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1. Pediatrics > Allergy & Immunology > Flashcards

Allergy & Immunology Flashcards

1
Q

[Allergy/HS]

Acute Type 1 hypersensitivity?
- Different name: __
- Mediators: __
- Cells involved: __
- Timing: __

A

Type 1 - acute
Name: Immediate, acute HS
Mediators: Allergen specific Immunoglobulin E (IgE) mediated
Cells: Mast cells and basophils
Timing: Minutes to an hour

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2
Q

[Allergy/HS]

Late phase Type 1 hypersensitivity?
- Different name: __
- Mediators: __
- Cells involved: __
- Timing: __

A

Name: Immediate, late phase HS
Mediators: IgE
Cells: Eosinophils and basophils
Timing: 2 - 12 hours after the immediate reaction, Can last hours to days

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3
Q

[Allergy/HS]

Type 2 hypersensitivity?
- Different name
- Mediators
- Cells involved

A

Name: Cytotoxic HS
Mediators: IgG, rarely IgM
Cells: Phagocytes

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4
Q

[Allergy/HS]

Type 3 hypersensitivity?
- Different name
- Mediators
- Cells involved

A

Name: Immune complex mediated HS
Mediators: IgG or IgA immune complex precipitation
Cells: Phagocytes

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5
Q

[Allergy/HS]

Type 4 hypersensitivity?
- Different name
- Mediators
- Cells involved

A

Name: Delayed or cell mediated
Mediators: T-Cells
Cells: T-cells and phagocytes

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6
Q

[Allergy/HS]

Examples of Type 1 hypersensitivity? (3)

A
F
U

A

Allergic conjunctivitis, allergic rhinitis, and allergic asthma
Foods (e.g., peanuts, tree nuts), insect stings, latex allergy
Urticaria (angioedema and ana­phylaxis when severe)

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7
Q

[Allergy/HS]

Examples of drugs of Type 1 hypersensitivity? (2)

A
  1. Penicillin
  2. Chemotherapies
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8
Q

[Allergy/HS]

Function?
H1 receptor: __
H2 receptor: __

A

H1: Wheal and flare reaction, bronchoconstriction, and pruritus

H2: Increased gastric acid secretion
(Eg. H2 blocker, Ranitidine, Zantac)

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9
Q

[Allergy/HS]

Examples of Type 2 hypersensitivity? (3)
Target cell receptors and disease

A

Platelets - immune thrombocytopenia
RBCs - Autoimmune hemolytic anemia
WBCs - Leukopenia

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10
Q

[Allergy/HS]

Examples of Type 2 hypersensitivity? (3)
Target fixed-tissue antigen and disease

A
  1. Basement membrane component in kidney and lungs - Goodpasture syndrome
  2. ACh receptor on muscle cells - Myasthenia gravis
  3. Thyroid hormone receptor - Graves disease
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11
Q

[Allergy/HS]

2 types of type 3 hypersensitivity?

A
  1. Serum sickness
  2. Arthus reaction
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12
Q

[Allergy/HS]

Mechanism?
Serum sickness reaction vs Arthus reaction (type 3 hypersensitivity)?

Amount of antigen: __
Immunization status: __
Presentation: __

A

Serum sickness
Amount of antigen: Large
Immunization status: Non-immunized
Presentation: Necrotic vasculitis

Arthus reaction
Amount of antigen: Small
Immunization status: Hyperimmunized
Presentation: 4-6 hours of vaccination, painful induration and sterile abscess

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13
Q

[Allergy/HS]

Examples of type 3 hypersensitivity autoimmune diseases? (4)

A
  1. Systemic lupus erythematosus
  2. Rheumatoid arthritis
  3. Pernicious anemia
  4. IgA vasculitis
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14
Q

[Allergy/HS]

Examples of type 4 hypersensitivity? (4)

A
  1. Allergic contact dermatitis (Poison ivy, Nickel)
  2. Granulomatous disease (Crohn disease, Sarcoidosis)
  3. Allograft rejection
  4. Graft-versus-host disease
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15
Q

[Allergy/Anaphylaxis]

Anaphylaxis diagnosis criteria? (3)

Any 1 of the following 3 criteria:
1. Sudden onset with involvement of the skin or lmucosal tissue and either (2): __
2. >=2 of the following occur suddnely after exposure to a likely allergen (3): __
3. __ after exposure to a known allergen

A

Any 1 of the following 3 criteria:
1. Sudden onset with involvement of the skin or lmucosal tissue and either:
i) Sudden respiratory symptoms or
ii) Hypotension
2. >=2 of the following occur suddnely after exposure to a likely allergen
i) Skin or mucosal tissue involvement (hives, rash, swelling)
ii) Respiratory symptoms (wheezing, cough, chest tightness)
iii) Hypotension
iv) GI symptoms
3. Hypotension after exposure to a known allergen

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16
Q

[Allergy/Anaphylaxis]

Common anaphylaxis allergens? (5)

F
I
B
A
R

A

Foods (MNEWS: milk, nuts, wheat, eggs, seafood)
Insulin
Blood products
Antibiotics (Penicillin), NSAIDs,
Radioactive dye

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17
Q

[Allergy/Anaphylaxis]

Treatment of anaphylaxis? (3)

A
  1. Epinephrine 1st line, IM
  2. IV dephenhydramine and cimetidine (relieves hives not swelling or shock)
  3. +/- Steroid for late phase
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18
Q

[Allergy/Anaphylaxis]

Epinephrine dose for anaphylaxis?

IM dose __ mg/kg, max __ mg in 1:__ epinephrine

A

IM dose 0.01 mg/kg, max 0.5 mg in 1:1000 epinephrine

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19
Q

[Allergy/Urticaria]

Duration for acute vs chronic urticaria?

Acute urticaria < __ weeks
Chronic urticaria > __ weeks

A

Acute urticaria < 6 weeks
Chronic urticaria > 6 weeks

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20
Q

[Allergy/Urticaria]

Common triggers for acute urticaria? (4)

D
I
F
I

A

Drugs (penicillin, cephalosporins)
Infection, viral
Foods
Insect bites

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21
Q

[Allergy/Urticaria]

Test for immediate pressure urticaria?

A

Dermatographism

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22
Q

[Allergy/Urticaria]

Proposed mechanism for chronic urticaria?

A

Autoimmune etiologies

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23
Q

[Allergy/Urticaria]

Treatment for chronic urticaria? (3)

A
  1. H2 antihistamins, non-sedating 2nd Generation: loratadine (claritin), cetirizine (zyrtec)
  2. Immunosuppressive: Omalizumab, cyclosporine
  3. Steroid
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24
Q

[Allergy/Urticaria]

Causes other than autoimmune for chronic urticaria? (4)

A
  1. Cold: Acquired cold urticaria, familial cold urticaria
  2. Heat: Cholinergic urticaria
  3. Pressure: Immediate pressure urticaria, delayed pressure urticaria
  4. Insect bite: Papular urticaria
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25
Q

[Allergy/Urticaria]

Diagnosis?

Autosomal dominant
After cold exposure, urticaria, myalgias, fever and joint pain

A

Familial cold urticaria

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26
Q

[Allergy/Urticaria]

Diagnosis?

Hives lasting > 24 hours, fixed
Ecchymosis, hyperpigmentation, and purpura
Elevated ESR, ANA positive, hypocomplementemia
Leukocytoclastic vasculitis in skin biopsy

A

Urticarial vasculitis

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27
Q

[Allergy/Urticaria]

Diagnosis?
Treatment?

Trigger: After insect bites, especially fleas
Sx: Papules in group with central punctum

A

Papular urticaria

  • Treatment:
    2nd gen antihistamines: loratadine (Claritin), cetrizine (Zyrtec)
    Topical glucocorticoids
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28
Q

[Allergy/Urticaria]

Diagnosis?
Diagnostic test?

Infants with reddish-brown macular lesions

A

Urticaria pigmentosa (mastocytosis)

  • Test:
    Diagnosed by formation of wheal on gentle stroking
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29
Q

[Allergy/Urticaria]

Two types of isolated angioedema without urticaria?

A
  1. ACE inhibitor induced angioedema
  2. Hereditary angioedema
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30
Q

[Allergy/ARC]

Physical findings of allergic rhinoconjunctivitis? (6)

A
  1. Nasal polyps
  2. Allergic shiners (dark circles under the eyes)
  3. Nasal crease (due to nasal salute)
  4. Dennie-Morgan lines (folds below the eyes due to edema)
  5. Enlarged tonsils and adenoids
  6. Cobblestoning in oropharynx
31
Q

[Allergy/ARC]

Most common environmental seasonal triggers?

Spring: __
Summer: __
Fall: __
Year-around: __

A

Spring: Tree pollens
Summer: Grass pollens
Fall: Weeds
Year-around: Mold

32
Q

[Allergy/AR]

Treatment for allergic rhinitis (3)

A
  1. Intranasal spray
  2. 2nd gen antihistamines: cetirizine (zyrtec), loratadine (claritin)
  3. Montelukast (singulair)
33
Q

[Allergy/Food]

Vaccine administration needs to be monitored with egg allergy (2)?

A
  1. Influenza
  2. Yellow fever
34
Q

[Allergy/Food]

Contraindication/indication of influenza vaccine with egg allergy? (3)

Only hives: __
Systemic or anaphylaxis: __
Severe reaction to influenza vaccine: __

A

Only hives: can receive
Systemic or anaphylaxis: can receive under medical supervision
Severe reaction to influenza vaccine: can’t receive

35
Q

[Allergy/Food]

Examples of non-IgE mediated food allergy? (3)

A
  1. Eosinophilic esophagitis
  2. Protein-induced proctitis/proctocolitis
  3. Food protein-induced enterocolitis syndrome (FPIES)
36
Q

[Allergy/Food/PIP, FPIES]

Protein-induced proctitis/proctocolitis vs Food protein-induced enterocolitis syndrome

Streaks of blood in stools in infants otherwise well: __

Protracted vomiting, diarrhea, abdominal distention, lethargy, hypotension in infants: __

A

Protein-induced proctitis/proctocolitis
Streaks of blood in stools in infants otherwise well

Food protein-induced enterocolitis syndrome
Protracted vomiting, diarrhea, abdominal distention, lethargy, hypotension in infants

37
Q

[Allergy/Food]

Fruits with cross reactivity to latex allergy?

(PeeKaBoo PACT)

A

Papaya, Kiwi, Banana
Potato, Avocado, Chestnut, Tomato
(PeeKaBoo PACT)

38
Q

[Allergy/Latex]

High risks for developing latex allergy (2)?

A
  1. Spina bifida, congenital urologic problems
  2. Multiple surgeries at early age
39
Q

[Allergy/Drug]

Antibiotics of choice with penicillin allergy?

A

2nd and 3rd generation cephalosporine

40
Q

[Allergy/Drug]

Diagnosis?
Management?

Flushing, erythema itching after Vancomycin

A

Vancomycin flushing syndrome

  • Management:
    Lowering infusion rate with antihistamines
41
Q

[Allergy/Drug]

Diagnosis?
Common triggering medication?
Treatment?

‘String of pearls signs’: rings of blisters

A

Linear IgA dermatosis

  • Trigger:
    Vancomycin, most common
  • Treatment:
    Dapson
42
Q

[Allergy/Drug]

Diagnosis?
Common triggering medication?

Well-circumscribed, re-appearing lesions with the same trigger,

A

Fixed drug eruption

  • Trigger:
    TMP/SMX, tetracyclines, quinolones
    Antiseizure meds, pseudoephedrine
43
Q

[Allergy/Drug]

Distinctions between Stevens-Johnson syndrome and toxic epidermal necrolysis?

SJS < __% body surface area (BSA)
TEN > __ % BSA

A

SJS < 10 % body surface area (BSA)
TEN > 10 % BSA

44
Q

[Allergy/Drug]

Diagnosis?
Treatment?

Urticaria, edema, arthralgia, GI: nausea/vomiting
Children 1-3 weeks after antibiotics
Eosinophilia, Proteinuria, Elevated ESR, decreased C3, C4

A

Serum-sickness like reactions

  • Tx:
    Supportive care, discontinuing offending drug
45
Q

[Allergy/Drug/SS]

Difference between serum sickness and serum sickness like reactions?

A

Serum-sickness: usually adults, with monoclonal antibodies
Serum-sickness like reactions: children after antibiotics

46
Q

[Allergy/eczema]

Treatment options for atopic dermatitis? (3)

A
  1. Moisturizers
  2. Topical corticosteroid, topical calcineurin inhibitor, crisaborole ointment
  3. Wet wraps
47
Q

[Imm/ID]

Which immunodeficiency?

Sinopulmonary infections after maternal antibodies depleted

Common organisms:
Encapsulated bacteria: NHS and P (Neisseria, Haemophilus, Staph or Strep, Pseudomonas) (No IgG or IgM)
Virus: Enterovirus (no IgA)
Protozoa: Giardia (no IgA or IgE)

A

B-cell deficiency

48
Q

[Imm/ID]

Which immunodeficiency?

Intracellular organisms and opportunistic infections

Common organisms:
Intracellular bacteria: Salmonella, Syphilis
Mycobacteria: tuberculosis, Mycobacteria avium complex
Virus: CMV, Herpes, VZV, EBV, hepatitis, HPV, Molluscum
Fungi: Candida, Aspergillus, Coccidioidomycosis, Cryptococcus, Histoplasmosis
Protozoa: Pneumocystis, toxoplasmosis, cryptosporidiosis,

A

T-cell deficiency

49
Q

[Imm/ID]

Which immunodeficiency?

Sx: Skin and organ abscesses

Common organism:
SNS (S. aureus, Nocardia, Serratia)

A

Phagocytic disorder

50
Q

[Imm/ID]

Which immunodeficiency?

Sx: recurrent severe infections like cellulitis, arthritis, meningitis, osteomyelitis, sepsis

Common organisms:
Bacteria: pyogenic bacteria, mycobacteria
Virus: Herpes

A

Toll-like receptor defects

51
Q

[Imm/ID]

Which immunodeficiency?

Sx: overwhelming sepsis

Common organism:
Neisseria meningitis
S. pneumoniae

A

Complement deficiency

52
Q

[Imm/ID/B-cell]

Test for B-cell deficiency?

Quantitative (2): __
Qualitative (1): __

A

Quantitative
- Flow cytometry for CD 19+ cells
- Immunoglobulines

Qualitative
- Response to vaccines

53
Q

[Imm/ID/T-cell]

Test for T-cell deficiency?

Quantitative (2): __
Qualitative (2): __

A

Quantitative
- Flow cytometry for CD3+ , CD4+ and CD8+ cells
- CBC

Qualitative
- Delayed-type hypersensitivity
- Lymphocyte proliferation to mitogens and antigens

54
Q

[Imm/ID/Phago]

Test for phagocyte deficiency?

Quantitative (1): __
Qualitative (1): __

A

Quantitative
- CBC

Qualitative
- Neutrophil oxidation (DHR: DiHyroRhodamine oxidation)

55
Q

[Imm/ID/Comp]

Test for complement defects?

Quantitative (1): __
Qualitative (1): __

A

Quantitative
- C3, C4, CH50, AH50, C1 esterase inhibitor

Qualitative
- C1 esterase inhibitor function

56
Q

[Imm/ID]

Which immunodeficiency?
Mechanism?

Age: Between 6 months to 2 years old
Sx: Recurrent bacterial infections (AOM), GI infection (persistent diarrhea), FTT
PE: absence or small lymph nodes
Lab: low or no B-cell on flow cytometry, low in all Igs

A

X-linked Agammaglobulinemia (XLA)

Mechanism:
BTK gene (B cell development) defect
-> Arrest in pre-B cell stage

57
Q

[Imm/ID]

Which more commonly seen?
Common variable immunodeficiency (CVID) vs X-linked Agammaglobulinemia (XLA)

Sarcoid-like disease with noncaseating granulomas
Immune thrombocytopenia
Pernicious anemia, hemolytic anemia
Amyloidosis

A

Common variable immunodeficiency (CVID)

58
Q

[Imm/ID]

Which immunodeficiency and its mechanism?

Age: early infancy or early childhood
Sx: Recurrent and severe bacterial infections pneumonia and Opportunistic infections (PJP), chronic diarrhea with cryptosporodium
PE: Mouth ulcers, periodontal disease, HSM, LAD

A

Hyper IgM syndrome

Mechanism:
X-linked and AR, CD40L gene defect on T cells
-> Defect in T cell-B cell signaling
-> can’t switch IgM to other class Ig

59
Q

[Imm/ID]

Which immune disorder?

Age: childhood, <10 years old
Sx: Fulminant infectious mononucleosis, HLH, lymphoma, aplastic anemia
PE: HSM, LAD

A

X-linked lymphoproliferative disease (Duncan syndrome)

60
Q

[Imm/Basic]

Time line for Lowest Ig in infancy and time for reach adult level?

A

Lowest at 2-3 months
Adult level at 3-4 years

61
Q

[Imm/ID]

Nezelof syndrome

Inheritance: __
Immune dysfunction: __

A

Autosomal recessive
Varying degree of T-cell dysfunction

62
Q

[Imm/SCID]

Two common forms of severe combined immunodeficiency (SCID)?

A
  1. X-linked IL-2 receptor γ (IL-2Rγ) defect (X-linked SCID)
  2. AR adenosine deaminase (ADA) deficiency
63
Q

[Imm/ID/WAS]

Classic triad of Wiskott-Aldrich Syndrome?

E
X
I
T

A

Eczema
X-linked
Immunodeficiency
Thrombocytopenia

Newborn with prolonged bleeding after circumcision, eczema, small platelets

64
Q

[Imm/ID]

Which immunodeficiency?
Mechanism?

Sx: Delayed umbilical cord separation, omphalitis, and severe gingitvitis

A

Leukocyte adhesion deficiency (LAD) type 1

Mechanism:
CD18 gene defect, phagocyte chemotaxis disorder

65
Q

[Imm/ID]

Which immunodeficiency?
Common cause of skin infection?

Abscess without redness, heat (cold abscess), eczema, dysmorphic fase, delayed dental exfoliation

A

Hyper IgE syndrome (Job syndrome)
S. aureus

66
Q

[Imm/ID]

Which immunodeficiency?
Mechanism?
Peripheral smear finding?

Partial oculocutaneous albinism, progressive neurologic deterioration, cutaneous, sinopulmonary infections

A

Chediak-Higashi syndrome

Mechanism:
Impaired lysosome degranulation

PBS:
Giant granules in neutrophils

67
Q

[Imm/ID]

Which immunodeficiency?
Diagnostic test?

Serious skin, perirectal infection, liver abscess, and osteomyelitis with S. aureus, Norcadia, Serretia

A

Chronic granulomatous disease

Test:
DHR (dihydrorhodamine) oxidation

68
Q

[Imm/ID]

Which immunodeficiency?

Pyogenic, encapsulated bacterial infection and SLE

A

Early complement deficiency
(C1, C2, or C4 deficiency, C3 deficiency)

69
Q

[Imm/ID]

Which immunodeficiency?

Severe Neisseria infection

A

Terminal complement deficiency
(C5-9 MAC deficiency)

70
Q

[Imm/ID/Comp]

What CH50 measures and meaning?

A

CH50 measures total complement hemolytic activity
Normal test means all C1-9 present

71
Q

[Imm/ID]

Which immunodeficiency and screening/diagnostic test?

Sudden abdominal pain and extremity swelling

A

Hereditary angioedema

Screening:
- low C4

Diagnose:
- decreased C1-INH level (C1 inhibitor defect)

72
Q

[Imm/ID]

Screening test for immunodeficiency?

Humoral: __
Cellular: __
Complement: __

A

Humoral: IgG levels
Cellular: flow cytometry with lymphocyte substes
Complement: CH50

73
Q

[Imm/ID]

Newborn screening suspected of primary immunodeficiency, what’s the next step? (3)

A
  1. Prophylactic antibiotics (TMP-SMX)
  2. CBC and flow cytometry
  3. Urgent referral to allergy/immunology

1. Pediatrics (22 decks)

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