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2020 ABIM Awesome Review > Allergy & Immunology 2% > Flashcards

Allergy & Immunology 2% Flashcards

1
Q

Hypersensitivity rxns

A

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

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2
Q

Type I Hypersensitivity

A

Immediate, IgE

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

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3
Q

Tyope II - Cytotoxic

A

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

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4
Q

Type III Immune complex IgG/M

A

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

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5
Q

Type IV Cell medicated

A

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

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6
Q

IgE

A

Type I

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7
Q

Cytotoxic cell mediated (Ab nwsuRWS XTRIRIZUX EZB(

A

Type II

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8
Q

Immune complex mediated

A

Type III

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9
Q

Cell mediated/delayed

A

Type IV

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10
Q

ABPA

A

Type I (mold)

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11
Q

Hyperseitivity pneumonitis

A

Type III

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12
Q

Rh incompatibility

A

Type II

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13
Q

ABO incomaptiblity

A

Type II

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14
Q

Arthus rxn

A

Type III (Immune complex dep mediated)

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15
Q

Serum Sickness

A

Type III

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16
Q

SLE, PAN, RA, Hep B

A

Type III (Hep C low complement)

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17
Q

PPD, Poison Ivy, Nickel, Latex

A

Type IV

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18
Q

Hyperacute graft rejection

A

Type II

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19
Q

Acute or chronic graft rejection

A

Type IV

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20
Q

Allergic Rhinitis/Urticaria

A

Type I

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21
Q

Wheal and flare

A

Type I

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22
Q

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

A

Antigen-ab rxn (type III)

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23
Q

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

A

immune complex depeostion - serum complement low

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24
Q

RAST (radioallergosorbent test

A

measures IgE in serum (quantitiative immunoglobulins)

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25
Q

Skin testing (pin prick test)

A

more specific and sensitive

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26
Q

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

A

Pin Prick test

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27
Q

Can you do skin testing if pt on anti-histamine

A

No - reduces sensitivity for 7 days

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28
Q

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

A

RAST for allergy to latex

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29
Q

Can yo give allergy injections to ABPA?

A

NO!! will make it worse

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30
Q

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

A

No not IgE mediated….

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31
Q

How can you dx ABPA

A

Serum IgE level

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32
Q

Effetive immunotherapy causes increas in what ab type

A

IgG

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33
Q

What med will you NOT use during immunotherapy

A

BB - will interfere with epi tx

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34
Q

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

A

glucagon to reverse BB effect

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35
Q

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

A

Salicylate

36
Q

Best way to reduce rxn in pt allergic to radiocontrast media

A

Diphenyhydramine, steroids, lower osmolar radiocontrast

37
Q

HLA I ag

A

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

38
Q

HLA II ag

A

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

39
Q

Pt gets utricaria when exposed to COLD

A

cold cryoglobulin - IgE mediated

40
Q

All the following are T cell mediated

A 
Nickel
Poison IVY
PPD
Cosmetics/hair dyes 
(NOT NSAIDS)
41
Q

Which anti inflamm drug contraindicated with sulfa allergy

A

Celecoxib (has sulfa)

42
Q

Pt with latex allergy while using condoms

A

polyurethane condoms

43
Q

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

A

Vasovagal syncope

44
Q

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

A

atropine to inc vagal tone

45
Q

Pt gets utricaria when exposed to heat or hot shower

A

Cholinergic utricaria

46
Q

You suspect allergic rhinitis wtd?

A

nasal secretions - smear for eosinophils

47
Q

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

A

Nasal glucocorticoids

Cromolyn on good with allergic rhinitis

48
Q

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

A

SQ Epinephrine

49
Q

Whic of follwing would benefit from immunotx?

A

Bee keeper

not ABPA, not hypersensitiveity pneumonits

50
Q

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

A

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

51
Q

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

A

reassurethat this is normal rxn to insect bite

52
Q

Bee stings on face, neck throat ->

A

swelling lips, tongue largngeal edema

53
Q

Bee sting to other parts of body

A

local rxn

54
Q

Immune defiicenices

A 
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
Q

MOst common Immunoglobulin def

A

IgA def

56
Q

Does IVIG help in IgA deficieny?

A

No - causes anaphylaxis

57
Q

IN IGA nephropathy what is complement level?

A

Normal

58
Q

Pt with severe IgA deficiency which is contraindicated

A

IVIG - anaphylaxis

HAV vacc, HBV vacc, FFP, plts all ok

59
Q

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

A

Immunoglobulin titers

60
Q

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

A

Immunoglobulin titers

61
Q

Neutropenia

A

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

62
Q

Phagocytic deficit

A

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
Q

Chronic mucocutaneous candidiasis

A

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

64
Q

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

A

DX: Nasal colonization with staph (under finger nails)

Can eradicate with mupirocin ointment and rifampin

65
Q

Complement C1 esterase inhibitor deficiency

A

Hereditary angioedema
responds to FFP
no response to Epi

66
Q

Type I hereditary angioedema

A

dec’d C4, dec’d C1 inhibitor (total)

67
Q

Type II hereditary angioedema

A

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

68
Q

Acquired Angioedema

A

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

69
Q

ACEi induced angioedmea

A

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

70
Q

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

A

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

71
Q

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

A

Low C4, CH50

screen for C1 esterase inhibitor deficiency

72
Q

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

A

check C2, C4

73
Q

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

A

C1 esterase inhibitor activity level

74
Q

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

A

FFP (NOT EPI)

Long term tx: Danazol -> stimulates release of C1 esterase inhibitor

75
Q

SLE

A

Complement dec’d (C3 more than C4)

76
Q

IgA nephropathy

A

Complement normal

77
Q

Post strep GN

A

complement dec’d (C3 only dec’d)

78
Q

Wegeners

A

complement normal

79
Q

Churg Strauss

A

COmplement normal

80
Q

PAN

A

Complement normal

81
Q

Cryoglobulinemia

A

complement dec’d (C4 more than C3)

82
Q

Goodpasture’s

A

complement normal

83
Q

Membranoproliferative nephritis

A

Complement dec’d

84
Q

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

A

CH50

if dec’d check C5-9

85
Q

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

A

C3

86
Q

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

A

C3

Major opsonin of complement system responsible for defense against encapsulated bacteria

2020 ABIM Awesome Review (14 decks)

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