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A&I > Hypersensitivity disorders > Flashcards

Hypersensitivity disorders Flashcards

1
Q

what are the primary mechanisms of early and late-phase allergic rhinitis?

A
  • Early phase mechanisms are allergen-induced mast cell secretion of histamine, prostaglandins, and leukotrienes
  • late phase mechanisms are eosinophil chemotaxis caused by chemical mediators produced in the early reaction
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2
Q

what is the most common cause of rhinitis during pregnancy?

A

Pre-existing allergic rhinitis (about one third of women experience worsening of symptoms udring pregnancy)

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3
Q

Why can nasal congestion or rhinorrhea develop in hypothyroidism?

A

turbinate edema resulting from the release of thyroid-stimulating hormone

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4
Q

Acute onset of unilateral, clear rhinorrhea that is worse when the patient leans forward should prompt evaluation with what test?

A

check beta-2 transferrin in nasal secretions for suspected CSF rhinorrhea

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5
Q

what is the pathophysiologic mechanism for pale, boggy nasal mucosa in AR?

A

fluid extravasation leading to mucosal edema and venous constriction

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6
Q

how does allergic fungal rhinosinusitis lead to bone destruction and extension outside the sinuses?

A

Expansile growth of fungal hyphae and generation of allergic mucin

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7
Q

what lab values can be monitored to assess interval progression of AFRS s/p FESS?

A

increase in IgE >10% in post-surgical IgE correlate with increase risk of recurrence

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8
Q

what value of total serum IgE is necessary to diagnose AFRS?

A

total IgE is not one of Bent and Kuhn diagnostic criteria of AFRS.
- need to meet all 5 major criteria

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9
Q

In a patient with recurrent sinusitis and CT findings of pansinusitis and inspissated mucin, what role does SPT to aeroallergens play? (2)

A
  • identification of fungal sensitization
  • preparation for post-FESS allergen IT to fungal and nonfungal allergens.
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10
Q

what is ciliary flushing, and in which condition is it found?

A
  • ciliary flushing is an injection of the deep episcleral vessels, causing redness around the cornea
  • seen in corneal inflammation, iridocyclitis, and acute glaucoma
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11
Q

what is the treatment of choice for mild to moderate allergic conjunctivitis?

A
  • antihistamine (H1) + mast cell stabilizer
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12
Q

a 10 year old boy is seen for redness of his eyes. He has seasonal allergies and asthma. main complaints include itchy eyes, light sensitivity and feeling like sth is stuck in his eye. His sclera is injected and his R eyelid is lower than his left. what is the diagnosis?

A

Vernal keratoconjunctivitis

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13
Q

a 45 year old woman presents with ocular pruritus. Also has redness of eyes, difficulty with light, and sometimes pain. She always feels dry and has issues with dry skin. Her eyes feel like leather and she lost her eyelashes. Denies any vision problems requiring glasses or contacts. What is the diagnosis?

A

Atopic keratoconjunctivitis

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14
Q

sight threatening conditions include all of the following except:
- acute glaucoma
- uveitis
- infective conjunctivitis
- herpes simplex keratitis

A

infective conjunctivitis

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15
Q

which contact lenses put the wearer at greatest risk for developing giant papillary conjunctivitis?
- hard contact lens
- extended-wear soft contact lens
- daily disposable soft contact lens
- rigid gas permeable contact lens

A

extended-wear soft contact lens

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16
Q

which subtype of cataracts occur more frequently in patients exposed to glucocorticoids?

A

posterior subcapsular cataracts

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17
Q

which cytokine is primarily associated with pruritus in atopic dermatitis?

A

IL-31

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18
Q

what can a person with eczema develop after small pox vaccination?

A

Eczema vaccinatum (vaccinia virus disseminates to cause an extensive rash and systemic illness).

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19
Q

evidence supports a role of which aeroallergen in AD?

A

dust mite

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20
Q

which vaccine is contraindicated in severe AD?

A

small pox vaccine

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21
Q

what do IL-4 and IL-13 do to cathelicidin in the skin?

A

inhibit cathelicidin expression

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22
Q

which interleukins does dupilumab inhibit?

A

IL-4 and IL-13

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23
Q

what age group is Dupilumab approved for AD?

A

6 months and older

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24
Q

what are the causes of delayed peaked reaction (6-7 day) on patch testing? (3)

A
  • metals
  • neomycin
  • corticosteroids
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25
Q

what is the most frequent infectious cause of asthma exacerbations?

A

Rhinovirus

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26
Q

what percentage of children will have episodes of wheezing in the first 3 years of life due to viral respiratory tract infections?

A

50%

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27
Q

sensitization to what aeroallergen in children under 6 years old is associated with development of persistent asthma by age 11 years?

A

Alternaria

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28
Q

What is part of Asthma Predictive Index (API)? (6)

A

better NPV than PPV

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29
Q

What is part of Pediatric Asthma Risk Score (PARS)?

A

better PPV than API

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30
Q

what biomarker can be readily measured and is increased in eosinophilic asthma?

A

exhaled nitric oxide

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31
Q

what is the cause of skeeter syndrome?

A

sensitization to mosquito salivary secretions

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32
Q

what immune deficiency is associated with an ice cube negative cold urticaria?

A

PLAID syndrome (PLC-gamma-2-associated antibody deficiency and immune dysregulation)

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33
Q

false-positive (irritant) results to intradermal testing are more likely above what venom concentration?

A

> 1 ug/ml. (therefore, not recommended for diagnostic purposes)

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34
Q

a 35 year old female with hives lasting >6 mo complains of intermittent arthralgias and bruises on her arms/legs that are unsightly. What condition should you be concerned about?
- cholinergic urticaria
- urticarial vasculitis
- chronic spontaneous urticaria
- dermatographism

A
  • urticarial vasculitis
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35
Q

what is the febrile illness that occurs in workers after exposure to dust contaminated by toxin-producing fungi in grain, hay and textiles and is 30-50 times more common than farmer’s lung?

A

Organic dust toxic syndrome (ODTS)

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36
Q

Smoking is an associated risk factor for which agent of occupational asthma?

A

Platinum (welder, metal/chemical workers)

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37
Q

what is the usual causative agent in hot tub lung?

A

MAC (mycobacterium avium complex)

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38
Q

what is the most effective treatment for HP?

A

avoiding offending agent

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39
Q

what two immunizations are critical for COPD patients?

A
  • yearly flu vaccine
  • one-time 23-polyvalent pneumococcal vaccine
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40
Q

what medication is associated with red meat allergy (2)

A
  • allergy to Fab segment of cetuximab via an allergy to galactose-alpha-1,3-galactose (alpha-gal)
  • tickborne through Lone Star tick in the southeast US.
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41
Q

if severe hypotension occurs after a hymenoptera sting, what key blood test should be done?

A

tryptase

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42
Q

how many hours does it take for symptoms to peak after the application of a vibratory stimulus to the skin in patients with vibratory urticaria/angioedema?

A

4-6 hours

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43
Q

20% of patients with hypocomplementemic urticarial vasculitis syndrome (HUVS) have what chronic health conditions? (2)

A

Asthma and COPD

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44
Q

which medication is considered to be a risk factor for severe reaction to stings?

A

ACEI

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45
Q

what is the first step in evaluating ABPA in a patient with asthma?

A

establish IgE sensitization to Aspergillus via skin prick or serum specific IgE

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46
Q

patients sensitized to latex can also have a hypersensitivity reaction to which foods? (7)

A

ABC
Avocado, Banana, Chestnut, kiwi, white potato, bell pepper and tomato

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47
Q

updated GINA guidelines no longer recommends short-acting beta-2 agonist (SABA)-only treatment for Step 1. What medication should be used in its place for Step 1 treatment?

A

low dose ICS-LABA

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48
Q

what is the standard maintenance dose for venoms in children?

A

50 mcg

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49
Q

can you mix honeybee with vespids?

A

No

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50
Q

How is a definitive diagnosis of EoE made?

A

endoscopy with esophageal biopsy, >15 eos/hpf

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51
Q

serum total IgE levels usually exceed what level in ABPA?

A

> 1000 ng/mL (>417 IU/mL)

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52
Q

Within 20 minutes of eating mahi mahi on vacation in Florida, a 39 year old man develops abdominal cramps, vomiting, swelling of tongue and trouble breathing. SPT to all white fish is negative. What is the cause of this illness?

A

scombroid fish poisoning

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53
Q

what is the classic finding on CT chest in patients with ABPA?

A

central bronchiectasis and “finger in glove”

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54
Q

which component protein of peanut is a Bet v1 homolog, heat labile and associated with mild OAS-like sx?

A

Ara h 8

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55
Q

what condition should be evaluated in patients with acute worsening of asthma sx, rise in serum total IgE and serum eosinophils?

A

ABPA (allergic bronchopulmonary aspergillosis)

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56
Q

a 6 year old boy camping in Texas awakens with diffuse hives, SOB, and wheezing after a painless bug bite. What insect would you be most concerned about?

A

Triatoma (kissing bug)

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57
Q

what are some common high molecular weight agents that can cause occupational asthma?(9)

A
  • most derived from animals, plants and food
  • furry animal proteins, shellfish proteins, flour, wheat, coffee, tobacco dust, psyllium, latex and enzymes (amylase, lipase, pectinase)
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58
Q

Can you mix wasps and vespids?

A

No

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59
Q

what are the most common food allergies in adults (3)?

A
  • crustacean shellfish
  • peanut
  • tree nuts
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60
Q

Roofers, insulators, and painters (esp in autobody industry) can develop occupational asthma from being exposed to what?

A

isocyanates

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61
Q

what are the two most common forms of hypersensitivity pneumonitis?

A

Farmer’s lung and bird fancier’s lung

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62
Q

what does Toxicodendron cross-react with?

A

mango peels
- toxicodendron dermatitis (aka poison ivy, oak, and sumac) is the most common form of ACD. it is caused by urushiol, an oleoresin that is found in sap and oozes.

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63
Q

what drugs are commonly implicated in drug-induced ILD? (9)

A
  • Amiodarone, beta blockers, cyclosporine, fluoxetine, heroin, methotrexate, nitrofurantoin, procarbazine, sulfasalazine.
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64
Q

a point mutation in what mast cell gene has been associated with idiopathic anaphylaxis?

A

an activating point mutation (D816V) in KIT.

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65
Q

exposure to anhydrides is common in what occupation?

A

manufacturing paint, plastic and epoxy.

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66
Q

what is the allergen in vespids?

A

Antigen 5 (reverse “V” is similar to “A”)

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67
Q

workers in what field are at risk of occupational asthma due to exposure to plicatic acid? (3)

A

Woodworkers, carpenters, and mill workers exposed to western red cedar

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68
Q

what is the preferred inhaled corticosteroid for use during pregnancy?

A

Budesonide

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69
Q

How do you stage a COPD patient with FEV1/FVC ratio of 65% and FEV1 of 45%

A

GOLD stage 3 or severe COPD

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70
Q

GOLD stage for COPD

A
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71
Q

what type of emphysema is seen in alpha-1-antitrypsin deficiency?

A

Panacinar (or panlobular, involving lower lungs)

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72
Q

what is the typical presentation of acute hypersensitivity pneumonitis? (5)

A
  • similar to infectious sx
  • abrupt onset (4-6h after exposures) of fever, chills, malaise, nausea, cough, chest tightness, and dyspnea.
  • PE: diffuse fine crackles.
  • CXR: normal or transient patchy micronodular opacities.
  • improvement within 12h to several days after removal of antigen
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73
Q

which cytokines induce isotype switching of B cells to IgE and support eosinophil survival? (3)

A

Th2 cytokines: IL 4,5,13

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74
Q

Maintenance dose for mixed vespids

A

300 mcg

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75
Q

what test should be obtained for a young non-smoker with symptoms and signs of COPD?

A

test for alpha-1-antitrypsin deficiency

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76
Q

what allergen is found in henna tattos?

A

paraphenylenediamine (PPD)

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77
Q

if a patient has typical sx of COPD but has normal spirometry, what is her stage?

A

GOLD stage 0 or at risk of COPD

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78
Q

what is typically found in BAL in patients with HP? (2)

A

marked BAL lymphocytosis (>50%) and CD4/8 ratio <1.0

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79
Q

what is the most common type of interstitial lung disease of unknown cause?

A

idiopathic pulmonary fibrosis

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80
Q

this protein is produced in eosinophils, appears as a colorless, needle shaped structure and is released in eosinophilic disorders like asthma

A

Charcot leyden crystals

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81
Q

hairdressers are at risk of developing occupational asthma due to what agents? (3)

A

persulfate (ammonium) salts
amines
latex

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82
Q

receptor for rhinovirus on T cells that play a role in signal transduction

A

ICAM-1 (binding of rhinovirus may lead to more severe or prolonged asthma flare)

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83
Q

factors that decrease FeNO (6)

A

caffeine
smoking
alcohol
CF
pulm HTN
prev use of spirometry

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84
Q

factors that increase FeNO (3)

A

viral URI
allergic rhinitis
nitrate rich food (like hot dogs)

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85
Q

Diagnostic criteria for asthma using methacholine challenge

A

measures airway hyperresponsiveness
- PC20 <4 mg/mL is diagnostic
- 4-16mg/mL suggestive if appropriate sxs are present

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86
Q

.

A

.

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87
Q

name three validated tools of asthma control

A
  • asthma control questionnaire (ACQ)
  • asthma control test (ACT)
  • asthma therapy assessment questionnaire (ATAQ)
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88
Q

SMART management for asthma flare

A
  • use of low-med dose of budesonide/formoterol for relief and maintenance
  • reduce asthma flare and less ICS exposure
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89
Q

a short course of daily ICS for 0-4yo with recurrent viral-induced wheezing is recommended by?

A

EPR-3

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90
Q

what is a well-known complication of acute asthma flare?

A

PTX

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91
Q

onset of sx for exercise induced asthma (2)

A

10 min after aerobic activity, resolve by 15-30 min after
- FEV1 dec by >15% after exercise

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92
Q

lung volume changes in pregnancy

A
  • inc minute ventilation (compensated resp. alkalosis) due to inc progesterone
  • inc TV, dec RV and FRC (functional residual capacity)
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93
Q

EPR-3 classification of moderate persistent asthma severity for 0-4 yo

A
  • daily sx
  • 3-4 night time sx/month
  • daily use of SABA
  • some limitation in normal activity
  • > 2 flares/6mo OR >4 wheezing/1yr AND risk factors
  • recommended step is Step 3 and consider oral steroids
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94
Q

EPR-3 classification of not well controlled asthma for 0-4 yo

A
  • sx >2d/week
  • night-time sx >1/mo
  • some interference with normal activity
  • SABA use > 2d/weel
  • exacerbations 2-3x/yr
  • recommended tx = one step up
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95
Q

EPR-3 classification of moderate persistent asthma severity for 5-11 yo

A

daily sx
night time >1x/week
daily SABA use
some limitation
FEV1 60-80%; FEV1/FVC 75-80%
>2 excerbations/yr
Step 3 tx, consider oral steroids

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96
Q

EPR-3 classification of not well controlled asthma for 5-11 yo (7)

A

sx >2x/week
night time >1x/month
some limitation
SABA use >2d/week
FEV1 60-80%
2-3 excerbations/yr
tx one step up

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97
Q

EPR-3 classification of moderate persistent asthma severity for >12 yo

A

daily sx
night time >1x/week
daily SABA
some limitation
FEV1 60-80%; FEV1/FVC dec by 5%
>2 exacerbations /yr
step 3, consider oral steroids

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98
Q

EPR-3 classification of not well controlled asthma for >12 yo

A

sx >2d/week
night time 1-2x/week
some limitatino
SABA >2d/week
FEV1 60-80%
ATAQ 1-2/ ACQ>1.5/ ACT 16-19
>2 exacerbations/yr
tx one step up

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99
Q

EPR-3 stepwise approach tx for 0-4yo. Step 1 and 3 (1,3)

A

step 1 = SABA PRN +daily ICS at the start of sx
step 3 = daily low dose ICS/LABA
low dose ICS+montelukast
med-dose ICS

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100
Q

EPR-3 stepwise approach tx for 5-11 yo. Step 1 and 3

A

step 1 = SABA prn
step 3 = low dose ICS/formoterol
med-dose ICS
low dose ICS/LABA
low dose ICS + LTRA
low dose ICS/theophylline

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101
Q

EPR-3 stepwise approach tx for >12yo. Step 1 and 3

A

step 1 = SABA prn
step 3= low dose ICS/formoterol
med dose ICS
low dose ICS/LABA
lose dose ICS+LAMA
low dose ICS +LTRA
low dose ICS + theophylline or zileuton

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102
Q

GINA 2020 stepwise approach tx for 0-4yo. Step 2 and 3

A

step 2 = daily low dose ICS // daily LTRA // intermittent short courses of ICS at onset of sx
Step 3 = double low dose ICS
low dose ICS +LTRA

SABA prn

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103
Q

GINA 2020 stepwise approach tx for 6-11yo. Step 1 and 3

A

step 1 =low dose ICS + SABA prn // daily low dose ICS
step 3 = low dose ICS/LABA // med dose ICS
low dose ICS + LTRA

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104
Q

GINA 2020 stepwise approach tx for >12yo. Step 1 and 3

A

step 1 = low dose bud/formeterol prn // low dose ICS+SABA
step 3 = low dose ICS/LABA
med dose ICS
low dose ICS + LTRA
(preferred reliever is bud/form)

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105
Q

MOA of benralizumab (2)

A
  • binds to IL5Ralpha
  • induce apoptosis of eos via interaction with NK cells by Ab dep cell mediated cytotoxicity
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106
Q

characteristics of class 1 food allergens (6)

A

glycoproteins
glycosylation residue
heat resistant
acid stable
stable to proteases
water soluble

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107
Q

characteristics of class 2 food allergens (3)

A

plant derived
labile
due to allergic sensitization to inhalant allergens

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108
Q

linear epitope is associated with

A

more prolonged allergy and more stable/persistent allergen

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109
Q

proteins and food allergens of milk

A

casein - Bos d 8 - major allergen, more persistent
whey (lactoglobulins) - Bos d 4-6 - heat labile

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110
Q

egg white proteins and allergens

A

ovomucoid - Gal d 1 - more persistent. best predictor of reaction to heated egg
ovalbumin - Gal d 2 - heat labile. associated with outgrowing egg allergy
ovotransferrin - Gal d 3 - heat labile

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111
Q

peanut protein and allergens (8)

A

vicilin (seed storage protein) - Ara h 1 - major. heat stable
conglutin (seed storage) - Ara h 2, 6, 7 - major, heat stable
glycinin (seed storage) - Ara h 3 - major. heat stable
profilin/ Bet v 2 homolog - Ara h 5 - heat labile
Bet v 1 homolog - Ara h 8 - heat labile. OAS
lipid transfer protein - Ara h 9 - stable protein
oleosin - Ara h 10, 11
defensins - Ara h 12, 13 - associated with severe anaphylaxis

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112
Q

soy bean protein and allergens

A

Bet v 1 homolog - Gly m 3,4 - mild sx and OAS
storage proteins - Gly m 5,6 - severe rxn

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113
Q

wheat protein and allergens

A

lipid transfer protein - Tri a 14
seed storage protein - Tri a 19 (omega 5 gliadin) - major. anaphylaxis and wheat dependent exercise induced anaphylaxis

114
Q

fish protein and allergen

A

parvalbumin - Gad c 1, Gad m 1

115
Q

shrimp protein and allergen

A

tropomyosin - Pen a 1, Pen m 1 - shrimp, cockroach and DM

116
Q

cashew protein and allergen

A

albumin - Ana o 3 - predictive of allergy

117
Q

hazelnut protein and allergens (4)

A

Bet v 1 homolog - Cor a 1 - heat labile, OAS
lipid transfer protein - Cor a 8 - severe rxn
globulin - Cor a 9 - severe rxn
Albumin - Cor a 14 - severe rxn

118
Q

walnut protein and allergen (3)

A

seed storage proteins - Jug r 1,4 - severe rxns
Bet v 1 homolog - Jug r 5 - mild sx

119
Q

when is it ok to test someone who has never eaten peanut before?

A

infant with IgE mediated egg allergy
infant with recalcitrant mod/sev AD

120
Q

which peanut allergens does Palforzia contain?

A

Ara h 1,2,6

121
Q

what is Heiner’s syndrome

A
  • non IgE mediated cow’s milk induced pulmonary disease in chilren
  • recurrent PNA, pulm infiltrates, hemosiderosis, Fe def anemia and FTT
  • dx by history, peripheral eos, milk precipitins, lung biopsy, elimination diet
122
Q

name cross-reactive allergens for venom (5)

123
Q

treatment for food-induced rhinitis

A

intranasal ipratropium

124
Q

which medication is ineffective for rhinitis of pregnancy?

A

intranasal steroids

125
Q

Drugs that can cause drug-induced rhinitis (6)

A
  • ASA/NSAIDs
  • antihypertensives (bB or ACEi)
  • intranasal decongestants - rebound
  • OCPs
  • Sildenafil (other PGD5 inhibitors)
  • intranasal cocaine or methamphetamine
126
Q

atrophic rhinitis (2)

A
  • primary/idiopathic - usually in young/middle-aged pt in developing countries with a warm climate. colonization with Klebsiella
  • secondary - usually due to sinonasal surgeries
127
Q

NARES (5)

A
  • symptoms of AR + eosinophilia on nasal smear
  • anosmia, polyps, bronchial hyperreactivity
  • no elevated total IgE or sIgE
  • related to abnormal prostaglandin metabolism
  • typically in middle aged men
128
Q

which cytokine uniquely promotes airway mastocytosis and mast cell progenitor dev and localization to airway?

129
Q

pt population affected by AFRS

A

young, immunoCOMPETENT population

130
Q

common fungi implicated in AFRS (4)

A

Aspergillus, Bipolaris, Curvularia, Drechslera

131
Q

CT and MRI findings of AFRS

A
  • CT: central hyper-attenuation and heterogeneous opacification
  • MRI: peripheral enhancement (inflammation) with a dark center (fungal concretions)
132
Q

Bent and Kuhn criteria for AFRS diagnosis (5)

A

need all five criteria
- type I hypersensitivity to fungi confirmed with SPT or sIgE
- nasal polyps
- characteristic CT findings
- noninvasive fungal hyphae in mucin OR positive fungal culture of mucin
- eosinophilic mucin without invasion into sinus tissue

133
Q

epidemiology of vernal keratoconjunctivitis (3)

A
  • sight-threatening bilateral eye disease seen in young atopic males
  • warm and dry climates
  • usually resolve by late puberty
134
Q

clinical features of vernal keratoconjunctivitis (6)

A
  • severe photophobia
  • intense ocular itching
  • papillary hypertrophy
  • cobblestone papillae
  • Horner-Trantas dots (peri-limbal white dots)
  • keratoconus
135
Q

clinical features of atopic keratoconjunctivitis (5)

A
  • ocular pruritus with eczema
  • can have loss of vision due to superficial punctate keratitis, corneal infiltrates, keratoconus and anterior subcapsular cataracts
136
Q

steroids result in what type of cataracts?

A

posterior subcapsular cataracts

137
Q

epidemiology of Giant Papillary conjunctivitis (3)

A
  • associated with foreign body intolerance (ocular prostheses, sutures, contact lenses)
  • extended wear > daily hard lens > daily soft lens
  • can be aggravated by concomitant allergy
138
Q

clinical features of vernal keratoconjunctivitis (3)

A
  • ocular itching after lens removal
  • morning mucus discharge
  • tarsal papillary hypertrophy (initially smaller than VKC)
139
Q

7 sight-threatening eye diseases

A
  • acute glaucoma
  • scleritis
  • iritis
  • uveitis
  • herpes simplex keratitis
  • atopic keratoconjunctivitis
  • vernal conjunctivitis
140
Q

malignancy that needs to be considered in an adult patient with new-onset dermatitis without a history of eczema/atopy

A

cutaneous T cell lymphoma (can be patchy)

141
Q

which cytokine is implicated in itch?

142
Q

genetic mutations associated with AD (4)

A

FLG2
SPRR3
CLDN1
TMEM79

143
Q

cytokines implicated in chronic eczema (30

A

IL-5, IL-12 and IFN gamma
- education is CHRONIC starting at FIVE through “G”rade TWELVE

144
Q

What is different about FceRI receptors on Langerhans cells?

A

lack classic beta chain

145
Q

distinguishing features of Zn deficiency (acrodermatitis enteropathica) -2

A
  • periorificial rash
  • does not respond to steroids
146
Q

distinguishing features of pyridoxine deficiency (Vit B6 and niacin) -3

A

seizures, irritability, cheilitis

147
Q

what is Crisaborole (3)

A

topical PDE4 inhibitor
- approved for mild/mod eczema >3mo old
- efficacy is uncertain

148
Q

three characteristic features of asthmatic sputum

A
  • Curschmann’s spirals
  • Creola bodies
  • Charcot Leyden crystals
149
Q

structural changes seen in asthma (3)

A
  • small airway smooth mm hypertrophy
  • thickening of reticular basement membrane
  • subepithelial fibrosis
150
Q

genetic factors associated with asthma (4)

A
  • Chr. 5q - has IL-4 gene cluster
  • b2 adrenoreceptor gene - affect response to b2 agonists
  • Cd14 polymorphism - shift to Th1
  • Chr 20p13 - has ADAM33 metalloproteinase that affects remodeling
151
Q

which integrin ligand binds to rhinovirus that result in more severe and prolonged asthma flare?

152
Q

occupational contact dermatitis to chromium is seen in which population?

A

workers who handle wet cement

153
Q

Contact dermatitis can be differentiated from irritant dermatitis based on which finding?

A

ACD is poorly defined, unlike irritant dermatitis

154
Q

95% predictive values for milk allergy sIgE (2)

A
  • <2yo: 5
  • > 2yo: 15
155
Q

95% predictive values for egg allergy sIgE (2)

A

< 2yo: 2
> 2yo: 7

156
Q

95% predictive value for soy allergy sIgE

A

sIgE of 65

157
Q

95% predictive value for wheat allergy sIgE

158
Q

95% predictive value for peanut allergy sIgE

159
Q

95% predictive value for tree nut allergy sIgE

160
Q

95% predictive value for fish allergy sIgE

161
Q

4 pairs of cross-reactive food

A
  • cashew-pistachio
  • pecan- walnut
  • almond- hazel nut
  • lentil- chick pea
162
Q

pt with alpha-gal can have reactions to which medication and food, aside from red meat? (2)

A
  • cetuximab
  • gelatin (contains alpha-gal)
163
Q

what is Latex-Fruit syndrome?

A

30-50% of latex-allergic pts have reactions to some plant-derived foods, like Avocado, Banana, Chestnut, and Kiwi

164
Q

pollen implicated for OAS to apple, plum, peach, pear, etc (씨 있는 과일)

A

Birch (Bet v 1)

165
Q

pollens implicated in OAS to cantaloupe, watermelon, honeydew (2)

A

Ragweed, Orchard

166
Q

pollen implicated in OAS celery, carrot, parsley, etc

167
Q

2 HLA molecules associated with celiac disease

168
Q

high levels of these cytokines correlate with hypotension during anaphylaxis (6)

A

IL-6, IL-10, TNF receptor I, tryptase, histamine, C3a

169
Q

ACEI in VIT vs AIT

A
  • theoretical increased risk in VIT, but no data for AIT
170
Q

premedication protocol for contrast media (2)

A
  • 50mg of prednisone 13, 7, and 1 hour before procedure + 50mg of benadryl 1h before
  • use low or iso-osmolar, non ionic contrast material
171
Q

what are latex allergens (5)

A

Hev b 1 -13
- endo-1,3 β-glucosidases (Hev b 2), patatin-like proteins (Hev b 7), profilins (Hev b 8), and nonspecific lipid transfer proteins (Hev b 12).

172
Q

food associated with natural rubber allergen Hev b 2 (2)

A

Bell pepper, olive

173
Q

food associated with natural rubber allergen Hev b 5 (3)

A

Kiwi, potato, sugar beet

174
Q

food associated with natural rubber allergen Hev b 6 (4)

A

Avocado, banana, chestnut, sweet peper

175
Q

food associated with natural rubber allergen Hev b 7 (2)

A

potato and tomato

176
Q

food associated with natural rubber allergen Hev b 13

177
Q

Hev b proteins more commonly associated with health care workers (3)

A

Hev b 5, 6, 7

178
Q

insects part of Family Apidae (2)

A
  • honey bees (Apis Mellifera, includes Africanized killer bees)
  • bumble bees (Bombus spp)
179
Q

insects part of Family Vespidae (4)

A
  • yellow jacket (Vespula spp)
  • yellow hornet (Dolichovespular arenaria)
  • white faced hornet (D. maculata)
  • paper wasp (subfamily polistes spp)
180
Q

characteristics of yellow jacket

A
  • highly aggressive (around garbage cans or food)
  • can sting repeatedly
  • nests in concealed locations underground, wall cavities or decaying wood
181
Q

key allergen for hornets

A

Dol m 5 - Antigen 5

182
Q

major allergens for honeybee (5)

A
  • Api m 1 = phospholipase A2
  • Api m 2 = hyalurondiase
  • Api m 3 = acid phosphatase
  • Api m 7 = CUB serine protease
  • Api m 10 = Icarapin
183
Q

major allergens for hornet/vespid (3)

A
  • Ves v 1 = phospholipase A1
  • Ves v 2 = hyaluronidase
  • Ves v 5 = antigen 5
184
Q

major allergens for paper wasp (3)

A
  • Pol a 1 = phospholipase A1
  • Pol a 2 = hyaluronidase
  • Pol a 5 = antigen 5
185
Q

major allergens for fire ant (2)

A

Sol i 1 = phospholipase A2
Sol i 3 = antigen 5

186
Q

injection schedule for VIT maintenance (3)

A

q4 weeks for 1-1.5yrs
q6-8 weeks until 4yrs
q12 forward

187
Q

What agent should you suspect in an automobile worker with occupational asthma who works in finish coating?

A

Hexamethylene diisocyanate (HDI) as it is used extensively in spray paints.

188
Q

what is Reactive airway dysfunction syndrome

A

a type of occupational asthma without latency and immunologic sensitization, occurring after a single massive irritant exposure with consequent severe airway injury

189
Q

Occupational asthma related to western red cedar is due to exposure to?

A

Plicatic acid

190
Q

what is the order of sx development in AERD? (3)

A

Rhinosinusitis with polyps, asthma, aspirin hypersensitivity

191
Q

What is the target dose of aspirin desensitization to maintain cross- desensitization to any dose of all NSAIDs vs for AERD?

A
  • 325mg for NSAIDs
  • 650mg BID for AERD
192
Q

characteristic bite of a kissing bug (triatoma)

A

nocturnal painless bite that causes erythematous urticarial nodule/plaque

193
Q

what is an indoor allergen that cross-reacts with cockroaches?

A

Asian Lady Beetle (Harmonia Axyridis)

194
Q

treatment for cold urticaria

A

cyproheptadine (C for cold)

195
Q

what can be SPT positive in patients with cholinergic urticaria?

A

their own sweat

196
Q

cold urticaria syndromes with negative ice cube test (6)

A
  • PLAID (PLC-gamma-2-associated antibody deficiency and immune dysregulation)
  • delayed cold urticaria
  • cold-induced cholinergic urticaria
  • systemic cold urticaria
  • familial cold autoinflammatory syndromes (FCAS)
  • cold-dependent dermographism
197
Q

diagnostic criteria for hypocomplementemic Urticarial Vasculitis Syndrome

A
  • needs both major criteria and at least 2 minor criteria
  • Major: urticaria > 6mo, low C3/4/C1q
  • Minor: venulitis of dermis on biopsy, arthralgias/arthritis, mild glomerulonephritis, uveitis or episcleritis, recurrent abdominal pain, positive C1q precipitin test with an associated low level of C1q
198
Q

common agent associated with OA for carpenters and woodworkers

A

Plicatic acid (western red cedar wood dust) - activates complement

199
Q

common agent associated with OA for roofers, insulators, painters

A

isocyanates

200
Q

common agent associated with OA for nail salon workers, dental hygienists, and plastic manufacturers (2)

A

Acrylates, Epoxy

201
Q

common agent associated with OA for manufacturers of paint, plastic, and epoxy resins

A

anhydrides

202
Q

common agent associated with OA for hospital workers, laboratories (2)

A

formaldehyde, glutaraldehyde

203
Q

common agent associated with OA for drug industry workers (2)

A

beta lactams, opiates

204
Q

name LMW agents associated with OA (10)

A
  • plicatic acid
  • isocyanates
  • acrylates
  • epoxy
  • metals
  • dyes/bleaches
  • anhydrides
  • amines
  • formaldehyde
  • beta lactams/opiates
205
Q

diagnosis of OA with PFT (3)

A
  • PFT or peak flow to be done q2h at work and at home for 2 weeks
  • PEFR lower at work with variability >20%
  • FEV1 reduction by 15-20% after exposure is suggestive
206
Q

antigen for Farmer’s lung

A

Thermophilic actinomyteces

207
Q

antigen for humidifier fever/AC lung (3)

A
  • Thermoactinomyces
  • Klebsiella
  • Acanthamoeba
208
Q

antigen for hot tub lung (2)

A

MAC or Cladosporium

209
Q

antigen for Woodworker’s lung

A

Alternaria species

210
Q

antigen for wheat weevil lung/miller’s lung (2)

A

Sitophilus, Aspergillus fumigatus

211
Q

antigen for chemical worker’s lung (2)

A
  • toluene diisocyanate (TDI)
  • diphenylmethane diisocyanate (MDI)
212
Q

antigen for epoxy resin worker’s lung

A

phthalic acid

213
Q

findings on BAL for HP (2)

A

lymphocytosis and low CD4/CD8 ratio (<1)

214
Q

what is organic dust toxic syndrome (or pulmonary mycotoxicosis) (6)

A
  • non-infectious, febrile illness after exposure to toxin-producing fungi
  • more common than HP
  • young patients
  • usually during summer
  • no prior sensitization is needed
  • serologic response to common fungi may be absent
215
Q

GOLD staging for COPD (5)

A
  • GOLD 0 = at risk. normal spirometry but with sx
  • GOLD 1 = mild. FEV1 >80%
  • GOLD 2 = moderate. FEV1 50-80%
  • GOLD 3 = severe. 30-50%
  • GOLD 4 = very severe. FEV1 <30%.
216
Q

pathogenesis of COPD (2)

A
  • neutrophils, Mo and CD8 T cells release proteases that cause parenchymal lung destruction/ emphysema
  • nicotine may also enhance tissue destruction
217
Q

different types of emphysema and its associated dz (3)

A
  • centrilobular emphysema = involves upper lobes. associated with cigarette
  • panlobular = alpha1-antitrypsin deficiency
  • paraseptal (distal acinar) = subpleural collections of gas in the periphery. associated with spontaneous PTX in young adults
218
Q

what is the predominant histologic features in contact derm? (2)

A

lymphocytic infiltration and spongiosis

219
Q

what is an Angry Back syndrome?

A
  • strong reaction that can lead to negative sites appearing positive
220
Q

don’ts for patch testing (5)

A
  • no testing within 3 weeks of UV treatments, heavy sun exposure or tanning bed
  • avoid using systemic and topical steroids in the area
  • avoid using alcohol or other irritating substances prior to application
  • avoid sweating or getting it wet
  • avoid using razors to shave the area
221
Q

allergens associated with contact derm on eyelids (3)

A

fragrances, nickel, formaldehyde

222
Q

allergens associated with contact derm on hands and feet (3)

A

nickel, chromium, formaldehyde

223
Q

allergens associated with contact derm on hands and perioral region (2)

A
  • CAPB (cocamidopropyl butaime)
  • fragrance
224
Q

allergens associated with contact derm on eyelids and periaxillary area (2)

A

fragrance and formaldehyde

225
Q

what is CAPB?

A

surfactant found in shampoos and other cleansers

226
Q

interpretation of 1+ on patch test

A

erythema and edema that is palpable with slight infiltration that occupies 50% of the site

227
Q

interpretation of 2+ on patch test

A

microvesicles and erythema that occupy at least 50% of site

228
Q

interpretation of 3+ on patch test

A

confluent vesicles or bullae, ulcerative

229
Q

irritant reaction on patch test

A

discrete, follicular or homogenous erythema without infiltration

230
Q

what is the source of quaternium15? (3)

A

topical medications, creams, lotions

231
Q

what are the sources of colophony? (5)

A

adhesives, glues, cosmetics, soaps, sealants

232
Q

what are the sources of K dichromate? (3)

A

shoes, leather, stainless steel

233
Q

what are the sources of bisphenol A and epichlorohydrin? (3)

A

sporting goods, vehicle parts, building construction

234
Q

what are the sources of cobalt? (5)

A

dental implants
artificial joints
engines or rockets
leather
ceramics

235
Q

what are the sources of chromates? (3)

A

textile
leather tanners
construction workers using wet cement

236
Q

what can be used to test metals to see if it contains nickel?

A

dimethylglyoxime test (pink = positive)

237
Q

toxicodendron dermatitis cross-reacts with what?

A

mango peels
- urushiol is the oleoresin that sensitizes pts

238
Q

characteristics of contact derm to Alstroemeria (Peruvian lily) (3)

A
  • causes hand eczema in flower workers
  • intensely pruritic
  • affects 1st three fingers, dorsal hands, forearms, V-region of neck and face
239
Q

Balsam of Peru cross-reacts with? (2)

A

cinnamon and vanillin

240
Q

name four major chemical classes of topical steroids (4)

A

Group A = hydrocortisone type
Group B = triamcinolone type
Group C = Betamethasone type
Group D = hydrocortisone-17-butyrate type

241
Q

if positive for EDTA (ethylenediamine dihydrochloride) on patch test, what should you avoid? (3)

A
  • aminophylline
  • nystatin
  • piperazine-based antihistamines (meclizine, cyclizine)
242
Q

if positive for neomycin on patch test, what should you avoid? (5)

A

gentamicin
kanamycin
streptomycin
tobramycin
bacitracin

243
Q

Females over age 15 have higher rate of anaphylaxis than males. The reason for this is unknown but may be due to?

A

Hormonal changes which increase sensitivity to anaphylaxis.

244
Q

IL-33 may be important in anaphylaxis due to its role in?

245
Q

impaired TLR2 expression has been linked with?

A

severe AD with frequent bacterial infections

246
Q

skin finding of omenn sydrome

A

diffuse, exudative erythroderma

247
Q

dock8 deficiency (5)

A
  • difficult to treat viral skin infections
  • also bacterial skin infections
  • mucocutaneous candidiasis
  • respiratory tract infections
  • high incidence of malignancy
250
Q

an allergen in Kissing Bug

A

Procalin
- Kissing bug = triatoma

251
Q

Main allergens in baker’s asthma (4)

A
  • hydrolytic enzymes
  • latex
  • flour
  • egg powder
252
Q

How is pollination from angiosperms achieved?

A

Pollen constituents either diffuse out or are expelled from the grains onto the stigma surface, after which the pollen tube emerges and grows toward the ovum.

253
Q

How is pollination from gymnosperms achieved?

A

Pollen is either trapped by a pollination drop that emanates from the exposed ovula or are engulfed by the ovula extensions.

254
Q

scientific name of Lone Star tick

A

Amblyomma americanum

255
Q

What is the family of small extracellular proteins that mammalian allergenics such as cat (Fel d 1) and cattle (Bos d 2) belong to?

A
  • lipocalins
    Allergenic source materials such as from rodents (Mus m 1) and dog (Can f 1) and cat (Fel d 1) belong to a family of small extracellular proteins called lipocalins.
256
Q

agents that are associated with occupational asthma in auto body repair industry (3)

A

acrylates
isocyanates
amines

257
Q

latex allergens for healthcare workers (2)

A
  • Hev b 5 and 6.01/6.02
  • Hev b 1 and 3 in pts with spinal bifida
258
Q

High molecular weight protein has a molecular mass of?

260
Q

Fire ant venom contains?

A

95% piperidine alkaloids

261
Q

initial treatment for ABPA

A

oral steroids

262
Q

which T helper cell type is predominant during acute vs chronic HP? (3)

A
  • Th1 during acute
  • Th2 during subacute/chronic
  • increased Th17 response during subacute/chronic phage –> lymphocyte apoptosis and impaired Treg function (normal number)
263
Q

allergen in HP for wind-pipe instrument players

A

Candida albicans

264
Q

Aspergillus is associated with HP in which populations? (2)

A

Malt workers (moldy malt)
Wheat weevil or miller’s lung (moldy grains)

265
Q

WHO criteria for systemic mastocytosis

A

1 Major + 1 minor
OR 3 minors

266
Q

what type of mastocytosis has the worst prognosis?

A

Mastocytosis leukemia

267
Q

Midostaurin is used for? (6)

A
  • treatment of aggressive systemic mastocytosis, mast cell leukemia, and systemic mastocytosis associated with hematologic malignancy
  • can be used regardless of kit mutation status
    -***imatinib is only used for pts who DONT have kit mutation
268
Q

What is a potential mechanism for thunderstorm asthma?

A

Ruptured grass pollen

269
Q

examples of Type III hypersensitivity reactions (5)

A
  • vasculitis
  • glomerulonephritis
  • SLE
  • serum sickness
  • Arthus reaction
270
Q

symptoms to differentiate between infectious vs allergic conjunctivitis

A

Mucous stranding suggests a viral process, but secondary bacterial infections commonly lead to “glue eye”.
- watery discharge and ocular pruritus for allergic conjunctivitis
- mucus stranding can also be seen with VKC**

271
Q

age difference in AKC vs VKC

A

VKC- 3~20yo
AKC - 20~50yo

272
Q

ocular pathology most likely seen in AKC (4)

A

Punctate epithelial keratopathy (most likely)
- corneal scarring and keratoconus can also be seen
- anterior or subcapsular cataracts
- shield ulcers

273
Q

unique cytokine involved in irritant contact derm

A

IL-1alpha
- IL-1b and TNFa are involved in both ICD And ACD.
- IL-18 only in ACD.

274
Q

characteristics of primary/idiopathic atrophic rhinitis (2)

A
  • young-middle aged patients from developing countries with warm climate
  • associated with Klebsiella colonization of the nose
275
Q

LMW agents that can cause occupational asthma in pts who work with pain

A
  • Acrylates
  • anhydrides (can also cause AR)
  • amines
276
Q

rhinitis due to irritants is mediated by which receptor?

A

transient receptor potential ankyrin type 1 (TRPA1)

277
Q

rare side effect associated with topical decongestants in children

278
Q

risk of epistaxis with intranasal steroid

279
Q

definition of chronic rhinosinusitis in adults vs children (1)

A

sx >12 weeks for both

280
Q

when is the best time to obtain sinus CT?

A

at baseline. after acute illness.

281
Q

Which antibody is most associated with severe local eosinophilic inflammation in nasal polyposis?

A

IgE selective for Staphylococcus aureus enterotoxins

A&I (10 decks)

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