Allergy and Immunology

Question 1

______ is considered part of anaphylaxis, not just an allergy.

Answer 1

Urticaria

Question 2

What is the best initial treatment for anaphylaxis

Answer 2

Epinephrine
Diphenhydramine and Ranitidine
Methylprednisolone or Hydrocortisone
Intubation or Cricothyroidotomy

Question 3

This is characterized by sudden facial swelling and stridor with the absence of pruritus and urticaria. It DOES NOT respond to Glucocorticoids

Answer 3

Hereditary Angioedema

Question 4

What is the best initial test for Angioedema?

Answer 4

decreased levels of C2 and C4

deficiency of C1 esterase inhibitor

Question 5

What is a specific therapy for Angioedema?

Answer 5

Ecallantide

Question 6

Give 3 therapy you can give for acute angioedema.

Answer 6

Fresh frozen plasma, ecallantide, icatibant

Question 7

If respiratory compromise and urticaria are present at the outset of Angioedema, what would you give?

Answer 7

Epinephrine
Antihistamines
Steroids

Question 8

What is the best initial therapy for Hereditary Angioedema with severe laryngeal involvement

Answer 8

C1 esterase inhibitor concentrate

Question 9

What are long-term therapy you can consider for Angioedema?

Answer 9

Androgens

• Danazole
• Stanazole

Question 10

This is a form of allergic reaction that causes sudden swelling of the superficial layers of the skin.

Answer 10

Urticaria

Question 11

What are your treatment options for Urticaria?

Answer 11

Antihistamines

Leukotriene receptor antagonist: montelukast, zafirlukast

Question 12

Patient came in with watery eyes, sneezing, itchy nose, and itchy eyes. Upon inspection, you noticed inflamed, boggy nasal mucosa; pale or violaceous turbinates. What is the most likely diagnosis?

Answer 12

Allergic Rhinitis

Question 13

In this patient, B cells are present in normal numbers but they do not make effective amounts of immunoglobins. There is a decrease in all the subtypes: IgG, IgM, and IgA.

It presents with recurrent sinopulmonary infections in adults with equal gender distribution. There are frequent episodes of bronchitis, pneumonia, sinusitus, and otitis media.

Answer 13

Common Variable Immunodeficiency

Question 14

This is a primary immunodeficiency disorder that gives a marked increase in the risk of lymphoma.

Answer 14

CVID

Question 15

What is the chronic maintenance for CVID?

Answer 15

Regular infusions of intravenous immunoglobulins

Question 16

This is a primary immunodeficiency disorder that presents in male children with increased sinopulmonary infections. B cells and lymphoid tissue are diminished. There is a decrease or absence of the tonsils, adenoids, lymph nodes, and spleen. T cells are normal. What is the most likely diagnosis?

Answer 16

X-link (Bruton) Agammaglobulinemia

Question 17

What can you give children with X-linked Agammaglobulinemia?

Answer 17

Long-term regular administration of IVIG

Question 18

This is a primary immunodeficiency disorder that had deficiency in both B and T cells.

Answer 18

SCID

Question 19

What is a common infection you’ll acquire when you have T cell deficiency

Answer 19

Candida

Question 20

What treatment option can you consider for SCID?

Answer 20

Bone marrow transplant (can be curative)

Question 21

This patient presents with sinopulmonary infections. He also suffers from atopic diseases, anaphylaxis to blood transfusion, spruelike condition with fat malabsorption, increase in the risk of vitiligo, thyroiditis, and rheumatoid arthritis. What is the most likely diagnosis?

Answer 21

IgA Deficiency

Question 22

How would you treat a patient with IgA deficiency?

Answer 22

Treat as infections arise.

Give blood that comes from IgA-deficient donors or that has been washed.

Question 23

Will giving IVIG injections to IgA patients work?

Answer 23

NO.

The amount of IgA in the product is too insignificant to be therapeutic. The trace amounts of IgA in IVIG may provoke anaphylaxis in the same way that a blood transfusion does.

Question 24

This presents as recurrent skin infections with Staphylococcus.

Answer 24

Hyper IgE Syndrome

Question 25

How would you treat a patient with Hyper IgE Syndrome?

Answer 25

Treat infections as they arise and consider prophylactic antibiotics such as dicloxacillin or cephalexin

Question 26

This is an immunodeficiency combined with thrombocytopenia and eczema. T lymphocytes are markedly deficient in the blood and the lymph nodes.

Answer 26

Wiskott-Aldrich Syndrome

Question 27

What is the definite treatment for Wiskott-Aldrich Syndrome?

Answer 27

Bone marrow transplantation

Question 28

This is a genetic disease resulting in extensive inflammatory reactions. This leads to lymph nodes with purulent material leaking out. Aphthous ulcers and inflammation of the nares is common. Granulomas may become obstructive in the GI or urinary tract.

Answer 28

Chronic Granulomatous Disease

Question 29

What is the most likely diagnosis if the patient’s culture shows combinations of Staphylococcus, Burkholderia, Nocardia, Aspergillus?

Answer 29

Chronic Granulomatous Disease

Question 30

What diagnostic test can you do for a patient with Chronic Granulomatous Disease?

Answer 30

Nitroblue Tetrazolium Test or

Dihydrorhodamine Test