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PPS - From Nelson's > Allergy > Flashcards

Allergy Flashcards

1
Q

feature of atopic dermatitis
prominent infraorbital skin folds that extend in an arc from the inner canthus beneath and parallel to the lower lid margin.

A

Dennie-Morgan folds (Dennie lines)

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2
Q

unique feature of atopy and APCs

A

Presence of allergen-specific IgE on the cell surfaces of Antigen presenting cells

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3
Q

location of mast cells

A

adjacent to blood vessels and beneath epithelial surfaces that are exposed to the external environment, such as the respiratory tract, gastrointestinal tract, and skin

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4
Q

early-phase response

A

immediate response after allergen is introduced
characterized by mast cell degranulation and release of preformed mediators, occurring within an immediate time frame of between 1 and 30 min after allergen exposure and resolving within 1-3 hr

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5
Q

late-phase response

A

can occur within hours of allergen exposure, reaching a maximum at 6-12 hr and resolving by 24 hr

Late- phase responses are characterized in the skin by edema, redness, and induration; in the nose by sustained nasal blockage; and in the lung by airway obstruction and persistent wheezing

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6
Q

third phase/chronic allergic disease

A

tissue inflammation can persist for days to years.

recurrent exposure to allergens and microbial agents contribute

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7
Q

a single-gene disorder associated with erythroderma, food allergy, and high serum IgE levels

serine protease inhibitor

A

Netherton disease

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8
Q

fetus capable of producing igE at

A

11th wk AOG

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9
Q

igE levels peak at

A

10 years old

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10
Q

presence of IgE specifc for a particular allergen can be documented ]by the measurement of allergen-specific IgE (sIgE) levels in the serum

A

radioallergosorbent test RAST previously but now automated enzymatic sIgE immunoassays

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11
Q

intradermal test not used for food allergies because of risk of

A

anaphylaxis

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12
Q

how long should antihistamines be stopped prior to skin test

A

3-10 days

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13
Q

performed to document the presence and degree of bronchial hyperreactivity in a patient in whom asthma is suspected

A

Methacholine challenge

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14
Q

isomer of salbutamol developed to reduce adverse effects

A

levalbuterol

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15
Q

moa of anticholinergic drugs ie ipratropium

A

antagonize acteylcholine at muscarinic receptors

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16
Q

ETHYLENEDIAMINES

First-generation

A

Antazoline, pyrilamine, tripelennamine

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17
Q

TYPE II ETHANOLAMINES

First-generation

A

Carbinoxamine, clemastine, diphenhydramine

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18
Q

TYPE III ALKYLAMINES

First-generation

A

Brompheniramine, chlorpheniramine, triprolidine

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19
Q

TYPE III ALKYLAMINES

Second-generation

A

Acrivastine

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20
Q

TYPE IV PIPERAZINES

First-generation

A

Cyclizine, hydroxyzine, meclizine

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21
Q

TYPE IV PIPERAZINES

Second-generation

A

Cetirizine, levocetirizine

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22
Q

TYPE V PIPERIDINES

First-generation

A

Azatadine, cyproheptadine, ketotifen

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23
Q

TYPE V PIPERIDINES

Second-generation

A

Fexofenadine, loratadine, desloratadine

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24
Q

TYPE VI PHENOTHIAZINES

First-generation

A

Methdilazine, promethazine

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25
Q

toxic effect of theophylline when

A

exceed 20mcg/ml

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26
Q

moa of theophylline

A

phosphodiesterase inhibitor

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27
Q

laba used in kids. _ yrs old

A

> 4yrs old

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28
Q

Allergen immunotherapy is reserved for patients with

A

an allergic disease demonstrated to respond to this form of therapy, such as sea-sonal or perennial allergic rhinoconjunctivitis, asthma triggered by allergen exposures, and insect venom sensitivity

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29
Q

allergen immunotherapy is not used for

A

treatment of food allergy, atopic dermatitis, latex allergy, and acute or chronic urticaria

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30
Q

risk factors for allergic rhinitis

A

family history of atopy
serum immunoglobulin > 100 IU/mL before age 6 yr
mothers smoke heavily
heavy exposure to indoor allergens.

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31
Q

occurence of __ or more episodes of rhinorrhea in first year of life is associated with AR at _ yrs old

A

3 times

7 yrs old

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32
Q

to avoid false negative skin test for allergy

how long should meds be stopped

A

montelukast should be withheld for 1 day
most sedating antihistamine preparations for 3-4 days
and nonsedating antihistamines for 5-7 days

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33
Q

most common cause of visit to ER

A

asthma

34
Q

worlwide asthma prevalence is inc or dec

A

increasing

35
Q

80% of asthmatic report symptoms prior to _yrs old

A

6

36
Q

aside from allergens, what else can trigger asthma

A

hyperventilation (laughing, exercise)
cold or dry air
airway irritants
urti

37
Q

onset of exercise induced asthma

A

within 15 mins

resolve in 30-60mins

38
Q

true or false

asthma severity is assessed only once

A

true

39
Q

true or false

asthma control is assessed only once

A

false

40
Q

how often should we evaluate asthmatics

A

every 2-6 weeks

41
Q

asthmatic patient must exhibit good control for __ months before you can step down treatment

A

3 months

42
Q

if a child has very poorly controlled asthma, how to manage?

A

go 2 steps up
short course oral steroids
reassess after 2 weeks

43
Q

most commmon side effects of ICS

A

oral candidiasis

dysphonia

44
Q

which is the active form: prednisone or prednisolone

A

prednisolone

Prednisone is an inactive prodrug that requires biotransformation via firrst-pass hepatic metabolism to prednisolone

45
Q

which drugs increase the metabolism of steroids

A

phenytoin
phenobarbital
carbamazepine

46
Q

which drugs decrease the metabolism of steroids

A

ketoconazole

oral contraceptive

47
Q

drugs that can delay theophylline clearance

A 
macrolide
cimetidine
 oral antifungal agent
 oral contraceptive, 
eukotriene synthesis inhibitor 
ciprofloxacin
48
Q

criteria for discharging patient from ER after asthma exacerbation

A

sustained improvement in symptoms, normal physical ndings, PEF >70% of predicted or personal best, an oxygen saturation >92% while the patient is breathing room air for 4 hr

49
Q

discharge instructions patient from ER after asthma exacerbation

A

inhaled β-agonist up to every 3-4 hr plus a 3-7 day course of an oral corticosteroid

50
Q

what is starting MV settings in respi failure due to asthma (volume)

A

short inspiratory and long expiratory times, 10-15 mL/kg tidal volume, 8-15 breaths/min, peak pressures <60 cm H2O, and without positive end-expiratory pressure

51
Q

asthma severity by the ages of _ yr is predictive of asthma persistence in adulthood

A

7-10 years old

52
Q

atopic dermatitis presents in infancy

__% in 1st year of life

A

50%

53
Q

fibrotic papules

A

prurigo nodularis

54
Q

3 features of atopic dermatitis

A

pruritus
eczema
relapsing or chronic

55
Q

high potency corticosteroids should not be used

A

on face

intertriginous areas

56
Q

rank by potency
most potent to least potent
mometasone ointment, mometasone cream, betamethasone, fluticasone ointment, desonide, hydrocortisone ointment, hydrocortisone cream

A 
1 betamethasone
2 mometasone ointment
3 fluticasone ointment
4 mometasone cream
5 hydrocortisone ointment
6 desonide 
7 hydrocortisone cream
57
Q

recurrent viral skin infection
caused by HSV
eruption of multiple itchy vesicopostular lesions that are umbilicated and tend to crop

A

kaposi varicelliform eruption

or eczema herpeticum

58
Q

withdrawal of systemic glucocorticoid used to control severe AD causes generalized redness, scaling, weeping, crusting, systemic toxicity, lymphadenopathy, and fever,

A

exfoliative erythroderma

59
Q

transient yellow white spots in Allergic conjunctivitis

A

trantas dost - in limbus

horner points - conjunctivae

60
Q

life threatening form of edema
deficient c1 inhibitor activity
deep seated edema
laryngeal edema with ab pain

A

hereditary angioedema

61
Q

small, yellow-tan to reddish brown macules or raised papules that urticate on scratching

A

Darier sign -> Urticaria pigmentosa -> mastocytosis manifestation

62
Q

dominantly inherited conditions associated with recurrent urticaria-like lesions, arthritis and joint pain that usually appears in adolescence, progressive nerve deafness, recurrent fever, elevated ESR, hypergammaglobulinemia, renal amyloidosis, and a poor prognosis

A

Muckle-Wells syndrome

familial cold autoinflammatory syndrome

63
Q

lab test in anaphylaxis

A

plasma B tryptase

64
Q

__% of biphasic reactions in anaphylaxis occur in _ hrs

A

90%

4 hours

65
Q

which complement implicated in serum sickness

A

c3a

c5a

66
Q

complications of serum sickness

A

carditis
glomerulonephritis
guillain barre syndrome
peripheral neuritis

67
Q

milk allergies develop by

A

12 months

68
Q

egg allergies develop by

A

18 months

69
Q

peanut allergies develop by

A

14 months

70
Q

allergy that typically manifests in the first several months of life as irritability, intermittent vomiting and protracted diarrhea, and may result in dehydration

A

food protein–induced enterocolitis syndrome (FPIES)

71
Q

allergy that manifests in the first several months of life as diarrhea, often with steatorrhea and poor weight gain

A

Food protein–induced enteropathy

72
Q

allergy that presents in the first few mo of life as blood-streaked stools in otherwise healthy infants

A

Food protein-induced proctocolitis

73
Q

most common cause of Food protein–induced enteropathy

A

cows milk allergy

74
Q

may appear from infancy through adolescence, more frequently in boys
cell mediated
chronic GER
intermittent emesis, food refusal, abdominal pain, dysphagia, irritability, sleep disturbance, and failure to respond to medications

A

eosinophilic esophagitis

75
Q

what food allergies will you not outgrow

A

peanut, seafood, nut

76
Q

most common drugs that cause rash

A

ampicillin
amoxicillin
cotrimoxazole
penicillin

77
Q

epidermal detachment of __% is suggestive of SJS, ___% detachment suggests TEN, and ___% detachment suggests overlap

A

10% SJS
30% TEN
10-30 overlap

78
Q

skin biopsy difference between TEN and SSSS

A

TEN- subepidermal cleavage

SSSS - intraepidermal cleavage

79
Q 
fever, maculopapular rash, facial edema, eosinophilia, generalized lymphadenopathy, and potentially life-threatening damage of 1 or more organs, usually renal or hepatic
delayed onset (usually weeks)
A

Drug-induced hypersensitivity syndrome

DRESS

80
Q

drugs implicated in DRESS

A

Phenytoin, carbamazepine, phenobarbital, sulfonamides, allopurinol, minocycline, nitrofurantoin, terbinafine, vancomycin, dapsone, abacavir, nevirapine, nonsteroidal antiin ammatory drugs (NSAIDs)

PPS - From Nelson's (24 decks)

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