Allergy & Immunology Flashcards
1
Q
Hypersensitivity rxns
A
Type I: Immediate, IgE
Type II: Cytotoxic, IgG/M
Type III Immune complex IgG, M
Type IV: Cell Medidiated
2
Q
Type I Hypersensitivity
A
Immediate, IgE
Weed, pollen, dust, grass, mold cat or Dog progeins (atopic), hives, utricaria, peanuts, shellfish, bee stings, drugs
3
Q
Tyope II - Cytotoxic
A
Antibody mediated (no ab/ag complexes)
Hemolytic rxn, goodpastrure’s
hyperacute graft rejection
4
Q
Type III Immune complex IgG/M
A
Serum sickness, SLE, Post Strep Glomerulonephritis, PAN, RA, Arthus rxn, hypersensitive Pneumonitis
5
Q
Type IV Cell medicated
A
PPD, Poison Ivy, Nicketl, Type I DM, acute and chronic graft rejection, Latex
6
Q
IgE
A
Type I
7
Q
Cytotoxic cell mediated (Ab nwsuRWS XTRIRIZUX EZB(
A
Type II
8
Q
Immune complex mediated
A
Type III
9
Q
Cell mediated/delayed
A
Type IV
10
Q
ABPA
A
Type I (mold)
11
Q
Hyperseitivity pneumonitis
A
Type III
12
Q
Rh incompatibility
A
Type II
13
Q
ABO incomaptiblity
A
Type II
14
Q
Arthus rxn
A
Type III (Immune complex dep mediated)
15
Q
Serum Sickness
A
Type III
16
Q
SLE, PAN, RA, Hep B
A
Type III (Hep C low complement)
17
Q
PPD, Poison Ivy, Nickel, Latex
A
Type IV
18
Q
Hyperacute graft rejection
A
Type II
19
Q
Acute or chronic graft rejection
A
Type IV
20
Q
Allergic Rhinitis/Urticaria
A
Type I
21
Q
Wheal and flare
A
Type I
22
Q
Pt with sore throat - hematuria _-> Pre-renal azotemia
A
Antigen-ab rxn (type III)
23
Q
Pt receiving IV abx for endocarditis - pt c/o arthralgias - mechanism of arthralgia is….
A
immune complex depeostion - serum complement low
24
Q
RAST (radioallergosorbent test
A
measures IgE in serum (quantitiative immunoglobulins)
25
Skin testing (pin prick test)
more specific and sensitive
26
Pt with rhinitis, occular itching exacerbated by pollen best test?
Pin Prick test
27
Can you do skin testing if pt on anti-histamine
No - reduces sensitivity for 7 days
28
Nursing student started using latex glove for first time and pw hives - best test to confirm?
RAST for allergy to latex
29
Can yo give allergy injections to ABPA?
NO!! will make it worse
30
Can you give allergy injections to prevent contrast dye rxn or hypersensivity pneumonitis
No not IgE mediated....
31
How can you dx ABPA
Serum IgE level
32
Effetive immunotherapy causes increas in what ab type
IgG
33
What med will you NOT use during immunotherapy
BB - will interfere with epi tx
34
Pt on BB - receives immunotx and gets anaphylactic rxn - in addition to epi what else to give?
glucagon to reverse BB effect
35
Pt has allergy to ASA 0 what NSAID can you use?
Salicylate
36
Best way to reduce rxn in pt allergic to radiocontrast media
Diphenyhydramine, steroids, lower osmolar radiocontrast
37
HLA I ag
most tissues EXCEPT RBCs
presented to T8 cells
responsible for TRANSPLANT rejection and destroying tumor cells
38
HLA II ag
B cells, macrophages, langerhan cells, dendritic cells - presented to T4 helper cells - > responsible for cell mediated immunity
39
Pt gets utricaria when exposed to COLD
cold cryoglobulin - IgE mediated
40
All the following are T cell mediated
```
Nickel
Poison IVY
PPD
Cosmetics/hair dyes
(NOT NSAIDS)
```
41
Which anti inflamm drug contraindicated with sulfa allergy
Celecoxib (has sulfa)
42
Pt with latex allergy while using condoms
polyurethane condoms
43
Pt after seeing needle or blood - becomes anxious, pale diaphoretic and passes out BP 80/60, HR 40 dx?
Vasovagal syncope
44
Pt post IWMI gets TPA - 30min later HR 35, BP 70/40 wtd?
atropine to inc vagal tone
45
Pt gets utricaria when exposed to heat or hot shower
Cholinergic utricaria
46
You suspect allergic rhinitis wtd?
nasal secretions - smear for eosinophils
47
What is effetive in any type of rhinits including perennial allergic rhinitis?
Nasal glucocorticoids
| Cromolyn on good with allergic rhinitis
48
Pt stung by bee pw broncospasm, utricaria, flusing BP 94/60 HR 100 IVF started wtd?
SQ Epinephrine
49
Whic of follwing would benefit from immunotx?
Bee keeper
| not ABPA, not hypersensitiveity pneumonits
50
Pt with wasp sting, local wheal, burnign sensation wtd?
cool compress, antihitamine, topical calamine, elevate for local rxn
51
Young man was picking apples and was stung by bee - next day presents to you with large wheal on R arm - itch wtd?
reassurethat this is normal rxn to insect bite
52
Bee stings on face, neck throat ->
swelling lips, tongue largngeal edema
53
Bee sting to other parts of body
local rxn
54
Immune defiicenices
```
dec'd ab (immunoglobulins
MM
AIDS
Asplenia
ALL/CLL
CVID
All inc'd risk for capsulated bugs - S pneumo, H flu, Meningiococcus
```
B cells -> plasma cells -> Ab's (HLA II)
55
MOst common Immunoglobulin def
IgA def
56
Does IVIG help in IgA deficieny?
No - causes anaphylaxis
57
IN IGA nephropathy what is complement level?
Normal
58
Pt with severe IgA deficiency which is contraindicated
IVIG - anaphylaxis
| HAV vacc, HBV vacc, FFP, plts all ok
59
32yo Pt with recurrent sinusitis for 5 years - nasal endoscopic surgery done couple years ago now pw facial pain and xray shows total opacification of maxillary sinuses
Immunoglobulin titers
60
Pt with recurrent bronchitis x 25 years - when he takes TMP-SMZ infxn resolves CXR normal wtd?
Immunoglobulin titers
61
Neutropenia
Bacterial: Pseudomonas, corynebacterium jeikeium
Fungal: andida, aspergillus (halo sign), Mucor
Tx: INc'd count with G=-CSF and tx infection
62
Phagocytic deficit
Staph aureus, Gram neg, fungal, nocardia
Able to INGEST , but UNABLE to DIGEST - recurrent infections, fhx for recurrent infexns, NBT abnormal failure to produce O2 super radicals
dx: Chronic granulomatous dz, NADPH oxidase deficiency
Tx: Interferon gamma and abx
63
Chronic mucocutaneous candidiasis
Candidiasis of skin and MM
severe, recurrent thrush, onychomyosis, vaginitis, chronic skin lesions
maylook hyperkeratotic, crusted on face, scalp, hands
64
Solitary furuncle infection 4x in past 5 years - easily tx with incision and drainage
DX: Nasal colonization with staph (under finger nails)
| Can eradicate with mupirocin ointment and rifampin
65
Complement C1 esterase inhibitor deficiency
Hereditary angioedema
responds to FFP
no response to Epi
66
Type I hereditary angioedema
dec'd C4, dec'd C1 inhibitor (total)
67
Type II hereditary angioedema
Dec'd C4, NORMAL C1 inhibitor total but dec'd C1 inhibitor fxn
68
Acquired Angioedema
all decreased (C4, C1q, C1 inhib total and fxn)
69
ACEi induced angioedmea
All normal (C4, C1q, C1 inhib total and fxn)
70
Pt after pillow fight or after camping with non-pitting facial edema - no itching - similar sx before - most likely dx?
C1 esterase inhib deficiency - if don't know why welling - r/o C1 esterase inhibitor deficiency
71
Teen pw swelling arm, no erythema or itching what to expect
Low C4, CH50
| screen for C1 esterase inhibitor deficiency
72
Pt post excercise deelops swelling of arms, no hx of trauma, father died at early age wtd?
check C2, C4
73
Pt hiking in shenandoah mtns pw facial swelling no itching no erythema wtd?
C1 esterase inhibitor activity level
74
Best management for pt with facila swelling ,laryngeal edema and h/o C1 esterase inhibitor deficiency
FFP (NOT EPI)
| Long term tx: Danazol -> stimulates release of C1 esterase inhibitor
75
SLE
Complement dec'd (C3 more than C4)
76
IgA nephropathy
Complement normal
77
Post strep GN
complement dec'd (C3 only dec'd)
78
Wegeners
complement normal
79
Churg Strauss
COmplement normal
80
PAN
Complement normal
81
Cryoglobulinemia
complement dec'd (C4 more than C3)
82
Goodpasture's
complement normal
83
Membranoproliferative nephritis
Complement dec'd
84
Pt h/o meningiococcemia and gonorrhea what test to order?
CH50
| if dec'd check C5-9
85
Pt with SLE, CH50 undectectable - what complement component def suspect?
C3
86
Pt with recurrent infections in skin, sinusitis, PNA now with liver abscess - Immunoglobulins normal, CH50 low which complement likely deficient?
C3
| Major opsonin of complement system responsible for defense against encapsulated bacteria
