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RACP Paeds Written Exam > Allergy > Flashcards

Allergy Flashcards

1
Q

Type 1 hypersensitivity?

A

Immediate
IgE mediated - allergen binds to IgE on basophils/mast cells causing degranulation and inflammation
Anaphylaxis, Urticaria, angioedema, asthma, rhinitis

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2
Q

Type 2 hypersensitivity?

A

Sub-acute
Antibody-dependant cytotoxic - IgG/M/A attacks antigen on cell surface and complement pathway activated
Haemolytic anaemia, Goodpasture, blood transfusion reaction, myasthenia, graves

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3
Q

Type 3 hypersensitivity?

A

Sub-acute
Immune complex - Ag-Ab complexes deposit in tissues and activate complement/inflammation
SERUM SICKNESS LIKE REACTION
SLE, GN, HSP

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4
Q

Type 4 hypersensitivity?

A

Cell mediated
Lymphocyte - cytokine release
Contact dermatitis, transplant rejection, TEN/SJS

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5
Q

When is an IgE specific allergen test indicated?

A

Confirmation of IgE mediated food allergy

Determine if safe to proceed to oral food challenge

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6
Q

When is IgE specific food allergen test NOT indicated?

A

If tolerating the food without an IgE reaction (eg eczema)
Food “intolerance”
Non-IgE mediated reaction (FPIES)
Chronic idiopathic urticaria

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7
Q

What medication to withhold prior to skin prick testing?

A

No antihistamines for 3-5 days

No tricyclic antidepressants or antipsychotics for 7 days

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8
Q

Factors influencing skin prick result?

A

Certain medications - antihistamines, amitriptyline, olanzapine
Dermatographism
Recent episode of anaphylaxis

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9
Q

Positive skin prick test and positive hx?

A

Confirmation of food allergy

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10
Q

Negative skin prick test and positive hx?

A

Proceed to food challenge

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11
Q

What is most common use of CRD test? When not to do?

A

Peanut

Don’t do if high ARA H 2

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12
Q

Definition of anaphylaxis?

A

Skin features AND resp/cardio/GI sx OR hypotension

Can still consider anaphylaxis if hx suggestive if skin features not present

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13
Q

Insect bite anaphylaxis?

A

GI sx alone is sufficient for adrenaline

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14
Q

Most common food allergy?

A

Egg

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15
Q

Most common anaphylactic allergy?

A

Peanut, tree-nut, milk

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16
Q

Risk factors for fatal anaphylaxis?

A

Adolescent age
Nut/shellfish trigger
Poorly controlled asthma
Treatment delay

17
Q

What not to do when child has anaphylaxis?

A

Let them stand or walk -> HIGH RISK OF DEATH

18
Q

Which allergens is child likely to outgrow or not outgrow?

A

Nuts and seafood - tends to persist

Egg, wheat, milk - vast majority outgrow

19
Q

Risk factors for allergic rhinitis?

A 
FHx
Smokers in family
High IgE
Indoor allergens
LUSCS
20
Q

Severe allergic rhinitis?

A

Sleep disturbance or school interruption

21
Q

Prevalence of eczema?

A

10-30% worldwide; 80% outgrow by age 5

22
Q

Pathophys of eczema?

A

Defective barrier
- keratinocytes induce cytokines
- filaggrin mutation in 50% of severe eczema
- SPINK5 mutation in netherton (severe eczema syndrome)
Immune dysregulation
- Increased Th2 cytokines

23
Q

Environmental factors influencing eczema?

A 
1 Environmental irritants (all pts)
2 Infections (all patients)
 - staph colonisation producing superantigen TH2 response
3 Airborne (some pts)
 - dustmites
4 Food (some pts)
 - 40% have co-existing food allergy
24
Q

Eczema treatment pillars?

A

Manage triggers
Reduce inflammation
Treat super-infections

25
Q

AEs of topical corticosteroids in eczema treatment?

A

Peri-oral dermatitis
Striae if used in striae prone areas
Theoretical suppression of HPA

26
Q

YEs of topical pimecrolimus in eczema?

A

Application area burning
Irritation, pruritus, erythema
Skin infections
Desquamation (rare)

27
Q

Peri-oral dermatitis VS eczema?

A

Peri-oral dermatitis:

  • zone of sparing around lips
  • occurs as rebound following corticosteroids
  • treated with erythropoietin/tetracycline
  • is a variant of rosacea
28
Q

Treatment of large local reaction to insect bite/sting?

A 
Cold compress
Oral prednisolone
NSAID for analgesia
Antihistamine for pruritis
RISK OF SYSTEMIC REACTION IN FUTURE IS 7%
29
Q

Most common conjunctivitis and is assoc w allergic rhinitis?

A

Allergic conjunctivitis?

30
Q

Conjunctivitis of upper tarsal plate, long eyelashes and worse in spring/summer?

A

Vernal conjunctivitis

31
Q

Conjunctivitis of lower tarsal plate in late adolescent with atopic dermatitis?

A

Atopic conjunctivitis

32
Q

Giant papillae in contact lens wearer?

A

Giant papillary conjunctivitis

33
Q

Serum sickness pathophysiology?

A

Type 3 hypersensitivity reaction

Ag-Ab complexes, intermediate size deposit in vessels

34
Q

Signs/symptoms of serum sickness/serum sickness like reaction?

A

Fever, rash, poly arthritis/arthralgia

35
Q

Most common drug cause of serum sickness like reaction?

A

Cefaclor

36
Q

Investigation findings in serum sickness/SSLR?

A

Low plts and neuts
High ESR and CRP
Urinanlysis - proteinuria, haematuria
Low C3 and C4 and low total haemolytic complement (CH50)

RACP Paeds Written Exam (15 decks)

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