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ENT Written Board Prep > Allergy/Immunology > Flashcards

Allergy/Immunology Flashcards

1
Q

Name implicated foods in oral pollen food allergy syndrome against Birch pollen.

A

apple, almond, carrot, celery, cherry, hazelnut, kiwi, peach, pear, plum (Stone fruits!)

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2
Q

Name implicated foods in oral pollen food allergy syndrome against Ragweed pollen.

A

banana, cucumber, melons, sunflower seeds, zucchini( Melons and cylindrical things!)

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3
Q

Name components of Innate immunity (4) and adaptive immunity (2).

A

innate- nonspecific. phagocytes/natural killer cells, skin/mucous membranes, complement system/proteins, innate lymphoid cells. adaptive - T cells and B cells. specific to antigen.

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4
Q

Function, cell types, and inflammatory mediators of Th1, Th2, and Th17.

A

Th1 - neutrophils. IFN-y, IL-2. Delayed hypersensitivity, bacterial/viral immunity. Th2 - allergy, IgE. Mast cells, eosinophils, IL4, 5, 13. Th17 - autoimmunity; IL17.

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5
Q

Name 3 specific entities implicated as Th2 dominant/eosinophilic entities in CRS.

A

AERD/asthma, AFRS, CRS w NP

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6
Q

Specific functions of IL4, IL5, and IL13?

A

IL4 - IgE. IL5- eosinophil production. IL13 - polyp formation

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7
Q

Shape and function of IgG, IgM, IgE, and IgA?

A

IgG - dimer, chronic immunity/memory. IgM - pentamer, acute response. IgE - dimer, allergy. IgA - dimer, mucous membranes. IgG crosses placenta. IgA is in breastmilk. IgE has lowest serum concentration

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8
Q

Which immunoglobulin crosses placenta?

A

IgG

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9
Q

Which immunoglobulin is in breastmilk?

A

Ig!

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10
Q

Which immunoglobulin has the lowest serum concentration?

A

IgE

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11
Q

IgE: found on surface of which cell types? Induced by what mediator? Inhibited by which mediator?

A

Basophils and mast cells. Induced by Ig4. Inhibited by IFNy [Also a fun fact: confers immunity to helminths]

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12
Q

Fc vs Fab: heavy chain vs light chain? binds to cell or antigen? which determines Ig class?

A

Fc = heavy, binds to cell, determines Ig class. Fab = light chain, binds to antigen.

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13
Q

IgG subclass deficiencies: which ones are a/w protein antigens? polysaccharide antigens? Which one is the most common subclass deficiency in children?

A

protein - 1&3. Polysaccharide = 2&4. IgG2 most common subclass def in children.

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14
Q

What is the immunologic derangement in CVID

A

CVID = quantative + qualitaive issue with IgG.

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15
Q

What is the immunologic derangement in Specific Polysaccharide Antibody Deficiency

A

SPAD = can’t produce sufficient antibodies to polysaccharide organisms.

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16
Q

What is the immunologic derangement in Bruton’s agammaglobulinemia

A

Bruton’s = issue with B cell maturation.

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17
Q

What is the immunologic derangement in Digeorge? What is the mnemonic CATCH-22?

A

DiGeorge = full syndrome, thymic aplasia. C= cardiac defects, A = atresia of the choanae, T= thymic aplasia, C = cleft palate, H = hypocalcemia. 22 = chr 22

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18
Q

What is the immunologic derangement in Wiskott-Aldrich?

A

Wiskott-Aldrich = issue with WAS protein, eczema, bleeding + recurrent infections.

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19
Q

Which immunologic derangement disorders cause susceptibility to encapsulated organisms?

A

Encapsulated organisms: SPAD, Bruton’s.

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20
Q

Which immunologic derangement disorders are X-linked?

A

X-linked: Bruton’s, Wiskott-Aldrich.

21
Q

Which immunologic derangement disordershave B cell issues only? Which ones have B and T cell issues?

A

B cell issues: Bruton’s, SPAD. B&T issues = Wiskott Aldrich, also often CVID, DiGeorge.

22
Q

Which immunologic derangement disorder is implicated in CRSsNP? Which one will have absent tonsils/adenoids? Which one is missing thymus?

A

CRSsNP = SPAD. Absent tonsils/adenoids: Bruton’s. Absent thymus = DiGeorge.

23
Q

Name, Mechanism, and 1-2 Examples of each of the Gel-Coombs Hypersensitivity Reaction Types?

A

I = IgE mediated; anaphylaxis/allergy. II - cytotoxic. Antibody binds to cell and signals inflammatory cells/mediators. Ex - Hashimoto, hemolytic disease of the newborn, transfusion reactions. III= immune complex, antigen-antibody complexes deposit in tissues. Ex - SLE, glomerulonephritis. IV - delayed/cell-mediated. T cell mediated, NOT antibody. Ex- contact dermatitis

24
Q

Adult and Pediatric Doses of Epinephrine?

A

Adult = 0.3mg 1:1,000 epi. Pediatric = 0.1mg 1:1,000 epi. More precise is 0.01mg/kg. Given IM

25
Q

Effect of epinephrine on alpha, beta-1, and beta-2 receptors?

A

alpha = vasocontriction. beta 1 - incr cardiac contractility/rate. beta 2 - bronchodilation, inhibition of mast cell degranulation

26
Q

When do histamine and tryptase levels peak after an anaphylactic reaction?

A

15m for histamine, normal after ~30-40. 2h for tryptase, normal after 6h.

27
Q

Angioedema: mediator in allergy vs ACE?

A

allergy = mast cell mediated. ACE = kinin mediated.

28
Q

mode of inheritance for C1 esterase deficiency? screening test for this condition?

A

Autosomal dominant. quantitative C4 levels (always low)

29
Q

What is dupilumab and what is it used for?

A

dupilumab - monoclonal antibody against IL-4; used for refractory polyposis

30
Q

What is Samter’s triad/AERD? What is the MOA?

A

asthma, nasal polyposis, ASA sensitivity. MOA is disruption of the arachidonic acid pathway leading to increase in leukotrienes

31
Q

Name 3-5 benefits of aspirin rx after desensitization. Can it eliminate pre-existing polyps?

A

Decrease need for surgery, decrease episodes of infectious sinusitis, improve asthma control, improve sense of smell, reduce dosage of daily systemic steroids, decrease nasal congestion. Does NOT eliminate pre-existing polyps.

32
Q

Early vs Late phase of allergic response: a) timing of onset after exposure? b) mediators? c) symptoms?

A

early: 5-15 minutes, mediated by degranulation of mast cells/histamine, rhinorrhea/watery eyes. late: 3-4h, mediated by cellular infiltration with basophils/eosinophils, nasal congestion/postnasal drip

33
Q

Classification of allergic rhinitis: a) cutoff for intermittent vs persistent? b) mild vs moderate/severe?

A

a) intermittent = <4 days a week OR < 4 weeks. Persistent = >4 days a week AND >4 weeks. b) mild = no interference with daily life (sleep, work, etc). moderate = interference with one part of life. severe = interference with more than one part of life

34
Q

Name 3-4 nonallergic causes of rhinitis.

A

vasomotor, hormonal, atrophic, rhinitis medicomentosa, viral, systemic disease, drug-induced

35
Q

In vitro vs skin prick allergy testing: a) influenced by meds? b) cost? c) sensitivity?

A

a) skin prick influenced by meds, in vitro is not. b) in vitro more expensive c) skin prick more sensitive

36
Q

Do oral corticosteroids affect skin test results? Do leukotriene modifiers (-lukasts) affect skin test results?

A

Oral corticosteroids and leukotriene modifiers do NOT affected skin test results.

37
Q

Name 2-3 notable meds that affect skin test results.

A

Theophylline, H1&H2 blockers, TCAs, and topical steroids affect results.

38
Q

Explain how to identified the skin endpoint in skin endpoint titration.

A

Identify the last concentration that led to progressive enlargement beyond 5mm.

39
Q

What is a plateau response in skin testing and how to deal with it? What is a flash response and how to deal with it?

A

Plateau means it flattens out instead of getting progressively bigger — keep going until you get the progressive wheal. Flash response is a suddenly huge response compared to the previous dilution; stop testing and try again in 4-7 days.

40
Q

What is modified quantitative testing?

A

Hybrid testing that basically has replaced skin endpoint titration (SET). You do skin prick to get a range of likely dilutions to start with — then do intradermal testing to identify the specific one (rather than sequential identification like in SET).

41
Q

Assign seasonality to the following: ragweed, dust mites, grasses, trees, weed, outdoor molds, indoor molds

A

trees - spring. grasses - trees. weed/ragweed - fall. outdoor molds - perennial above freezing temperatures. indoor mold + dust mites - perennial.

42
Q

Latex-Fruit Syndrome. Name 4 fruits overlapping with latex allergy.

A

ABC Kiwi. Avocado, banana, chestnut, Kiwi.

43
Q

Name of the protein/allergen implicated in cat allergy?

A

Fel d1

44
Q

Name of the protein/allergen implicated most commonly in peanut allergy?

A

Ara h2

45
Q

What allergic rhinitis pharmacotherapy should be considered in a patient with exercise or cold-induced asthma?

A

Leukotriene receptor antagonists

46
Q

Name 2-3 mechanisms of success for immunotherapy.

A

Reduce allergen-specific IgE (after initial rise). Increased Th1 levels, induction of antigen-specific IgG4. Increase IL-10 secretion - reduces mast cell/eosinophil activation + induces T cell tolerance for specific antigens.

47
Q

What interleukin is implicated in inducing T cell tolerance for specific antigens in immunotherapy?

A

IL-10 implicated.

48
Q

Name 3-4 potential treatments for vasomotor rhinitis.

A

ipratropium, azelastine, capsaicin, vidian neuronectomy

49
Q

What oral medications can cause rhinitis medicamentosa and what is the treatment for this?

A

antihypertensives; change meds/cessation

ENT Written Board Prep (13 decks)

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