Hypersensitivities

Question 1

Food, Drug, Bee sting allergies.
Asthma
Type __ HSR

Answer 1

1

Question 2

Autoimmune- hemolytic anemia
ITP
Hemolytic Disease of Newborn
Transfusion reactions
Type \_\_ HSR

Answer 2

2

Antibody dependent Cellular Cytotoxicity
NK cell killing

Question 3

Good Pasture Syndrome
Rheumatic Fever
Hyperacute Transplant Rejection
Type __ HSR

Answer 3

2

Complement system & Fc receptor-mediated Inflammation

Question 4

Myasthenia Gravis
Graves Disease
Pemphigus Vulgaris (IgG-Desmoglein)
Type __ HSR

Answer 4

2

ABs bind to cell surface receptor and block or activate downstream processes.

Question 5

SLE
Polyarteritis Nodosa (Hep. B association)
PSGN
Serum Sickness
Type \_\_ HSR

Answer 5

3

Question 6

Poison Ivy
Nickel Allergy
Type __ HSR

Answer 6

4

Contact Dermatitis

Question 7

Graft Vs Host Disease
PPD test for TB
Candida skin test
Type __ HSR

Answer 7

4

Question 8

Hypersensitivity reaction does NOT involve Antibodies

Answer 8

Type 4

Delayed Type

Question 9

What HSR is described?

Direct cell cytotoxicity via CD8+ T cells killing target

Answer 9

Type 4
Delayed Type

(+CD4+ releasing inflammatory cytokines)

Question 10

Immune complexes (antigen-antibody) activate complement and neutrophils release lysosomal enzymes.
Complexes are insoluble and may deposit onto tissue surfaces.

Answer 10

Type 3

Ag-Ab-C3 (3 things stuck together)

Question 11

What HSR is described?

Antibodies bind to cell surface antigens causing cellular destruction, inflammation, and organ dysfunction.

Answer 11

Type 2

Question 12

One mechanism is the cell is opsonized by antibodies leading to either, complement mediated phagocytosis or NK cell killing (ADCC).

Answer 12

Type 2

Question 13

Detects Antibodies attached DIRECTLY to the RBC surface. + result means agglutination

Answer 13

Coombs

Question 14

Detects the presence of unbound antibodies in the serum.

Answer 14

Indirect Coombs

Question 15

ELISA blood test for allergen specific IgE to diagnose which HSR type?

Answer 15

Type 1

Question 16

Anaphylactic & Atopic reactions occur in 2 phases:

The immediate reaction occurs in minutes when the antigen crosslinks ____ IgE on PRESENSITIZED Mast cells.

Answer 16

Pre-formed

Question 17

Mast cell degranulation releases (2)

Answer 17

Histamine (increased permeability of capillary)

Tryptase

Question 18

The second or delayed phase of Type 1 HSRs occur hours later when chemokines attract ___ and ___ causing inflammation and tissue damage.

Answer 18

Eosinophils

leukotrienes

Question 19

Describe 
Type 1 HSR 
Type 2 HSR
Type 3 HSR
Type 4 HSR

Answer 19

Mast cell/ IgE mediated (Immediate)
Antibody mediated
Immune Complex mediated
T Cell mediated (Delayed)

(MACT)

Question 20

This patient with recurrent episodes of abdominal pain and an episode of facial swelling likely has angioedema due to

Answer 20

C1 inhibitor (C1INH) deficiency

Question 21

C1 inhibitor (C1INH) deficiency causes increased cleavage of C2 and C4 and results in inappropriate activation of the complement cascade. C1INH also blocks ____-induced conversion of kininogen to bradykinin

Answer 21

kallikrein

Question 22

a potent vasodilator associated with angioedema due to increased permeability:

Answer 22

bradykinin

Question 23

Direct Mast Cell Activation can be done by ____ which caused pruritis & urticaria

Answer 23

Opioids

Question 24

Facial edema (without itchiness or rash) or laryngeal swelling caused by recent use of ACE-I is due to accumulation of _____

Answer 24

Bradykinin

Question 25

Excess Bradykinin resulting in edema can be caused by

Answer 25

C1 inhibitor deficiency | ACE-I

Question 26

Angiedema without urticaria or pruritis Labs: low C4, High Bradykinin indicative of

Answer 26

C1 inhibitor deficiency High levels of activated C1 Low levels of C1 esterase inhibitor

Question 27

Kallikrein converts what to proteins

Answer 27

Plasminogen to Plasmin | Kininogen to Bradykinin

Question 28

Activated C1 inhibits what protein

Answer 28

Kallikrein

Question 29

____ inhibitor suppresses activation of the C1 complement component and therefore the rest of the classic complement pathway. 

Answer 29

C1 esterase

Question 30

An erythematous area with indistinct margins over the skin. The area feels hot and indurated and is exquisitely tender.

Answer 30

Cellulitis

Question 31

Myeloperoxidase is found predominately in

Answer 31

neutrophils

Question 32

Drugs causing a nonimmunologic reaction that can cause itching, urticarial rash, wheezing, hypotension, and tachycardia that closely mimic true IgE-mediated type 1 hypersensitivity (eg, anaphylaxis). (3)

Answer 32

Opioids Vancomycin (red man syndrome) radioiodine contrast

Question 33

Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit cyclooxygenase, which leads to increased _____ activity.  This effect can precipitate bronchoconstriction and wheezing due to increased production of leukotrienes (ie, NSAID-exacerbated respiratory disease)

Answer 33

5-lipoxygenase

Question 34

During initial allergen exposure, antibody class switching from IgM to IgE antibodies specific for the allergen occurs.  IgE binds to high-affinity ____ on basophils and mast cells.  Re-exposure to the allergen results in cross-linking of bound IgE antibodies with subsequent degranulation and release of inflammatory mediators ( histamine, tryptase, leukotrienes, prostaglandins). 

Answer 34

IgE Fc receptors

Question 35

TH1 cells are responsible for inducing macrophage and ____ inflammatory reactions.

Answer 35

cytotoxic T lymphocyte-mediated (type IV)

Question 36

__ is a cytokine produced by TH1 lymphocytes that increases proliferation and activity of helper, cytotoxic, and regulatory T cells as well as NK cells. 

Answer 36

IL-2

Question 37

IL-4 is responsible for driving the production of TH2 cells, which promote antibody-mediated (humoral) immunity and facilitate type __ hypersensitivity.

Answer 37

I

Question 38

IL-4 is responsible for driving the production of __ cells

Answer 38

TH2

Question 39

Dyspnea, hypotension, and tachycardia soon after administration of β-lactam antibiotics are suggestive of

Answer 39

anaphylactic shock | *give epinephrine

Question 40

release of ___ causing widespread increased vascular PERMEABILITY aka Anaphylactic Shock

Answer 40

chemical mediators | histamine, prostaglandin, leukotrienes

Question 41

In response to anaphylaxis-induced hypotension, an intact ____ reflex leads to increased sympathetic activity, tachycardia, and compensatory vasoconstriction.

Answer 41

baroreceptor

Question 42

A toxin-mediated decrease in myocardial contractility and an increase in capillary permeability occur in

Answer 42

toxic shock syndrome (TSS)

Question 43

TSS toxin 1 is capable of nonspecifically activating T cells (superantigen).  The subsequent dramatic release of inflammatory cytokines results in increased capillary permeability and hypotension, as well as high fever and a diffuse, erythematous rash.  In addition, the exotoxin can directly inhibit myocardial function.

Answer 43

Anaphylactic Shock is due to CHEMIACAL mediators (like Histamine) not TOXIN mediators like TSS.

Question 44

Hypotension, Tachycardia, N/V, & Wheezing | are all signs of

Answer 44

Anaphylactic Shock | other signs: Edema, hoarseness, stridor, flushing, itchiness, rash, abdominal pain

Question 45

Erythema Pruiritis Urticaria characteristic of Type __ HSR

Answer 45

1