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Tao Le A/I Board Review > Hypersensitivity Disorders > Flashcards

Hypersensitivity Disorders Flashcards

1
Q

Name some protective factors for allergic rhinitis

A

rural upbringing with early life exposure to farm animals, day care attendance, large family size, exposure to pets, number of siblings

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2
Q

When does the late phase allergic response begin and how long does it last ?

A

4-8 hours; 24 hours

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3
Q

What is typical of FeNo in allergic rhinitis and sinusitis, respectively?

A

high, low

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4
Q

What is the term used to describe the effect by which progressively lower doses of allergen are needed to trigger subsequent symptoms?

A

priming

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5
Q

What symptom is prominent in the late phase response of allergic rhinitis?

A

congestion

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6
Q

What is the most effective medication for allergic rhinitis?

A

nasal steroids

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7
Q

How is nonallergic rhinitis with eosinophilia (NARES) different from allergic rhinitis?

A

no elevated total or specific IgE

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8
Q

Nasal crusting is characteristic of what kind of rhinitis?

A

atrophic

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9
Q

Hormone induced rhinitis may be associated with what endocrine disorder?

A

hypothyroid - TSH stimulates edema in turbinates

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10
Q

What are the common pathogens that cause bacterial acute rhinosinusitis?

A

strep pneumo, moraxella catarrhalis, haemophilus influenzae

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11
Q

What is a Haller cell?

A

A pneumatized ethmoid cell that blocks the ostiomeatal complex

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12
Q

Where do nasal polyps typically originate?

A

ethmoid sinuses

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13
Q

Which mediators are increased in CRS without nasal polyps?

A

IL-3, PGE2

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14
Q

Which mediators are increased in CRS with nasal polyps?

A

IL-5, Eotaxin, LCTC4/D4/E4

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15
Q

Conjunctivitis with otitis is more likely caused by what organism?

A

H. influenzae

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16
Q

How is recurrent otitis media defined?

A

> 3 episodes within 6 months or >4/yr

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17
Q

What is the leading cause of hearing loss in children?

A

otitis media with effusion (non-infectious)

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18
Q

What is a destructive, expanding accumulation of keratinized squamous epithelium in the middle ear or mastoid?

A

cholesteatoma

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19
Q

Papillary hypertrophy, thick ropey ocular discharge, and Horner-Trantas dots are characteristic of what?

A

Vernal keratoconjuctivitis

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20
Q

Where do cataracts arise due to steroid administration?

A

posterior capsule

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21
Q

What is the greatest risk factor for giant papillary conjunctivitis?

A

contact lens use

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22
Q

A decrease in what antimicrobial peptides increase the risk of infection in atopic dermatitis?

A

defensins, cathelicidin

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23
Q

What are the cytokines involved in acute and chronic atopic dermatitis, respectively?

A

IL-4, IL-13; IL-5, IL-12, IFNγ

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24
Q

Polymorphisms in which TLR is linked to severe atopic dermatitis with frequent bacterial infections?

A

TLR2

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25
Q

Loss of function mutations in what predisposes to development of atopic dermatitis?

A

filaggrin

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26
Q

What is the ligand for E selectin that helps T cells home to the skin in atopic dermatitis?

A

cutaneous lymphocte-associated antigen (CLA)

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27
Q

The presence of Birbeck granules are characteristic of what cell type?

A

Langerhans cells

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28
Q

Which cytokine is primarily associated with pruritis in atopic dermatitis?

A

IL-31

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29
Q

Where are cataracts due to atopic keratoconjunctivitis found?

A

anterior capsule

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30
Q

Deficiency of which antimicrobial peptide in atopic skin may contribute to eczema vaccinatum?

A

cathelicidin (LL-37)

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31
Q

A 3 y/o boy presents with bloody stools, ear drainage and eczema. What PID should be considered?

A

Wiscott-Aldrich syndrome

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32
Q

Vitamin D induces production of which antimicrobial peptide in atopic individuals?

A

cathelicidin (LL-37)

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33
Q

Accumulation of what cell type is associated with fatal asthma?

A

neutrophils

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34
Q

Hyperplasia of submucosal glands in asthma is promoted by which cytokine?

A

IL-9

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35
Q

Sensitization to what by age 6 is associated with persistence of asthma at age 11?

A

alternaria

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36
Q

A 5q31-33 polymorphism can contribute to atopic asthma by increasing production of which interleukin ?

A

IL-4

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37
Q

A β2-adrenoreceptor gene can lead to what?

A

decreased response to β2 agonist

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38
Q

What is the most frequent infections cause of asthma exacerbations?

A

rhinovirus

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39
Q

What is the asthma predictive index?

A 
Major criteria (1 needed): parental asthma, dx of eczema, allergic sensitization
Minor criteria (2 needed): sensitization to foods, eosinophilia, wheezing apart from colds
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40
Q

Classify the asthma severity of a 3 y/o with daily symptoms, 3 nighttime awakenings/month, and daily SABA use. What initial step therapy should be used?

A

moderate persistent, step 3

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41
Q

Classify the asthma severity of a 8 y/o with symptoms/SABA use 4 days/week, 3 nighttime awakenings/month, and an FEV1 of 83%. What initial step therapy should be used?

A

mild persistent, step 2

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42
Q

Classify the asthma severity of a 8 y/o with symptoms/SABA use 4 days/week, weekly nighttime awakenings, and an FEV1 of 76%. What initial step therapy should be used?

A

moderate persistent; step 3

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43
Q

Classify the asthma severity of a 13 y/o with symptoms/SABA use 4 days/week, 3 nighttime awakenings/month, and an FEV1 of 83%. What initial step therapy should be used?

A

mild persistent, step 2

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44
Q

What initial step of therapy should be used for an 8 y/o with severe persistent asthma?

A

step 3-4

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45
Q

What initial step of therapy should be used for an 15 y/o with severe persistent asthma?

A

Step 4-5

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46
Q

Classify the asthma severity of a 3 y/o with daily symptoms, weekly nighttime awakenings, and SABA use several times per day. What initial step therapy should be used?

A

severe persistent; step 4

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47
Q

Classify the asthma severity of a 3 y/o with symptoms/SABA use 4 days/week, nighttime awakenings twice/month. What initial step therapy should be used?

A

mild persistent; step 2

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48
Q

Classify the asthma severity of an infant with 3 exacerbations in the last 6 months who’s mother has asthma. No symptoms outside of exacerbations. What initial step therapy should be used?

A

mild persistent; step 2

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49
Q

Classify the asthma severity of a 23 y/o with 3 exacerbations/year and an FEV1 of 65%. What initial step therapy should be used?

A

moderate persistent; step 3

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50
Q

Assess the asthma control in a 2 y/o with symptoms 3 days/week with 1 nocturnal awakening/month and 2 exacerbations/year. What action should be taken?

A

not well controlled; step up 1 step

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51
Q

Assess the asthma control in a 10 y/o with symptoms 2 days/week with 1 nocturnal awakening/month and 1 exacerbation/year. What action should be taken?

A

controlled, no action

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52
Q

Assess the asthma control in a 14 y/o with symptoms throughout the day, 5 nocturnal awakenings/month, an FEV1 of 58% and 2 exacerbations/year. What action should be taken?

A

very poorly controlled; step up 1-2 steps and consider oral steroids

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53
Q

Assess the asthma control in a 2 y/o with daily symptoms, 5 nocturnal awakenings/month and 4 exacerbations/year. What action should be taken?

A

very poorly controlled; step up 1-2 steps, consider oral steroids

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54
Q

Assess the asthma control in a 10 y/o with symptoms 3 days/week with 2 nocturnal awakenings/month, and FEV1 of 78%, and 2 exacerbations/year. What action should be taken?

A

not well controlled; step up 1 step

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55
Q

Assess the asthma control in a 14 y/o with symptoms 5 days/week, 3 nocturnal awakenings/month, an FEV1 of 62% and 2 exacerbations/year. What action should be taken?

A

Not well controlled; step up one step

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56
Q

What is step 1 therapy for children ages 0-4?

A

SABA PRN

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57
Q

What is step 1 therapy for children ages 5-11?

A

SABA PRN

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58
Q

What is step 1 therapy for adults?

A

SABA PRN

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59
Q

What is step 2 therapy for children ages 0-4?

A

low dose ICS; alternative = montelukast or cromolyn

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60
Q

What is step 2 therapy for children ages 5-11?

A

low dose ICS; alternative = montelukast, theophylline or cromolyn

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61
Q

What is step 2 therapy for adults?

A

low dose ICS; alternative = montelukast, nedocromil, theophylline or cromolyn

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62
Q

What is step 3 therapy for children ages 0-4?

A

medium dose ICS

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63
Q

What is step 3 therapy for children ages 5-11?

A

low dose ICS + LABA or LTRA or theophylline; alternative = medium dose ICS

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64
Q

What is step 3 therapy for adults?

A

low dose ICS + LABA or LTRA or theophylline or zileuton; alternative = medium dose ICS

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65
Q

What is step 4 therapy for children ages 0-4?

A

medium dose ICS + LABA or LTRA

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66
Q

What is step 4 therapy for children ages 5-11?

A

medium dose ICS + LABA or LTRA or theophylline

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67
Q

What is step 4 therapy for adults?

A

medium dose ICS + LABA or LTRA or theophylline or zileuton

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68
Q

What is step 5 therapy for adults?

A

high dose ICS + LABA and consider omalizumab

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69
Q

What is step 5 therapy for children ages 5-11?

A

high dose ICS + LABA or LTRA or theophylline

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70
Q

What is step 5 therapy for children ages 0-4?

A

high dose ICS + LABA or LTRA

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71
Q

What is step 6 therapy for children ages 0-4?

A

high dose ICS + LABA or LTRA + oral corticosteroids

72
Q

What is step 6 therapy for children ages 5-11?

A

high dose ICS + LABA or LTRA or theophylline + oral steroids

73
Q

What is step 6 therapy for adults?

A

high dose ICS + LABA + oral steroids and consider omalizumab

74
Q

What agents are the most common causes of occupational asthma?

A

latex, wheat, isocyanates, plicatic acid

75
Q

Smoking is a risk factor for sensitization to what?

A

Platinum

76
Q

β-1,3-glucan in fungal cell walls binds to what on macrophages?

A

dectin-1; important in ABPA

77
Q

What serological marker can indicate an exacerbation of ABPA?

A

IgE doubles

78
Q

What are the diagnostic criteria for allergic fungal sinusitis?

A

sensitization to fungi
nasal polyps
positive fungal stain of sinus contents
histology showing eosinophils, fungal elements

79
Q

What are the CT findings in acute, subacute, and chronic hypersensitivity pneumonitis?

A

acute - normal or fleeting ground glass opacities
subacute - diffuse micronodules, air trapping, mild fibrosis
Chronic - ground glass, emphysema, honeycombing, micronodules

80
Q

What antigen is implicated in farmer’s lung (hypersensitivity pneumonitis)?

A

mold

81
Q

What antigen is implicated in hot tub lung (hypersensitivity pneumonitis)?

A

mycobacterium avium

82
Q

What antigen is implicated in bird fancier’s lung (hypersensitivity pneumonitis)?

A

aspergillus and avian proteins

83
Q

What antigen is implicated in air conditioner lung (hypersensitivity pneumonitis)?

A

aureobasidium

84
Q

What are the diagnostic criteria for hypersensitivity pneumonitis?

A 
HP symptoms 
Evidence of exposure (history and +IgG)
Radiographic evidence
BAL showing >20% lymphocytes (low CD4:CD8 ratio)
symptoms on re-exposure
85
Q

What is seen on biopsy in hypersensitivity pneumonitis?

A

noncaseating granulomas
lymphocytes
foamy histiocytes in alvioli
giant cells

86
Q

What PFT findings are seen after exposure in hypersensitivity pneumonitis?

A

drop in FEV1, FVC and DLCO 4-6 hrs after exposure

87
Q

What is the non-infectious febrile illness that occurs in workers after exposure to dust contaminated with toxin producing bacterial and/or fungal spores?

A

organic dust toxic syndrome (ODTS)

- 30-50 x more common than hypersensitivity pneumonitis

88
Q

What causes symptoms in silo unloaders disease?

A

acute exposure to NO2 leading to asphyxia

89
Q

What causes symptoms in byssinosis?

A

dust inhalation of cotton, flax and hemp

90
Q

What causes symptoms in humidifier fever?

A

toxic alveolitis due to endotoxin in recirculated water

91
Q

What is the most common form of hypersensitivity pneumonitis?

A

farmer’s lung - but more common is organic dust toxic syndrome which can occur after only one exposure

92
Q

What is seen on PFTs in idiopathic pulmonary fibrosis (usual interstitial pneumonitis)?

A

restrictive pattern with reduced DLCO

93
Q

What is seen on CT in idiopathic pulmonary fibrosis (usual interstitial pneumonitis)?

A

honeycombing, diffuse interstitial infiltrates

94
Q

What are the GOLD criteria for grading severity of COPD?

A

GOLD 1: mild - FEV1 > 80%
GOLD 2: moderate - FEV1 50 - 80%
GOLD 3: severe - FEV1 30 - 50%
GOLD 4: FEV1

95
Q

Which cell types are prominent in the airway in COPD?

A

neutrophils and macrophages

96
Q

Sputum eosinophils are a marker of what in COPD?

A

viral exacerbation

97
Q

Centrilobular emphysema seen in COPD is associated with what?

A

smoking

98
Q

Panlobular emphysema seen in COPD is associated with what?

A

α1-antitrypsin deficiency

99
Q

What is the only treatment that prolongs life in COPD?

A

O2 supplementation

100
Q

A 39 y/o man eats tuna and within 20 minutes develops abdominal cramps, vomiting, swelling of the tongue and SOB. He has no hx of fish allergy and SPT is negative. What is the Dx?

A

scromboid poisoning - contaminated fish, resembles allergic reaction

101
Q

How does sensitization take place in Class 1 and 2 allergens, respectively?

A

through the skin (foods); through the respiratory system (pollens with epitopes similar to food epitopes)

102
Q

What is the difference between conformational and linear epitopes?

A

conformational epitopes allergenicity is dependent upon the folding into the 3D structure, linear are not

103
Q

Name the antigen in birch and in apples/peaches that cross react.

A

Bet v 1 (birch), Mal d 1 (apple,peach)

104
Q

What syndrome is characterized by recurrent pneumonia, pulm infiltrates, hemosiderosis, Fe def. anemia, failure to thrive, eosinophilia, and milk precipitins?

A

Heiner’s syndrome

105
Q

What does dermatitis herpetiformis look like and what is it associated with?

A

vesicular, pruritic lesions on sun exposed areas; celiac disease

106
Q

In galactose-α-1,3-galactose hypersensitivity, how soon after ingestion do symptoms begin?

A

3-6 hours

107
Q

What type of allergen is galactose-α-1,3-galactose, and what chemotherapeutic mAb does it react with?

A

carbohydrate part of a glycoprotein; cetuximab

108
Q

Which peanut component is associated with systemic reactions?

A

Ara h 2

109
Q

Which peanut component is associated with oral reactions?

A

Ara h 8

110
Q

What are the most common causes of anaphylaxis?

A

food and drug reactions

111
Q

How can chymase act to improve symptoms of anaphylaxis?

A

Can convert angiotensin I to II - improves BP

112
Q

What are the diagnostic criteria for anaphylaxis?

A

hives and/or angioedema with at least 1 of:

respiratory sx, drop in BP or end organ dysfunction

113
Q

What % of anaphylactic episodes experience a biphasic or late phase reaction?

A

20%

114
Q

What medications can modify the effects of anaphylaxis?

A

Beta blockers, ACEI, MAOIs (prevent degradation of epi)

* tricyclics exaggerate the response to epi

115
Q

How can you differentiate anaphylaxis from mastocytosis?

A

look at total tryptase and mature tryptase - mature tryptase is released in anaphylaxis
mastocytosis total/mature tryptase is >20

116
Q

When should serum histamine be checked when evaluating possible anaphylaxis?

A

15-60 minutes - levels rise in 5 minutes but only remain elevated for 30-60 minutes

117
Q

For how long does urinary histamine remain elevated after anaphylaxis?

A

24 hours

118
Q

When does serum tryptase peak after anaphylaxis?

A

60-90 minutes - can remain elevated for up to 5 hours

119
Q

Besides histamine and tryptase, what other serological marker is elevated in anaphylaxis?

A

platelet-activating factor

120
Q

Which allergenic component is common to those with spina bifida?

A

latex - Hev b 1 and 3

121
Q

Which latex component is common for health care worker reactions?

A

Hev b 5, 6, and 7

122
Q

Which allergen cross reacts with bell pepper, kiwi, potato, avocado, and chestnut?

A

latex

123
Q

Which foods are the most commonly implicated in food dependent exercise induced anaphylaxis?

A

celery and wheat

124
Q

What is the major honeybee allergen?

A

Phospholipase A

125
Q

What is the major vespid allergen?

A

hyaluronidase

126
Q

If severe hypotension occurs after a hymenoptera sting, what key blood test should be ordered?

A

tryptase

127
Q

Which biting insect is the most common cause of systemic reactions?

A

Triatoma (kissing bug) - bites are painless

128
Q

What is a Type II hypersensitivity reaction?

A

antibody dependent cytotoxic reaction

129
Q

What is a type III hypersensitivity reaction?

A

Immune complex reaction

130
Q

What is a type IV hypersensitivity reaction?

A

cell mediated or delayed type

131
Q

In a type IVa hypersensitivity reaction, what cytokines are prominent, cell types involved and clinical manifestations?

A

IFNγ; monocytes; eczema

132
Q

In a type IVb hypersensitivity reaction, what cytokines are prominent, cell types involved and clinical manifestations?

A

IL-4 and IL-5; eosinophils; maculopapular or bullous rxn

133
Q

In a type IVc hypersensitivity reaction, what cytokines are prominent, cell types involved and clinical manifestations?

A

perforin and granzyme; CD4 and CD8 T cells; maculopapular or bullous rxn

134
Q

In a type IVd hypersensitivity reaction, what cytokines are prominent, cell types involved and clinical manifestations?

A

IL-8; neutrophils; pustular rxn

135
Q

HLA-B*5701 is strongly associated with reactions to which drug?

A

abacavir

136
Q

HLA-DR3 is associated with reactions to which medications?

A

insulin, penicillamine and gold

137
Q

What is in the Pre-Pen (major determinants)?

A

benzylpenicilloyl polylysine

138
Q

What is in the minor determinants for PCN testing?

A

PCN G

139
Q

Which medication cross reacts with ceftaZidime?

A

aZtrionam

140
Q

80% of people taking augmentin will have a skin reaction if infected with what?

A

EBV

141
Q

HIV patients will very commonly have a type IV reaction to which medication?

A

Bactrim

142
Q

Type I hypersensitivity reactions to Bactrim are due to what?

A

N4 sulfonamidoyl hapten

143
Q

What is the mechanism in radiocontrast reactions?

A

direct mast cell stimulation

144
Q

Which medications are common causes of SJS and TEN?

A

PCN, sulfonamides, antconvulsants, NSAIDS, allopurinol

145
Q

Which medications are common to DRESS?

A

anticonvulsants, sulfonamides, allopurinol, minocycline

146
Q

What are the symptoms of dress?

A

fever, lymphadenopathy, hepatitis, facial edema weeks after therapy

147
Q

Perioperative reactions are commonly due to which agents?

A

quaternary ammonium muscle relaxants (succinylcholine)

148
Q

Fever, rash, bronchospasm, capillary leak syndrome, meningoencephalopathy, and elevated LFTs after rituximab (anti-CD20) is likely what Dx?

A

cytokine release syndrome

also due to muromonab (anti-CD3)

149
Q

Which autoantibody is associated with drug induced cutaneous lupus?

A

anti-Ro (SSA)

150
Q

Which autoantibody is associated with drug induced systemic lupus?

A

antihistone

151
Q

How is acute urticaria defined?

A

less than 6 weeks

152
Q

Which autoantibody is common in chronic idiopathic urticaria?

A

thyroid

153
Q

How can you distinguish between cholinergic urticaria and exercise induced anaphylaxis?

A

EIA will not react with passive heating

154
Q

What syndrome is characterized by urticaria with arthritis, obstructive lung disease, glomerulonephritis, uveitis, angioedema and recurrent abdominal pain? Also has low C3, C4, C1q, anti-C1q Ab and elevated ESR?

A

Hypocomplementemic urticarial vasculitis syndrome

155
Q

How are patch tests graded?

A

Irritant
+/- = unlikely
+ = erythema and palpable edema
++ = microvesicles and erythema > 50% patch
+++ = confluent vesicldes or bullae, ulcerative

156
Q

What is a common contact allergen for cement workers?

A

Chromates

157
Q

What does the dimethylglyoxime test evaluate?

A

presence of nickel-containing material

158
Q

What fruit can poison ivy/oak cross react with?

A

mango peels

159
Q

What is the most common cause of eczema in flower workers?

A

peruvian lily

160
Q

What is the common allergen in fragrances?

A

Balsam of Peru

161
Q

What common allergen is a preservative found in fabrics?

A

Quaternium-15 (releases formaldehyde)

162
Q

What is the most common contact allergen in hair dressers?

A

paraphenylenediamine

163
Q

What is a common allergen in nail polishes?

A

ethylacrylate

164
Q

What is the most common topical antibiotic causing contact dermatitis?

A

neomycin

165
Q

What is systemic contact dermatitis?

A

the term used for generalized allergic contact dermatitis due to ingestion of an allergen

166
Q

Which vaccines are live?

A 
MMR
nasal flu
polio
rotavirus
smallpox
shingles
varicella
167
Q

How far apart should live vaccines be separated if not given the same day?

A

28 days

168
Q

What are the common allergic components in vaccines?

A

gelatin, egg, latex, yeast

169
Q

What recommendations regarding an egg containing vaccine should be given to someone who has an egg allergy with hives only?

A

give vaccine and observe in PCP office for 30 minutes

170
Q

What recommendations regarding an egg containing vaccine should be given to someone who has an egg allergy with anaphylaxis?

A

give vaccine and observe in allergist office and observe for 30 minutes

171
Q

What are the contraindications to vaccinations?

A

previous anaphylaxis to vaccine

encephalopathy

172
Q

What is the most common cause of bronchiolitis?

A

RSV

173
Q

What is the monoclonal antibody against RSV and when should it be given?

A

Palivizumab - give monthly to high-risk infants youger than 2 yrs

174
Q

What is the major cause of croup?

A

parainfluenza virus

175
Q

What is the common radiographic sign seen in croup?

A

subglottic narrowing (steeple sign)

176
Q

What are the time classifications for acute, subacute and chronic rhinosinusitis?

A

Less than 4 weeks, 4-8 weeks, 8-12 weeks

177
Q

What must the particle size be to cause hypersensitivity pneumonitis?

A

less than 5 micrometers

Tao Le A/I Board Review (11 decks)

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