CLINICAL CARE OF THE IMMUNE SYSTEM

Question 1

What is an immunologically mediated hypersensitivity reaction to a foreign antigen manifested by tissue inflammation and organ dysfunction?

Answer 1

Allergy

Question 2

The clinical expression of allergic diseases depends on what?

Answer 2

1. prior immunologic responsiveness
2. antigen exposure
3. genetically influenced host factors

Question 3

What is the most serious and potentially life-threatening manifestation of mast cells and basophil mediator release?

Answer 3

Anaphylaxis

Question 4

What is defined as, allergen exposure followed by the acute onset of illness involving skin or mucosal tissue and either respiratory compromise or hypotension?

Answer 4

Anaphylaxis

Question 5

Immediate allergic reactions within 2 hours of ingestion of foods are much less common among what group?

Answer 5

much less common among adults than with children

Question 6

What are the most common causes of food anaphylaxis in adults?

Answer 6

1. shellfish
2. peanuts
3. tree nuts

Question 7

True or false

Milk and egg allergies in atopic children are often outgrown by adulthood

Answer 7

True

Question 8

How quickly or slowly can signs and symptoms of anaphylaxis typically occur?

Answer 8

1. within 30 minutes

2. can take up to several hours

Question 9

What are some lab findings you would see with anaphylaxis ?

Answer 9

Elevated serum levels of mast cell mediators, such as tryptase and histamine,
may be detected shortly after a reaction providing support to the diagnosis.

Question 10

What is the cornerstone of treatment for anaphylaxis?

Answer 10

Epinephrine (adrenaline, epi-pen)

0.2-0.5mcg SC or IM q 5-15 minutes as needed (max 1mg)

Question 11

What are these examples of?

• Loratadine 10mg orally once daily
• Desloratadine 5mg once daily
• Fexofenadine 60mg twice daily or 120mg once daily

Answer 11

Adjunctive antihistamine treatments for anaphylaxis

Question 12

What is a bronchodilator you can use for anaphylaxis?

Answer 12

Albuterol
2 puffs q 15 minutes as needed for SOB
OR 20mg continuous nebulizer treatment

Question 13

What is a corticosteroid you could use for anaphylaxis ?

Answer 13

Methylprednisone 
125mg IV (x1 dose)

Question 14

After initial anaphylaxis, can you have a delayed repeat episode?

Answer 14

Yes, you need to monitor for this. Can happen up to 4 hours after initial treatment

Question 15

Patients with new or unexplained anaphylaxis should be evaluated by who?

Answer 15

allergist

Question 16

What is the formation of a allergen mediated rash known as?

Answer 16

Urticaria

Question 17

What is the eruption of evanescent wheals or hives that are acute and self limited?

Answer 17

urticaria

Question 18

What could possibly be the cause for chronic urticaria?

Answer 18

autoimmune basis

Question 19

itchy red swellings of a few millimeters to many centimeters would be what?

Answer 19

Urticaria

Question 20

Individual lesions in true urticaria last how long?

Answer 20

less than 24 hours, often only 2-4 hours

Question 21

What form of urticaria is triggered by a rise in core body temperature (hot showers, exercise)? Describe the wheals associated with this

Answer 21

1. Cholinergic urticaria

2. wheals are 2-3 mm in diameter with large surrounding red flare

Question 22

What is urticaria that is triggered from insect bites?

Answer 22

papular urticaria, can last for days

Question 23

True or False

Lab studies are likely to be helpful in the evaluation of acute urticaria

Answer 23

False

Question 24

What is the initial mainstay treatment for urticaria?

Answer 24

Antihistamines

Question 25

How long does acute urticaria usually last?

Answer 25

few days to weeks

Question 26

What is the swelling of vascular tissue involving deep subcutaneous tissue with the swelling of lips, eyelids, palms, soles and genitalia?

Answer 26

Angioedema

Question 27

True or False Angioedema, like urticaria is allergen mediated and often associated with a food allergy

Answer 27

true

Question 28

Is urticaria apart of angioedema?

Answer 28

no urticaria is not apart of the syndrome and lesions are not pruritic

Question 29

True or False Laryngeal angioedema can be life threatening during a classic anaphylaxis reaction

Answer 29

TRUE GIVE EPI

Question 30

These are all triggers for what? - NSAIDS - ACE Inhibitors - Estrogens - ASA - CCB's - Amiodarone

Answer 30

Angioedema

Question 31

What is known as a multisystem autoimmune disease?

Answer 31

Lupus

Question 32

What is an inflammatory autoimmune disorder characterized by autoantibodies to nuclear antigens, it can affect multiple organ systems?

Answer 32

Systemic Lupus Erythematous (SLE)

Question 33

Many clinical manifestations of what are secondary to the trapping of antigen antibody complexes in capillaries of visceral structures or to autoantibody-mediated destruction of host cells?

Answer 33

Systemic Lupus Erythematous (SLE)

Question 34

The clinical course of SLE is marked by what?

Answer 34

spontaneous remission and relapses

Question 35

Who does SLE occur mainly in?

Answer 35

mainly in young women, 85%

Question 36

What percentage of patients with SLE have joint symptoms?

Answer 36

90%

Question 37

What is one classic presentation for SLE?

Answer 37

the characteristic "butterfly" (malar) rash

Question 38

True or False SLE The pericardium is affected in the majority of patients. Heart failure may result from myocarditis and hypertension. Cardiac arrhythmias are common.

Answer 38

True