Allergy & Immunology

Question 1

MCC of anaphylaxis

Answer 1

food

Question 2

Tx of anaphylaxis

Answer 2

IM Epi, corticosteriods and H1 blocker(diphenhydramine, or hydroxyzine)

Question 3

Angioedema

sx?

Answer 3

sudden swelling of the face, palate, tongue and airway in association with minor trauma to the face, hands or ingestion of ACEi. +/- stridor, ab pain and lack of response to steroids

• *NO URTICARIA OR PRURITIS!
• may be hereditary due to C1 esterase inhibitor deficiency

Question 4

dx of angioedema?

Answer 4

low levels of C2, C4 and C1.

Question 5

tx of angioedema

Answer 5

epinephrine then Icatibant(bradykinin B2 antagonist), androgens(danazol, stanazol), Fresh frozen plasma

Question 6

Urticaria

sx? tx?

Answer 6

sudden swelling of the superficial skin layers ccaused by: insects, medication, pressure, cold, vibration.

tx: antihistamines or LT antagonist

Question 7

man with neurosyphillis who is allergic to PCN and has a hx of essential tremor tx with propanolol. tx?

Answer 7

stop propanolol and desensitize to PCN. if you dnt stop propranolol can worsen anaphylaxis and interfear with epi administration in the event of anaphylaxis

Question 8

sx of Allergic Rhinitis

Answer 8

recurrent episodes of nasal itching, stuffiness, rhinorrhea, paroxysms of sneezing, eye itching and dermatitis. Inflammed boddy nasal mucosa, pale turbins and +/- nasal polyps

Question 9

tx of allergic rhinits?

Answer 9

avoid!, intranasal steroids, antihistamines, nasal saline wash/spray

Question 10

CVID

sx?

Answer 10

Impaired maturation of B cells = have b cell but they dnt make Ig!

• recurrent sinopulmonary infection
• sprue-like malabsorption
• GIARDIASIS
• older patient(teens+)
• often linked with AI disorders
• enlarged lymph nodes, adenoids and spleen
• decreased all Ig!
• normal Tcells, normal B cell #s

Question 11

Tx of CVID

Answer 11

abx for infections + IVIG infusions

Question 12

XL agammaglobulinemia/Bruton’s

Answer 12

absent B-cells due to them not maturing past proB.

• normal T cells
• NO Bcells = small/absent lymph, adenoids and spleen
• male children(XLR) with recurrent sinopulmonary infections

Question 13

tx of Brutons agamm?

Answer 13

IVIG

Question 14

IgA Deficiency

sx? tx?

Answer 14

• recurrent sinopulmonary infections
• spruelike malabsorption syndrome
• increased incidence of ATOPIC conditions
• anaphylaxis when recieving blood donations

tx: tx infections as they arise

Question 15

how do you prevent anaphylaxis with pt who have IgA deficiency

Answer 15

washed pack RBCs on transfusion

Question 16

Hyper IgE syndrome

sx? tx?

Answer 16

recurrent SKIN INFECTIONS caused by STAPHYLOCOCCUS

tx: ppx w/Docloxacillin or Cephalexin

Question 17

SCID sx? tx? cause?

Answer 17

ADA mutation resulting in low B/T cells

• everythigns gone = get AIDs like infections
  tx: abx + BONE MARROW TRANSPLANT

Question 18

Wiskott-Aldrich Syndrome

inheritance + sx?

Answer 18

XLR, WAITER
Wiskott
Aldrich
IgE/A increased
Thrombocytopenia
Eczema
Recurrent infections

Question 19

Chronic Granulomatous Disease

sx?

Answer 19

• def NADPH = cant make oxide to kill shit = make granulomas instead
• extensive inflammatory rxn w/purulent material that just dnt heal, increase risk of Aphthous ulcer & infalmmation of the nares. Granulomatous formation that may obstruct GU/GI tract, increased infections with catalast + organims

Question 20

CGD are at an increased risk of infections with what bugs? name them!

Answer 20

catalase + = SPACE-LMN = Staph A, Pseudomonas, Aspergillus, Candida, Ecoli, Listeria, Mycobaterium, Nocardia

Question 21

dx of CGD

Answer 21

negative Nitroblue tetrazolium or Dihydrorhodamine test = doesnt turn paper blue = no superoxide made = neutrophils are messed up due to CGD