allergy/immunology

Question 1

risk of atopy if one parent has atopy

Answer 1

50%

Question 2

risk of atopy if both parents have atopy

Answer 2

70%

Question 3

risk factors for asthma persisting into adulthood

Answer 3

onset < age 3
IgE elevation
parental hx
atopic dermatitis

Question 4

percent of children with mild asthma who outgrow sx

Answer 4

60%

Question 5

percent of children with severe RSV who develop recurrent wheezing

Answer 5

50%

Question 6

when is skin prick testing not reliable

Answer 6

antihistamine use
antidepressants
eczema

–> do IgE testing (higher cost, higher false positive)

Question 7

firt line tx for allergic rhinitis

Answer 7

nasal steroids

Question 8

nasal polyps, aspirin intolerance, asthma

Answer 8

aspirin exacerbated respiratory disease

Question 9

rhinitis triggered by emotion, pollution, cold drafts, rapid temperature change, humidity change

Answer 9

vasomotor rhinitis

Question 10

rebound reaction to adrenergic nose drops

Answer 10

rhinitis medicamentosa

Question 11

how old to develop allergic rhinitis

Answer 11

> 3 yo

Question 12

tinging in/around mouth when eating a specific food

Answer 12

oral allergy syndrome

Question 13

who should be sent for food testing

Answer 13

severe eczema

persistent asthma

Question 14

fruits to avoid in latex allergy

Answer 14

avocado
banana
chestnut
fig
kiwi
peach
tomato

Question 15

which food allergies are often outgrown

Answer 15

milk, eggs, soy

Question 16

when to test for peanut allergy before introduction of peanuts

Answer 16

severe eczema or egg allergy –> skin or IgE testing

if > 0.35, go to allergist

Question 17

when to introduce peanuts into diet

Answer 17

4-6 mos

6 mos for infants with mild to mod eczema

Question 18

timeframe for chronic urticaria

Answer 18

> 6 weeks

Question 19

tx of chronic urticaria

Answer 19

2nd/3rd gen antihistamines

Question 20

who needs allergy testing after bee sting

Answer 20

only systemic allergic reaction

Question 21

how to remove bee stinger

Answer 21

ASAP

scrape with credit card/fingernail - do not squeeze

Question 22

deep abscesses, pneumonia, osteomyelitis, urinary/bowel obstruction

Answer 22

CGD
XL
NBT or phagocytic burst test

ppx with bactrim and itraconazole

NO live vaccines

Question 23

leukocytosis, indolent skin infections, perirectal abscesses, no pus in infections

Answer 23

LAD

dx: flow cytometry

Question 24

easy bruising, oculocutaneous albinism, recurrent sinopulmonary and skin infections

Answer 24

Chediak Higashi
AR
dx: smear - lysosomal granules in WBCs
Staph, Strep pyogenes, pneumococcus

Question 25

recurrent sinopulmonary infections, anaphylaxis to transfusion

Answer 25

IgA deficiency

most common primary immunodeficiency

Question 26

small lymphoid tissues, recurrent sinopulmonary/encapsulated infections

Answer 26

Brutons X-L agammaglobulinemia
humoral deficiency
dx:immunoglobulin levels, B/T subsets

tx: IVIG

Question 27

recurrent respiratory and GI infections, HSV and VZV; increased autoimmunity and lymphoma

Answer 27

CVID
B and T cell defect

tx: IVIG

Question 28

boy with frequent otitis, sinopulmonary infections, diarrhea, opportunistic infections; lymphoid hypertrophy, PCP infection

Answer 28

Hyper IgM
XL
T cell defect –> class switching problem
dx: immunoglobulin levels

tx; IVIG

Question 29

eosinophilia, eczema, recurrent skin and sinopulmonary infections

Answer 29

Job = Hyper IgE
staph aureus, chronic thrush, abnormal facies, fractures
tx: antibiotics, steroids

Question 30

decreased immunity, outgrown by 3-6 years

Answer 30

transient hypogammaglobulinemia of infancy

low IgG, normal IgM

Question 31

ataxia, conjuncival discoloration, developmental regression, frequent sinus infections

Answer 31

ataxia telangiectasia - AR

Question 32

neonatal tetany, congenital heart disease, low set ears

Answer 32

DiGeorge - 22q11 
AD/de novo
no parathyroids, small/absent thymus
20% with ID
incr freq of learning disabilities and psych

Question 33

FTT, chronic diarrhea, recurrent opportunistic infections

Answer 33

SCID

dx: CBC with leukopenia, absence of T cell function
tx: BMT

ADA deficiency is one form

Question 34

eczema, recurrent sinopulmonary infections, easy bleeding/bruising

Answer 34

WAS
XL
cellular deficiency
encapsulated and opportunistic infections

Question 35

most common cause of death in WAS

Answer 35

lymphoma

Question 36

can kids with complement deficiency get vaccines

Answer 36

yes