Allergy

Question 1

A chronic nonallergic rhinitis described as a syndrome of sneezing, rhinorrhea, congestion, or postnasal discharge in the absence of an identified cause

Answer 1

Vasomotor rhinitis

later onset than allergic rhinitis, exacerbated by weather and irritants rather than allergens

Question 2

Diagnosis: systemic illness with saddle nose deformity, chronic sinusitis, malnourishment, infertility, and chronic or recurrent bronchitis

Answer 2

Granulomatosis with polyangiitis (Wegener granulomatosis)

Question 3

Diagnosis: young person, nasal polyposis, chronic sinusitis, malnourishment, infertility, and chronic or recurrent bronchitis

Answer 3

Cystic fibrosis

Question 4

Diagnosis: nonseasonal rhinitis with negative skin tests

Answer 4

Vasomotor rhinitis

Question 5

Diagnosis: refractory congestion after chronic use of topical nasal decongestants

Answer 5

Rhinitis medicamentosa

Question 6

Diagnosis: nasal congestion in the last 6 or more weeks of pregnancy

Answer 6

Pregnancy rhinitis

Question 7

Diagnosis: rhinitis, nasal polyps, asthma, and aspirin intolerance (respiratory symptoms)

Answer 7

Aspirin sensitivity (triad asthma or Samter syndrome)

Question 8

First-line drugs for allergic rhinitis

Answer 8

Intranasal corticosteroids

Question 9

Most consistently effective treatments for chronic nonallergic rhinitis (3)

Answer 9

Topical intranasal corticosteroids, topical intranasal antihistamines, and topical ipratropium bromide

Question 10

Hallmark of urticaria

Answer 10

Wheal

Question 11

Chronic urticaria is defined as having symptoms most days for this duration

Answer 11

> 6 weeks

Question 12

Most patients with chronic urticaria should be evaluated for this endocrine condition due to its higher incidence

Answer 12

Hypothyroidism

Question 13

Chronic urticaria with lesions persisting >24 hours with purpura/ecchymoses upon resolution are likely due to this condition

Answer 13

Urticarial vasculitis

Question 14

Definitive diagnosis of urticarial vasculitis

Answer 14

Skin biopsy

Question 15

Diagnosis: urticaria with fever, adenopathy, arthralgias, and antigen or drug exposure

Answer 15

Serum sickness

Question 16

First-line therapy for urticaria

Answer 16

Nonsedating antihistamines

Question 17

Drug that blocks H1, H2, and serotonin receptors and is often effective for urticaria

Answer 17

Doxepin

Question 18

Presence of this finding points against bradykinin-mediated angioedema

Answer 18

Urticaria
(bradykinin-mediated angioedema [e.g., hereditary angioedema, acquired C1 inhibitor deficiency, ACE inhibitor effect] is not associated with urticaria)

Question 19

Treatment for acute episodes of bradykinin-mediated angioedema (hereditary or acquired)

Answer 19

IV C1 inhibitor concentrate

use FFP in an emergency

Question 20

Long-term management of hereditary angioedema

Answer 20

Danazol or stanozolol

elevates hepatic synthesis of C1 esterase inhibitor protein

Question 21

First-line therapy for anaphylaxis when only hives or pruritus are the presenting signs

Answer 21

Epinephrine

Question 22

Treatment for epinephrine-refractory anaphylaxis

Answer 22

Glucagon

Question 23

Dose and route of epinephrine as first-line treatment for classic anaphylaxis

Answer 23

IM or SC epinephrine (0.3-0.5 mg of 1:1000)

IV epinephrine [1:10,000] is reserved for anaphylactic shock or refractory symptoms

Question 24

Most common self-reported medication allergy

Answer 24

Penicillin

Question 25

Test that identifies 95% of patients at risk for immediate reaction to penicillin if it must be used in a patient with penicillin allergy (e.g., neurosyphilis)

Answer 25

Skin test

not RAST or ELISA

Question 26

IgE-mediated cephalosporin reaction occurs in this percentage of patients who are allergic to penicillin

Answer 26

2%

Question 27

Diagnosis: acute onset of widespread pustules, fever, leukocytosis, eosinophilia after drug exposure

Answer 27

Acute generalized exanthematous pustulosis (AGEP)

Question 28

Diagnosis: acute onset of generalized papular eruption, facial edema, fever, arthralgia, generalized lymphadenopathy, elevated serum aminotransferases, eosinophilia, and lymphocytosis

Answer 28

Drug reaction with eosinophilia and systemic symptoms (DRESS) also known as hypersensitivity syndrome

Question 29

Antibiotic associated with a phototoxic reaction consisting of severe sunburn after drug exposure

Answer 29

Tetracycline

Question 30

Antibiotic associated with a photoallergic reaction presenting as a rash after days or months of use

Answer 30

Sulfonamides

Question 31

Aside from vancomycin, this commonly used antibiotic is also associated with red man syndrome

Answer 31

Ciprofloxacin

Question 32

Most common type of drug reaction

Answer 32

Morbilliform rash

Question 33

Second most common drug-reaction type

Answer 33

Urticaria

Question 34

Two most common classes of drugs that cause skin eruptions

Answer 34

Antibiotics (penicillin and sulfa drugs) and anticonvulsants (phenytoin and carbamazepine)

Question 35

In patients with EBV or CMV infection, or underlying acute lymphoblastic leukemia, use of this drug is associated with the appearance of a maculopapular rash

Answer 35

Ampicillin

Question 36

Most common mechanism of drug fever

Answer 36

Hypersensitivity

Question 37

Most common primary immunodeficiency

Answer 37

Congenital IgA deficiency

Question 38

Most common symptomatic immunodeficiency

Answer 38

Common variable immunodeficiency

Question 39

Malignancies with increased incidence in common variable immunodeficiency (3)

Answer 39

Gastric adenocarcinoma, intestinal lymphoma, non-Hodgkin lymphoma

Question 40

First-line therapy for common variable immunodeficieny

Answer 40

IV immune globulin

Question 41

Initial test for suspected complement deficiency

Answer 41

CH50 assay