Allergy and Immuno

Question 1

Pathophysiology of anaphylaxis

Answer 1

Pt already sensitized to Ag

IgE binds mast cells releasing granules

Question 2

Common causes of anaphylaxis

Answer 2

Bites
Meds
Foods
Latex

Question 3

Characteristics of anaphylaxis

Answer 3

Hypotension
Tachy
SOB, wheezing, lip/tongue/face swelling
Urticaria

Question 4

Rx anaphylaxis

Answer 4

Epi
Antihistamines
Steroids
Emergent airway protection if required

Question 5

What is angioedema

Answer 5

Swelling of Face, Tongue, Eyes, Airway

Question 6

Causes of angioedema

Answer 6

Hereditary angioedema
ACEI AE
Idiopathic

Question 7

Defect in hereditary angioedema

Answer 7

Deficiency of C1 esterase inhibitor

Question 8

Presentation of hereditary angioedema

Answer 8

Sudden facial swelling
Stridor
No Pruritis or Urticatia

Question 9

What doesn’t work in hereditary angioedema

Answer 9

Steroids

Question 10

Best initial test for hereditary angioedema

Answer 10

Decreased C2, C4

Deficient C1 esterase inhibitor

Question 11

Acute rx hereditary angioedema

Answer 11

FFP

Ecallantide (works for all angioedema)

Question 12

Long term management of angioedema

Answer 12

Androgens

Question 13

What should be ensured first in angioedema

Answer 13

Airway protection

Question 14

What is Urticaria

Answer 14

Sudden swelling of superficial skin layers

Question 15

Physical agents causing urticaria

Answer 15

Pressure
Cold
Vibration

Question 16

Rx urticaria

Answer 16

Antihistamines

LTr antagonists

Question 17

What causes allergic rhinitis

Answer 17

IgE dependent triggering of mast cells

Question 18

What can be seen on nasal smear of allergic rhinitis

Answer 18

Eosinophils

Question 19

Dx test in allergic rhinitis

Answer 19

Clinical
- recurrent episodes of allergy presentation
Skin/Blood testing for Ag
Allergen-specific IgE levels

Question 20

Rx allergic rhinitis

Answer 20

Avoid precipitant
Intranasal steroids
Antihistamines
Intranasal anticholinergics
Desensitization

Question 21

Etiology of common variable immunodeficiency (CVID)

Answer 21

Normal B cell numbers

Decreased !gG, M, A

Question 22

Presentation of CVID

Answer 22

Recurrent sinopulmonary infections in adults M=F
Bronchitis, PN, sinusitis, otitis media
Giardiasis, sprue-like, autoimmune diseases

Question 23

Dx tests in CVID

Answer 23

Ig levels decreased

Decreased response to Ag stimulatino of B cells

Question 24

Clue to pick CVID

Answer 24

Decreased output of B cells
Normal number of B cells
Normal amounts of lymphoid tissue

Question 25

Rx CVID

Answer 25

ABX for infections | IVIG for chronic maintenance

Question 26

Picture of Bruton's

Answer 26

Male children w/ increased sinopulmonary infections

Question 27

Abnormality in Bruton's

Answer 27

B cells and lymphoid tissue dminished Decreased/Absent tonsils, adenoids, LNs, spleen NL T cells

Question 28

Rx Bruton's

Answer 28

ABX for infections | IVIG

Question 29

What is the issue in SCID

Answer 29

Deficiency in B and T cells

Question 30

B cell deficiency infections

Answer 30

Recurrent sinopulm starting at age 6

Question 31

T cell deficiency infections

Answer 31

Things seen in AIDS | - PCP, varicella, candida

Question 32

Curative rx in SCID

Answer 32

BM transplant

Question 33

Unique features of IgA deficiency

Answer 33

Atopic diseases Anaphylaxis to blood transfusions from non-IgA def donors Spru-like condition Increased risk of vitiligo, thyroiditis, RA

Question 34

Rx IgA deficiency

Answer 34

ABX for infections

Question 35

Important points about Hyper IgE

Answer 35

Recurrent staph skin infections | PPX w/ dicloxacillin or cephalexin

Question 36

Important points about Hwiskott-aldrich

Answer 36

``` Immunodeficiency Thrombocytopenia Eczema T cells deficient BM transplant only cure ```

Question 37

Features of CGD

Answer 37

LNs w/ purulent material leaking Aphthous ulvers Inflammation in nares Obstruction in GI/urinary

Question 38

Infections in CGD

Answer 38

Staph Burkholderia Nocardia Aspergillus

Question 39

Dx tests in CGD

Answer 39

Nitroblue tetrazolium | Decreased NADPH oxidase