'd C1 inhibitor fxn

68

Acquired Angioedema

all decreased (C4, C1q, C1 inhib total and fxn)

69

ACEi induced angioedmea

All normal (C4, C1q, C1 inhib total and fxn)

70

Pt after pillow fight or after camping with non-pitting facial edema - no itching - similar sx before - most likely dx?

C1 esterase inhib deficiency - if don't know why welling - r/o C1 esterase inhibitor deficiency

71

Teen pw swelling arm, no erythema or itching what to expect

Low C4, CH50
screen for C1 esterase inhibitor deficiency

72

Pt post excercise deelops swelling of arms, no hx of trauma, father died at early age wtd?

check C2, C4

73

Pt hiking in shenandoah mtns pw facial swelling no itching no erythema wtd?

C1 esterase inhibitor activity level

74

Best management for pt with facila swelling ,laryngeal edema and h/o C1 esterase inhibitor deficiency

FFP (NOT EPI)
Long term tx: Danazol -> stimulates release of C1 esterase inhibitor

75

SLE

Complement dec'd (C3 more than C4)

76

IgA nephropathy

Complement normal

77

Post strep GN

complement dec'd (C3 only dec'd)

78

Wegeners

complement normal

79

Churg Strauss

COmplement normal

80

PAN

Complement normal

81

Cryoglobulinemia

complement dec'd (C4 more than C3)

82

Goodpasture's

complement normal

83

Membranoproliferative nephritis

Complement dec'd

84

Pt h/o meningiococcemia and gonorrhea what test to order?

CH50
if dec'd check C5-9

85

Pt with SLE, CH50 undectectable - what complement component def suspect?

C3

86

Pt with recurrent infections in skin, sinusitis, PNA now with liver abscess - Immunoglobulins normal, CH50 low which complement likely deficient?

C3
Major opsonin of complement system responsible for defense against encapsulated bacteria