ALLERGY DISORDERS Flashcards
Patients with decreased C6 levels are susceptible to:
Neisserial infections
Pneumococcal infections
Meningococcal infections
Pneumo and meningococcal infection
Neisserial infections
It is the most common relapsing skin disease in infancy and childhood
Contact dermatitis
Psoriasis
Seborrheic dermatitis
Atopic dermatitis
Atopic dermatitis
Patients with Bruton’s agammaglobulinemia usually can overcome common viral infections EXCEPT
Varicella Zoster
Rotavirus infection
Echovirus infection
Dengue fever
Echovirus infection
Viral infections are usually handled normally, with the exceptions of hepatitis viruses and enteroviruses. There were several examples of paralysis when live polio vaccine was administered to these patients, and chronic, eventually fatal, central nervous system (CNS) infections with various echoviruses and coxsackieviruses have occurred in a significant number of patients. An enterovirus-associated myositis resembling dermatomyositis has also been observed. Neutropenia, typically seen at diagnosis when infected, can be associated with Pseudomonas or staphylococcal infections.
Which of the following is TRUE in the prevention of Food Allergy?
Introduce low-risk complementary foods altogether
Breastfeed exclusively for 4 months
Probiotic supplements may reduce the incidence and severity of eczema Avoid allergenic foods during pregnancy or nursing
Breastfeed exclusively for 4 months
What is the MOST important predisposing factor for a child to develop allergies?
Presence or absence of other allergic diseases
Positive family history of allergies
Exposure to common allergens
Early onset of allergic disease in the patient
Positive family history of allergies
A family history of allergic disease is common and is one of the most important factors predisposing a child to the
development of allergies. The risk of allergic disease in a child approaches 50% when 1 parent is allergic and 66% when both parents are allergic, with maternal history of atopy having a greater effect than paternal history.
You examined a patient that you are entertaining for Allergic rhinitis, one of the pertinent physical examination findings is a horizontal skin fold over the bridge of the nose. What do you call this presentation?
Allergic gape
Nasal crease
Allergic salute
Nasal bridge
Nasal crease
Children with AR often perform the allergic salute, an upward rubbing of the nose with an open palm or extended index finger. This maneuver relieves itching and briefly unblocks the nasal airway. It also gives rise to the nasal crease, a horizontal skin fold over the bridge of the nose. The diagnosis of AR is based on symptoms in the absence of an upper respiratory tract infection and structural abnormalities.
What treatment option for patients with Allergic rhinitis should be considered if children have IgE-mediated allergic symptoms but cannot be adequately controlled by avoidance and medication, especially in the presence of comorbid conditions?
Systemic corticosteroids
Topical corticosteroids
Allergen-specific immunotherapy
Intranasal inhaled corticosteroids
Allergen-specific immunotherapy
Allergy immunotherapy is an effective treatment for AR and allergic conjunctivitis. In addition to reducing symptoms, it may change the course of allergic disease and induce allergen-specific immune tolerance. Immunotherapy administered by subcutaneous injection should be considered for children in whom IgE-mediated allergic symptoms cannot be adequately controlled by avoidance and medication, especially in the presence of comorbid conditions.
It is a complication of Atopic dermatitis that presents with itching, burning, tearing and copious mucoid discharge; It involves the eyes and is usually bilateral with Tantras dots or Giant papillae may be present, this is a case of
Atopic keratoconjunctivitis
Keratoconus
Allergic conjunctivitis
Exfoliative dermatitis
Atopic keratoconjunctivitis
One of the current goals of treatment in the latest Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines is to promote safe, effective prevention and relief of symptoms. Which of the following specific measure is a very helpful method to reduce the symptoms of allergic disease:
Keep windows open to facilitate exit of pollens and dust
Allow pets at home
Bed linens and blankets washed 3 times a week
Allergen proof encasings
Allergen proof encasings
This immunodeficiency condition is considered an medical emergency right after birth as the neonate will need immune reconstitution to survive
DiGeorge syndrome
X-linked Agammaglobulinemia
Chronic Granulomatous disease
Severe Combined Immunodeficiency Disorder
Severe Combined Immunodeficiency Disorder
It is a severe bilateral chronic inflammatory process of the upper tarsal conjunctival surface that occurs in a limbal or palpebral form. There is severe ocular itching exacerbated by exposure to irritants, light or perspiration. This condition is called
Vernal keratoconjunctivitis
Giant papillary conjunctivitis
Atopic keratoconjunctivitis
Contact allergy
Vernal keratoconjunctivitis
Infants with eczema are predisposed to Atopic march which is comprised of:
Food allergy and asthma
Food allergy, Asthma, Allergic rhinitis
Contact dermatitis, Allergic rhinitis and Asthma
Allergic rhinitis and Asthma
Food allergy, Asthma, Allergic rhinitis
A 15-month-old male child presented with thrombocytopenic purpura, atopic dermatitis, and recurrent infections caused by cytomegalovirus and P. jiroveci. Immunoglobulin assay revealed elevated IgE and IgA with decreased IgM levels. Of the following, the MOST likely diagnosis is
Wiskott-Aldrich syndrome
Hyper Ig E syndrome
Chediak-Higashi Syndrome
Lazy Leukocyte Syndrome
Wiskott-Aldrich syndrome
Agnes an 6 month old infant was brought for consult due to erythematous fine rashes confined on the cheek area, neck area, arm pit, folded areas of the arms and legs. She was also noted to be slightly irritable This was noted a day after she was introduced with pureed brocolli as her complementary feeding. You managed this as a case of Mild Atopic Dermatitis, management for this patient will be by giving:
a. Application of emolients and Fluticasone propionate ointment
b. Daily bath with lukewarm water and use of moisturizers afterwards. Application of Betamethasone ointment as the anti-inflammatory treatment
c. Daily bath with lukewarm water, use of moisturizers as occlusive emolient and application with Hydrocortisone cream afterwards
d. Daily bath with cold water, use of moisturizers and application of Desonide cream afterwards
c. Daily bath with lukewarm water, use of moisturizers as occlusive emollient andapplication with Hydrocortisone cream afterwards
Moisturizers are first-line therapy. Lukewarm soaking baths or showers for 15-20 min followed by the application of an occlusive emollient to retain moisture provide symptomatic relief.
Occlusive ointments are sometimes not well tolerated because of interference with the function of the eccrine sweat ducts and may induce the development of folliculitis.
Topical corticosteroids are the cornerstone of antiinflammatory treatment for acute exacerbations of AD. Because of their potential adverse effects, the ultrahigh-potency glucocorticoids should not be used on the face or intertriginous areas and should be used only for very short periods on the trunk and extremities. Mid-potency glucocorticoids can be used for longer periods to treat chronic AD involving the trunk and extremities.
Abigail, a 6 months old infant presented with intense itching on the face and neck more prominent at night time, no other associated symptoms were noted. Upon physical examinations, lesions were red, scaly, patchy like formation distributed on the cheek and neck area. You were entertaining Atopic dermatitis; to further strengthen your initial impression, what are the 3 major features that must be present for the said condition?
a. Pruritus; Positive family history of asthma, Chronic or chronically relapsing course
b. Eczematous dermatitis that fits the typical pattern of skin inflammation; Positive family history of asthma; Immediate skin test reactivity
c. Pruritus; Eczematous dermatitis that fits the typical pattern of skin inflammation; Chronic or chronically relapsing course
d. Family history of asthma, Chronic or chornically relapsing course; Pruritus
c. Pruritus; Eczematous dermatitis that fits the typical pattern of skin inflammation; Chronic or chronically relapsing course
One of the closest differential diagnosis for infant patients presenting with colds, cough and wheezing that is often interpreted as bronchial asthma
Pediatric community acquired pneumonia
Foreign body aspiration
Viral bronchiolitis
Bronchopulmonary dysplasia
Viral bronchiolitis
Tiffany, 6 months old infant has been having recurrent rashes that are quite reddish with skin thickening, confined on the neck area and folded areas of the skin. Mother also noted that her baby is fussy attempting to scratch the said affected areas. If you are to categorize the type of Eczema for this case, what will it be?
Mild Atopic dermatitis
Severe Atopic dermatitis
Moderate Atopic dermatitis
Clear
Moderate Atopic dermatitis
Patients with decreased C2 levels are susceptible to :
Neisserial infections
Pneumococcal infections
Meningococcal infections
Meningococcal infections
Pneumococcal infections
Dane, a 3 year old child came in for consult due to cough and colds associated with sneezing and nasal congestion more prominent at night, no febrile episodes noted, patient is not tachypneic. Condition started around 4 days prior to consult, and according to the mother she usually wakes up at night because of her nasal congestion. Based on her symptoms which ARIA classification does the patient belong?
Moderate to severe intermittent
Mild intermittent
Mild persistent
Moderate to severe persistent
Moderate to severe persistent
Findings of pneumatocoeles, typical facies, “cold abscesses” will give you an impression of this deficiency.
DiGeorge Syndrome
Hyper IgE Syndrome
Selective Ig A deficiency
Wisckott Aldrich Syndrome
Hyper IgE Syndrome
Technique in Allergen testing that utilizes an allergen extract and is injected in to the dermis of the skin:
Dermatographism
Puncture technique
Intradermal technique
Metacholine test
Intradermal technique
This feature is found in 60% of allergic patients and is described as blue-gray to purple discolorations beneath the child’s lower eyelids.
Dennie lines
Allergic shiners
Allergic conjunctivitis
Allergic duck
Allergic shiners
A 2 week old managed as sepsis neonatorum with oral candidiasis, with absent tonsils and with markedly decreased lymphocytes will give you an initial diagnosis of:
Common variable deficiency
Severe combined immunodeficiency
Leukocyte adhesion defects
Chronic Granulomatous disease
Severe combined immunodeficiency
Emmanuel, 12 year old child is diagnosed for Allergic Rhinitis classified as Moderate-Severe Persistent disease.
Based on this classification what treatment is BEST for the patient?
a. Oral antihistamine alone
b. Oral antihistmaine + Leukotriene modifying agents
c. Intranasal antihistamine + Sympathomimetic + Intranasal Inhaled Corticosteroids
d. Intranasal antihistamine + Intranasal Inhaled Corticosteroids
Intranasal antihistamine + Intranasal Inhaled Corticosteroids
Light microscopy of neutrophils for the presence of giant granules can help to diagnose
chronic granulomatous disease
Chédiak-Higashi syndrome
hyperimmunoglobulin E (Job syndrome)
lazy leukocyte syndrome
Chédiak-Higashi syndrome
This type of vaccine will cause paralysis in patients 6-9 months old with absent tonsils and nonpalpable lymph nodes
Polio
Tetanus
Varicella
Measles
Polio
Neonatal seizures secondary to this deficiency is associated with thymic hypoplasia
Hypoglycemia
Hypokalemia
Hypocalcemia
Hypogammaglobulinemia
Hypocalcemia
Failure to thrive, diarrhea, malabsorption, and infections with opportunistic infections (i.e., fungi, Candida sp, Pneumocystis jiroveci [carinii]) suggest
B-cell defects
Complement defects
T-cell defects
neutrophil defects
T-cell defects
This is one of the key elements of Allergic diseases which are likely involved in the induction of Asthma, Allergic rhinitis, Eosinophilic esophagitis and Atopic dermatitis?
Innate Lymphoid cells (ILC) 2
T-Helper cells
Antigen Presenting Cells (APCs)
Immunoglobulin E (IgE)
Innate Lymphoid cells (ILC) 2
Allergic diseases are characterized by peripheral blood and tissue eosinophilia, Of the many roles that Eosinophils play, which mechanism is the one that is responsible for the pathogenesis of Asthma?
Induce airway hyperresponsiveness
Cause degranulation of basophils and mast cells
Causes bronchoconstriction
Damage epithelial cells
Induce airway hyperresponsiveness
Autosomal recessive inheritance; oculocutaneous albinism, neuropathy, giant neutrophilic cytoplasmic inclusions; malignancy, and neutropenia are features of one of the following phagocytic disorders
chronic granulomatous disease
Chédiak-Higashi syndrome
Hyperimmunoglobulin E (Job syndrome)
Lazy leukocyte syndrome
Chédiak-Higashi syndrome
Stephen, a 4 year old child came in for difficulty of breathing associated with cough and colds of 2 days. He was noted also to be tachycardic (HR 110bpm), tachypneic (RR 40 cpm) with desaturations (O2sat 90%), O2 inhalation via nasal cannula was provided which improved 2 saturations to 92%. He prefers to sit and is able to talk in phrases when asked how he was. Other pertinent PE findings revealed: alar flaring, tight air entry, wheezes both lung fields on auscultation, subcostal and intercostal retractions. How would you categorize this patient based on Severity of Asthma exacerbation?
Bronchial asthma in moderate exacerbation
Bronchial asthma in severe exacerbation Bronchial asthma, respiratory arrest imminent Bronchial asthma in mild exacerbation
Bronchial asthma in moderate exacerbation
Delayed separation of umbilical cord, absence of pus at site (s) of infection, and poor wound healing suggest
B-cell defects
complement defects
T-cell defects
neutrophil defects
neutrophil defects
What is considered as a primary treatment for Ocular allergies?
Avoidance of allergens, cold compresses and lubrication
Oral or topical antihistamines
Topical decongestants
Topical tacrolimus or topical cyclosporine
Avoidance of allergens, cold compresses and lubrication
Patrick, a 7 year old child came in for difficulty of breathing, flushing, intense pruritus, dry cough and hoarseness of voice. Symptoms manifested an hour after eating peanuts for snacks. You were entertaining Anaphylaxis secondary to food allergy (peanuts) for this patient. What will be your initial intervention?
Give Epinephrine intramuscularly or intravenously (0.01mg/kg), supplemental oxygen and inhaled beta agonists and corticosteroids, IV fluids
Give Oxygen, start IV fluids, give Epinephrine (0.1mg/kg) IM
Give Epinephrine intramuscularly or intravenously (0.01mg/kg), supplemental oxygen and inhaled beta agonists and corticosteroids
Give Epinephrine (0.01mg/kg) IM or IV and Oral Antihistamine
Give Epinephrine intramuscularly or intravenously (0.01mg/kg), supplemental oxygen and inhaled beta agonists and corticosteroids, IV fluids
This is a common complication of Allergic rhinitis that is associated with purulent infection but with negative bacterial cultures despite marked mucosal thickening.
Rhinitis medicamentosa
Childhood asthma
Chronic sinusitis
Nasal polyposis
Chronic sinusitis
It is the most common hypersensitivity response of the eye:
Allergic conjunctivitis
Vernal keratoconjunctivitis
Atopic keratoconjunctivitis
Giant papillary conjunctivitis
Allergic conjunctivitis
This kind of physical urticaria results to localized pruritus, erythema and urticaria/angioedema after exposure to a cold stimulus:
Aquagenic urticaria
Solar urticaria
Cholinergic urticaria
Cold urticaria
Cold urticaria
A 5-month-old infant presented with reluctance to feed, lethargy, abdominal distension, and severe gingivitis. The parents are healthy relatives and gave history of non-purulent omphalitis with separation of umbilical stump at the age of 2 months. His peripheral smear showed neutrophil count 24,000/mm3.Of the following, the MOST likely diagnosis is:
Lazy leukocyte syndrome
Hyperimmunoglobulin E (Job syndrome)
Chronic granulomatous disease
Chediak-Higashi syndrome
Lazy leukocyte syndrome
One of the following is NOT a clinical features of Ataxia Telangiectasia
Cerebral ataxia
Ocular telangiectasia
Chronic otitis media
High incidence of Adenocarcinoma
Cerebral ataxia
-CEREBELLAR ATAXIA DAPAT
Among the Early Childhood Risk Factors for developing Asthma, which is considered a major risk factor?
Formula feeding
Food allergy
Male gender
Parental asthma
Parental asthma
Immunodeficiency disorders involving a T-cell defect will have increased susceptibility to what type of infectious agents?
Gr. (+) organisms
Pyogenic organisms
Catalase (+) organisms
Gm. (-) organisms, mycobacterium, viruses
Gm. (-) organisms, mycobacterium, viruses
DiGeorge syndrome, also known as velocardiofacial syndrome or CATCH 22 syndrome. One of the following IS NOT a feature of this syndrome
cardiac anomalies
abnormal facies
thymic hypoplasia
cleft lip
hypocalcemia
cleft lip
-CLEFT PALATE DAPAT
Majority of immunodeficiency disorders in the pediatric population involve this arm in the immune system
Humoral
Cellular
Phagocytic
Complement
Humoral
Asthma is a chronic inflammatory condition of the lung airways resulting in
episodic airflow obstruction. The etiology behind asthma is said to be:
A. Associated with environmental factors such as living in rural areas and
strongly linked to female gender
B. Caused by exposure to indoor allergens such as house dust mites, animal danders, mice and cockroaches
C. Always associated in the presence of having Allergic rhinitis
D. A combination of environmental and
genetic factors in early life shape how the immune system develops and responds to environmental exposures
D. A combination of environmental and
genetic factors in early life shape how the immune system develops and responds to environmental exposures
This IgE mediated immune response is characterized by edema of the skin,redness and induration. It is also associated with early infiltration of neutrophils and eosinophils.
a. Acute allergic disease
b. Early phase response
c. Late phase response
d. Chronic allergic disease
c. Late phase response
Which of the following can help lessen the risk of the occurrence of Allergic rhinitis?
a. Exposure to dogs, cats and endotoxins early in childhood
b. Serum IgE higher than 100 IU/mL before age 6 years
c. Delivery by cesarean section
d. Exclusive breastfeeding
a. Exposure to dogs, cats and endotoxins early in childhood
What is the suggested initial controller treatment for Adolescents (>12yo) with adiagnosis of Asthma?
a. Daily low dose ICS or as needed low dose ICS formoterol
b. As needed low dose ICS formoterol
c. Medium dose ICS-LABA
d. Low dose ICS-LABA
b. As needed low dose ICS formoterol
Ritz, is a 7 year old female, who was diagnosed as a case Bronchial Asthma - MildPersistent Asthma. What preferred
controller will you give for this patient?
a. Low dose ICS + leukotriene receptor antagonist (LTRA)
b. Medium dose inhaled corticosteroid - long acting beta agonist
c. Short acting beta agonist PRN
d. Daily low dose inhaled corticosteroid (ICS)
d. Daily low dose inhaled corticosteroid (ICS)
After the patient was stabilized, further digging up in history revealed daytime symptoms lasting for > 2 days in a week with episodes of stat nebulization using Salbutamol especially during episodes of
difficulty of breathing and frequent bouts of cough at nighttime at least once in a month. There were no maintenance medications as claimed by the mother. How would you further classify this patient?
a. Bronchial asthma in intermittent
b. Bronchial asthma mild persistent
c. Bronchial asthma moderate persistent
d. Bronchial asthma severe persistent
b. Bronchial asthma mild persistent
You recently diagnosed a 3 year old child who presented with cough, wheezing and dyspnea having Bronchial Asthma, moderate persistent. With this working diagnosis, what treatment shall you give for this patient?
a. Step 1: Short acting Beta Agonist (SABA) as needed
b. Step 2: Low dose Inhaled Corticosteriods (ICS)
c. Step 3: Medium dose ICS with SABA as needed
d. Step 4: Medium dose ICS + Long Acting Beta Agonist (LABA) or Leukotiene Receptor Antagonist
(LRTA)
d. Step 4: Medium dose ICS + Long Acting Beta Agonist (LABA) or Leukotiene Receptor Antagonist
(LRTA)
Preferred treatment for ALL patients with persistent Asthma is ICS therapy as MONOTHERAPY or in COMBINATION with ADJUNCTIVE THERAPY.
Low dose ICS therapy
treatment of choice for all children at Treatment 2 (Mild persistent asthma)
Alternative medications:
Leukotriene modifying agent: Montelukast
NSAID: Cromolyn, Nedocromil
Theophylline
Treatment step 3: (Moderate persistent asthma)
Medium dose ICS, combination low dose ICS and inhaled long acting beta agonist (LABA), leukotriene receptor antagonist (LTRA) or theophylline
Treatment Step 4: (Moderate Persistent Asthma)
Medium dose ICS/LABA combination
Alternatives: medium dose ICS (Theophylline or an LTRA)
Treatment Steps 5 and 6: (Severe Persistent Asthma)
Combination high dose ICS + LABA
Long term administration of oral corticosteroids as controller therapy is effective but is rarely required. Omalizumab can be used in children ≥6yo with severe allergic asthma
Rescue course of systemic corticosteroids may be necessary at any step for very poorly controlled asthma
Acute Atopic Dermatitis skin lesions are characterized by:
a. Hyperplastic epidermis with hyperkeratosis and minimal spongiosis
b. Predominantly IgE-bearing Langerhans cells in the epidermis and macrophages in the dermal
mononuclear cell infiltrate
c. Marked intercellular edema of the epidermis
d. Mast cell and eosinophil numbers are increased contributing to skin inflammation
c. Marked intercellular edema of the epidermis
Abigail, a six month old infant presented with intense itching on the face and neck more prominent at night time, no other associated symptoms were noted. Upon physical examination, lesions were red, dry, scaly, patchy like formation distributed on the cheek, and neck area. You were entertaining Atopic Dermatitis. To further strengthen your initial impression, what are the 3 major features that must be present with Atopic Dermatitis?
a. Pruritus, Positive family history of Asthma, Chronic or chronically relapsing course
b. Eczematous dermatitis that fits the typical pattern of skin inflammation, Positive family history
of Asthma, immediate skin test reactivity
c. Family history of asthma, Chronic or chronically relapsing course, Pruritus
d. Pruritus, eczematous dermatitis that fits the typical pattern of skin inflammation; Chronic
or chronically relapsing course
d. Pruritus, eczematous dermatitis that fits the typical pattern of skin inflammation; Chronic or chronically relapsing course
Abigail, a six month old infant presented with intense itching on the face and neck more prominent at night time, no other associated symptoms were noted. Upon physical examination, lesions were red, dry, scaly, patchy like formation distributed on the cheek, and neck area. You were entertaining Atopic Dermatitis. To further strengthen your initial impression, what are the 3 major features that must be present with Atopic Dermatitis?
How would you further categorize the Physical severity of Atopic Dermatitis for the above patient?
a. Clear
b. Mild atopic dermatitis
c. Moderate atopic dermatitis
d. Severe atopic dermatitis
c. Moderate atopic dermatitis
The most common cause of chronic idiopathic urticaria is:
a. Allergic condition
b. Endocrine disorder
c. Autoimmune disease
d. Idiopathic
d. Idiopathic
A life threatening form of hemophagocytic lymphohistiocytosis is commonly associated with this deficiency.
a. Chediak Higashi Syndrome
b. Leukocyte Adhesion Defect
c. Wisckott Aldrich Syndrome
d. Severe Combined
Immunodeficiency
a. Chediak Higashi Syndrome
Bruton tyrosine kinase protein is
commonly associated with this
type of immunodeficiency.
a. Chediak Higashi Syndrome
b. Leukocyte Adhesion Defect
c. Chronic Granulomatous
Disease
d. X-linked Agammaglobulinemia
d. X-linked Agammaglobulinemia
Leukocyte adhesion defect will
have a significant leukocytosis of:
a. >22,000
b. >23,000
c. >24,000
d. >25,000
d. >25,000
The accelerated phase in Chediak-
Higashi Syndrome is characterized
by the following features
EXCEPT:
a. High fever
b. Thrombocytopenia
c. Lympocytopenia
d. Shortened bleeding time
d. Shortened bleeding time
A severe case of Myositis caused
by Echoviruses is commonly
associated with this primary
deficiency.
a. Selective Ig A deficiency
b. X-linked
Agammaglobulinemia
c. Common variable
immunodeficiency- echovirus
meningitis rare
d. Severe combined
Immunodeficiency
b. X-linked
Agammaglobulinemia
A finding of angioneurotic edema
will possibly have a deficient defense system involving the:
a. Antibodies
b. Cellular immunity
c. Phagocytosis
d. Complement system
d. Complement system
This immunodeficiency is
commonly associated with
phenytoin treatment.
a. Selective IgA deficiency
b. Hyper Ig E syndrome
c. X linked hypogammaglobulinemia
d. Ataxia Telangiectasia
a. Selective IgA deficiency
The following are TRUE of Hyper
IgE syndrome EXCEPT:
a. Autosomal dominant
b. Gene on Stat 3
c. Fine facial features
d. Minimal trauma fractures
c. Fine facial features
