Allergy and Immunology Flashcards
Cut off for making to intermittent vs. persistent asthma
Daytime sx >2 days a week
Nighttime sx >2 a month
SABA use >2 days a week
Steroid need >1 a year
FEV1/FVC <85%
Disorders of T-lymphocyte function include ____ (3 things)
- severe combined immunodeficiency,
- DiGeorge syndrome
- X-linked hyperimmunoglobulin M
The best study to assess vaccine response is _____
humoral immune panel (titers)
Defects of the humoral immune system present as ____
sinopulmonary infections with encapsulated bacteria
Disorders of humoral immune system: (2); and how you test it
- X-linked aggamaglobulinemia
- common variable immunodeficiency
Lab: serum immunoglobulins
Defects of the innate immune system (3) and how you test it
- chronic granulomatous disease (CGD),
- leukocyte adhesion defects, and
- complement deficiencies
Labs: Phagocyte oxidative response evaluates the neutrophil defect of CGD and total hemolytic complement (CH50) determines complement activity
Clinical presentation of T-lymphocyte immune disorders
failure-to-thrive, chronic diarrhea, and recurrent opportunistic infections, including CMV, CANDIDA, and PCP (think HIV) – not really bacterial
The most common etiology for atelectasis in status asthmaticus is ____
mucus plugging
Definition of “reversibility” in asthma
more than or equal to 12% increase in FEV1 from baseline or by an increase of 10% or more of predicted FEV1 after inhalation of a short-acting bronchodilator, in adults also 200 ml increase
clinical presentation of chronic granulomatous disease (CGD)
mucocutaneous candidiasis, mesenchymal lymphadenitis, deep granuloma formation, and infections with Staphylococcus aureus, Escherichia coli, Burkholderia, and other gram-negative organisms
Newborn screen showing low T-cell receptor excision circle (TREC). What does it mean and what is the next step?
Primary immunodeficiency (severe combined)
For premature infants, repeat until 37wk corrected GA
*start child on ppx abx: Bactrim (>2mo but ok for ppx) and fluconazole
When should mothers be cautioned in breastfeeding (immunodeficiency)
severe combined immunodeficiency
- can get CMV from mother
What does allergen immunotherapy do for asthmatics?
decrease ICS use and other controller therapy
Does NOT decrease rescue inhaler use
Sores in mucosa (mouth, lips, genitalia, conjunctiva) and palms and soles, history of using a drug, diagnosis and treatment?
SJS
Supportive care
Low IgG, Positive anti-granulocyte ab, Positive DAT IgG, multiple bacterial infections what’s the diagnosis?
common variable immune deficiency
X-linked agammaglobulinemia (Bruton). What’s the pathophysiology
Mutation in Bruton’s tyrosine kinase
–> B-cell defect
–> decreased immunoglobulin
Shows up after 3 mo (maternal Ig protects infants until then)
Pathophysiology of allergic rhinitis
Ag-specificIgE on mucosal mast cells and basophils –> cascade of immunologic reactions releasing histamine and tryptase (mast cell granules) and generate leukotrienes
In patients not adherent to controller meds, gets frequent steroids, still worsening, hypoxic to low 90s, RML atelectasis, what’s the next step?
admit to inpatient for systemic steroids
After finding absence of TREC (t-cell receptor excision circles), what is the next step to confirm diagnosis?
Lymphocyte subsets via flow cytometry
What does flow cytometry for dihydroxy-rhodamine123 reduction test for
neutrophil function
Dx for chronic granulomatous disease (CGD)
What does flow cytometry for dihydroxy-rhodamine123 reduction test for
neutrophil function
Dx for chronic granulomatous disease (CGD)
Child with foul odor and worse rhinitis of one nare more than the other in a young, mobile child, what do you think of?
Nasal foreign body
Major factors of asthma (outside of respiratory risk factors)
Obesity and vitamin D deficiency
Residency in farm is PROTECTIVE
Frequency of infections that would make you think immunodeficiency
> =4 ear infx a year
=2 serious sinus infection ever
=2 pneumonias a year
=2 systemic bacterial infections per year
