Allergy & Immunology

Question 1

Tx of anaphylaxis

Answer 1

IM Epi, corticosteriods and H1 blocker(diphenhydramine, or hydroxyzine)

Question 2

Angioedema

sx?

Answer 2

sudden swelling of the face, palate, tongue and airway in association with minor trauma to the face, hands or ingestion of ACEi. +/- stridor, ab pain and lack of response to steroids

• *NO URTICARIA OR PRURITIS!
• may be hereditary due to C1 esterase inhibitor deficiency

Question 3

dx of angioedema?

Answer 3

low levels of C2, C4 and C1.

Question 4

tx of angioedema

Answer 4

epinephrine then Icatibant(bradykinin B2 antagonist), androgens(danazol, stanazol), Fresh frozen plasma

Question 5

Urticaria

sx? tx?

Answer 5

sudden swelling of the superficial skin layers ccaused by: insects, medication, pressure, cold, vibration.

tx: antihistamines or LT antagonist

Question 6

man with neurosyphillis who is allergic to PCN and has a hx of essential tremor tx with propanolol. tx?

Answer 6

stop propanolol and desensitize to PCN. if you dnt stop propranolol can worsen anaphylaxis and interfear with epi administration in the event of anaphylaxis

Question 7

sx of Allergic Rhinitis

Answer 7

recurrent episodes of nasal itching, stuffiness, rhinorrhea, paroxysms of sneezing, eye itching and dermatitis. Inflammed boddy nasal mucosa, pale turbins and +/- nasal polyps

Question 8

tx of allergic rhinits?

Answer 8

avoid!, intranasal steroids, antihistamines, nasal saline wash/spray

Question 9

CVID

sx?

Answer 9

Impaired maturation of B cells = have b cell but they dnt make Ig!

• recurrent sinopulmonary infection
• sprue-like malabsorption
• GIARDIASIS
• older patient(teens+)
• often linked with AI disorders
• enlarged lymph nodes, adenoids and spleen
• decreased all Ig! (especially IgA & IgG
• normal Tcells, normal B cell #s

Question 10

Tx of CVID

Answer 10

abx for infections + IVIG infusions

Question 11

XL agammaglobulinemia/Bruton’s

Answer 11

absent B-cells due to them not maturing past proB.

• normal T cells
• NO Bcells = small/absent lymph, adenoids and spleen
• male children(XLR) with recurrent sinopulmonary infections

Question 12

tx of Brutons agamm?

Answer 12

IVIG & ppx abx

Question 13

IgA Deficiency

sx? tx?

Answer 13

• recurrent sinopulmonary infections
• spruelike malabsorption syndrome
• increased incidence of ATOPIC conditions
• anaphylaxis when recieving blood donations
• recurrent GI infections

tx: tx infections as they arise

Question 14

how do you prevent anaphylaxis with pt who have IgA deficiency

Answer 14

washed pack RBCs on transfusion

Question 15

Hyper IgE syndrome

sx? tx?

Answer 15

recurrent SKIN INFECTIONS caused by STAPHYLOCOCCUS

tx: ppx w/Docloxacillin or Cephalexin

Question 16

SCID sx? tx? cause?

Answer 16

ADA mutation resulting in low B/T cells

• everythigns gone = get AIDs like infections
  tx: abx + BONE MARROW TRANSPLANT

Question 17

Wiskott-Aldrich Syndrome

inheritance + sx?

Answer 17

XLR, WAITER
Wiskott
Aldrich
IgE/A increased
Thrombocytopenia
Eczema
Recurrent infections

Question 18

Chronic Granulomatous Disease

sx?

Answer 18

• def NADPH = cant make oxide to kill shit = make granulomas instead
• extensive inflammatory rxn w/purulent material that just dnt heal, increase risk of Aphthous ulcer & infalmmation of the nares. Granulomatous formation that may obstruct GU/GI tract, increased infections with catalast + organims

Question 19

CGD are at an increased risk of infections with what bugs? name them!

Answer 19

catalase + = SPACE-LMN = Staph A, Pseudomonas, Aspergillus, Candida, Ecoli, Listeria, Mycobaterium, Nocardia

Question 20

dx of CGD

Answer 20

negative Nitroblue tetrazolium or Dihydrorhodamine test = doesnt turn paper blue = no superoxide made = neutrophils are messed up due to CGD

Question 21

Pt experiences angioedema after a surgical or dental procedure. What can be given as prophylaxis for the next procedure?

Answer 21

Any of the following: antifibrinolytics(tranexamic acid), androgens(danaxol, stanozolol), infusion of C1 inhibitor

Question 22

Mutation associated with Hyper-IgM syndrome? sx?

Answer 22

CD40 ligand, increase sinopulmonary infections - increased IgM and low levels of all other Ig w/normal # lymphocytes

Question 23

DiGeorge Syndrome

sx? tx?

Answer 23

CATCH22: Cardiac defects, Abnormal faces, Thymic dysplasia(no Tcells or Low T cells), Cleft Palate, Hypocalcemia, 22q11 deletion mutation

TX: bone marrow transplant and IVIG for ab deficiency, ppx against PCP(bactrim)

Question 24

Ataxia-telangiectasia

mutation/inheritance? sx? tx? what are these patients at an increased risk of?

Answer 24

Mutation: AR mut in ATM - DNA repair defect = dsDNA breaks
SX: progressive cerebellar ataxia & oculocutaneous telangiectasis, increased risk of CANCER = non hodgkin lymphoma, leukemia, gastric carcinoma

TX:may need IVIG

Question 25

Severe Combined Immunodeficiency(SCID)

mutation? sx? tx?

Answer 25

Mutation: XLR mutation causing defect in ADA & JAK causing SEVERE lack of T & B cells = “bubble boy disease”
SX: severe frequent bacterial infections, chronic candidiasis & other opportunistic organisms
TX: bone marrow or stem cell transplant, IVIG & PCP ppx