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Peds Boards > Allergy/Immunology > Flashcards

Allergy/Immunology Flashcards

1
Q

Skin testing for which type of allergy is fairly unreliable?

A

Food allergies

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2
Q

For how long can food allergy symptoms continue to progress after ingestion?

A

2 hours

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3
Q

What are some common allergies in infants and toddlers?

A

Eggs
Milk
Soy
Wheat

Usually outgrown by 5 years

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4
Q

What medications blunt the effect of epinephrine?

A

Beta blockers

Give glucagon to reverse the effect and then give epi

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5
Q

What are the features of a true milk protein allergy?

A
  • True IgE mediated allergy
  • GI symptoms + extraintestinal symptoms
  • Vomiting, diarrhea, GI bleeding
  • Eczema, wheezing
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6
Q

What are the features of food protein induced enteropathy?

A
  • aka, Formula induced enteropathy
  • Sxs: diarrhea +/- emesis, bloody stool while on formula but not on clears or non-whole-protein-containing formulas
  • Dx: flexible sigmoidoscopy with bx
  • Tx: stop milk, change to hydrolysate formula or amino acid derived formula
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7
Q

What are the 4 types of hypersensitivity reactions?

A
  1. Type 1: IgE mediated, Anaphylactic (PCN allergy, if rxn occurs >24 hrs after administration, it is not a PCN allergy)
  2. Type 2: antiBody mediated = B cell = Humoral
  3. Type 3: immune Complex
  4. Type 4: Delayed = T cell mediated = Cellular immunity
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8
Q

What are the drugs that cause and symptoms of Anticonvulsant Hypersensitivity Syndrome?

A
  • Drugs: Carbamazepine, Phenobarbital, Phenytoin

- Sxs: Fever + LAD + Rash +/- Visceral involvement

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9
Q

What are the symptoms of and treatment for serum sickness?

A
  • Sxs: arthritis, arthralgias, nephritis, rash within 1 to 2 weeks of exposure
  • Tx: remove offending agent, anti-histamines for pruritis and rashes, NSAIDs for fever, steroids for severe symptoms
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10
Q

How do you test for humoral defects?

A

AntiBody tests

  • Isohemagglutinins
  • Serum IgG (subclasses from previous vaccination to tetanus, varicella, rubella)
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11
Q

What tests do you do to check for cellular defects?

A

Type IV Delayed Type Hypersensitivity Anergy

  1. Skin testing: PPD, candida, mumps, tetanus
  2. Candida delayed type hypersensitivity intradermal test.
    • If >10mm after 48 hrs, cellular immunity is intact, no primary T cell defects
    • If test is negative ->
  3. Lymphocyte count, T-cell subtype with flow, lymphocyte stim test

T-cell mediated immunity includes activation of antigen specific cytotoxic T lymphocytes, macrophages, NK cells, and CD4 cells

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12
Q

How do you test for phagocytic defects?

A

DHR test

Nitroblue Tetrazolium dye

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13
Q

How do you test for complement defects?

A

Total complement assay (CH50)

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14
Q

What are the clinical features of T-cell mediated immunity?

A
  • Activation of antigen specific cytotoxic T lymphocytes, macrophages, and NK cells
  • Recurrent viral, fungal, and bacterial infections
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15
Q

What are the clinical features of severe combined immunodeficiency (SCID)?

A
  • T and B cell deficiency
  • Lymphopenia
  • No LAD
    • thymus
  • BMT is an option
  • All kinds of infections (viral, bacterial, fungal, opportunistic)
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16
Q

What are the five cardiac associations with DiGeorge syndrome?

A

“A curious George INTERRUPTS you to look through all FOUR TRUNKS full of treasure. His greatest find is a PALM tree studded with Very Sparkly Diamonds which he accidentally drops into the CANAL.”

INTERRUPTS = interrupted aortic arch
FOUR = tetralogy of fallot 
TRUNKS = truncus arteriosus
PALM = pulmonary stenosis with 
Very Sparkly Diamonds = VSD
CANAL = AV Canal
17
Q

What are the clinical features of DiGeorge syndrome?

A
  • 22Q11.2
  • Diagnosed with FISH
  • No thymus (BMT does not cure) -> no T cells -> no antigen presentation -> no B cells
  • Cardiac problems
  • Hypoparathyroidism
  • Velocardiofacial Syndrome: palatal abnormalities + cardiac abnormalities + craniofacial abnormalities (unusual palpebral fissures, broad nasal root, narrow upper lip)
18
Q

What are the clinical features of ataxia telangiectasia?

A 
ATAXIA
A: ataxia (cerebellar)
T: telangiectasias
A: AFP elevated
X: visual motor disturbances
I: immune deficiency (pneumonia, decreased T cell fxn, increased risk of malignancy)
A: abnormal cognition and neuro
19
Q

What are the clinical features of common variable immune deficiency?

A
  • B cells fail to transform into plasma cells
  • Deficiency of all Ig subtypes
  • Tx: IVIG
20
Q

What kind of infections are those with B cell deficiencies predisposed to?

A 
Encapsulated organisms
"Some Nasty Killers Have Some Capsular Protection."
Streptococcus pneumoniae 
Neisseria meningitidis
Klebsiella pneumoniae
Haemophilus influenzae
Salmonella typhi 
Cryptococcus neoformans
Pseudomonas aerginosa
21
Q

What are the clinical features of Hyper IgM Syndrome?

A
  • IgM to IgG switch does not occur due to missing signal
  • Lymphocytosis and neutropenia
  • T-cell abnormality
  • Tx: IVIG
22
Q

What are the clinical features of Bruton’s Agammaglobulinemia?

A
  • X-linked = only in boys
  • High T-cell counts
  • Total absence of B cells
  • No nodes
  • Recurrent infections with encapsulated organisms
  • No PCP pneumonia
  • Tx: IVIG, BMT
23
Q

What are the clinical features of transient hypogammaglobulinemia of infancy?

A
  • B cells are not deficient
  • Low levels of IgG +/- IgA
  • Infections similar to Bruton’s around 3 to 6 months
  • No treatment in asymptomatic patients
  • Usually outgrow by 3 to 6 years of age
24
Q

What are the clinical features of Hyper IgE syndrome?

A
  • Autosomal dominant
  • Impaired neutrophil chemotaxis
  • Eosinophilia + Eczema + Elevated IgE
  • Eczema starting the first week of life
  • Recurrent sinus and pulmonary infections
  • Pneumatoceles seen on chest x-ray after a pneumonia
  • “Cold” staph infections (no surrounding erythema due to impaired neutrophil chemotaxis)
  • Delayed shedding of primary dentition
25
Q

What do patients with C5-9 complement deficiency get frequently?

A

Neisseria infections

26
Q

What conditions have low complement levels?

A 
"Even though CPS is COMPLEMENTARY, they need MANy more MEMBerS of their staff to Hack it."
Cryoglibulinemia
Poststreptococcal glomerulonephritis
Systemic lupus erythematosis
MANY: multiple myeloma
MEMBranoproliferative glomerulonephritis
Sjögren's syndrome
Hepatitis C
27
Q

What are the clinical features of leukocyte adhesion deficiency?

A
  • Adhesion defect -> neutrophils can’t leave the vasculature to get to infected areas
  • No pus/inflammation
  • Delayed umbilical cord separation
  • Delayed wound healing
  • Leukocytosis, Neutrophilia
  • Dx: CD11/CD18 flow cytometry
28
Q

What are the clinical features of Chediak-Higashi syndrome?

A

CHINA
Chediak
Higashi
Infections: skin, lung
Neutropenia (poor neutrophil chemotaxis, platelet dysfunction) - Neutrophils contain giant lysosomal granules
Neurologic dysfunction (peripheral neuropathy)
Albinism (oculocutaneous)

Peds Boards (24 decks)

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