Anaphylaxis Flashcards

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1
Q

Anaphylaxis may be defined as a severe, life-threatening, generalised or systemic hypersensitivity reaction. How common is anaphylaxis?

1 - 2 cases per 100,000
2 - 20 cases per 100,000
3 - 200 cases per 100,000
4 - 2000 cases per 100,000

A

2 - 20 cases per 100,000

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2
Q

Anaphylaxis may be defined as a severe, life-threatening, generalised or systemic hypersensitivity reaction. What age is the peak incidence of anaphylaxis?

1 - 1-10
2 - 10-30
3 - 20-30
4 - 40-60

A

3 - 20-30

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3
Q

Anaphylaxis may be defined as a severe, life-threatening, generalised or systemic hypersensitivity reaction. Is there a gender effect of anaphylaxis?

A
  • no
  • affects females and males equally
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4
Q

In anaphylaxis do people have an allergic reaction they are exposed the first time to the allergen?

A
  • no
  • 1st = sensitisation
  • 2nd = allergic reaction or even anaphylaxis
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5
Q

The first time a patients body is exposed to an allergen the foreign allergen is phagocytosed by an antigen presenting cell (APC) before being presented to which cell?

1 - B cells
2 - cytotoxic CD8 T cells
3 - CD4 T helper cells
4 - natural killer cells

A

3 - TCD4 T helper cells

  • APC activates T cell that then secretes inflammatory cytokines that activate B cells
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6
Q

The first time a patients body is exposed to an allergen the foreign allergen is phagocytosed by an antigen presenting cell (APC) before being presented to CD4 T helper cells and inflammatory cytokines are released that activate B cells. These B cells then produce and secrete which antibodies?

1 - IgM
2 - IgE
3 - IgD
4 - IgA

A

2 - IgE

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7
Q

Once B cell produce and secrete IgE antibodies they move around the body in the blood stream and bind to which 2 of the following immune cells?

1 - mast cells
2 - neutrophils
3 - basophils
4 - macrophages

A

1 - mast cells
3 - basophils

Both cells are full of granules that contain pro-inflammatory molecules

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8
Q

The second time a patient is exposed to the same allergen, the body is already primed with IgE antibodies that are bound to mast cells and basophils. The allergen binds with the IgE antibodies and undergoes degranulation releasing which 2 of the following?

1 - histamine and CRP
2 - histamine and tryptase
3 - tryptase and CRP
4 - CRP and CK

A

2 - histamine and tryptase

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9
Q

The second time a patient is exposed to the same allergen, mast cells are able to release what that causes vasoconstriction of smooth muscle in the airways and GIT?

1 - CRP
2 - histamine
3 - leukotrienes
4 - thromboxane

A

2 - histamine

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10
Q

The second time a patient is exposed to the same allergen, in addition to causing vasoconstriction of smooth muscle in the airways and GIT, does histamine cause vasodilation or constriction of blood vessels?

A
  • vasodilation
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11
Q

The second time a patient is exposed to the same allergen, histamine induces vasodilation of blood vessels and causes what?

1 - increased blood flow to site of initial allergen exposure
2 - oedema and drop in blood pressure
3 - increase blood vessel diameter and permeability
4 - urticaria (hives)
5 - all of the above

A

5 - all of the above

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12
Q

The second time a patient is exposed to the same allergen, in addition to histamine, what do mast cells secrete that is a protease and able to induce tissue damage?

1 - tryptase
2 - CRP
3 - leukotrienes
4 - thromboxane

A

1 - tryptase

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13
Q

The second time a patient is exposed to the same allergen, in addition to histamine and tryptase, mast cells and basophils are able release cytokines IL-4 and IL-13 that tell B cells to produce more IgE and release TNF-a. But mast cells and basophils also secrete what else that is important for attracting immune cells?

1 - prostaglandins
2 - CRP
3 - leukotrienes
4 - thromboxane

A

3 - leukotrienes
- fatty acids

Recruit neutrophils, mast cells and eosinophils

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14
Q

The second time a patient is exposed to the same allergen, mast cells and basophils secrete leukotrienes that attracts other immune cells. Is this a quick or slow response?

A
  • slow response

Often occurs after the allergen is gone and are often not seen until hours after the initial reaction

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15
Q

Which type of hypersensitivity is most commonly associated with anaphylaxis?

1 - IgE mediated hypersensitivity
2 - IgG mediated cytotoxic hypersensitivity
antibody-dependent cytotoxic hypersensitivity
3 - immune complex mediated
4 - cell mediated hypersensitivity

A

1 - IgE mediated hypersensitivity

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16
Q

Is anaphylaxis always caused by a type I IgE mediated hypersensitivity?

A
  • no

Some can be IgG hypersensitivity, such as those caused by a blood transfusion

17
Q

In a patient with anaphylaxis, what is the 1st thing we must do?

1 - perform ABCDE
2 - take blood
3 - request imaging
4 - request fluids and observations

A

1 - perform ABCDE

18
Q

Which of the following are clinical presentations of anaphylaxis?

1 - itchy rash (urticaria or erythema)
2 - vomiting and diarrhoea
3 - respiratory wheeze and dyspnoea (SOB)
4 - swelling of the throat and tongue with hoarse voice and stridor
5 - hypovolaemia and cardiovascular collapse
6 - all of the above

A

6 - all of the above

If there is no issues with ABC as part of the ABCDE, then the patient is unlikely to be having anaphylaxis

19
Q

In a patient who is anaphylactic we would do the usual ABCDE and put them on high flow oxygen. We then need to prescribe all of the following EXCEPT?

1 - Adrenaline (1:1000 1 mg/ml IM in adults)
2 - IV fluids: 0.5 L – 1.0 L of NaC l/ Hartmann’s (avoid colloids)
3 - aspirin
4 - Inhaled ß2 agonist (salbutamol)

A

3 - aspirin

  • always refer to anaphylaxis guide
20
Q

In anaphylaxis all of the following should be given asap, but which is most important?

1 - high flow oxygen
2 - Adrenaline (1:1000 1 mg/ml IM in adults)
3 - IV fluid challenge: 500ml – 1000ml of NaC l/ Hartmann’s (avoid colloids)
5 - Inhaled ß2 agonist (salbutamol)

A

2 - Adrenaline (1:1000 1 mg/ml IM in adults)

Best location is anterolateral aspect of the middle third of the thigh.

21
Q

Adrenaline (1:1000 1 mg/ml IM in adults) is the most important medication given to a patient with anaphylaxis. How often can adrenalin be given?

1 - once only
2 - every 5 minutes
3 - every 30 minutes
4 - every hour

A

2 - every 5 minutes

22
Q

Prior to giving adrenaline, the patients legs should be raised during anaphylaxis. Why is this?

1 - more comfortable for patients
2 - reduces risk of oedema
3 - increases venous return and cardiac output
4 - all of the above

A

3 - increases venous return and cardiac output

23
Q

All of the following should be given during anaphylaxis. Organise the order of the following:

1 - IV fluids
2 - high flow oxygen
3 - adrenaline
4 - inhaled ß2 agonist (salbutamol)

A

3 - adrenaline
2 - high flow oxygen
1 - IV fluids
4 - inhaled ß2 agonist (salbutamol)

24
Q

Once a patient has stabilised following anaphylaxis, which 2 of the following should be performed?

1 - give antihistamines (preference to chlorphenamine = non-drowsy)
2 - give hydrocortisones
3 - test tryptase levels (high for 12h following anaphylaxis)
4 - blood transfusion to increase low BP

A

1 - give antihistamines (preference to chlorphenamine = non-drowsy)
3 - test tryptase levels (high for 12h following anaphylaxis)