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A. Block B Dermatology > Urticaria (Hives) > Flashcards

Urticaria (Hives) Flashcards

1
Q

Urticaria is the medical name for hives, which is a skin reaction that causes itchy welts, also called wheals. What are wheals (or welts)?

1 - dry itchy cysts
2 - oedematous papules due to dermal swelling
3 - allergic reaction causing a systemic eczema reaction
4 - can be any of the above

A

2 - oedematous papules due to dermal swelling

  • papules are raised skin <0.5cm
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2
Q

Urticaria is the medical name for hives, which is a skin reaction that causes itchy welts, also called wheals. Which of the following is NOT a common symptom patients with urticaria present with?

1 - transient itchy skin (very itchy)
2 - mucosal swelling
3 - present in all layers of the skin superficial dermis

A

3 - present in all layers of the skin
- typically confined to superficial dermis

  • Wheals can be single, multiple, small or large
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3
Q

Urticaria is the medical name for hives, which is a skin reaction that causes itchy welts, also called wheals. Which of the following is NOT a typical cause of urticaria?

1 - allergy
2 - burns
3 - autoimmunity
4 - drugs
5 - diet
6 - infections

A

2 - burns

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4
Q

Which of the following has been identified as the most common cause of Urticaria?

1 - allergy
2 - autoimmunity
3 - drugs
4 - diet
5 - infections

A

1 - allergy

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5
Q

Angioedema relates to swelling of the skin. Is this confined to the superficial or deep layers of the skin?

A
  • affects deep layers of the skin
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6
Q

Angioedema relates to swelling of the deep layers of the skin. Does this cause pain?

A
  • yes
  • often associated with pain
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7
Q

What had been identified as a key component causing recurrent angioedema?

1 - cytotoxic T cell inhibitor deficiency
2 - B cell inhibitor deficiency
3 - mast cell inhibitor deficiency
4 - C1 esterase inhibitor deficiency

A

4 - C1 esterase inhibitor deficiency
- only known inhibitor of the complement pathway

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8
Q

All of the following can be used to diagnose patients with angioedema and urticaria, except which one?

1 - history and clinical findings
2 - blood tests
3 - urine analysis
4 - physical and dietary challenges
5 - skin tests and biopsy

A

3 - urine analysis
- if a patient presents with just angioedema, need to check C1 esterase inhibitor levels

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9
Q

Patients with urticaria typically present to primary care, emergency rooms, dermatologists or allergists. However, typically how long to the wheals/hives lasts for?

1 - <1h
2 - <6h
3 - <12h
4 - <24h

A

4 - <24h
- episodes can be prolonged though

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10
Q

Patients with urticaria typically present to primary care, emergency rooms, dermatologists or allergists and typically only last up to 24h. Are wheals/hives always accompanied by angiodema?

A
  • no
  • urticaria can be alone
  • urticaria can include angioedema
  • urticaria can include angioedema and anaphylaxis
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11
Q

What is the term given to urticaria when the wheals/hives last >24h?

1 - urticarial vasculitis
2 - angioedemitis
3 - urticarialitis
4 - systemic urticarial

A

1 - urticarial vasculitis

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12
Q

Although the exact cause of urticaria remains unknown, the following have been identified in the potential pathophysiolohy:

  • Mast cell stimulation
  • Mast cell independent urticaria
  • Prostaglandins
  • Cyropyrins (node like receptors, involved in inflammatory pathways)
A

All of the following have been identified in the aetiology urticaria:

  • Immunologic - autoimmune
  • IgE dependent (type I)
  • Immuno complex (type III)
  • Kinin and complement dependant
  • Non immunologic –direct mast cell activation(opiates) , vasoactive stimuli (wasp), aspirin, dietary pseudoallergens, ACEI
  • Idiopathic
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13
Q

Which of the following is NOT a real classification of urticaria?

1 - hand and foot urticaria
2 - spontaneous urticaria
3 - physical (inducible)
4 - urticarial vasculitis (>24h)
5 - contact urticaria
6 - angioedema without urticaria
7 - distinctive urticarial syndromes

A

1 - hand and foot urticaria

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14
Q

Which of the following is the definition of chronic urticaria?

1 - lasting >6 weeks
2 - lasting >6 weeks at least twice a week
3 - lasting >12 weeks
4 - lasting >12 weeks at least once a week

A

2 - lasting >6 weeks at least twice a week

  • <6 weeks it is called episodic /recurrent urticaria
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15
Q

Ordinary/spontaneous urticaria can be acute and is commonly seen in which age group with atopic dermatitis (eczema)?

1 - babies
2 - young children
3 - teenagers
4 - adults

A

2 - young children

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16
Q

Ordinary/spontaneous urticaria can be chronic and typically peaks at what age?

1 - 2nd decade
2 - 3rd decade
3 - 4th decade
4 - 5th decade

A

3 - 4th decade

17
Q

Urticaria can occur any time, but is it more common during the day or evening?

A
  • evening
18
Q

Urticaria can be associated with all of the following, EXCEPT which one?

1 - pre-menstrual exacerbations
2 - fatigue
3 - osteoporosis
4 - chills
5 - arthralgia

A

3 - osteoporosis

19
Q

Which of the following conditions are associated with urticaria?

1 - Thyroid disease
2 - Vitiligo
3 - Insulin dependent diabetes
4 - Rheumatoid arthritis
5 - Pernicious anaemia
6 - Helicobacter pylori
7 - Strongyloidiasis
8 - all of the above

A

8 - all of the above
- strong autoimmune component

20
Q

Physical/inducible urticaria can be caused by exogenous stimuli. This can include which of the following?

1 - mechanical (dermographism, delayed pressure urticaria, vibratory)
2 - Temperature – heat, cold
3 - Sweat, stress- cholinergic, adrenergic, exercise induced
4 - Solar urticaria (heat)
5 - Aquagenic urticaria (water)
6 - all of the above

A

6 - all of the above

Dermographism can be:
- Simple or symptomatic
- Whealing occurs in response to gentle skin stroking
- Resolves in an hour
- No association with atopy
- Delayed dermographism

21
Q

Delayed pressure urticaria is another form of urticaria. Which of the following is NOT correct about this form of urticaria?

1 - deep erythematous swellings at sites of sustained pressure
2 - 30 seconds to 12 minutes
3 - pruritic/painful or both
4 - tight clothing , soles – after walking
5 - flu like symptoms, arthralgia
6 - vibratory angioedema

A

2 - 30 seconds to 12 minutes
- typically occurs between 30 minutes to 12 hours

22
Q

Urticaria due to temperature changes is another form of urticaria. Does heat urticaria typically occur quickly or slowly?

A
  • quickly
  • within minutes, can last hours
23
Q

Cholinergic urticaria is a form of urticaria caused by the sweat and are typically associated with stress. Which of the following occur?

1 - transient, papular 2-3 mm wheals with surrounding flare
2 - 15 minutes of sweat inducing stimuli
3 - common in young adults
4 - exercise induced anaphylaxis
5 - ood and exercise induced anaphylaxis - gliadin
6 - all of the above

A

6 - all of the above

  • cholinergic urticaria is typically much smaller than standard urticaria
24
Q

Urticarial vasculitis is a form of urticaria. Which of the following are true about urticarial vasculitis?

1 - lasts for more than 24 hours
2 - can show bruise like skin changes
3 - burning than itching
4 - arthralgia, renal, ocular changes
5 - aistology – vasculitis
6 - all of the above

A

6 - all of the above

25
Q

All of the following can be used to diagnose acute urticaria, EXCEPT which one?

1 - IgE test
2 - IgG test
3 - RAST screen
4 - skin prick test

A

2 - IgG test

Rast = Radioallergosorbent test, a laboratory test performed on blood. It tests for the amount of specific IgE antibodies in the blood which are present if there is a “true” allergic reaction.

26
Q

All of the following can be used to diagnose chronic urticaria, EXCEPT which one?

1 - skin prick test
2 - ESR
3 - CRP
4 - thyroid autoantibodies

A

1 - skin prick test

  • often autoimmune so can use this to diagnose patients
27
Q

How is physical urticaria diagnosed?

1 - skin prick test
2 - ESR
3 - CRP
4 - challenged with potential agent they came into contact with

A

4 - challenged with potential agent they came into contact with

28
Q

How is Urticarial vasculitis diagnosed?

1 - skin prick test
2 - ESR
3 - CRP
4 - skin biopsy

A

4 - skin biopsy

29
Q

How is angioedema without wheals diagnosed?

1 - low C4 level and/or C1 inhibitor levels
2 - ESR
3 - CRP
4 - skin biopsy

A

1 - low C4 level and/or C1 inhibitor levels

30
Q

What is typically the 1st line treatment for urticaria?

1 - prednisolone
2 - cyclosporine
3 - methotrexate
4 - antihistamines

A

4 - antihistamines
- fexofenadine is 1st line

  • Classic antihistamines –sedation
  • Second generation antihistamines, preferred choice as no sedation
  • H1 and H2 antihistamines
31
Q

Which of the following is typically NOT a 2nd line treatment for urticaria?

1 - prednisolone
2 - Epinephrine (if anaphylaxis)
3 - Montelukast
4 - Antihistamines

A

4 - Antihistamines

  • prednisolone only in short courses, but is 1st out of the 3
32
Q

Which of the following is NOT a non-drug therapy that can be used to treat urticaria?

1 - Exclusion of food additives, salicylates
2 - Tolerance by repeated exposure
3 - Ultraviolet light
4 - Exercise

A

4 - Exercise

33
Q

Which of the following is NOT a 3rd line therapy for urticaria?

1 - Cyclosporine
2 - Flumazenil
3 - Methotrexate
4 - Mycophenolate mofetil
5 - Omalizumab – anti IGE monoclonal antibody

A

2 - Flumazenil
- benzodiazepine antagonist

34
Q

If a patient is diagnosed with C1 esterase inhibitor deficiency, which of the following can be used to treat them?

1 - C1 concentrate for emergency use
2 - Fresh frozen plasma
3 - given as prophylaxis 1 hr before surgery
4 - oral tranexamic acid
5 - avoid oestrogen –OCP/HRT
6 - all of the above

A

5 - all of the above

35
Q

If a patient has been diagnosed with angioedema, which of the following should be used in their management?

1 - ABCDE
2 - Stop any trigger
3 - Antihistamines
4 - Steroids
5 - all of the above

A

5 - all of the above

  • can lead to anaphylaxis, asphyxia, cardiac arrest and death
36
Q

Once treated, typically how long before angioedema resolves?

1 - 1-3h
2 - 1-3 days
3 - 1-3 weeks
4 - 1-3 months

A

2 - 1-3 days

A. Block B Dermatology (32 decks)

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