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Heme > Allergy/immunology > Flashcards

Allergy/immunology Flashcards

1
Q

Four types of hypersensitivity reactions and their mechanism

A

Type 1: anaphylactic. IgE mediated mast cell degranulation, released of mediators (angioedema, urticaria, anaphylaxis)
Type 2: cytotoxic. IgG or IgM antibodies with cell antigens, complement activation (auto immune hemolytic anemia, goodpasture syndrome)
Type 3: immune complex: complex deposition leading to complement activation (SLE, RA, serum sickness)
Type 4: cell mediated (t cells, eg contact dermatitis)

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2
Q

Management anaphylaxis

A

Epi: 0.3-0.5 mg 1:1000 IM, 0.01 mg/kg in pers
Refractory or hypotension 0.1-05 mg iv epi over 5 mins
Glucagon for pt on BB and fluid and ep refractory
NS bolus
Antihistamines
Steroids
Ventolin

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3
Q

Three causes of angioedema

A

Hereditary angioedema (C1 inhibitor deficiency)
Meds: ace and arb – mediated through bradykinin and substance P
Mast cell mediated: IgE with anaphylaxis or direct mast cell stimulation (anaphylactoid)

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4
Q

Management of angioedema

A

Supportive, depends on cause
Stop offending agent if med or anaphylactic related
Try epi etc
In hereditary purified CI inhibitor, icatiband (Bradykinin b2 receptor agonist)

Can do FFP as has C1 inhibitor

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5
Q

What type of hypersensitivity reaction is serum sickness
When does it present
What are the common offending agents

A

Type 3: immune complex mediated
Presents 7-10 days post exposure
Agents: antibiotics, phenytoin, thiazide diuretics, horse serum antivenom, barbiturates, envenomation

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6
Q

Treatment serum sickness

A 
Supportive
NSAIDs
Antihistamines
Steroids
Plasmapheresis for severe cases
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7
Q

Clinical presentation serum sickness

A

Flu like symptoms 7-10d post exposure

Fever, malaise, arthralgias

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8
Q

Diagnosis of DRESS syndrome

A

Exposure to med (antibiotics, anti epileptics, allopurinol, sulfazalazine)
Mucous membrane spared delayed onset rash
Systemic symptoms/end organ involvement on blood work
Eosinophilia

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9
Q

Treatment of DRESS

A

Stop offending agent
Supportive
Steroids

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10
Q

4 conditions associated with raynauds

A 
Vasculitis
Lupus
Sjogrens
Scleroderma
Dermatomyositis
Sympathomimetics
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11
Q

Bugs implicated in reactive arthritis

A 
Chlamydia CN gonorrhea
Yersinia
Shigella
Salmonella
Campylobacter
C diff
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12
Q

Management reactive arthritis

A

STI treatment for urethritis
Ophtho if uveitis
NSAIDs for joints

Rheum consult

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13
Q

Airway consideration for rheumatoid arthritis

A

Can see degeneration of transverse ligaments, C1-C2 instability
Use spine precautions during intubation

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14
Q

Five drugs that can induce lupus

A 
Hydralazine
Isoniazid
Phenytoin
Procainamide
Sulfonamides
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15
Q

7 emerge complications of lupus

A

Nephrotic syndrome, renal failure
Pleural effusion or tamponade
Purulent pericarditis
Interstitial lung disease, pulmonary hypertension
Coronary artery vasculitis, acute MI
Libman sacks endocarditis: noninfectious endocarditis
Mesenteric vasculitis

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16
Q

Criteria for lupus diagnosis

A 
Malar rash
Discoid rash
Serositis (pleural, pericardial, pertinoneal)
Oral ulcers
Arthritis
Photosensitive rash
Blood (anemia, thrombocytopenia, leukopenia)
Renal disease (protein)
ANA
Immunologic (anti ds DNA, anti sm)
Neuro logic (psych, seizures)
17
Q

Treatment of acute lupus flare

A

Steroids

Treat complications

18
Q

Components of CREST syndrome (limited cutaneous systemic sclerosis)

A 
Calcinosis cutis
Raynaud's phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasias
19
Q

Treatment Raynaud’s phenomenon

A

Warming
Stop offending agent eg sympahomimetics
Consider CCB
prevention (avoid cold, smoking, sympathomimetics)

20
Q

6 extracutaneous manifestations of scleroderma

A 
GI: esophageal dysmotility
Lower esophageal sphincter incompetence
Lung: pulm htn 
ILD
lung cancer
Cardiac: pericarditis, pericardial effusion
Myocardial fibrosis
Heart failure
MI
Arrhythmias and conduction abnormalities
Kidney
Neuropathies
21
Q

3 examples large vessel vasculitis

A

Giant cell arteritis
Behcets
Takayasu artertitis

22
Q

4 medium vessel vasculitis

A 
Polyarteritis nodosa
Wegener granulomatosis (sinusitis, nephritis, pulm infiltrates) or now granulomatosis with polyangitis 
Buerger disease (young male smoker, necrotic digits, superficial thrombophlebitis)
Microscopic polyangiitis
23
Q

3 small vessel vasculitis

A

Hypersensitivity
HSP
Good pasture syndrome (lung and kidney)

24
Q

Four types of transplant related infection

A

Chronic infection from donor tissue eg HCV, CMV
Acute infection from donor tissue eg influenza, bacteremia
Reactivation of host infection due to immunesuppression eg TB
Opportunistic infection due to immune suppression
Community acquired due to immunecompromised

25
Q

Timeframe for CMV, EBV, PJP, TB, Chagas post transplant

A

Usually 1-6 months

26
Q

Most common infections 0-1 month post transplant

A

Surgical infections

Donor infected tissue eg hiv, west Nile, occult bacteremia

27
Q

Treatment of CMV infection or flare in transplant patient

A

Gancyclovir

28
Q

Which vaccines are contraindicated in transplant patients

A

Live vaccines : MMR, varicella, rotavirus

29
Q

Three categories of transplant rejection

A

Hyperacute (minutes to hours post surgical, irreversible graft destruction)
Acute: 1-12 weeks post transplant, can be reversed
Chronic: progressive, insidious decline from fibrosis, ischemia, death. Nothing to do,

30
Q

Clinical presentation kidney transplant rejection
Work up
Management

A

Presentation: pain to allograft site, edema, htn, decreased urine output, elevated creatinine
Work up: cr, urine ACR, UA, renal ultrasound, cyclosporine level
Treatment is steroids, consult

31
Q

How do heart transplant patients in rejection present

A

Generalized fatigue, feeding intolerance, fever

Can also see chf, dysrhythmias

32
Q

Management heart transplant failure

A

Iv steroids
Isoproterenol for bradysyrhythmias
Dopamine or dobutamine for hypotension

Obviously get to transplant centre

33
Q

5 causes of normocytic anemia

A 
Bleeding
Hemolysis
Aplastic
Sickle cell
Chronic disease / kidney disease
34
Q

Findings in iron deficiency anemia

A

Low iron
High TIBC
Low percentage saturation
Low ferritin

35
Q

Causes sideroblastic anemia

A 
Congenital
Acquired: pre-leukaemia state
Drugs( TB drugs, chloramphenicol)
Infections
Malignancy
Hemolytic anemia
36
Q

4 causes of aplastic anemia

A

Viral (parvo virus, hiv, hepatitis)
Drugs (NSAIDs, Sulfa, antiepileptic, nifedipine)
Toxin (radiation, pesticides, solvents)
Congenital disorder

37
Q

Four types of hereditary hemolytic anemias

A

Abnormal membrane (spherocytosis, elliptocytosis), enzyme eg G6PD, hemoglobinopathies (sickle cell, thalassemia)

38
Q

4 examples of acquired hemolytic anemia

A

Immune (warm and cold)
DIC, TTP, pre-eclampsia
Mechanical from cardiac valves
Splenomegaly sequestration

39
Q

Blood test findings in hemolytic anemia

A

Low hb
Elevated LDH
Low haptoglobin
Schistocytes (intravascular) or spherocytes (extravascular)
Increased unconjugated bili in extravascular hemolysis
Hemoglobinuria in intravascular
Positive Coombs test if antibody mediated
Elevated reticulocyte count

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