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allergy questions Flashcards

1
Q

15kg child dev anaphylaxis, how much 1:1000 epi do you inject?

A

child: 0.01 mg/kg = .15mL

adult 03.-0.5 mL

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2
Q

what is used in treatment vials as preservative? at what [ ] ? how long does it keep? as a bacteriostatic agent?

A

10% glycerin
breaks down after 6-8 weeks, so preserves vial for 12 weeks
phenol

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3
Q

what cytokines are halmark for Th1? Th2?

A

A major theory of allergy is based on the difference between Th1 and Th2 Tcells. Th1 steer the immune system towards fighting infection/autoimmunity by activating macrophages. The main cytokines of Th1 modulated defenses are IFN, IL2, and TNF. Th2 cells steer the immune system towards defense of parasites/worms which require the release of IgE. There is a main theory that an allergic person’s immune system is imbalanced, favoring Th2 reactions whenever an allergen is encountered. The cytokines involved in Th2 immunity are: IL4, IL5 (assoc’d with eos), IL10, IL13.

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4
Q

what are risk factors to anaphylaxis in immunotherapy?

A

. Risk factors for anaphylaxis include: labile/symptomatic asthma, buildup phase of IT, high sensitivity by testing, previous anaphylaxis during prior injections, active allergy season, new vial, vial prepared at another office, human error.

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5
Q

During traditional escalation schedule during injection immunotherapy, a patient tolerates 0.10 ml IT shot without acute/delayed symptoms. If no change in health, what volume in same vial is recommended in 7 days?

A

0.15mL
The traditional schedule goes: each 5-7 days, advance dose by an increment of 0.05ml up to a total 0.50 ml dose. At that point, make a new vial 5 times more concentrated than the one you just used.
You can judge whether a pt tolerated an injection by the size of the wheal. If <25mm, give the next dose. If 25-35 mm wheal, give same dose. If 35-50 mm wheal, decrease the dose by 0.05ml.

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6
Q

A patient is receiving SQ IT using standard techniques. A 0.1 ml injection from a second treatment vial should be antigenically equivalent to what volume in 1st treatment vial?

A

0.50

This question points out that once you get to the beginning 0.1ml from a second vial, it really is the same as the largest dose you can get from the last vial you used, which is 0.50ml. When escalating the dose during IT, a lot of people skip the 0.1ml dose from a second vial, since is it the same as the 0.50ml dose from the previous dose, going directly to 0.15ml from a second vial.

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7
Q

65yo patient is waiting after his allergy shot. He mentions his asthma is worse after beta blocker. How much epi to give for anaphylactic reaction?

A

0.15mL
The dose of IM epi given for anaphylaxis is 0.3 to 0.5 ml from a 1:1000 vial of epi in an adult. However, decrease this dose by ½ if the patient is on a beta blocker to prevent unopposed alpha adrenergic agonist activity. Repeat as necessary q5 minutes.
Other components of anaphylaxis management include ABC’s. You can also add on Benadryl IV, pepcid IV, IV fluids, heparin IV 100 units/kg, which binds histamine. If the patient develops uncontrolled hypertension, give the pt IV phentolamine and nitroglycerine. You can also give glucagon in lieu of epi.

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8
Q

An IT patient misses 2 consecutive weekly appointments during escalation. 20 days ago, he received 0.3 ml injection from a second vial with 15mm reaction at 20 minutes.

A

0.25mL from same vial
First of all, the patient tolerated his 0.3 ml dose since he only made a 15mm wheal in 20 minutes. If he had been on schedule, he would have received a 0.35 ml dose a week later. The schedule is altered if weeks are missed like this:
Miss 1 wk: repeat dose
Miss 2 wks: decrease dose
Miss 3-4 wks: repeat the vial test. (vial test is when you take 0.01ml of the vial and do a IDT test. If the wheal is <13mm, give the normal dose from that vial. If =13mm, wait 72 hrs and then give normal dose. If >13mm, then dilute vial by 1ml of diluent).

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9
Q

A cat allergic pt tolerated weekly maintenance IT for a year receiving 0.5 ml injection from 5 ml vials containing 0.20 ml of cat extract. Pt continues to have pruritis, sneezing.

A

escalate 5x more concentrated vial

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10
Q

In treatment of anaphylaxis that does not respond adequately to first dose of epi, how often can you readminister?

A

q5mins

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11
Q

Specific IgE class score best correlates with…

A

SPECIFIC IGE CORRELATE WELL WITH SKIN TEST AND NASAL CHALLENGES, NOT WITH SEVERTITY OF SYMPTOMS.

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12
Q

During IDT, results are obtained:
#6 #5 #4
5mm 5mm 13mm
Appropriate interpretation of test?

A

During intradermal testing, a positive test is when the wheal enlarges by 2mm. The endpoint of titration is the first or weakest titration that produces a positive wheal. Its importance is that it is the concentration that we can safely start immunotherapy. A confirming wheal is the next concentration that gives a + wheal after endpoint of titration.
However, if the response is very rigorous positive wheal, then it is called a flash response. You should stop testing. REPEAT THE TEST IN ONE WEEK.
A plateau response is when there is no progressive wheal growth after endpoint of titration. It is still safer to start immunotherapy at the first + wheal.

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13
Q

When preparing 5 fold dilutions of antigen for IDT, what is the appropriate diluents for testing vials

A

sterile NS

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14
Q

A patient’s current meds are reviewed prior to allergic testing. Which medications are contra indicated around time of testing?

A

TCA, antihistamine (beta agonists inhibit wheal formation too)

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15
Q

Which cell surface marker is present on all mature T cells:

a. CD 3
b. CD1
c. CD25
d. CD4

A

CD3 is known as the pan Tcell marker. CD4 and CD1 is for the T helper cell.

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16
Q

meningioma above planum sphenoidale, what vessel embolize?

A

ant ethmoid, can also do posterior ethmoid

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17
Q

strawberry mass in nose, what use to treat?

A

rhinosporidiosis–surgical excision!

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18
Q

what is deregulated in angioedema?

A

bradykinin

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19
Q

CT of mucous retention cyst, pt complains of sharp facial pain, what do?

A

trial NSAIDS for a week vs work up facial pain further

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20
Q

JNA vascular supply unilateral or bilateral?

A

30-70% bilateral SPA supply

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21
Q

HHT: how treat non bleeding septum prophylactically?

A

laser vs hormone therapy

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22
Q

what is the 10 year risk of malignant transformation of IP?

A

10%

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23
Q

what is best way to identify CSF leak location

A

CT cisternogram

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24
Q

what treat for invasive fungal aspergillus? mucor?

A

voriconazole vs amphoteracin

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25
Q

what is a common t cell marker

A

cd3

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26
Q

allergen pathway is MHC2 with what markers

A

CD4 and TH2

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27
Q

what is trachealization of esophagus w dysphagia dx?

A

eosinophilic esophagitis

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28
Q

if have soybean allergy, avoid which anesthetic med?

A

propofol

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29
Q

manometry shows inc LES pressure w/o peristalsis

A

achalasia

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30
Q

which vials shold you neverm ix together bc they have high proteases?

A

cockroach/insect, mold

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31
Q

how much glycerin is in concentrate vial? treatment vial?

A

concentrate comes in 50% glycerin, treatment vial is 10%

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32
Q

in what population of people undergoing SCIT has the highest mortality risk?

A

asthmatics

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33
Q

what is omilizumab?

A

anti IgE (tx really bad asthma and CRS with mild asthma)

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34
Q

what is dupilumab?

A

IL 4 and 13

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35
Q

churg straus symptoms?

A

eosinophilia, nasal polyps, neuropathy

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36
Q

in allergic fungal, what is elevate?

A

total IgE

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37
Q

when does histamine present and go away? tryptase?

A

peaks and goes away by 1 hr, tryptase 2 hr peak, 6 hr go away; indicates anaphylaxis

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38
Q

after allergy IT, what happens to IgA, IgG4, total IgE, IL10

A

IgA inc (th1), IgG4 inc (blocks), dec total IgE, inc IL10 (since treg)

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39
Q

Merkel cell of cheek w negative parotid, negative neck, what do you do? if with neck node?

A

SNL (regardless of stage)

parotid and neck dissection

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40
Q

botox is more effective in abd or adductor spasmotic dysphonia?

A

more effective for adductor

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41
Q

gender voice, how treat?

A

cricothyroid suspension

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42
Q

picture of ant commisure webbing after rrp, how do you avoid it?

A

stage it

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43
Q

silver stain on histo is to show what organism?

A

fungus

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44
Q

contact granuloma after excision, how prevent?

A

ppi

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45
Q

pt w nodules didn’t want to do voice therapy, what else can add?

A

PPI

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46
Q

what’s the mutation in familial medullary thryoid? what protein does it code for?

A

RET, tyrosine kinase

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47
Q

biologic for medullary thyroid ca? what does it target?

A

cabozantanib, a tyrosine kinase inhibitor

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48
Q

inc PTH, inc urine Ca, what does pt have?

A

primary PTH

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49
Q

histopath shows nuclear fissures and inclusions

A

PTC

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50
Q

pt has inc TG with negative neck u/s, what do next?

A

whole body scan

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51
Q

2cm nodule w decreased TSH, what do next?

A

thyroid scan (not FNA yet)

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52
Q

CT scan shows rapidly enlarging thyroid mass w VF paralysis, what are the two on the differential

A

anaplastic, lymphoma

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53
Q

amyloid positive on thyroid biopsy, need to test for what?

A

calcitonin

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54
Q

what is the inspire BMI cutoff? can you implant w pacemaker?

A

<32; OK w pacemaker

55
Q

CSF hypocretin tests for what?

A

narcolepsy w cataplexy (low)

56
Q

what meds dec REM sleep?

A

SSRI, TCA is a potent REM suppressor

57
Q

what stage of sleep does sleep walking occur?

A

stage 3

58
Q

OSA worst in what stage of sleep

A

REM

59
Q

how long is MSLT dx for narcolepsy?

A

<8 mins

60
Q

effect of caffeine on sleep? what does it antagonize?

A

adenosine antagonist, shortens sleep

61
Q

check what blood level in RLS?

A

ferritin

62
Q

NP stensois after UPPP and multiple tries to correct, how best treat?

A

laser then obturator

63
Q

what modality does lidocaine affect first?

A

temperature

64
Q

what is associated with non-recurrent laryngeal nerve?

A

anomalous right subclavian artery–Bayford sd

65
Q

which branchial structure is styloid process from?

A

second branchial arch

66
Q

palatopharyngeal innervated by

A

x

67
Q

which palatal mm innervated by V3?

A

tensor veli palatini

68
Q

posterior belly of digastric innervated by

A

VII

69
Q

auriculotemporal nn is branch of

A

v3

70
Q

physiologic reaction to bicarbonate injection, systemically

A

hypocalcemia and increase cardiac output

71
Q

patient has laryngeal rrp, what should you do to the sexual partner?

A

nothing bc no horizontal transmision

72
Q

what percentage chance of malignant transformation of lichen planus?

A

1-4%

73
Q

histoplasmosis laryngitis–what stain to look for organisms?

A

silver stain

74
Q

pt with lidocaine toxicity, has cardiac arrhythmia, what do first?

A

O1 (increases seizure threshold), can lso give lipid emulsion therpay which binds lidocaine to dec plasma concentration

75
Q

treat cocaine OD with what?

A

benzo

76
Q

levels of evidence?

A

1a: SR of RCTs
1b: individual RCTs with narrow confidence interval
2a: SR of cohort studies
2b: cohort studies and low quality RCTs
3a: SR of case controlled-studies
3b: case controlled studies
4 case series and poor quality cohort/case-control studies
4- expert opinion

77
Q

cidofovir is what?

A

an antiviral, carcinogenic

78
Q

aspergillus procduces what toxin that affects which organ?

A

aflatoxin, liver

79
Q

function of e6? e7?

A

inhibit p53; inhibit rb

80
Q

pharyngeal recon using jejunal flap vs radial forearm has what advantages and disadvantages?

A

less incidience of stricture but worse voice and worse flap viability

81
Q

breslow depth is from top of what?

A

granullar layer (first cellular layer of epidermis) to bottom of melanoma

82
Q

bad allens test, what do you do?

A

ultrasound arm

83
Q

MC bug causing skull base OM

A

pseudomonas

84
Q

what sx can you do for bppv?

A

posterior scc occlusion

85
Q

mastoid ossillator for bppv help?

A

doesn’t help, there’s a paper in 95 that said it does, but since v mixed results

86
Q

HIV pt w persistent acute serous OM despite abx, what do next?

A

adenoidectomy to look for lymphoma

87
Q

ct of bilateral soft tissue occlusion, pt has persistent drainage and blunted EAC on exam, cant see TM

A

do canalplasty (not wick, not gtt)

88
Q

what decibel increase doubles sound?

A

3dB

89
Q

what age start microtia recon w rib?

A

6 bc pinna is 90% acctula size, some say until 9 to let ribs grow

90
Q

xr of cochlear implant, where is hte impant?

A

hypotympanic air cell

91
Q

1/3 of upper lip scc involving oral commisure, how recon

A

using estlander flap (vs karapanzic vs abbe)

92
Q

pt w ear vacsular lesion, pulsitile, how treat

A

surgery, otherwise lasers

93
Q

mechanism of action of lidocaine on cell membrane?

A

inhibit Na channel

94
Q

stria vascularis atrphy causes what kind of hearing loss?

A

b/l SNHL flat audiometric patterns w good discrims; common pattern of age related HL

95
Q

gray granulation in TM perf, cultures negative, otorrhea persistent, next step?

A

pcr for acid fast (biopsy?)

96
Q

rivaroxaban, when stop before surgery?

A

half life 5-9 hrs, stop 24hrs before

97
Q

dermoid vs teratoma?

A

dermoids contain only dermal/epidermal elements–ectoderm; teratomas have more than one of the three embryonic germ layers (mesoderm and endoderm)

98
Q

most common H&N location of rhabdomyosarcoma

A

orbit

99
Q

adults have what food allergy more commonly than kids?

A

shellfish

100
Q

last laryngeal cartilage to chondrify?

A

epiglottis (thyroid–>arytenoid–>cricoid)

101
Q

you dermabrade until which layer?

A

papillary dermis

102
Q

what look out for when debulking tongue for amyloidosis in other organ systems?

A

cardiac arrhythmias

103
Q

how treat relapsing polychondritis?

A

steroids and dapsone/mtx/other biologics

104
Q

thronwaldt cyst derived from what?

A

cystic remnant of caudal notochord

105
Q

which sinonasal lymphoma has the best prognosis?

A

b-cell (vs nk t cell vs t cell)

106
Q

CULLP is hypoplasia of what?

A

DAO

107
Q

what regulates IgE production?

A

Tcells

108
Q

what inherent protein acts like antibiotics? how?

A

defensins (binds to cell membrane and punctures holes–>ions efflux, celldeath) vs opsonins coat bacteria and target for phagocytosis/complement

109
Q

esophageal pH testing is positive if over 5% time spent at what pH?

A

<4

110
Q

what is the most common risk/complication in CI in general?

A

facial nerve stimulation

111
Q

zofran’s MC side effect?

A

HA

112
Q

baby with recurrent croup, DL was normal, what test do next?

A

pH testing

113
Q

what’s the 5 year laryngeal prservation rate for T3N0M0 tx with chemoxrt?

A

80%

114
Q

which tumor has highest risk of occult neck met?

A

oral tongue 90%>BOT>HP

115
Q

what type of CI use for pt with mondini?

A

straight array

116
Q

1 mo afterclosed nasal, pt has deviation of lower 1/3 of nose, why?

A

detachment of ULCs

117
Q

44F with red facial mass present since birth enlarging with growth of patient, phleboliths, what is it?

A

lymphovenous malforation (phelboliths just tell you its venous)

118
Q

how treat Kasabach Merrit phenomenon associated with Kaposiform hemangioendothelioma?

A

just KHE steroids

KHE + KMP: steroid + vincristine

119
Q

pt with Samter’s fails intranasal steroids, add what before aspirin desensitization?

A

montelukast and or cromolyn spray

120
Q

what allergy med has been shown to reduce AHI in kids with OSA?

A

montelukast and intranasal steroids

121
Q

what bacteria responsible for brain abscess from acute sinusitis? aerobic/anaerobic/fungi/microaerophilic, etc.

A

Strep if it’s an answer, if not anaerobic

122
Q

Which recon option best for total lower lip defect minimizing risk of microstomia

A

bernard-burrow flap (least microstomia)

123
Q

cochlear hydrops caused by what and presents with what symptoms?

A

caused by syphilis, presents like meniere’s with hearing loss/fluctuation, vertigo, can present with sundden HL

124
Q

lidocaine affects on smooth muscle and blood vessels?

A

relaxes muscle and stops vasospasms

125
Q

PTT indicates which clotting cascade pathway? PT? which dependent on vitamin K?

A

intrinsic
both
PT

126
Q

what factors dep vit K?

A

II, VII, IX, X, c, s

127
Q

MC mandibular fx after trauma?

A

parasymphysis>condyle>body/angle >ramus

128
Q

what abx inhibits syntehsis of 50s ribosomal subunit?

A

clinda (vs aminoglycosides inhib 30s)

129
Q

during scit, hospitalized for asthma exacerbation, what should you test prior to next SCIT?

A

maybe NO, which can tell you if eosinophilic vs non; if eosinophilic asthma, add anti IgE ab

130
Q

what isthe most common inherited form of SNHL?

A

autosomal recessive nonsyndromic SNHL

131
Q

bogdasarian classfication for PGS

A

I: interarytenoid scar band anterior and separate from posterior mucosa
II: scarring of musoca/muscles of posterior interarytenoid space
III: unilateral CA joint fixation
IV: bilateral CA joint fixation

132
Q

what is the MOA of KI for graves prior to tt?

A

dec thyroid hormone produection by decreasing iodine organification

133
Q

you embolize IMA for epistaxis, then later rebleed, what aa is causing this?

A

ipsilateral AEA (not contralalteral IMA)

  1. internal carotid ® ophthalmic ® anterior ethmoid
  2. external carotid ® facial ® superior labial
  3. external carotid ® maxillary ® descending palatine ® greater palatine
  4. external carotid ® maxillary ® sphenopalatine

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