Allergy/immunology Flashcards Preview

Heme > Allergy/immunology > Flashcards

Flashcards in Allergy/immunology Deck (39):
1

Four types of hypersensitivity reactions and their mechanism

Type 1: anaphylactic. IgE mediated mast cell degranulation, released of mediators (angioedema, urticaria, anaphylaxis)
Type 2: cytotoxic. IgG or IgM antibodies with cell antigens, complement activation (auto immune hemolytic anemia, goodpasture syndrome)
Type 3: immune complex: complex deposition leading to complement activation (SLE, RA, serum sickness)
Type 4: cell mediated (t cells, eg contact dermatitis)

2

Management anaphylaxis

Epi: 0.3-0.5 mg 1:1000 IM, 0.01 mg/kg in pers
Refractory or hypotension 0.1-05 mg iv epi over 5 mins
Glucagon for pt on BB and fluid and ep refractory
NS bolus
Antihistamines
Steroids
Ventolin

3

Three causes of angioedema

Hereditary angioedema (C1 inhibitor deficiency)
Meds: ace and arb -- mediated through bradykinin and substance P
Mast cell mediated: IgE with anaphylaxis or direct mast cell stimulation (anaphylactoid)

4

Management of angioedema

Supportive, depends on cause
Stop offending agent if med or anaphylactic related
Try epi etc
In hereditary purified CI inhibitor, icatiband (Bradykinin b2 receptor agonist)

Can do FFP as has C1 inhibitor

5

What type of hypersensitivity reaction is serum sickness
When does it present
What are the common offending agents

Type 3: immune complex mediated
Presents 7-10 days post exposure
Agents: antibiotics, phenytoin, thiazide diuretics, horse serum antivenom, barbiturates, envenomation

6

Treatment serum sickness

Supportive
NSAIDs
Antihistamines
Steroids
Plasmapheresis for severe cases

7

Clinical presentation serum sickness

Flu like symptoms 7-10d post exposure
Fever, malaise, arthralgias

8

Diagnosis of DRESS syndrome

Exposure to med (antibiotics, anti epileptics, allopurinol, sulfazalazine)
Mucous membrane spared delayed onset rash
Systemic symptoms/end organ involvement on blood work
Eosinophilia

9

Treatment of DRESS

Stop offending agent
Supportive
Steroids

10

4 conditions associated with raynauds

Vasculitis
Lupus
Sjogrens
Scleroderma
Dermatomyositis
Sympathomimetics

11

Bugs implicated in reactive arthritis

Chlamydia CN gonorrhea
Yersinia
Shigella
Salmonella
Campylobacter
C diff

12

Management reactive arthritis

STI treatment for urethritis
Ophtho if uveitis
NSAIDs for joints

Rheum consult

13

Airway consideration for rheumatoid arthritis

Can see degeneration of transverse ligaments, C1-C2 instability
Use spine precautions during intubation

14

Five drugs that can induce lupus

Hydralazine
Isoniazid
Phenytoin
Procainamide
Sulfonamides

15

7 emerge complications of lupus

Nephrotic syndrome, renal failure
Pleural effusion or tamponade
Purulent pericarditis
Interstitial lung disease, pulmonary hypertension
Coronary artery vasculitis, acute MI
Libman sacks endocarditis: noninfectious endocarditis
Mesenteric vasculitis

16

Criteria for lupus diagnosis

Malar rash
Discoid rash
Serositis (pleural, pericardial, pertinoneal)
Oral ulcers
Arthritis
Photosensitive rash
Blood (anemia, thrombocytopenia, leukopenia)
Renal disease (protein)
ANA
Immunologic (anti ds DNA, anti sm)
Neuro logic (psych, seizures)

17

Treatment of acute lupus flare

Steroids
Treat complications

18

Components of CREST syndrome (limited cutaneous systemic sclerosis)

Calcinosis cutis
Raynaud's phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasias

19

Treatment Raynaud's phenomenon

Warming
Stop offending agent eg sympahomimetics
Consider CCB
prevention (avoid cold, smoking, sympathomimetics)

20

6 extracutaneous manifestations of scleroderma

GI: esophageal dysmotility
Lower esophageal sphincter incompetence
Lung: pulm htn
ILD
lung cancer
Cardiac: pericarditis, pericardial effusion
Myocardial fibrosis
Heart failure
MI
Arrhythmias and conduction abnormalities
Kidney
Neuropathies

21

3 examples large vessel vasculitis

Giant cell arteritis
Behcets
Takayasu artertitis

22

4 medium vessel vasculitis

Polyarteritis nodosa
Wegener granulomatosis (sinusitis, nephritis, pulm infiltrates) or now granulomatosis with polyangitis
Buerger disease (young male smoker, necrotic digits, superficial thrombophlebitis)
Microscopic polyangiitis

23

3 small vessel vasculitis

Hypersensitivity
HSP
Good pasture syndrome (lung and kidney)

24

Four types of transplant related infection

Chronic infection from donor tissue eg HCV, CMV
Acute infection from donor tissue eg influenza, bacteremia
Reactivation of host infection due to immunesuppression eg TB
Opportunistic infection due to immune suppression
Community acquired due to immunecompromised

25

Timeframe for CMV, EBV, PJP, TB, Chagas post transplant

Usually 1-6 months

26

Most common infections 0-1 month post transplant

Surgical infections
Donor infected tissue eg hiv, west Nile, occult bacteremia

27

Treatment of CMV infection or flare in transplant patient

Gancyclovir

28

Which vaccines are contraindicated in transplant patients

Live vaccines : MMR, varicella, rotavirus

29

Three categories of transplant rejection

Hyperacute (minutes to hours post surgical, irreversible graft destruction)
Acute: 1-12 weeks post transplant, can be reversed
Chronic: progressive, insidious decline from fibrosis, ischemia, death. Nothing to do,

30

Clinical presentation kidney transplant rejection
Work up
Management

Presentation: pain to allograft site, edema, htn, decreased urine output, elevated creatinine
Work up: cr, urine ACR, UA, renal ultrasound, cyclosporine level
Treatment is steroids, consult

31

How do heart transplant patients in rejection present

Generalized fatigue, feeding intolerance, fever
Can also see chf, dysrhythmias

32

Management heart transplant failure

Iv steroids
Isoproterenol for bradysyrhythmias
Dopamine or dobutamine for hypotension

Obviously get to transplant centre

33

5 causes of normocytic anemia

Bleeding
Hemolysis
Aplastic
Sickle cell
Chronic disease / kidney disease

34

Findings in iron deficiency anemia

Low iron
High TIBC
Low percentage saturation
Low ferritin

35

Causes sideroblastic anemia

Congenital
Acquired: pre-leukaemia state
Drugs( TB drugs, chloramphenicol)
Infections
Malignancy
Hemolytic anemia

36

4 causes of aplastic anemia

Viral (parvo virus, hiv, hepatitis)
Drugs (NSAIDs, Sulfa, antiepileptic, nifedipine)
Toxin (radiation, pesticides, solvents)
Congenital disorder

37

Four types of hereditary hemolytic anemias

Abnormal membrane (spherocytosis, elliptocytosis), enzyme eg G6PD, hemoglobinopathies (sickle cell, thalassemia)

38

4 examples of acquired hemolytic anemia

Immune (warm and cold)
DIC, TTP, pre-eclampsia
Mechanical from cardiac valves
Splenomegaly sequestration

39

Blood test findings in hemolytic anemia

Low hb
Elevated LDH
Low haptoglobin
Schistocytes (intravascular) or spherocytes (extravascular)
Increased unconjugated bili in extravascular hemolysis
Hemoglobinuria in intravascular
Positive Coombs test if antibody mediated
Elevated reticulocyte count