Allergy/Immunology

Question 1

1 parent with atopy = ? % risk for allergic disease?

2 parents with atopy = ? % risk for allergic disease?

Answer 1

50% and 75%

Question 2

Which allergies are often outgrown by 5 yo? Which ones are not?

Answer 2

Milk, Egg, and Soy are usually outgrown. Tree nuts, peanuts, and seafood usually not outgrown.

Question 3

What dose of epinephrine for anaphylaxis in < 30kg? >=30 kg?

Answer 3

0.15 mg if < 30 kg; 0.30 mg if >=30 kg.

Question 4

What is the most likely cause of chronic urticaria (>6 months)?

Answer 4

Food

Question 5

What type of allergic reaction caused by poison ivy?

Answer 5

Type 4, delayed hypersensitivity

Question 6

What type of allergic reaction causes anaphylaxis?

Answer 6

Type 1, IgE mediated

Question 7

Albuterol increases or decreases serum potassium

Answer 7

Decreases

Question 8

When is ipratroprium (anticholinergic) indicated in acute asthma exacerbation?

Answer 8

Give for severe exacerbation with albuterol for first 1-2 hours

Question 9

What role does magnesium sulfate have in asthma exacerbation?

Answer 9

Bronchodilator. Can decrease admission rates.

Question 10

Patient with nighttime awakenings >2x/month, sx requiring SABA >2days/week (not daily)

Answer 10

Mild Persistent asthma

Question 11

Patient with daily symptoms, daily SABA use, night time awakenings >1x/week but not nightly

Answer 11

Moderate persistent

Question 12

Patient with daily sx, daily SABA use, nightly awakenings

Answer 12

Severe persistent

Question 13

What are salmeterol/Formoterol classified as? When are they indicated?

Answer 13

LABA; Indicated as addition to low-dose ICS in >5yo with moderate persistent asthma

Question 14

Long term tx of moderate persistent asthma

Answer 14

Low dose ICS –> increase to medium dose if 0-4 yo. Keep low dose and add LABA if >5 yo. May then increase to medium dose if not working.

Question 15

Long term tx of severe persistent asthma

Answer 15

High dose ICS + LABA

Question 16

Cholinergic rhinitis secondary to foods or cold air. Tx?

Answer 16

Ipratroprium

Question 17

Infant < 3yo, blood streaked stool (no diarrhea). Not ill. Tx?

Answer 17

Food protein induced proctitis. Tx with protein hydrolysate formula (or breastfeeding mothers eliminate milk from diet)

Question 18

Infant 1 week to 9 months old with severe vomiting, diarrhea, toxic appearing, dehydrated. Heme positive stools. Dx? Tx?

Answer 18

Food protein induced enterocolitis. Tx by discontinuing causative agent. Resolves by 2-3 yo.

Question 19

3 month old with recurrent thrush, otitis media, diarrhea, dermatitis. Dx? Tx?

Answer 19

SCID. Dx with fluorometric analysis of T,B,NK cells. Tx BMT

Question 20

Male infant with low levels of IgM, severe eczema, bloody diarrhea/bruising

Answer 20

Wiskott-Aldrich Syndrome

Question 21

Male with absence of lymphoid tissue, recurrent encapsulated infections, Elevated T cells, low to absent B cells. Tx?

Answer 21

Brutons X-linked agammaglobulinemia. Tx IVIG

Question 22

Kid with recurrent upper and lower respiratory infections, recurrent herpes and zoster infections. Tx? Increased risk of what cancer?

Answer 22

CVID. Tx with IVIG. Increased risk of lymphoma, EBV associated

Question 23

6 mo to 1 yo M with recurrent otitis media, sinopulm infections, diarrhea. High incidence of opportunistic infections.

Answer 23

X-linked Hyper IgM Syndrome

Question 24

Male infant with PCP pneumonia, no HIV infection

Answer 24

Think X-linked Hyper IgM Syndrome

Question 25

Immunodeficiency for which Ig replacement is most appropriate

Answer 25

X-linked Hyper IgM Syndrome

Question 26

Abnormal facies, eczema with recurrent staph skin infections, chronic thrush, eosinophilia in blood

Answer 26

Job Syndrome = Hyper IgE

Question 27

6 mo old with severely low IgG level, normal IgM. Natural history?

Answer 27

Transient hypogammaglobulinemia of infancy. Resolves by 6 yo.

Question 28

3 yo with multiple recurrent staph abscesses, UTI caused by serratia marcescens. Dx? Tx?

Answer 28

Chronic granulomatous disease. Dx with nitroblue tetrazolium test. Tx abx, IFN gamma

Question 29

High WBC (20k), perirectal abscess/indolent skin infections/omphalitis. Infected areas with no pus or inflammation. Delayed wound healing. Dx? Tx?

Answer 29

LAD. Dx with Rebuck skin window. Tx BMT

Question 30

History of recurrent overwhelming infection with meningococci. Inheritance? Dx?

Answer 30

Complement deficiency. Autosomal recessive. Dx with CH50

Question 31

recurrent staphylococcal abscesses, sinopulmonary infections, and an intensely pruritic, diffusely distributed eczematous rash that begins soon after birth.

Answer 31

Hyper IgE (Job Syndrome)