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AI Boards > ACAAI Review Book Ch 3: Anatomy Physiology Pathology > Flashcards

ACAAI Review Book Ch 3: Anatomy Physiology Pathology Flashcards

1
Q

what hematopoeitic growth factor is produced by stromal cells in the bone marrow and thymus and is required for B and T cell development?

A

IL-7

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2
Q

see pic of LN architecture figure 3-2 pg 96

A

mnemonic for sinus drainage

FM AM PS SS

Frontal
Maxillary
Anterior ethmoids drain into
Middle Meatus via hiatus semilunaris

Posterior ethmoids
Sphenoids drain
Sphenoethmoidal recess above
Superior turbinate

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3
Q

Skin homing of memory, effector, and regulatory T cells subtypes (CLA+), are programmed by skin derived DCs via cytokines, including:

A

CCR4/CCL17

CCR10/CCL27

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4
Q

A patient presents with flaccid bullae affecting the scalp, chest, and involving the oral mucosa, + Nikolsky’s. What is the most likely expected lab finding?

A. IgG autoantibodies to desmoglein 1
B. IgG autoantibodies to plakin proteins, and desmoglein 1 & 3
C. IgG autoantibodies to desmoglein 3 and desmocollin 1
D. IgG autoantibodies to desmoglein 1 & 3
E. IgG autoantibodies to BP180 and BP230
F. IgG autoantibodies to epidermal tranglutaminase

A

D. IgG autoantibodies to desmoglein 1 & 3

Pemphigus vulgaris

Epidermal IgG and C3 cell surface staining of the SUPRABASAL layers = @ BASEMENT MEMBRANE

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5
Q

A patient presents with superficial bullae, erosions, + Nikolsky’s, more on the upper body, not involving the oral mucosa. What is the most likely expected lab finding?

A. IgG autoantibodies to desmoglein 1
B. IgG autoantibodies to plakin proteins, and desmoglein 1 & 3
C. IgG autoantibodies to desmoglein 3 and desmocollin 1
D. IgG autoantibodies to desmoglein 1 & 3
E. IgG autoantibodies to BP180 and BP230
F. IgG autoantibodies to epidermal tranglutaminase

A

A. IgG autoantibodies to desmoglein 1

Pemphigus foliaceous

Epidermal IgG and C3 cell surface staining of the GRANULAR LAYER = SUPERFICIAL

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6
Q

A patient presents with tense bullae, intense itching, hard to tell if Nikolsky’s is present. What is the most likely expected lab finding?

A. IgG autoantibodies to desmoglein 1
B. IgG autoantibodies to plakin proteins, and desmoglein 1 & 3
C. IgG autoantibodies to desmoglein 3 and desmocollin 1
D. IgG autoantibodies to desmoglein 1 & 3
E. IgG autoantibodies to BP180 and BP230
F. IgG autoantibodies to epidermal tranglutaminase

A

E. IgG autoantibodies to BP180 and BP230

Bullous pemphigoid

SUBEPIDERMAL

linear basement membrane zone IgG and C3

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7
Q

A patient presents with small bullae on elbows and knees, intense itching with crusted ulcers, and c/o some stomach upset. What is the most likely expected lab finding?

A. IgG autoantibodies to desmoglein 1
B. IgG autoantibodies to plakin proteins, and desmoglein 1 & 3
C. IgG autoantibodies to desmoglein 3 and desmocollin 1
D. IgG autoantibodies to desmoglein 1 & 3
E. IgG autoantibodies to BP180 and BP230
F. IgA autoantibodies to epidermal tranglutaminase

A

F. IgA autoantibodies to epidermal tranglutaminase

Dermatitis herpetiformis

granular basement membrane zone IgA with neutrophil rich infiltrate

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8
Q

A patient presents with flaccid bullae with mucosal involvement, severe stomatitis affecting the tongue, lichenoid and erythema multiforme like lesions, + Nikolsky’s.. What is the most likely expected lab finding?

A. IgG autoantibodies to desmoglein 1
B. IgG autoantibodies to plakin proteins, and desmoglein 1 & 3
C. IgG autoantibodies to desmoglein 3 and desmocollin 1
D. IgG autoantibodies to desmoglein 1 & 3
E. IgG autoantibodies to BP180 and BP230
F. IgA autoantibodies to epidermal tranglutaminase

A

B. IgG autoantibodies to plakin proteins, and desmoglein 1 & 3

Paraneoplastic pemphigus

Epidermal IgG and C3 cell surface and basement membrane zone staining

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9
Q

A patient presents with pustules, erythema, and flaccis lakes of pus. What is the most likely expected lab finding?

A. IgG autoantibodies to desmoglein 1
B. IgG autoantibodies to plakin proteins, and desmoglein 1 & 3
C. IgG autoantibodies to desmoglein 3 and desmocollin 1
D. IgG autoantibodies to desmoglein 1 & 3
E. IgG autoantibodies to BP180 and BP230
F. IgA autoantibodies to epidermal tranglutaminase

A

C. IgG autoantibodies to desmoglein 3 and desmocollin 1

Epidermal IgA cell surface staining

see table 3-5 pg 109

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10
Q

What is the matrix protein that promotes aggregation and disulfide bonding of keratin filaments?

A

Filaggrin

mutations a/w AD and ichthyosis vulgaris

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11
Q

What is the best way to obtain tissue for diagnosis of suspected immunobullous diseases?

A
  1. shave bx of intact vesicle for H&E

2. Bx of perilesional tissue for DIF

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12
Q

table 3-6 pg 112 autoimmune skin diseases

A

how important is this? who knows.

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13
Q

what are the most important cytokines implicated in EoE?

A

IL-5 and Eotaxin-3

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14
Q

where is the osteomeatal complex located?

A

under middle turbinate

- drains anterior ethmoid, frontal, and maxillary sinuses

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15
Q

where does the nasolacrimal duct drain?

A

into inferior meatus

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16
Q

where do the posterior ethmoids drain?

A

superior meatus

17
Q

where do the sphenoids drain?

A

sphenoethmoidal recess

18
Q

what is the concept of priming?

A

lower allergen doses needed to elicit a response in subsequent exposure

19
Q

INS block which phase of an allergic response?

A

early and late phases

20
Q

IT blocks which phase of an allergic response?

A

early and late phases

21
Q

Oral steroids blocks which phase of an allergic response?

A

late phase

22
Q

all of the following are risk factors for allergic rhinitis except:

A. maternal smoking
B. positive SPT to allergen
C. particulate air pollution
D. serum IgE >100 before age 6 yo
E. family h/o atopy
F. increased number of siblings
G. higher SES
A

F. increased number of siblings

also decrease risk:

  • grass pollen count
  • farm environment
  • mediterranean diet
23
Q

what AR intervention decreases bronchial HR to methacholine challenge and exercise?

A

INS

24
Q

all of the following allergens have been implicated in LAR except:

A. olive
B. ash
C.grass
D. dust mites

A

B. ash

TX:

  • INS, OAH
  • IT: DM, grass
25
Q

all of the following are true about NARES except:

A. defined as >25% eosinophils on nasal smear
B. non-allergic (negative SPT or sIgE)
C. abnormal prostaglandin metabolism
D. 75% have bronchial HR
E. Tx: INS
A

D. 50% have bronchial HR

  • middle aged men
  • congestion, hyposmia, perennial sx
  • increased risk OSA & NP
26
Q

what is the #1 cause of rhinitis in pregnancy?

A

AR
(worsens in 1/3)

Tx:

  • INS (budesonide)
  • IN cromolyn
  • OAH
27
Q

A pregnant patient presents with new onset symptoms of congestion in her 2nd trimester. she has a h/o smoking and + SPT HDM, but has not had rhinitis sx prior to pregnancy. what is the best treatment course?

A. nasal strips and hypertonic nasal saline lavage
B. oral decongestant
C. INS
D. OAH
E. IN AH
A

A. nasal strips and hypertonic nasal saline lavage

dont use oral decongestant- congenital malformations

INS ineffective

28
Q

A middle aged female patient who lives in Saudi Arabia for part of the year presents with nasal crusting, dryness, purulent discharge, and halitosis. what is the best treatment course?

A. nasal saline lavage & debridement
B. oral decongestant
C. INS
D. OAH
E. IN AH
A

A. nasal saline lavage & debridement

1’ atrophic rhinitis

2’ = older pts, 2/2 multiple nasal surgeries (also trauma, Wegener’s, syphilis)

29
Q

concha bullosa vs Haller cell

A

pneumatization of middle turbinate vs. ethmoid air cells extending along floor of orbit

30
Q

Staph enterotoxins can act as a superantigen in what disease causing Th2 skewing, increased polyclonal IgE and of areoallergens and staph enterotoxins, increased eos and MC activity, increased TSLP, and inhibition of Tregs?

A

CRSwNP

NP:

  • western: eos
  • Asian: neutros

TX: saline + INS

dont use topical antifungals

31
Q

All of the following are physiologic changes seen in AERD except?

A. high level of LTC4 synthase and IL5
B. elevated PGD2
C. elevated PGE2
D. decreased generation of COX-2
F. increased cysteinyl leukotrienes in tissue and urine
A

C. DECREASED PGE2

(anti-inflammatory activity)

Blocking PG pathway with NSAIDs, steers towards 5-LO/LT pathway, produce more LTE4, can measure in urine

(page 153 notes)

32
Q

treatment for fungus ball (mycetoma) vs AFS

A

resection (maxillary, unilateral) vs surgery, systemic and topical steroids, ?itraconazole

33
Q

AFS dx criteria

A 
\+ SPT or IgE to fungus
CT/MRI findings characteristic hyperintense areas with allergic mucin
\+ fungal stain
NP
eosinophilic mucin
34
Q

interventions for complications of CRS: Mucocele vs Cyst

A

Mucocele- surgery

Cyst-leave alone

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