Allergy/immunology Flashcards by Rebecca Brown

Four types of hypersensitivity reactions and their mechanism

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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Management anaphylaxis

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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Three causes of angioedema

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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Management of angioedema

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

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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Treatment serum sickness

Supportive
NSAIDs
Antihistamines
Steroids
Plasmapheresis for severe cases

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Clinical presentation serum sickness

Flu like symptoms 7-10d post exposure

Fever, malaise, arthralgias

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Diagnosis of DRESS syndrome

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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Treatment of DRESS

Stop offending agent
Supportive
Steroids

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4 conditions associated with raynauds

Vasculitis
Lupus
Sjogrens
Scleroderma
Dermatomyositis
Sympathomimetics

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Bugs implicated in reactive arthritis

Chlamydia CN gonorrhea
Yersinia
Shigella
Salmonella
Campylobacter
C diff

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Management reactive arthritis

STI treatment for urethritis
Ophtho if uveitis
NSAIDs for joints

Rheum consult

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Airway consideration for rheumatoid arthritis

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

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Five drugs that can induce lupus

Hydralazine
Isoniazid
Phenytoin
Procainamide
Sulfonamides

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7 emerge complications of lupus

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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Criteria for lupus diagnosis

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)

Treatment of acute lupus flare

Steroids

Treat complications

Components of CREST syndrome (limited cutaneous systemic sclerosis)

Calcinosis cutis
Raynaud's phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasias

Treatment Raynaud’s phenomenon

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

6 extracutaneous manifestations of scleroderma

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

3 examples large vessel vasculitis

Giant cell arteritis
Behcets
Takayasu artertitis

4 medium vessel vasculitis

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

3 small vessel vasculitis

Hypersensitivity
HSP
Good pasture syndrome (lung and kidney)

Four types of transplant related infection

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

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

Usually 1-6 months

Most common infections 0-1 month post transplant

Surgical infections | Donor infected tissue eg hiv, west Nile, occult bacteremia

Treatment of CMV infection or flare in transplant patient

Gancyclovir

Which vaccines are contraindicated in transplant patients

Live vaccines : MMR, varicella, rotavirus

Three categories of transplant rejection

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,

Clinical presentation kidney transplant rejection Work up Management

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

How do heart transplant patients in rejection present

Generalized fatigue, feeding intolerance, fever | Can also see chf, dysrhythmias

Management heart transplant failure

Iv steroids Isoproterenol for bradysyrhythmias Dopamine or dobutamine for hypotension Obviously get to transplant centre

5 causes of normocytic anemia

``` Bleeding Hemolysis Aplastic Sickle cell Chronic disease / kidney disease ```

Findings in iron deficiency anemia

Low iron High TIBC Low percentage saturation Low ferritin

Causes sideroblastic anemia

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

4 causes of aplastic anemia

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

Four types of hereditary hemolytic anemias

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

4 examples of acquired hemolytic anemia

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

Blood test findings in hemolytic anemia

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