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Section 4 Medical Exam Prep > Chapter 26 Immunologic Diseases > Flashcards

Chapter 26 Immunologic Diseases Flashcards

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USMLE® Step 1 flashcards
1
Q
  1. An antigen is MOST accurately defined as a:
    A) chemical the immune system produces to destroy an allergen.
    B) substance that causes the immune system to produce antibodies.
    C) chemical mediator that deactivates foreign substances in the body.
    D) harmless substance that the body does not recognize as being foreign.
A

Ans: B
Page: 1265
Type: General Knowledge

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2
Q 
2.  An abnormal immune response that the body develops when it is reexposed to an allergen is called:
A)  anaphylaxis.
B)  secondary response.
C)  hypersensitivity.
D)  an allergic reaction.
A

Ans: D
Page: 1265
Type: General Knowledge

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3
Q
  1. ____ antibodies respond in allergic reactions and are located _______.
    A) IgD, in the lymph and blood
    B) IgE, on the mast and basophil cells
    C) IgG, in the blood, lymph, and intestines
    D) IgA, in tears, saliva, blood, and lymph
A

Ans: B
Page: 1265
Type: General Knowledge

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4
Q 
4.  Which of the following immunoglobulins is thought to stimulate antibody-producing cells to make antibodies?
A)  IgD
B)  IgE
C)  IgG
D)  IgM
A

Ans: A
Page: 1265
Type: General Knowledge

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5
Q 
5.  The term anaphylaxis is MOST accurately defined as:
A)  overprotection.
B)  atopic disease.
C)  without protection.
D)  immune suppression.
A

Ans: C
Page: 1265-1266
Type: General Knowledge

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6
Q 
6.  Which of the following medications causes the MOST IgE-mediated drug reactions in the United States?
A)  Sulfa
B)  Aspirin
C)  Penicillin
D)  Erythromycin
A

Ans: C
Page: 1266
Type: General Knowledge

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7
Q 
7.  Patients with \_\_\_\_\_\_\_\_\_\_\_\_\_\_ are at an increased risk for anaphylaxis.
A)  strep infection
B)  acute pharyngitis
C)  immunosuppression
D)  atopic dermatitis
A

Ans: D
Page: 1267
Type: General Knowledge

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8
Q
  1. The longer the time between exposure to a substance:
    A) the greater the chance of massive IgE antibody production.
    B) the less likely a severe anaphylactic reaction will occur.
    C) the greater the chance that severe anaphylaxis will occur.
    D) the less likely that any kind of allergic reaction will occur.
A

Ans: B
Page: 1267
Type: General Knowledge

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9
Q
  1. In contrast to cellular immunity, humeral immunity:
    A) involves the use of antibodies dissolved in the blood plasma to fight off invading organisms.
    B) is the result of the body’s production of leukocytes called T cells that attack and destroy invaders.
    C) is an acquired form of immunity that involves desensitization through the use of immunizations.
    D) protects the body against foreign substances by antibodies that are located exclusively in the lymph nodes.
A

Ans: A
Page: 1268
Type: General Knowledge

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10
Q 
10.  Allergic rhinitis and asthma are MOST often the result of exposure to an allergen via the \_\_\_\_\_\_\_\_\_\_\_ route.
A)  injection
B)  ingestion
C)  inhalation
D)  absorption
A

Ans: C
Page: 1268-1269
Type: General Knowledge

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11
Q
  1. Following the primary response to a foreign substance, the body:
    A) recognizes the substance as foreign, but does not produce antibodies until subsequent exposure.
    B) utilizes macrophages to immediately destroy the substance and eliminate it from the body.
    C) develops sensitivity and is able to recognize the substance following subsequent exposure.
    D) releases massive amounts of antigen-specific antibodies, which produce a severe allergic reaction.
A

Ans: C
Page: 1269
Type: General Knowledge

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12
Q 
12.  The chemical mediators that initiate and maintain the immune response are:
A)  heparin and T cells.
B)  basophils and mast cells.
C)  macrophages and cytokines.
D)  eosinophils and neutrophils.
A

Ans: B
Page: 1269
Type: General Knowledge

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13
Q 
13.  Physiologic effects of histamine include all of the following, EXCEPT:
A)  systemic vasodilation.
B)  increased cardiac contractility.
C)  severe bronchoconstriction.
D)  increased vascular permeability.
A

Ans: B
Page: 1269
Type: General Knowledge

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14
Q
  1. When a person is vaccinated against a disease:
    A) the body develops antibodies in response to the vaccine and produces an immune response before the disease can enter the body and cause damage.
    B) the immune system does not produce any antibodies against that particular disease unless the person is directly or indirectly exposed to it.
    C) a secondary response occurs, as antibodies are produced and the vaccinated person experiences a milder form of the disease against which he or she has been vaccinated.
    D) smaller titers of the disease are injected into the person, which results in the production of antibodies that cause histamine release and a mild allergic reaction.
A

Ans: A
Page: 1269-1270
Type: General Knowledge

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15
Q
  1. In contrast to acquired immunity, natural immunity occurs when:
    A) the body is vaccinated, allowing it to produce antibodies without having to experience the disease itself.
    B) groups of people are immunized against a substance, which protects vulnerable people in the group.
    C) the mother passes antibodies to the fetus via the placenta, thus protecting the fetus against a variety of diseases.
    D) the body encounters the antigen and experiences a full immune response with all the pathology of the disease.
A

Ans: D
Page: 1270
Type: General Knowledge

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16
Q
  1. Histamine release causes all of the following effects, EXCEPT:
    A) vasodilation, which results in flushed skin and hypotension.
    B) contraction of the smooth muscles of the respiratory system.
    C) increased cardiac contractility, which results in hypertension.
    D) increased vascular permeability, which results in tissue edema.
A

Ans: C
Page: 1269, 1273-1274
Type: General Knowledge

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17
Q
  1. Hypotension secondary to histamine release is due to:
    A) profound bradycardia and vascular dilation.
    B) decreased cardiac filling because of tachycardia.
    C) vasodilation and decreased cardiac contractility.
    D) capillary leakage and increased cardiac afterload.
A

Ans: C
Page: 1273-1274
Type: General Knowledge

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18
Q
  1. Which of the following statements regarding leukotrienes is correct?
    A) In contrast to histamine, leukotrienes are less potent chemicals and do not cause vasodilation.
    B) Leukotrienes compound the physiologic effects of histamine and cause additional bronchoconstriction.
    C) Leukotriene release stimulates the release of histamine, which increases the severity of the allergic response.
    D) Leukotrienes attempt to mitigate the negative effects of histamine by causing coronary vasodilation.
A

Ans: B
Page: 1274
Type: General Knowledge

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19
Q 
19.  Early clinical manifestations of an allergic reaction include all of the following, EXCEPT:
A)  pruritus.
B)  stridor.
C)  urticaria.
D)  edema.
A

Ans: B
Page: 1274
Type: General Knowledge

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20
Q 
20.  Which of the following clinical signs or symptoms are MOST indicative of upper airway swelling in a patient experiencing a severe allergic reaction?
A)  Hoarseness and stridor
B)  Crackles and wheezing
C)  Facial edema and coughing
D)  Chest tightness and dyspnea
A

Ans: A
Page: 1274
Type: General Knowledge

21
Q
  1. Cardiovascular effects of anaphylaxis include:
    A) diaphoresis, bradycardia, and edema.
    B) an irregular pulse, pallor, and pruritus.
    C) peripheral vasoconstriction and cool skin.
    D) tachycardia, flushed skin, and hypotension.
A

Ans: D
Page: 1274
Type: General Knowledge

22
Q 
22.  Common central nervous system manifestations of anaphylactic shock include all of the following, EXCEPT:
A)  anxiety.
B)  headache.
C)  confusion.
D)  combativeness.
A

Ans: D
Page: 1275
Type: General Knowledge

23
Q 
23.  What physiologic effect of anaphylactic shock is seen MOST commonly in patients with neurogenic shock?
A)  Profound tachycardia
B)  Decreased cardiac contractility
C)  Widespread vasodilation
D)  Fluid leakage into the tissues
A

Ans: C
Page: 1275
Type: General Knowledge

24
Q
  1. The three MOST significant indicators of anaphylactic shock are:
    A) hives, chest tightness, and restlessness.
    B) dyspnea, hypotension, and tachycardia.
    C) pruritus, peripheral swelling, and urticaria.
    D) dizziness, flushed skin, and abdominal pain.
A

Ans: B
Page: 1275
Type: General Knowledge

25
Q
  1. An unresponsive patient with signs of anaphylactic shock:
    A) indicates cerebral hypoxia and hypercarbia.
    B) requires immediate antihistamine therapy.
    C) is often unable to be intubated successfully.
    D) needs hyperventilation with a bag-mask device.
A

Ans: A
Page: 1271
Type: General Knowledge

26
Q 
26.  The MOST ominous respiratory sign in a patient with anaphylactic shock is:
A)  diminished lung sounds.
B)  loud expiratory wheezing.
C)  diffuse coarse crackles.
D)  labored tachypnea.
A

Ans: A
Page: 1271
Type: General Knowledge

27
Q
  1. Which of the following general statements regarding anaphylactic shock is correct?
    A) In order to provide appropriate treatment, you must first determine what caused the allergic reaction.
    B) In the presence of anaphylaxis, intervention takes precedence over identifying the offending antigen.
    C) Anaphylactic shock would most likely occur following initial exposure to an offending antigen.
    D) Most patients who carry a prescribed EpiPen are not completely aware of what substances they are allergic to.
A

Ans: B
Page: 1272
Type: General Knowledge

28
Q
  1. During the secondary assessment of a patient experiencing a severe allergic reaction, you should:
    A) focus exclusively on the patient’s blood pressure.
    B) expect the patient to vomit, often without nausea.
    C) apply the cardiac monitor to detect dysrhythmias.
    D) recall that capnography will be a less reliable tool.
A

Ans: C
Page: 1272
Type: General Knowledge

29
Q 
29.  Transport of a patient in anaphylactic shock may be delayed for all of the following reasons, EXCEPT:
A)  aggressive airway control.
B)  epinephrine administration.
C)  assessment of lung sounds.
D)  a secondary assessment.
A

Ans: D
Page: 1272
Type: General Knowledge

30
Q 
30.  The primary treatment for hypotension secondary to anaphylaxis is:
A)  epinephrine.
B)  diphenhydramine.
C)  isotonic crystalloid.
D)  a dopamine infusion.
A

Ans: A
Page: 1275-1277
Type: General Knowledge

31
Q 
31.  In the absence of IV or IO access, the \_\_\_\_ route is the preferred route for the administration of epinephrine to a patient in anaphylactic shock.
A)  IM
B)  ET
C)  SQ
D)  intradermal
A

Ans: A
Page: 1276
Type: General Knowledge

32
Q 
32.  The correct dose, concentration, and route of epinephrine for a 40-pound child with an allergic reaction and no signs of cardiovascular collapse are:
A)  0.12 mg 1:1,000 IM.
B)  0.18 mg 1:1,000 SQ.
C)  0.21 mg 1:10,000 IV.
D)  0.25 mg 1:1,000 IV.
A

Ans: B
Page: 1277
Type: General Knowledge

33
Q 
33.  Adults in anaphylactic shock should receive the \_\_\_\_\_\_\_\_ concentration of epinephrine via the \_\_\_\_ route in a dose of \_\_\_\_ mg.
A)  1:1,000, IM, 1
B)  1:1,000, IV, 0.5
C)  1:10,000, IV, 0.1
D)  1:10,000, IM, 0.5
A

Ans: C
Page: 1277
Type: General Knowledge

34
Q
  1. When administering an EpiPen to a 30-year-old man with a severe allergic reaction, you should recall that:
    A) a 1:2,000 solution is used because the patient is an adult.
    B) the SQ route is used in order to achieve a rapid effect.
    C) 0.15 mg is the usual dose delivered by the adult EpiPen.
    D) the drug cartridge contains 0.3 mg of a 1:1,000 solution.
A

Ans: D
Page: 1277
Type: General Knowledge

35
Q
  1. Which of the following statements regarding the EpiPen Jr is correct?
    A) It is used for children who weigh less than 44 lb (20 kg).
    B) It is contraindicated for children with a history of asthma.
    C) It contains 0.15 mg of a 1:2,000 solution and is given IM.
    D) Benadryl should be given before the EpiPen in children.
A

Ans: C
Page: 1276-1277
Type: General Knowledge

36
Q 
36.  Systemic lupus erythematosus is a disease caused by:
A)  a multisystem autoimmune disorder.
B)  a marked deficiency of neutrophils.
C)  primary immune system failure.
D)  excessive IgE antibody production.
A

Ans: A
Page: 1267, 1277
Type: General Knowledge

37
Q
  1. Patients with systemic lupus erythematosus:
    A) are routinely treated with high-dose antibiotic therapy.
    B) often take medications that suppress their immune system.
    C) have increases in their red blood cell and platelet counts.
    D) are typically males between the ages of 50 and 75 years.
A

Ans: B
Page: 1267, 1277-1279
Type: General Knowledge

38
Q 
38.  Assessment of patients with collagen vascular diseases should focus on:
A)  ruling out life threats.
B)  high-dose analgesia.
C)  crystalloid fluid boluses.
D)  high-flow oxygen therapy.
A

Ans: A
Page: 1279
Type: General Knowledge

39
Q
  1. Diphenhydramine (Benadryl) is used to treat allergic reactions because it:
    A) binds to H2 receptors and blocks histamine release.
    B) blocks the histamine effects at the H1 receptor sites.
    C) destroys histamines and blocks their further release.
    D) reverses the vasodilatory and bronchoconstrictive effects.
A

Ans: B
Page: 1277
Type: General Knowledge

40
Q 
40.  Which of the following medications has the SLOWEST onset of action when given to a patient with a severe allergic reaction?
A)  Albuterol
B)  Glucagon
C)  Diphenhydramine
D)  Methylprednisolone
A

Ans: D
Page: 1277
Type: General Knowledge

41
Q
  1. You have treated the same patient several times for a severe allergic reaction. While educating him about the prevention of future reactions, you should advise him to:
    A) wear an identification bracelet.
    B) avoid the substance he is allergic to.
    C) carry at least two EpiPen injectors.
    D) call 9-1-1 as soon as he is exposed.
A

Ans: B
Page: 1280
Type: General Knowledge

42
Q 
42.  A 31-year-old man presents with diffuse hives, intense itching, and watery eyes that began acutely about an hour ago. He is conscious and alert, is breathing without difficulty, and tells you that he does not have any allergies or significant medical problems. His blood pressure is 126/76 mm Hg, pulse is 110 beats/min and strong, and respirations are 16 breaths/min and unlabored. The MOST appropriate drug, dose, and route for this patient are:
A)  diphendydramine, 25 to 50 mg, IM.
B)  epinephrine, 0.3 mg 1:1,000, IV.
C)  albuterol, 2.5 mg, via nebulizer.
D)  epinephrine, 0.01 mg/kg 1:1,000, SQ.
A

Ans: A
Page: 1277
Type: Critical Thinking

43
Q
  1. A 20-year-old woman complains of difficulty breathing and the feeling of a lump in her throat approximately 10 minutes after being stung by a wasp. Your assessment reveals that she is anxious, is in obvious respiratory distress, and has hives covering her arms and legs. Further assessment reveals diffuse wheezing, a blood pressure of 80/50 mm Hg, and a heart rate of 120 beats/min. You should:
    A) immediately sedate and intubate her to protect her airway, administer 25 mg of Benadryl IM, and consider an epinephrine infusion.
    B) administer albuterol via an inline nebulizer attached to a bag-mask device, assist ventilations, and consider administering epinephrine.
    C) apply oxygen via nonrebreathing mask, start an IV with normal saline, and administer 1 mg of epinephrine 1:10,000 via IV push.
    D) administer high-flow oxygen, start a large-bore IV, infuse up to 2 liters of normal saline, and administer 0.3 mg of epinephrine 1:1,000 SQ.
A

Ans: C
Page: 1275-1277
Type: Critical Thinking

44
Q
  1. You are caring for a 40-year-old man in obvious anaphylactic shock after being stung by a scorpion. The patient is responsive to pain only, has poor respiratory effort, and is hypotensive and tachycardic. Which of the following represents the MOST appropriate treatment sequence for this patient?
    A) Immediate intubation, 0.5 mg epinephrine 1:1,000 SQ, two large-bore IV lines with normal saline, a 250-mL normal saline bolus, and 25 mg of Benadryl IM
    B) Assisted ventilation, intubation if necessary, at least one large-bore IV with normal saline, 1 mg epinephrine 1:10,000 IV, and up to 50 mg of Benadryl IV or IM
    C) High-flow oxygen via nonrebreathing mask, 0.1 to 0.5 mg epinephrine 1:1,000 IM, two large-bore IV lines with normal saline, and 20-mL/kg boluses of normal saline
    D) Assisted ventilation, Combitube insertion, 25 to 50 mg of Benadryl IM followed immediately by 0.3 mg of epinephrine 1:1,000 SQ, and a large-bore IV with normal saline
A

Ans: B
Page: 1275-1277
Type: Critical Thinking

45
Q
  1. You have administered the appropriate dose of epinephrine to a patient with a severe allergic reaction. Reassessment reveals that the patient’s condition has improved markedly. The patient, who has a history of coronary artery disease, is receiving high-flow oxygen and is on a cardiac monitor. You should next:
    A) start an epinephrine infusion at 4 µg/min, administer 25 mg of Benadryl IV or IM, and begin transport.
    B) transport at once, monitor airway and breathing en route, and administer up to 50 mg of Benadryl IV or IM.
    C) administer a half dose of epinephrine, begin transport, and give the patient 125 mg of methylprednisolone en route.
    D) transport immediately, monitor the patient’s blood pressure en route, and give IV fluid boluses if symptoms recur.
A

Ans: B
Page: 1276-1277
Type: Critical Thinking

46
Q 
46.  A 56-year-old man is experiencing a severe allergic reaction following multiple ant bites. He tells you that he has a prescribed EpiPen, which is expired, and that he takes a beta blocker for hypertension. Which of the following medications would MOST likely improve his condition, given his medical history?
A)  Proventil and Benadryl
B)  Epinephrine and albuterol
C)  A norepinephrine infusion
D)  Glucagon and ipratropium
A

Ans: D
Page: 1277
Type: Critical Thinking

47
Q 
47.  A 26-year-old female presents with a fever, rash, and joint pain. Which of the following should you suspect?
A)  Lupus
B)  Anaphylaxis
C)  Scleroderma
D)  Allergic reaction
A

Ans: A
Page: 1267, 1277
Type: Critical Thinking

48
Q
  1. A middle-aged male who received a kidney transplant called EMS because he was not feeling well. Which of the following assessment findings is MOST suggestive of organ rejection?
    A) Excessive urine output, shortness of breath, and a diffuse rash
    B) Blood in the urine, diffuse abdominal pain, and hypothermia
    C) Fever with swelling and tenderness over the implanted kidney
    D) Bilateral flank pain that radiates to both shoulders and scapulae
A

Ans: C
Page: 1279-1280
Type: Critical Thinking

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