Allergy and Immunology 🤧

Question 1

Tacrolimus side effects

Answer 1

Hyperkalemia, glucose intol, HTN, glucose intol, irate high, neurotoxicity (tremor), lil N/V,

Question 2

Do you need to do allergy testing in the first episode of urticaria. When would we do testing

Answer 2

No, just give anti H. Only if severe or if sus specific trigger or if fails anti H

Question 3

Is it significant that lymph nodes or adenoids are undeveloped in in SCID/x linked agammaglob, less than 2 yo

Answer 3

No. They are underdeveloped in all less than 2 yo

Question 4

How to clinch the Dx of x linked agammaglob

Answer 4

BTK gene mutation

Question 5

How to Tx x linked agammaglob

Answer 5

Treatment is immunoglobulin replacement therapy (eg, intravenous immunoglobulin) with or without
prophylactic antibiotics.

Question 6

Transient hypogammaglobulinemia of infancy. Which Ig go up and which go down. When does it normalise? Which infx do they get

Answer 6

Transient hypogammaglobulinemia of infancy is characterized by decreased IgG, variable IgM, and
normal IgA and B-cell concentrations. Affected patients develop mild, recurrent sinopulmonary and gastrointestinal infections. Immunoglobulin levels generally normalize by age 9-15 months.

Question 7

Wisdom aldrich Ig levels (clue = vowels)

Answer 7

immunoglobulin profile shows low to normal lG and IgM with elevated IgA and IgE.

Question 8

Less than one month post transplant…. Infx cause?

Answer 8

<1 month: Bacterial causes from operative complications (eg, hepatic abscess, biliary leak, wound infection) or hospitalization (eg, intravascular catheter, external drain)

Question 9

Months 1-6 post transplant. Cause of infx

Answer 9

Months 1-6: Opportunistic pathogens (g, Cytomegalovirus, Aspergillus, Mycobacterium tuberculosis) in the setting of high-dose immunosuppressive medication

Question 10

More than 6 mo post transplant, cause of infx

Answer 10

> 6 months: Immunosuppressants usually at maintenance levels. Patients primarily at risk for typical
community-acquired pathogens (at a higher rate than the general population)

Question 11

Most transplant fever and pain etc. how to really tel if bac infx or acute rejection

Answer 11

Look at hemodynamic,,,, shock would be seen in infx, not acute rejection

Question 12

Chronic complications of CVID

Answer 12

• Autoimmune (eg, RA, thyroid disease)
  • Pulmonary (eg, bronchiectasis, fibrosis)
  • Gl (eg, chronic diarrhea, IBD-like
  conditions)

Question 13

How to Dx CVID

Answer 13

Diagnosis is made by quantitative measurement of immunoglobulin levels

Question 14

XLA, CVID. Do quant Ig and flow cytom for which ones

Answer 14

Flow cytom for XLA

Quant Ig for CVID

Question 15

Serum sickness like syndrome signs and symptoms. Any Tx needed? Main difference between serum sickness

Answer 15

Athralgia, urticaria, following a medication usually. Penicillin, ceph, TMP SMX. Compared to serum sickness, the fever, compliment activation and complex titre are more mild

Question 16

CGD prphlx and cure

Answer 16

Prophylaxis: TMP-SMX, itraconazole, interferon gamma
• Active infection: culture-based, antimicrobial therapy
Hematopoietic cell transplant is curative

Question 17

Two ways to prevent IgA def associated tranfusion anaphylaxis

Answer 17

wear medical alert bracelets and receive blood products that are washed of residual plasma or from an IgA-deficient donor.

Question 18

Tx of transient hypo gamma glob of infancy

Answer 18

Observation; self-resolution in early childhood. Abx if severe infx

Question 19

In transient hypogammaglob of infancy, what is the response to vx

Answer 19

Normal response to Vx, unlike XLA and SCID

Question 20

Do we see atopic features in transient hypogamaglob of infancy

Answer 20

Yes

Question 21

Early compliment disorders are marked by what type of infx? And what other disorders

Answer 21

Early complement disorders (eg, C1 complex) are marked by recurrent sinopulmonary bacterial
infection and childhood systemic lupus erythematosus.

Question 22

HIV cd4/cd8 ratio

Answer 22

CD4/CD8 ratio would be low.

Question 23

how do we screen for SCID

Answer 23

Therefore, SCID is included in routine newborn screening in the United States and is detected by the absence of T cell receptor excision circles (circular DNA excreted by developing T cells in the thymus) in dried blood.

Question 24

HiB infx in fully vx person… should raise suspicion for what

Answer 24

Hum oral immunodeficiency

Question 25

Vaccine responses…. XLA vs asplenic Patients

Answer 25

Vaccine antibody response is normal with anatomic or functional asplenia. Whereas in XLA they will have low Vx titres. Both have encapsulated bac infx, so this can help differentiate

Question 26

CVID and XLA are usually easy to tell apart… but if they have overlap, what’s the main way to decide the dx

Answer 26

XLA will occur around 3-6 mo old

Question 27

How to Dx hereditary angioedema

Answer 27

• 1 C4 level
• | C1 inhibitor protein or function

Question 28

Mx for hereditary angioedema (3 components)

Answer 28

C1 inhibitor concentrate
• Bradykinin antagonist (eg, icatibant)
• Kallikrein inhibitor (eg, ecallantide)

Question 29

Do patients with HIV have LN swell, and why?

Answer 29

HIV infection causes generalized lymphadenopathy in infants because B cells are produced normally.

Question 30

Hereditary angioedema… is the edema itchy?

Answer 30

No, it’s angioedema, not mast cell stuff

Question 31

Main bacteria seen in LAD

Answer 31

Staph A

Question 32

High high neutrophil is in the face of recurrent mucocut infx

Answer 32

LAD

Question 33

Weight requirement for infant to have hep B vx

Answer 33

The first hepatitis B vaccine is administered when the patient weighs 22 kg

Question 34

Chronic enteroviral infx common in which immunodef

Answer 34

XLA

Question 35

IFN receptor deficiency results in what

Answer 35

IFN-y receptor deficiency results in disseminated mycobacterial disease beginning in infancy.

Question 36

CI for DTaP Vx

Answer 36

Previous enceph, or anaphylaxis after vx, or uncontrollled epilepsy

Question 37

Abscesses difference in CGD and hyper IgE

Answer 37

Cold in hyper IgE

Question 38

Normal caloric intake

Answer 38

(up to 32
ounces a day)

Question 39

Tx of renal vein thrombosis. Consider if AKI present

Answer 39

Anticoag, or thrombolysis is AKI present