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Pediatric Questions > ALLERGY AND IMMUNOLOGY > Flashcards

ALLERGY AND IMMUNOLOGY Flashcards

1
Q

Antibody that has a major role in allergic
conditions, e.g., anaphylaxis, atopy, asthma,
allergic rhinitis, food allergies

A

IgE

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2
Q

Antibody that mediates type I hypersensitivity
reaction

A

IgE

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3
Q

First antibody produced in an infection

A

IgM

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4
Q

An antibody found in body mucosal secretions

A

IgA

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5
Q

What is the prevalence of atopic disorders in
children with one affected parent?

A

Up to 60%

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6
Q

What is the prevalence of atopic disorders in
children with 2 affected parents?

A

Up to 80% (family history is critical in all atopic
disorders)

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7
Q

What are atopic disorders?

A

Atopic dermatitis, asthma, allergic rhinitis, and
food allergies

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8
Q

What are the indications of allergy testing?

A

Significant allergies, e.g., asthma, anaphylaxis,
food or drug allergies, difficult to treat allergies
or requirement for specific treatment

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9
Q

An infant with severe eczema and/or severe egg
allergy

A

Evaluate for peanut reactivity with either skinprick testing and/or serum IgE levels, and if
necessary, oral food challenge

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10
Q

Which allergy test is preferred in cases of
dermatographism, generalized dermatitis, or a
clinical history of severe anaphylactic reactions to a given food?

A

Radioallergosorbent test (RAST) (allergenspecific
IgE antibody)

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11
Q

Which allergy test is associated with a high false
positive rate?

A

Both skin-prick testing and serum IgE levels

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12
Q

Child currently on diphenhydramine for allergies is scheduled for skin allergy testing. When should diphenhydramine be stopped?

A

At least 5 days prior to testing

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13
Q

Child currently on cetirizine for allergies is
scheduled for skin allergy testing. When should
cetirizine be stopped?

A

At least 7 days prior to testing

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14
Q

Child currently on amitriptyline for migraine
headache prophylaxis is scheduled for skin allergy testing. When should amitriptyline be stopped?

A

At least 2 weeks prior to testing

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15
Q

What is the first step that should be taken in the
management of allergic rhinitis?

A

Avoidance or reduction of allergen exposures

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16
Q

The first-line pharmacologic treatment of allergic rhinitis

A

Intranasal steroids and/or second-generation oral antihistamines

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17
Q

Common complications of untreated allergic
rhinitis

A

Recurrent acute otitis media, sinusitis, chronic
cough, and asthma

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18
Q

Complications of prolonged use of nasal
adrenergic drops

A

Rhinitis medicamentosa

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19
Q

An 8-year-old male presents with congestion, itchy nose, and watery eyes. Symptoms are exacerbated when playing with the pet cat. He loves his cat. What is the most effective treatment?

A

Avoid the trigger (e.g., by keeping the cat at
least outside the bedroom or the house all the
time; HEPA filters can help)

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20
Q

Child with a history of pollen allergy develops
rapid onset of itching, swelling of the lips, mouth, and throat when eating raw fruits and vegetables. What is the most likely cause?

A

Oral allergy syndrome (OAS) (cross-reactivity
with pollen)

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21
Q

What is the best treatment for OAS?

A

Avoid offending foods

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22
Q

How long do the allergies to peanuts, tree nuts,
seafood, and fish last?

A

Lifelong allergies

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23
Q

How long do the allergies to milk, eggs, and soy
last?

A

Most children outgrow by 5 years of age

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24
Q

A 2-month-old exclusively breastfed infant is seen for bloody stools; weight gain is appropriate, and physical exam is normal

A

Reassurance (counsel mother to avoid dairy, soy, eggs for 2 weeks, then re-evaluate)

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25
Q

Induration reaction to TB testing after 72 h is an
example of

A

Type IV: cell-mediated hypersensitivity

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26
Q

Allergy to contrast media is an example of

A

Non-IgE mediated

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27
Q

Child with a history of severe allergic reaction to
radiographic contrast media is going for CT scan
with IV contrast

A

Administer prednisone and diphenhydramine
before injection or choose other alternative
imaging tests

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28
Q

Child with a history of severe allergic reaction to
seafood is going for an abdominal CT scan with
oral and IV contrast. Does he or she need a
pretreatment with prednisone and
diphenhydramine?

A

No (iodine allergy is not a risk factor for
allergic-type contrast reactions)

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29
Q

A 16-year-old male with a new watch notices an
area of erythema located on the wrist where the
watch was worn. No other lesions

A

Type 4—contact dermatitis, a delayed
hypersensitivity reaction

30
Q

What is the best treatment in cases of contact
dermatitis?

A

Avoid offending agents

31
Q

Child received penicillin 10 days ago for the first
time, presents with fever, nausea, vomiting, pruritic skin rash (urticaria), angioedema, joint pain, lymphadenopathy, myalgia, and proteinuria

A

Serum sickness

32
Q

A common trigger of allergic reactions in a patient with spina bifida or congenital urogenital problems

A

Latex

33
Q

What is the most common specific autoimmune
association with chronic urticaria?

A

Autoimmune thyroid disease (laboratory
evaluation should include thyroid-stimulating
hormone (TSH) level and thyroid antibodies)

34
Q

Sudden onset of lip swelling, abdominal pain,
swelling of both feet, non-pruritic erythematous
skin rash; one family member has the same
condition

A

Hereditary angioedema

35
Q

What is the cause of hereditary angioedema
(HAE)?

A

Low levels or decreased function of plasma
protein C1 inhibitor (C1-INH). (Autosomal
dominant)

36
Q

Initial screening test for a patient with suspected hereditary angioedema

A

C4 level most reliable and cost-effective
screening test for HAE

37
Q

The test that can differentiate between various
types of hereditary angioedema

A

C1-INH functional assay

38
Q

A 6-year-old male with yellow-tan macules located on the upper extremities. Parents notice localized erythema following scratching of the lesions and after taking a hot shower

A

Mastocytosis—Darier sign: urticaria after
stroking lesions

39
Q

Common diagnostic lab for mastocytosis

A

Elevated tryptase levels

40
Q

A 15-year-old male presents with several
erythematous, pruritic circumscribed lesions that occur with exercise

A

Exercise-induced urticaria

41
Q

Child presents a few minutes after eating peanut butter with urticaria, skin flushing, pruritus, angioedema, rhinorrhea, wheezing, shortness of breath, abdominal pain, vomiting, diarrhea, lightheadedness. What is the next best step?

A

IM epinephrine to administer as quickly as
possible

42
Q

Child with a history of life-threatening reaction to a bee sting is coming to your office for a follow-up after he was discharged from the ER with EpiPen prescription. What is the next best step?

A

Referral to an allergist for immunotherapy

43
Q

A 4-year-old male scheduled for a well child
check; he was recently treated with a 5-day course of oral steroids for asthma exacerbation. Which vaccines can be given?

A

All vaccines including MMR and varicella

44
Q

A 4-year-old male scheduled for a well child
check; he has been treated with high dose steroids for 4 weeks. Should the MMR and varicella vaccines be given?

A

No—patients receiving high steroids for greater
than 2 weeks should be off steroids for at least
1 month

45
Q

Child is being treated with intranasal steroids for allergic rhinitis. Should the MMR and varicella vaccines be given?

A

Yes

46
Q

What is the best initial test for any child with
suspected immunodeficiency?

A

Complete blood count (CBC)

47
Q

Patient with recurrent meningococcal meningitis

A

The defect in terminal complement C5–C9
deficiency

48
Q

Initial screening test for a patient with suspected complement deficiency, e.g., recurrent (Neisseria meningitidis) meningitis

A

(CH50) test

49
Q

Complement deficiency that increases the risk of systemic lupus erythematosus

A

C2 deficiency

50
Q

What is the best screening test for cell-mediated
immunity associated with T-cell defects?

A

T-cell phenotyping (CD4/CD8, memory vs.
naïve T cells) and T-cell proliferative responses

51
Q

What is the best initial test for an infant with
suspected humoral immune deficiency?

A

Immunoglobulin levels

52
Q

An 8-week-old boy presents with diarrhea,
pneumonia, persistent oral thrush, eczematous-like skin lesions, sepsis, lymphopenia, and failure to thrive

A

Severe combined immunodeficiency (SCID)

53
Q

The enzyme deficiency that is found in SCID?

A

Adenosine deaminase deficiency

54
Q

A 9-month-old boy, previously healthy, presents
with recurrent otitis media, 2 episodes of
pneumonia in the last 2 months, persistent
giardiasis. O/E: the lymph nodes, the tonsils are
absent

A

X-linked agammaglobulinemia (usually starts
after first 6 months of life)

55
Q

Adolescent presents with recurrent sinus and
pulmonary infections due to encapsulated bacteria, malabsorption, hepatosplenomegaly, and low level of immunoglobulins (IgG, IgM, and IgA)

A

Common variable immunodeficiency

56
Q

The best treatment for a child with asymptomatic transient hypogammaglobulinemia of infancy

A

Observation (no treatment is necessary)

57
Q

An 8-year-old boy presents with eczema, recurrent Staphylococcus aureus skin infections without inflammatory response “cold abscess,”
pneumatoceles, coarse facial features, eosinophilia, and IgE level is 80,000 IU

A

Job syndrome (autosomal dominant hyper-IgE
syndrome)

58
Q

A 5-month-old presents with Pneumocystis jiroveci pneumonia, mouth ulcers, severe neutropenia, recurrent sinusitis, otitis media, chronic diarrhea, failure to thrive, and negative HIV

A

X-linked hyper IgM syndrome

59
Q

A 4-year-old boy with recurrent skin abscesses,
spleen and liver abscesses, and osteomyelitis

A

Chronic granulomatous disease (X-linked)

60
Q

Test of choice in a patient with a suspected chronic granulomatous disease

A

DHR oxidation is preferred, NBT reduction can
be used

61
Q

Severe progressive infectious mononucleosis and Epstein–Barr virus (EBV) fulminant hepatitis

A

X-linked lymphoproliferative syndrome (Duncan
syndrome)

62
Q

Highly elevated WBC in a 10-week-old
infant who still has an umbilical cord

A

Leukocyte adhesion defect type I

63
Q

Test of choice in a patient with suspected leukocyte adhesion defect

A

Flow cytometry beta 2 integrin CD11b/CD18 on
leukocytes

64
Q

Newborn with hypocalcemia, tetralogy of Fallot,
interrupted aortic arch, and abnormal facial
features

A

DiGeorge anomaly (deletion of chromosome
22q11.2)

65
Q

Recurrent ear infections, eczema, profuse bleeding during a circumcision procedure,
thrombocytopenia, and small platelets

A

Wiskott–Aldrich syndrome

66
Q

Persistent thrush, nail dystrophy, and
endocrinopathies

A

Chronic mucocutaneous candidiasis

67
Q

Short stature, fine hair, and severe varicella
infection

A

Cartilage-hair hypoplasia with short-limbed
dwarfism

68
Q

Oculocutaneous albinism, recurrent infections, and easy bruising

A

Chédiak–Higashi syndrome

69
Q

Candidiasis with raw egg ingestion

A

Biotin-dependent carboxylases deficiency

70
Q

A 4-year-old with short stature, micrognathia,
telangiectasia, immunodeficiency, learning
disability, deficiency of DNA ligase I

A

Bloom syndrome

71
Q

An 8-year-old boy presents with recurrent ear and sinus infections, ataxia, oculocutaneous
telangiectasia, and elevated α1-fetoprotein

A

Ataxia–telangiectasia (autosomal recessive)

Pediatric Questions (31 decks)

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