AllergyImmunology Flashcards

Question

asthma, aspirin sensitivity, and nasal polyps

Answer 1

Samter's triad

Answer 2

IVIG associated hemolytic anemia

Answer 3

anti-CD20 chimeric monoclonal antibody, B cell depleter 1. RA 2. CLL 3. GPA 4. MPA 5. NHL 6. Post-cardiac transplant immunosupression 7. AIHA 8. Burkitt lymphoma, CNS lymphoma, Hodgkin: off label 9. GVHDoff-label 10. TTP, ITP, membranous nephropathy, lupus nephritis, pemphigus - off-labe

Answer 4

anti-TNF, RA

Answer 5

EGFR inhibitor, metastatic colorectal cancer

Answer 6

anti-IgE, severe asthma + urticaria

Answer 7

anti-CD52 Indxn: CLL, T-cell lymphomas

Answer 8

Steroids + (? itraconazole | voriconazole)

Answer 9

small molecule, designed for: G551D mutation in at least one CFTR genes.

Answer 10

Highly accurate Skin testing is highly accurate for the identification of penicillin allergy OTOH: .. no valid reagents available for most antibiotic-specific IgE . Although the parent antibiotic compound may be used, a negative does not mean that IgE antibodies are absent. A negative result: insufficient sensitivity or, more likely, correct drug immunogen was not used

Answer 11

Mast-cell–specific neutral protease Indicates: systemic mast-cell activation is high for several hours after anaphylactic drug reactions.

Answer 12

BAL, lymphocytosis with CD4:CD8 \< 1 1. exposure to offending antigen(s); 2. compatible clinical, radiographic, or physiologic findings; 3. bronchoalveolar lavage with lymphocytosis; 4. positive inhalation challenge testing; 5. histopathology: Poorly formed, noncaseating granulomas OR a mononuclear cell infiltrate. Not all of these features are present in all patients. Two models for chronic HP have a high degree of specificity. Model 1 included the following predictor variables: age, a history of down feather and/or bird exposure, the presence of diffuse craniocaudal ground-glass opacity on HRCT, and the presence of mosaic perfusion on HRCT. An "HP score" point value ≥63 (range 0 to 100) showed a specificity of 91 percent and sensitivity of 48 percent for the diagnosis of chronic HP. Model 2 included: age, history of down feather and/or bird exposure, and a moderate to high confidence in the radiographic diagnosis of HP. Using model 2, HP scores ≥57 demonstrated a specificity of 91 percent and sensitivity of 50 percent for the diagnosis of chronic HP.

Answer 13

Cold air, exercise, worse at night

Answer 14

True On what basis?

Answer 15

inhaled glucocorticoid Could try LTA and then switch if failure

Answer 16

Allergen identification, avoidance 1. Intermittent: SABA 2. Mild persistent: inhaled glucocorticoid intermittent: short-acting inhaled beta-2-selective adrenergic agonist (Grade 1A). ) (Step 1 Rx). SABA PRN acute symptoms as well as for prevention of symptoms ●The cromoglycates can be used as alternative preventive agents (eg, prior to exercise), SABA must still be prescribed for acute bronchodilation. Problem: Withdrawal of MDI formulations from the market in most countries Mild persistent: daily antiinflammatory medication (Grade 2A). This represents step 2 + PRN SABA Alternative approach: LTA Increasing evidence suggests that at least some patients with mild persistent asthma can use their anti-inflammatory therapy intermittently (that is, taken daily during periods of increased symptoms, then discontinued 1 to 2 weeks after symptoms have abated).

Answer 17

No Only with glucocorticoid

Answer 18

Ultra-long-acting beta agonists with a duration of action of up to 24 hours (eg, vilanterol and others not approved for use in asthma)

Answer 19

Despite the beneficial effects of LABA, there has been a controversy over whether chronic use of long-acting beta agonists may be associated with rare severe asthma exacerbations and increased asthma and cardiac mortality in a *small* subgroup of patients.

Answer 20

1. routine monitoring of symptoms and lung function 2. patient education, 3. control of trigger factors 4. Rx comorbid conditions 5. Pharmacologic therapy

Answer 21

1. Symptoms over the previous two to four weeks 2. Current (PEFR or FEV1 )and FEV1/FVC values) 3. Number of exacerbations requiring oral glucocorticoids in the previous year

Answer 22

CT Most sensitive, most specific

Answer 23

1. Intermittent: Sx \< 2 days/week, Normal FEV1 in between, FEV1 \> 80% 2. Persistent 1. Mild: Sx \> 2 d/week , FEV1 \> 80 2. Moderate: Sx daily, 60\> FEV1 \< 80, 3. Severe: Sx throughout day, FEV1 \< 60

Answer 24

a patient over age four who demonstrates all of the following characteristics [56,81,82]: 1. Significantly reduced total IgG 2. Low IgA and/or IgM 3. Poor response to immunization 4. Absence of other immunodeficiency(ie, CVID is a diagnosis of exclusion)

Answer 25

Small vessel vaculitis + asthma + vasculitic rash + mononeuritis multiplex

Answer 26

Late summer + fall: weed Early spring: tree Late spring, early summer: grass

Answer 27

Extra-thoracic outflow obstruction

Answer 28

Flattening of expiratory phase

Answer 29

PVFM is often mistaken for asthma because it is episodic, may be brought on by exertion, and the stridor may sound similar to wheezing. Asthma: wheezing is **expiratory** PVFM: Flow-volume curves may show **flattening of the inspiratory loop** consistent with extrathoracic airway obstruction. Between episodes, spirometry normal. Diagnosis: flexible laryngoscopy during episode: abnormal adduction of the vocal folds, exclusion of other causes of glottic and subglottic obstruction.

Answer 30

1. asthma, 2. angioedema, 3. bilateral vocal fold palsy, 4. glottic and tracheal neoplasms 5. stenosis, 6. laryngotracheomalacia, 7. laryngospasm.

Answer 31

harsh, high-pitched wheezing or vibrating sound due to turbulent airflow in the upper airways. It can occur during inspiration, expiration, or both, although it most typically occurs with **inspiration**.

Answer 32

true vocal folds **abduct (**open) during **inspiration** and **partially adduct** (close) during **expiration**. Abduction can also be induced by *sniffing* and *panting*. Normal *adduction* of the true vocal folds occurs with phonation, coughing, throat clearing, swallowing, and during a *Valsalva* maneuver.

Answer 33

1. acute: reassurance + panting maneuvers (Grade 2C). 2. If not effective CPAP; HeliOx In patients with **recurrent** PVFM, we suggest a long-term management strategy that combines 1. speech therapy 2. psychological counseling, and 3. avoidance of perceived laryngeal irritants (Grade 2C). 4. exercise-related PVFM may : inhaled anticholinergic before exercise.

Answer 34

Atopic dermatitis

Answer 35

a less sedating metabolite of hydroxyzine, H1 Antagonist, Second Generation;

Answer 36

Think of GPA ( Wegener's) Look for : 50% GPA or MPA have skin lesions. The most common is **leukocytoclastic angiitis**, which causes **purpura** involving the **lower extremities** that may be accompanied by focal necrosis and ulceration. Skin lesions may also include urticaria, livedo reticularis, and nodules. Occasional patients with erythema nodosum, pyoderma gangrenosum, and Sweet syndrome may also have ANCA-positive disease.

Answer 37

Upper respiratory tract only: 70% Systemic: 90%

Answer 38

Serum sickness

Answer 39

FEV1 response to bronchodilator

Answer 40

Mycobacteria, Listeria, Histoplasma

Answer 41

1. Type 1: IgE, previous sensitization: immediately with first dose 2. Type II: uncommon, antibody-mediated cell destruction, hemolytic anemia, thrombocytopenia, or neutropenia 3. Type III: **antigen-antibody c**omplexes and serum sickness, vasculitis, or drug fever. **Unommon** and usually seen in high-dose, prolonged administration, similar to type II reactions. **1-2 weeks** , since significant quantities of antibody are needed. 4. Type IV: skin findings, T-cell mediated, delayed in onset by **at least** **48 to 72** hours and sometimes by days to weeks. Upon **rechallenge**, may appear within **24** hours.

Answer 42

Weeks after exposure, stops within days of stopping drug

Answer 43

Farmer's lung hypersensitivity pneumonitis due to Thermophilus actionmycetes exposure (moldy hay)

Answer 44

Type IV ## Footnote Type IV drug reactions involve the activation and expansion of **T cells**, which requires time (normally many h**ours or days after antigen exposur**e), hence the name delayed-type hypersensitivity (DTH). In some cases, other cell types (eg, macrophages, eosinophils, or neutrophils) are also involved.

Answer 45

Hypersensitivity pneumonitis due to exposure to MAI

Answer 46

Cystic fibrosis Asthma

Answer 47

Rhinoconjuctivitis + asthma + cows

Answer 48

1. Bevacizumab: Colon cancer, RCC, age related macular degeneration (anti-VEGF) 2. Alemtuzumab: CD52 leukemias 3. Gemtuzumab ozogamicin: AML

Answer 49

30% SLE-like illnes; Another presentation, especially in early childhood, is **recurrent pyogenic infections** with encapsulated bacteria, such as Streptococcus pneumoniae, Haemophilus influenza type b, and Neisseria meningitidis

Answer 50

90% sporadic, 10% familial

Answer 51

1. X-linked agammaglobulinemia: defect of B-cell development, recurrent sinopulmonary infection, first 2 years 2. SCID: T-cell defect that can affect B-cells, NK cells: fist 6 months. 3. CGD: neutrophil function defect, catalase positive infections during first 5 years.

Answer 52

Hereditary angioedema C1-esterase inhibitor function

Answer 53

C4 persistently low, C2 low during attacks

Answer 54

Anaphylaxis, hereditary mastocytosis ryptase is produced by both mast cells and basophils, although mast cells contain approximately **500**-fold more than basophils. Upon activation, mast cells degranulate, releasing tryptase, along with histamine, into the extracellular environmen

Answer 55

aspirin-exacerbated respiratory disease

Answer 56

chronic sinusitis, asthma, and aspirin sensitivity ## Footnote Nasal polyps are abnormal gray, glistening masses filled with inflammatory material, which may form in the nasal cavity or paranasal sinuses; appearance is diagnostic. Seen on computed tomography (CT) examination. In adults, nasal polyps are frequently associated with chronic sinusitis, asthma, and aspirin sensitivity, in the syndrome of aspirin-exacerbated respiratory disease (AERD). Some patients have concomitant allergic rhinitis or allergic fungal sinusitis. In children, nasal polyps are most commonly associated with cystic fibrosis.

Answer 57

Topical glucocorticoid bid

Answer 58

Presbycussis

Answer 59

1. Autoimmune hearing loss: rapid (over weeks to months). 2. Meniere's: Vertigo, tinnitus, unilateral, fluctuating, low frequency. 3. Otosclerosis: genetic cause, Rinne negative, low frequency loss.

Answer 60

Otoscleorsis Bony overgrowth that involves the footplate of the stapes. As the overgrowth develops, the stapes can no longer function as a piston, but rather rocks back and forth and eventually becomes totally fixated. Conduction gradually becomes worse until a maximal conductive hearing loss of 60 dB is reached.

Answer 61

All outer and middle ear: conductive hearing loss; Inner ear causes: sensorineural hearing loss.

Answer 62

lymphoplasmacytic tissue infiltration 1. lymphoplasmacytic tissue infiltration of IgG4-positive cells 2. May be accompanied by fibrosis, obliterative phlebitis 3. majority: high IgG4. 4. Presentation: subacute development of a mass in the affected organ or diffuse enlargement of an organ. 5. Lymphadenopathy is common 6. Symptoms of asthma or allergy may be present. 7. Good initial response to glucocorticoids.

Answer 63

1. Type 1 autoimmune pancreatitis (AIP) and IgG4-related sclerosing cholangitis 2. Mikulicz disease (or Mikulicz syndrome) and sclerosing sialadenitis (Küttner’s tumor), inflammatory orbital pseudotumor, and chronic sclerosing dacryoadenitis 3. Idiopathic retroperitoneal fibrosis 4. Chronic sclerosing aortitis and periaortitis 5. Riedel’s thyroiditis and a subset of Hashimoto’s thyroiditis 6. IgG4-related interstitial pneumonitis and pulmonary inflammatory pseudotumors 7. IgG4-related renal disease, particularly tubulointerstial nephritis

Answer 64

Headache, hypertension, Tremor, AKI

Answer 65

Tacrolimus

Answer 66

DRESS syndrome. Explanation Drug Rash with Eosinophilia and Systemic Symptoms. Patients typically develop a pleomorphic rash, peripheral eosinophilia, fever, lymphadenopathy, and multiorgan involvement (liver, kidney, cardiac, etc.). Usually occurs 2–8 weeks after exposure to the offending drug, typically with aromatic anticonvulsants, minocycline, and allopurinol. Recently, reactivation with human herpesvirus 6 has been implicated. Dx: Clinical diagnosis. Skin biopsy may be helpful, but not diagnostic. Tx: Stop the drug. Glucocorticosteroids and IVIG may be beneficial.

Answer 67

PJP ## Footnote DFA is the most commonly used method for detection. Respiratory viruses are also common in this time period—consider adenovirus, as influenza and RSV tests were negative. Dx: BAL + (DFA test or GMS stain). Tx: TMP/SMX ± prednisone (if pO2 ≤ 70, A-a gradient ≥ 35, or resting hypoxemia on pulse ox).

Answer 68

systemic lupus erythematosus (SLE) associated with early complement deficiency. Explanation Homozygous early complement deficiency (especially C1, C2, and C4) is associated with recurrent bacterial sinopulmonary disease and development of SLE. Usually, a case of untreated SLE without an underlying complement deficiency will not have the history of repeated pneumococcal infections. Dx: Clinical; complement deficiency is diagnosed with the CH50 assay, which assesses the classic pathway. Homozygous deficiencies result in a very low CH50 value. Tx: Vaccinations (can get live virus vaccines), especially meningococcal and pneumococcal conjugates + standard treatment for lupus (immunomodulation) + prophylactic antibiotics for sinopulmonary infections.

Answer 69

recurrent meningococcal infection associated with terminal complement deficiency. Explanation Suspect terminal complement deficiency when you see \> 1 episode of invasive Neisseria. Deficiencies in the alternative pathway (factors D and properdin) are also associated with Neisseria but are very rare. Dx: CH50 assay, which assesses the classic pathway; AH50 assay assesses the alternative pathway. Tx: Vaccinations (can get live virus vaccinations), especially meningococcal and pneumococcal conjugates and vigilance for symptoms/signs of infection.

Answer 70

anaphylaxis. Explanation Anaphylaxis is diagnosed when any 1 of the following 3 criteria is fulfilled: 1) Sudden onset with involvement of the skin/mucosal tissue and either: Sudden respiratory symptoms, or Hypotension 2) ≥ 2 of the following that occur suddenly after exposure to a likely allergen: Skin/Mucosal tissue involvement Respiratory involvement Hypotension GI symptoms 3) Hypotension after exposure to known allergen Note that hypotension is not required for the diagnosis of anaphylaxis. The patient in the vignette satisfies criterion #2, as patient had skin/mucosal involvement and respiratory symptoms after exposure to latex. Other common triggers include pollen, animal dander, food (nuts, shellfish, milk, eggs, fish), insects (bees, hornets, wasps), and drugs (beta-lactams, anesthetics, muscle relaxants). Dx: Clinical as above. Tx: Epinephrine is 1st line therapy! Albuterol can be given for wheezing, antihistamines for hives and pruritus, normal saline for hypotension.

AllergyImmunology Flashcards

(112 cards)