Allergy/Immunology Flashcards
Pneumocystis jirovecii prophylaxis is recommended in which primary immunodeficiency below? [Hamilton] A. Chronic granulomatous disease B. DiGeorge syndrome C. Wiskott-Aldrich syndrome D. Common variable immunodeficiency E. Complement deficiency
WAS
PCP for T cell/combined
- Digeorge: immunodeficiency rare, so unlikely opportunistic
- CVID - limited to B cells
- Complement: encapsulated bacteria, not opportunistic
In what situation is immunotherapy beneficial?
a) Food allergy
b) Bee sting allergy
c) Penicillin allergy
d) Atopic dermatitis
Bee sting allergy
A 6mos male has several abscesses (S. aureus) now and in the past. He has also had recurrent respiratory infections and Serratia UTI. Now has butt abscess. Which diagnosis is most likely?
a) SCID
b) LAD 1 def
c) CGD
d) Bruton’s agammaglobulinemia
Abscesses
Staph + serratia = catalase+
CGD
SCID = combined, bacterial, viral, fungal. Chronic diarrhea -> FTT. No LN/tonsil/thymus. Low T #+fxn, low B fxn. Medical emergency, needs HSCT
LAD = phagocytic. >4wk for umibilical cord. No pus. High ANC (think leukocyte). No CD11/18.
XLA = BTK. no B cell -> no LN/tonsils, no Ab.
A 2 year old male has a history of cervical adenitis at 18 months of age that required drainage and IV antimicrobials. Pus was obtained and the culture was positive for S. aureus. He has diarrhea that started 2 months ago and poor weight gain. His labs reveal: Normal CBC, differential, IgG, IgA, IgM Normal CD4+ T cell and CD8+ T cell numbers What is the most likely diagnosis? A. Common variable immunodeficiency B. Complement deficiency C. Leukocyte adhesion defect D. Chronic granulomatous disease
CGD
LAD - no pus
CVID - would expect probs with B cell function
Which condition can be treated with immunotherapy? [Hamilton]
a) Food allergy
b) Venom allergy
c) Penicillin allergy
d) Urticaria
Venom allergy
Aeroallergen allergy for allergic rhinitis, allergic asthma, atopic dermatitis
Child got IVIg recently. How long do you have to wait before giving the DTaP vaccine? a) Give now b) Wait 4 weeks c) Wait 8 weeks d) Wait 11 months ----------- When can you give DTap-IPV vaccine after ivig? a) Now b) 4wks after the ivig c) 8wks after the ivig d) 11 months
Give now
If MMR+/V, would depend on dose (0.2-2mg/kg), 3-11mo, but wait 11mo to be safe
Ideally give vaccine 14d prior to IVIG or until Ab in the Ig preparation or blood product have been degraded. If not during this time, repeat as per schedule
A 15-year old boy with recurrent pneumonias, RMLx3, RLL, LLL in the past. What would you do to investigate?
a) Quantitative immunoglobulins
b) Pulmonary function tests
c) Lung scan
?Quantitative immunoglobulins
Would be more concerning if >=2 pneumonias in past 1y
Maybe lung CT for bronchiectasis?
Multiple lobes doesn’t suggest anatomic abN
Child is brought to the ER with anaphylaxis. Epinephrine should be administered by which route? [Hamilton]
a) Subcutaneous in the abdomen
b) Intramuscular
c) Subcutaneous in the thigh
d) Intravenous
IM
Child with symptoms of rash with egg ingestion, here for 1 year MMR vaccinations
a) Refer to allergist
b) Give him entire dose of MMR vaccine in your office and observe
c) Break up the doses of MMR and administer in office with observation
Give him entire dose of MMR vaccine in your office and observe
A teenager has a tingling feeling in her mouth when she eats apples and peaches. What is the best test to confirm the diagnosis?
a) IgE (RAST)
b) Oral food challenge
c) Skin prick testing to pollen
SPT to pollen
A 7 year old girl is newly diagnosed with ovarian Burkitt lymphoma. She has no prior history of significant infections, but her parents note that she has always been a clumsy child and has difficulty climbing stairs, writing and doing up buttons. As you are taking the history, you notice that she sways from side to side while sitting and has oculomotor apraxia.
An MRI of her brain demonstrates diffuse cerebellar volume loss.
What is the most appropriate screening test for the suspected immunodeficiency? [Hamilton]
A. ADA level
B. Vitamin B12 levels
C. Alpha fetoprotein level
D. Blood smear
AFP level to screen for ataxia-telangiectasia
- Ataxia in child with lymphoma = think AT!
ADA level = SCID
Vit B12 is leevated in ALPS (enlarged LN)
Blood smears not helpful from PID perspective
Patient with egg allergy requires influenza vaccine. Most appropriate management? [Hamilton]
a) Allergy referral for skin testing
b) Give vaccine in split dose (10% of dose followed by 90% if there is no reaction)
c) Give full dose
d) Do not recommend the vaccination
Give full dose
A 6 month old boy was brought to the emergency department with a second episode of pneumonia. He has had intermittent thrush and diarrhea for the past 2 months.
On examination, he is in respiratory distress and hypoxic. His weight was < 3rd %ile and height was at 25%ile.
His differential shows: Neutrophils 10.8x109/L
Basophils 0.02x 109/L
Eosinophils 0.03x 109/L
Lymphocytes 0.8 x 109/L What is the most likely diagnosis? [Hamilton]
A. X-linked agammaglobulinemia
B. Common variable immunodeficiency
C. Severe combined immunodeficiency
D. Complement deficienc
2 pneumonia, thrush, FTT = RF for PID
SCID
X-linked agammaglobulinemia = male, no B cell, no Ig, no lymphoid tissue
CVID = 1) recurrent infection (sinopulm, GI), 2) autoimmunity, 3) malignancy. No vaccine titres, low IgG
Complement deficiency = Neisseria, encapsulated. Problem with complement
A young girl has hives and swelling the day after eating Chinese food. She was also sick with a URTI at the time. The hives have remained for a few weeks. What do you recommend? a) Antihistamines b) Steroids c) Epi pen d) Allergy testing ------------- 14y girl ate Chinese food 2 weeks ago and has had an urticarial rash since then. What is the best treatment? a) Oral antihistamine b) Administer an epipen c) IV antihistamine d) Oral steroids ------------- Kid ate Chinese food at birthday party. Since then has had 2 weeks of angioedema, urticaria. Rx? a) Steroids b) Antihistamine c) Auto epi injector -------------- Young girl has had 2 week history of urticarial rash and facial swelling, onset after having birthday party at Chinese restaurant. She is well otherwise. Examination – urticaria and angioedema. She also had a cold 3 weeks ago. Treatment: a) Benadryl prn b) Epi autoinjection d) Oral prednisone
PO antihistamine
Child has asthma and anaphylactic reaction to peanuts and you refer to allergist for testing. Mother is apprehensive regarding the serum test that the allergist will perform. She wants to know why the bloodwork? Best answer is:
a) RAST has a higher sensitivity than skin test
b) Child can stay on montelukast for the blood test
c) RAST decreases child’s risk for a severe systemic reaction with the skin test
d) RAST better predicts future anaphylactic rxn’s.
——————-
Child with peanut allergy. You order RAST. Mom asks you why you’re doing it. You tell her that the advantage of RAST is:
a) Avoids anaphylaxis that may happen with skin test
b) Does not have to go off daily meds
c) High sensitivity
——————-
5 year old had a severe reaction to peanut at 1 year of age. He also has asthma. Now, allergist has ordered an IgE level for peanut. Mom is wondering why. What do you tell them?
a) The RAST is more sensitive than skin prick
b) The child does not need to stop taking his montelukast for this test
c) RAST is a good predictor of the chances of a future reaction
d) It prevents systemic reactions that could result from the skin test
——————-
5 yr child with asthma and severe allergic reaction at 1 year of age to peanuts. Allergist wants RAST. Mom unsure about test. How do you counsel her?
a) Rast more specific than skin testing
b) Don’t need to stop his daily monteleukast
c) Rast prevents risk of severe allergic reaction with skin testing
——————-
A child has a history of severe peanut allergies when she was 18 months old. Her allergist now want her to have a specific IgE test for peanuts. Of the following what would you tell her mother?
a) The IgE level will determine how allergic to peanuts she is
b) She will not have to go off of her daily montelukast
c) This test negates the risk of possible anaphylaxis
d) This test is more sensitive than skin testing
—————
RAST.
a) More sensitive
b) No need to go off montelukast
c) Risk of anaphylaxis
d) More indicative of predictive severity
RAST decreases child’s risk for a severe systemic reaction with the skin test
Can also stay on montelukast (can do that with SPT too but would need to be off antihistamines + corticosteroids)
6mos. old baby with bloody diarrhea, eczema, FTT, hepatosplenomegaly, Recurrent Otitis and pneumonia and bloodwork shows Plts 12, and remaining CBC normal with eosinophilia, and lymphopenia. What lab abnormality would you expect:
a) Increased IgE and IgA
b) Decreased CD4 count
c) Neutropenia
d) Abnormal NBT
Increase IgE + IgA
WAS
Other PIDs don’t have plt probs
Which is true regarding serum specific IgE? [Hamilton]
a) More sensitive than skin testing
b) Affected by corticosteroids
c) Affected by antihistamines
d) False positive in patients with elevated total IgE
False positive in pts with elevated total IgE
Skin is more sensitive
Not affected by corticosteroids or antihistamines
What is the treatment for chronic urticaria in a patient who failed H1 antihistamines?
a) H2 – antihistamine
b) Steroids
Would increase dose first
Urticaria Mmgt
1st line: standard dose of 2nd gen antihistamine
If Sx persists after 2wks
2nd line: increase dose by 4X
If Sx persists after 1-4wks
3rd line: Add on montelukast or cyclosporin or (if >12yo) omalizumab
Short course (max 10d) of corticosteroids
An 11 month old presents with a scaly rash all over, especially in the diaper area. He also has exopthalmos and HSM. Xrays show bony lucencies on the scalp. What is the likely diagnosis?
a) Neuroblastoma
b) Langerhans cell histiocytosis
c) ALL
Langerhans cell histiocytosis
18 mo boy with meningococcal meningitis and sepsis. Which is most likely to be abnormal?
a) C3, C4 and CH50
b) Immune globulin levels
c) Lymphocyte count
C3, C4, CH50
A 3 year old boy presents with the following history:
• Pneumonia at 10 months and 27 months of age
• 6 episodes of acute otitis media
• Cord separated at 2 weeks, no abscesses, thrush or fungal infections
• Maternal uncle died from pneumonia at 2 years of age
His physical exam reveals no tonsils or palpable lymph nodes
Which of the following is the most helpful investigation to establish the diagnosis in this patient? [Hamilton]
A. Flow cytometry for T cell numbers
B. Immunoglobulin levels
C. Alpha fetoprotein level
D. Neutrophil oxidative burst index
E. Complement levels
Immunoglobulin levels
sinopulmonary
NO TONSILS OR LN
SCID vs XLA
Baby presenting with eczema, thrombocytopenia and infections. What is the likely diagnosis?
Wiscott-Aldrich
—————
4 month old baby with eczema, petechiae, infection, failure to thrive. What is the diagnosis?
a) Wiskott Aldrich
b) SCID
WAS
Thrombocytopenia
Immunodeficiency: sinopulm
Eczema
