MKSAP10

Question 1

What is the best tx for allergic conjunctivitis with recurrent sx refractory to artificial tears?

Answer 1

Long acting antihistamine eydrop with mast-cell stabilizing properties; olapatadine and azelastine

Question 2

The two pathogens most commonly responsible for post-influenza pneumonia are _______

Answer 2

Streptococcus pneumoniae and Staph aureus

Question 3

Patients who require contrast-enhanced imaging who have a history of an immediate hypersensitivity rxn to IV contrast should get premedicated with _______

Answer 3

Prednisone and antihistamine and use nonionic low osmolality contrast; Pred/Solumedrol 13 hours, 7 hours, and 1 hour before then 50 of benadryl after

Question 4

What can be used to reduce the risk of contrast induced AKI? Does this work for hypersensitivity?

Answer 4

NS (isotonic IVF); reduces risk of nephropathy but not useful for hypersensitivity

Question 5

What is the mots likely cause of chronic cough, fever, and weight loss, in an elderly woman with bronchiectasis and nodularity?

Answer 5

MAC; Lady Windermere disease

Question 6

Use of what drug class should be ruled out when making a dx of chronic idiopathic urticaria with angioedema?

Answer 6

NSAIDS

Question 7

Cough, fever, HA and dyspnea with crackles in a cattle farmer should raise concern for ________. Caused by ____________

Answer 7

Farmers lung (Hypersensitivity pneumonitis); Thermophilic Actinomycetes in moldy hay

Question 8

What should be considered in pt with long standing nasal congestion with loss of taste? Dx?

Answer 8

Chronic sinusitis; CT of sinuses

Question 9

What should happen after stabilizing a patient who had anaphylaxis to bees?

Answer 9

Refer to allergy for testing and immunotherapy

Question 10

When looking at asthma PFTs what is considered a low FEV1?

Answer 10

A reduced FEV1 is less than 80% predicted; increase in 12% w/ bronchodilator seals dx; if this finding is not present can do methacholine challenge

Question 11

The presence of purulent nodules associated with atopic dermatitis suggests ___________

Answer 11

S. aureus superinfection

Question 12

The ______ phenomenon is the development of skin dz at sites of prior trauma

Answer 12

Koebner phenomenon, seen in Sarcoid, Lichen planus, and Psoriasis (not same as pathergy, seen in Behcets)

Question 13

Appropriate mgmt of Acute Bronchitis

Answer 13

Symptomatic relief (often due to virus); if wheezing present (and no concern for asthma or COPD exac) then Rx an albuterol inhaler

Question 14

What are some organisms that can be described as small pleomorphic gram positive rods?

Answer 14

Rhodococcus, Listeria, Corynebacterium, and Propionibacterium

Question 15

What is Pollen-Associated Oral Allergy Syndrome?

Answer 15

A disorder where when a person with ragweed allergies eats cantaloupe, they get an itchy tongue

Question 16

What if allergic rhinitis not well controlled with oral antihistamines?

Answer 16

Inhaled nasal glucocorticoid (fluticasone); this is a viable first option as well

Question 17

What are the trypase levels in Hereditary Angioedema?

Answer 17

Should be normal; tryptase is released by mast cells and can be elevated in anaphylaxis and in mastocytosis; however, HAE is due to issues with bradykinin because activated by contact pathway in absence of tryptase from degranulation

Question 18

What is Samters triad?

Answer 18

Asthma, Nasal polyposis, and chronic sinusitis–often have sensitivity to aspirin

Question 19

What should you think of in patients who have received an antibiotic who develop joint pain and rash 7-10 days later

Answer 19

Serum Sickness; Type III hypersensitivity w/ immune complex formation which activates complement and leads to a SERPIGINOUS RASH on skin

Question 20

What are some issues with topical steroids on the eyes?

Answer 20

Can have vision-threatening effects such as increased intraocular pressure, corneal melts, cataracts

Question 21

This disorder has intense pruritis and erythematous excoriated skin at flexural areas

Answer 21

Atopic Dermatitis

Question 22

What should be included in the diagnostic workup of acute pulmonary TB?

Answer 22

At least 3 sputum cultures for acid fast bacilli (TST/PPD and IGRA have no utility in acute infxn); can get a BAL if unable to get sputum

Question 23

What is the best test to identify a rash around the neck, wrist, and earlobes?

Answer 23

Patch testing for Nickel hypersensitivity (Type IV)

Question 24

What is the preferred 1st line drug for acute bacterial rhinosinusitis?

Answer 24

Amoxicillin Clavulanate (875/125) PO bid; recommended over amoxicillin only due to resistant strains of H. flu and Moraxella

Question 25

What is the mainstay of Tx of ABPA? What if you cant make dx with skin testing?

Answer 25

Steroids and Itraconazole; check IgE abs to aspergillus fumigatus; serum precipitins

Question 26

What are the general characteristics of atopic dermatitis?

Answer 26

Intense pruritis, dry excoriated skin on flexural areas; often with other atopic sx like asthma, allergic rhinitis, etc.

Question 27

What is a diagnosis to be considered in patients with exertional dyspnea and spirometry showing abnormal inspiratory limb? Gold standard for Dx?

Answer 27

Vocal Cord Dysfunction; Gold Standard = flexible laryngoscopy showing adduction of vocal cords in inspiration; Tx w/ speech therapy relaxation technique or if severe Heliox and CPAP to stent

Question 28

What should you consider in pts with asthma and foot drop w/ evidence of leukocytoclastic vasculitis (palpable purpura)?

Answer 28

EGPA; foot drop from mononeuritis multiplex; Dx can be w/ skin bx or anti-MPO ab

Question 29

If a person has an anaphylactic reaction while on a beta blocker what is another consideration?

Answer 29

Should give epinephrine (1:1000) IM as usual but consider glucagon as well bc BB being on board can blunt the effect of epi

Question 30

What does a real food allergy look like?

Answer 30

Will have urticaria etc. otherwise just feeling diarrhea, upset stomach etc. more consistent with IBS; low level food specific IgE has low predictive value

Question 31

What should you think of in a patient with a "double sickening" syndrome of URI/Sinus issues?

Answer 31

Bacterial sinusitis; first there was likely a viral URI then infxn with bacteria; Tx 5-7 days Augmentin 875-125 BID per IDSA guidelines; levofloxacin if refractory

Question 32

What test would you have to order to check a CD4:CD8 ratio when considering a Dx of hypersensitivity pneumonitis?

Answer 32

Flow Cytometry of BAL fluids; recall BAL should be lymphocytic (lymphocytic stuff implies chronicity)

Question 33

What are allergies likely due to if: 1) Early spring 2) late spring early summer 3) late summer early fall

Answer 33

1) Tree pollen 2) Grass pollen 3) Weed pollen

Question 34

What if a person has chronic severe persistent asthma with only IVIG to seasonal aeroallergens and not IgE?

Answer 34

Would not be a good candidate for omalizumab as it is an anti-IgE

Question 35

What are the 2 major types of reaction to IV contrast?

Answer 35

Vasomotor - related to osmolality feels warm, nausea, and if severe can have seizure; hypersensitivity is allergy-like

Question 36

In addition to manifesting as bronchiectasis and recurrent infxns, CVID can also cause what hematologic issues?

Answer 36

Autoimmune cytopenias such as AIHA and ITP; Dx is w/ quantitative immunoglobulins

Question 37

What may be the etiology of acute anemia in patients receiving IVIG?

Answer 37

IVIG- associated AIHA as IVIG has high titers of Anti-A and Anti-B on ABO

Question 38

What is cold-induced urticaria?

Answer 38

When a person develops urticaria from eating cold things; different from Pollen-Associated Oral Allergy syndrome bc there the mc sx are pruritis of tongue

Question 39

The laboratory finding associated with HAE (Hereditary Angioedema) is \_\_\_\_\_\_\_\_\_\_\_

Answer 39

Low C1 esterase function; don?t forget it can affect the GI tract; also has low C4

Question 40

What issue might a person with Ragweed allergy (ask about Hay Fever) have when eating melons?

Answer 40

Pollen Associated Oral Allergy Syndrome; get pruritis of tongue when eating cantaloupe; due to cross-reactivity of pollen with melon allergens

Question 41

What is the most appropriate tx for a patient with two week history of severe paroxysmal coughing?

Answer 41

Suspect B. pertussis (may have lymphocytosis) and tx is Azithromycin

Question 42

What is Hay Fever?

Answer 42

Colloquial name for Allergic Rhinitis due to seasonal aeroallergens (Best Tx with nasal steroid); nasal steroids also decrease eye sx

Question 43

What exposure is the worst for patients with peanut allergy?

Answer 43

Peanut flour (i.e. a bakery) can become aerosolized

Question 44

What disease is often described as the photographic negative of pulmonary edema?

Answer 44

Eosinophilic pneumonia (not to be confused with eosinophilic granuloma which is a type of Histocytosis aka Histiocytosis X w/ thin walled cysts in upper middle lobes in young smokers)

Question 45

What are the bacteria usually referred to as "atypicals"?

Answer 45

Mycoplasma pneumoniae, Chlamydophila, Bordatella pertussis, and Legionella pneumophila

Question 46

What is the definition of chronic idiopathic urticaria w/ angioedema? Tx?

Answer 46

Sx of urticaria and angioedema without clear cause persisting greater than 6 weeks; due to random mast cell degranulation in skin so usually not an aeroallergen issue

Question 47

What are the appropriate clinical scenarios to use anti-streptococcal abs?

Answer 47

To support a dx of acute rheumatic fever or for post-streptococcal GN (PSGN); not for acute strep pharyngitis

Question 48

What is the triad of asthma, nasal polyposis, and chronic sinusitis? Sensitivity to what med is common?

Answer 48

Samters triad; Aspirin

Question 49

Likely dx in person with atypical PNA, target lesions, and AIHA?

Answer 49

Mycoplasma pneumoniae, target lesions = erythema multiforme; Azithromcyin is preferred; FQs and Doxy also options

Question 50

A person with chronic atopic dermatitis with an acute worsening may have \_\_\_\_\_\_\_\_

Answer 50

Bacterial superinfection, possibly S. aureus (esp. if purulent, or exfoliative toxin can cause blistering)