Allergy, Immunology, Poisoning

Question 1

child in impoverished neighborhood, language regression and anemia due to =

results from inhibition of ferrochelatase and _________, and leads to elevated zinc protoporphyrin levels

Answer 1

lead toxicity

delta - aminolevulinic acid dehydratase

Question 2

hepatitis B virus does not have a cytotoxic effect itself, however, the presence of viral HBsAg and HBcAg on the cell surface stimulate the host’s __________ to destroy infected hepatocytes

Answer 2

CD8+ CTL

Question 3

skin rash, photosensitivity, arthralgias, renal disease in 23 year old caucasian female =

antibodies include ANA, anti smith, and _______

Answer 3

SLE

anti-dsDNA

Question 4

acute salicylate intoxication typically presents with nausea/vomit, confusion, dizziness, ______, fever, and tachypnea. Patients present with respiratory ________ which occurs first, resulting in increased ventilation and loss of CO2 as salicylates directly stimulated medullary respiratory center. Then __________ begins to develop 12 hours later, which will present with an acidotic pH with both low plasma HCO3 and PaCO2.

Answer 4

Tinnitus

alkalosis

anion gap metabolic acidosis

Question 5

recurrent episodes of colicky abdominal pain and facial swelling likely has ______ due to ________ deficiency. It causes increased cleavage of C2 and C4 and results in unchecked conversion of kininogen to ________ resulting in increased levels and angioedema

Answer 5

angioedema

C1 inhibitor deficiency

bradykinin

Question 6

the structure genes for pilus proteins (gonococci virulence) undergo _____________ at a high frequency, preventing long lasting immunity from developing

Answer 6

antigenic variation

Question 7

boy with fever, chills, rash, sore throat, diffuse eyrthematous rash on chest and abdomen that blanches with pressure, numerous 1-2mm papules. The throat is erythematous with gray white tonsillar exudates and tongue is bright red =

due to

predisposes to __________ and glomerulonephritis

Answer 7

Scarlet fever

Group A streptococcus (pyrogenic exotoxins)

acute rheumatic fever

Question 8

treatment for diphtheria (fever, difficulty breathing, no vaccinations, neck swelling, gray pharyngeal exudate) include _________, Abx, and active immunization. Of these, _________ with antitoxin is the most important

Answer 8

passive immunization

passive immunization

Question 9

nonpathogenic Corynebacterium diphtheriae can cause severe pseudomembranous pharyngitis after acquiring the ____ gene via lysogenization by a temperate bacteriaphage

Answer 9

Tox

Question 10

_________ can cause severe constipation and should be suspected if patients are residing in a home built before 1978. Diagnosis made by measuring the patients blood level

Answer 10

lead poisoning

Question 11

________________________ associated with IgA and C3 deposition is typical of HSP. Most common in kids 3-11 with recent infection. Present with palpable skin lesions with or without __________ and _________. Should be carefully observed for glomerulonephritis

Answer 11

Small vessel leukoclastic angiitis

abdominal pain, arthralgia

Question 12

acute pruritic rash, history of environmental allergies and hives =

triggered by IgE dependent ______ degranulation

in older patients, _________ such as diphenhydramine, chlorpheniramine, hydroxyzine, promethazine) should be avoid while newer generation antihistamines such as _______ and cetirizine should be used

Answer 12

urticaria

mast cell

1st gen antihistamines

loratadine

Question 13

the HiB vaccine consists of a capuslar polysaccharide conjugated to a carrier protein ________ or outer membrane protein of Neisseria meningitidis. Protein conjugation causes a ___________ leading to long term immunity through the production of memory B lymphocytes

Answer 13

Tetanus toxoid

T cell mediated immune response

Question 14

the most important opsonins (coating proteins) are IgG and ______

Answer 14

C3b

Question 15

nasal mucosa ulcers and glomerulonephritis are most characteristic of -________

_____________are virtually pathognomonic

smooth muscle cell antibodies are seen in ________

GBM antibodies are seen in ___________

Answer 15

granulomatosis with polyangiitis (Wegener’s)

c-ANCA (antineutrophil)

autoimmune hepatitis

Goodpastures

Question 16

most adverse drug reactions are _______. Unpredictable reactions are less common and are due to genetic differences, immune interactions, or other mechanisms

Answer 16

predictable

Question 17

Most available rodenticides contain brodifacoum (similar to warfarin). Patient who ingested significant quantity requires immediate treatment with ________ in addition to vitamin K

Answer 17

fresh frozen plasma

Question 18

__________ and _________ are the major cause of morbidity and mortality from theophylline intoxication with with the former being the most significant

Answer 18

seizures

tachyarrhythmias

Question 19

___________ is the major virulence factor of Streptococcus pyogenes. It inhibits phagocytosis and complement activation

Answer 19

Protein M

Question 20

________ should be avoided in patients who have low C1 esterase inhibitor activity due to risk of angioedema

Answer 20

ACEI (captopril)

Question 21

anaphylactic shock is characterized by vasodilation, increased vascular permeability, bronchoconstriction. _______ counteracts these physiological meachanisms and is the drug of choice for this

Answer 21

epinephrine

Question 22

_______ is an essential protein in the activation of IL2, which promotes the growth and differentiation of ______. Immunosuppresants such as cyclosporine and tacrolimus work by inhibiting its activation

Answer 22

calcineurin

Question 23

wheal and flare lesions (bee sting) result from allergic _____ reactions. Initial exposure promotes antibody class switching to IgE. following exposures result in mast cell degranulation of _________

Answer 23

Type 1 HSR

histamine

Question 24

septic shock is due primarily to the actions of ______, IL1 and IL6

Answer 24

TNF alpha

Question 25

_________ is a relatively specific marker for mast cell activation and is elevated in anaphylactic shock

Answer 25

tryptase

Question 26

the high affinity IgE receptor (FceRI) is found on the surface of mast cells and basophils and normally binds the Fc portion of circulating IgE Abs. Cross linking of multiple membrane bound IgE Abs by a multivalent antigen results in ___________, causing degranulation

Answer 26

aggregation of FceRI receptors

Question 27

the triad of __________ is nongonococcal urethritis, conjunctivitis, and arthritis. It is an HLA - _____ assocaited arthropathy. It can cause ______ in about 20% of cases

Answer 27

reactive arthritis B27 sacroiliitis

Question 28

Hyperimmunoglobulin M (hyper IgM) syndrome results from defective Ig class switching due to a defect in ___________ interaction. Absence of ________ is the most common cause and is inherited in an X linked Recessive pattern. Clinical features include recurrent sinopulmonary, GI, and opportunistic infections

Answer 28

CD40-CD40L CD40L

Question 29

Pneumococcal conjugate vaccines are strongly immunogenic in infancy due to both ________ recruitment. The pneumococcal polysaccharide vaccine is poorly immunogenic in infants due to their immature ___________

Answer 29

B and T cell humoral immunity response

Question 30

patients can develop ___________ from high nitroprusside infusion, and presents with altered mental status, seizures, CV collapse, lactic acidosis, and bright red venous blood. Antidotal treatment can be achieved by 3 strategies: Direct binding of cyanide ions: induction of methemoglobinemia: and use of detoxifying donors (_____):

Answer 30

cyanide toxicity hydroxocobalamin sodium nitrate sulfur; sodium thiosulfate