Allergy and Immunology

Question 1

A pt presents hemodynamically unstable with hypotension, tachycardia and difficulty breathing after starting Bactrim most likely suffers from ….

Answer 1

Anaphylaxis

Question 2

What is the best initial treatment for anaphylaxis?

Answer 2

Intramuscular epinephrine (1:1000 concentration), corticosteroids (4-6 hours to work), antihistamine (diphenhydramine, hydroxyzine)

Question 3

A pt presents with sudden swelling of the face, palate, tongue and airway after being hit in the face with a pillow/ wood chips hitting them in the arm and have other associated symptoms like stridor, abdominal pain and lack of response to steroids most likely suffers from …

Answer 3

Hereditary Angioedema

Question 4

What is the pathophysiologic cause of Hereditary Angioedema?

Answer 4

deficiency of C1 esterase inhibitor

Question 5

What is the diagnostic test and findings associated with Hereditary Angioedema?

Answer 5

Low levels of C2 and C4 in the complement pathway

Question 6

A pt presents with sudden swelling of the face, palate, tongue and airway and has history of hypertension being treated with lisinopril most likely suffers from….

Answer 6

Angioedema secondary to ACE inhibitor use

Question 7

What is the best initial treatment for acute episodes of angioedema? (3)

Answer 7

1. infusion with fresh frozen plasma
2. stop ACE inhibitor (if using)
3. consider ICU admission (especially if airway compromised)

Question 8

What is the best initial treatment for chronic episodes of angioedema associated with hereditary angioedema?

Answer 8

Ecallantide (blocks bradykinin production)

can also use steroids such as danazol or stanazol

Question 9

What is the only effective treatment for neurosyphillis?

Answer 9

Penicillin

Question 10

What is the next best step in the management of a pt with neurosyphillis with a history of life threatening anaphylaxis to penicillin?

Answer 10

stop all beta blockers and desensitize to penicillin (have epinephrine ready for reaction)

Question 11

A pt presents with recurrent episodes of nasal itching, stuffiness, rhinorrhea, paroxysms of sneezing and itchy eyes most likely suffers from ..

Answer 11

Allergic Rhinitis

Question 12

Other than avoidance of allergen, what is the most effective treatment for allergic rhinitis?

Answer 12

Intranasal corticosteroids

can also use antihistamines, nasal saline spray and wash, leukotriene inhibitors

Question 13

What is the most important step in management of a patient being desensitized to an allergen?

Answer 13

Stop the use of beta blockers (will block effect of epinephrine if needed to treat anaphylactic reaction)

Question 14

What is the mechanism of action of cromolyn?

Answer 14

stabilizes mast cells to prevent degranulation and release of histamine and leukotrienes

Question 15

An adult pt presents with recurrent episodes of sinopulmonary infections (bronchitis, sinusitis, pneumonia, pharyngitis), episodes of malabsorption, steatorrhea and diarrhea, and splenomegaly most likely suffers from ….

Answer 15

Common Variable Immunodeficiency (B-cells are present but don’t produce Ig)

Question 16

What is the diagnostic test and findings associated with Common Variable Immunodeficiency?

Answer 16

total IgG

Question 17

What is the treatment for Common Variable Immunodeficiency?

Answer 17

Infusions of IV immunoglobulins

Question 18

A male child presents with recurrent sinopulmonary infections (bronchitis, sinusitis, pneumonia, pharyngitis) and is found have a small/absent spleen most likely suffers from..

Answer 18

X-linked Agammaglobulinemia (Bruton’s; B cells are missing so no Ig)

Question 19

What is the treatment for X-linked Agammaglobulinemia (Bruton’s)?

Answer 19

infusion with IV immunoglobulins

Question 20

A pt presents with anaphylaxis after blood donation and has a history of recurrent sinopulmonary infections and spruelike malabsorption syndrome most likely suffers from ….

Answer 20

IgA Deficiency

Question 21

What is the best treatment for IgA deficiency?

Answer 21

1. treat infections as they occur

2. avoid blood transfusions with blood for non-IgA deficient donors

Question 22

A pt presents with recurrent Staphylococcus skin infections most likely suffers from ….

Answer 22

Hyper IgE syndrome (treat infections as arise)