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Immunology Flashcards

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USMLE® Step 1 flashcards
1
Q

Your patient is experiencing dyspnea and urticaria after ingesting penicillin. Auscultation of his lungs reveals diffuse expiratory wheezes. Which of the following medications will best help correct your patient’s bronchospasm?
Question options:

A)

Epinephrine 1:1000 SC

B)

Solu-Medrol 125 mg IV

C)

100 percent oxygen via nonrebreather mask 15 lpm

D)

Ranitidine 50 mg IV

A

Epinephrine 1:1000 SC

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2
Q

Which treatment would best halt the urticaria associated with an allergic reaction?
Question options:

A)

Dopamine and albuterol

B)

Oxygen

C)

Solu-Medrol

D)

Epinephrine and diphenhydramine

A

Epinephrine and diphenhydramine

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3
Q

Your patient is experiencing profuse hives, itching, dyspnea, coughing, tachycardia, and dizziness after eating seafood 5 minutes ago. You might also expect to see all of the following additional signs EXCEPT:
Question options:

A)

cyanosis.

B)

laryngeal edema.

C)

bronchospasm.

D)

hypertension.

A

hypertension

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4
Q

Which sign associated with an allergic reaction should concern a caregiver the most?
Question options:

A)

Urticaria

B)

Wheezing

C)

Warm, flushed skin

D)

GI distress

A

wheezing

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5
Q

Which of the following best describes why the secondary response to an antigen is faster than the primary response?
Question options:

A)

The primary response uses B and T cells specific to the antigens.

B)

The secondary response has fewer steps than the primary response, allowing it to progress faster.

C)

The secondary response uses memory cells, which immediately release antibodies specific to the antigen.

D)

The secondary response uses memory cells, which immediately release antigens specific to the antibodies.

A

The secondary response uses memory cells, which immediately release antibodies specific to the antigen.

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6
Q

Which of the following treatment regimens for anaphylaxis lists the medications in the correct order of administration following oxygen?
Question options:

A)

Epinephrine, diphenhydramine, dexamethasone

B)

Diphenhydramine, epinephrine, dexamethasone

C)

Dexamethasone, diphenhydramine, epinephrine

D)

Epinephrine, dexamethasone, diphenhydramine

A

Epinephrine, diphenhydramine, dexamethasone

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7
Q

The first medication administered to a patient experiencing an anaphylactic reaction should be:
Question options:

A)

glucagon.

B)

epinephrine.

C)

diphenhydramine.

D)

high-concentration oxygen.

A

high concentration oxygen

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8
Q

Your patient is a conscious and alert 22-year-old female who was stung by a hornet. She states that she has “allergies to bee stings” and has been told that she could die if stung. Your physical examination reveals a 1-cm-diameter, red, edematous area where she was stung on the left forearm. Her skin is warm and dry, and her lung sounds are clear and equal bilaterally. HR = 12 and regular, BP = 122/82, RR = 12 and regular, SaO2 = 98%. The most appropriate treatment for this patient would include:
Question options:

A)

100 percent oxygen via nonrebreather mask 15 lpm, IV of NS 1-2 L, epinephrine 1:1000 0.3 mg SC, diphenhydramine 25 mg IV.

B)

15 lpm oxygen by nonrebreather, epinephrine 1:1000 0.3 mg SC, diphenhydramine 25 mg IV, transport.

C)

IV as soon as possible with a crystalloid solution.

D)

transport only.

A

IV as soon as possible with a crystalloid solution

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9
Q

Which of the following statements about corticosteroid use in anaphylaxis treatment is TRUE?
Question options:

A)

Corticosteroids can help reverse bronchospasm associated with anaphylaxis.

B)

Corticosteroids stabilize mast cell and basophil membranes, preventing degranulation and histamine release.

C)

Corticosteroids can reduce the inflammation associated with anaphylaxis.

D)

Administration of high-dose corticosteroids results in peripheral vasoconstriction.

A

corticosteroids can reduce inflammation associated with anaphylaxis

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10
Q

Epinephrine administration results in all of the following EXCEPT:
Question options:

A)

increased peripheral vasoconstriction.

B)

increased cardiac contractile force.

C)

hypotension.

D)

tachycardia.

A

hypotension

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11
Q

Your patient is a 46-year-old male who is unconscious on his front lawn after being stung by a bee. You note angioneurotic edema. HR = 132, BP = 76/40, RR = 24 and shallow. You should first:
Question options:

A)

intubate the patient.

B)

administer high-concentration oxygen with a nonrebreather mask or similar device.

C)

start an IV of NS wide open and administer epinephrine 1:10,000 IV.

D)

administer epinephrine 1:1000 SC.

A

administer high concentration oxygen with a nonrebreather mask or similar device

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12
Q

Your patient is a 36-year-old female, conscious and alert, sitting at her desk and complaining of a rash and itchiness after taking a sulfa antibiotic. Physical examination reveals warm and dry skin, urticaria on her chest and back, lung sounds that are clear and equal bilaterally. HR = 100, BP = 132/78, RR = 14, SaO2 = 98%. Which of the following is the most appropriate treatment for this patient?
Question options:

A)

Oxygen via nonrebreather mask, IV crystalloid solution, 25 mg diphenhydramine IV

B)

Transport only

C)

Oxygen via nasal cannula, IV crystalloid solution, 5 mg epinephrine IV, 25 mg diphenhydramine IV

D)

Oxygen via nonrebreather mask, IV crystalloid solution, 0.3 mg epinephrine SC, 25 mg diphenhydramine IV, albuterol 2.5 mg via nebulizer

A

Oxygen via nonrebreather mask, IV crystalloid solution, 0.3 mg epinephrine SC, 25 mg diphenhydramine IV, albuterol 2.5 mg via nebulizer

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13
Q

Which medication would be the best choice for reducing the bronchospasm and laryngeal edema associated with anaphylaxis?
Question options:

A)

Solu-Medrol

B)

Oxygen

C)

Albuterol

D)

Dexamethasone

A

albuterol

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14
Q

Upon identifying an antigen in the bloodstream, B cells launch a chemical attack by producing antigens specific to the antibody. This is an example of ________ immunity.
Question options:

A)

cellular

B)

humoral

C)

antibody

D)

secondary

A

humoral

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15
Q

Diphenhydramine is administered in anaphylaxis because it:
Question options:

A)

reduces histamine release from mast cells and basophils.

B)

is nonselective.

C)

blocks histamine receptors.

D)

produces all of these.

A

produces all of the above

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16
Q

Which of the following is the desired physiologic reaction that occurs after the administration of a vaccine that contains live, attenuated viruses?
Question options:

A)

The antibodies in the vaccine multiply in the body.

B)

The immune system will create specific antigens to the viruses in the vaccine.

C)

The immune system will create specific antibodies to the viruses in the vaccine.

D)

The viruses in the vaccine act as an antigen, resulting in a nonspecific immune response.

A

the immune system will create specific antibodies to the viruses in the vaccine

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17
Q

A male patient presents with a puncture wound to his heel from stepping on a nail. He informs you that he is visiting from El Salvador and has never received a tetanus vaccination. At the emergency room he is administered tetanus immune globulin, as well as a tetanus vaccination. Which of the following best describes the rationale for this treatment?
Question options:

A)

The tetanus immune globulin provides IgE antibodies for immediate protection, while the tetanus vaccination provides natural immunity by producing tetanus-specific antibodies.

B)

The tetanus immune globulin provides passive immunity, while the tetanus vaccination provides active immunity.

C)

The tetanus immune globulin provides IgG and IgM antibodies for immediate protection, while the tetanus vaccination provides passive immunity by producing tetanus-specific antibodies.

D)

The tetanus immune globulin provides immediate protection, while the tetanus vaccination provides passive immunity by producing tetanus-specific antibodies.

A

The tetanus immune globulin provides passive immunity, while the tetanus vaccination provides active immunity.

18
Q

Which of the following statements about the use of vasopressors in the treatment of anaphylaxis is TRUE?
Question options:

A)

A dopamine infusion can correct the peripheral vasodilation that occurs secondary to histamine release by basophils and mast cells.

B)

A norepinephrine infusion encourages a net movement of plasma from the intravascular space to the vascular space, raising blood pressure.

C)

A norepinephrine infusion can correct the peripheral vasodilation that occurs secondary to SRS-A release by basophils and mast cells.

D)

An epinephrine infusion can correct the peripheral vasodilation that occurs secondary to SRS-A release by basophils and mast cells.

A

A dopamine infusion can correct the peripheral vasodilation that occurs secondary to histamine release by basophils and mast cells.

19
Q

Which medication is best for improving hypotension secondary to anaphylactic shock?
Question options:

A)

Diphenhydramine

B)

Oxygen

C)

Epinephrine

D)

Hydrocortisone

A

epinephrine

20
Q

You are called to the home of a 28-year-old male who is complaining of hoarseness, a scratchy sensation in the back of his throat, and palpitations. The symptoms began about 30 minutes ago and have grown steadily worse ever since the patient ingested prescribed penicillin 1 hour ago. Patient management should include all of the following EXCEPT:
Question options:

A)

IV of crystalloid solution such as lactated Ringer’s or normal saline.

B)

epinephrine 1:1000 0.3 mg SC.

C)

high-concentration oxygen via nonrebreather mask.

D)

administration of an IV beta-blocker.

A

administration of an IV beta blocker

21
Q

Your patient is a 43-year-old female with a history of peanut allergy. She is complaining of dizziness after eating a casserole that she later discovered contained peanuts. Your physical examination reveals warm, diaphoretic skin; a blotchy, red rash covering her chest and arms; and lung sounds that are clear and equal bilaterally. HR = 122, BP = 124/76, RR = 15 and regular, SaO2 = 97%. In addition to providing oxygen, appropriate treatment for this patient includes:
Question options:

A)

IV with crystalloid solution such as lactated Ringer’s or normal saline.

B)

IV with crystalloid solution such as lactated Ringer’s or normal saline, epinephrine 1:1000 SC, diphenhydramine IV.

C)

IV with crystalloid solution such as lactated Ringer’s or normal saline, epinephrine 1:1000 SC, diphenhydramine IV, nebulized albuterol.

D)

IV of NS wide open, epinephrine 1:1000 SC, diphenhydramine IV.

A

IV with crystalloid solution such as lactated Ringer’s or normal saline, epinephrine 1:1000 SC, diphenhydramine IV.

22
Q

Your patient is a 48-year-old female who is supine on the floor of a neighborhood health clinic. She became unconscious after receiving 250 mg of IM doxycycline. Clinic staff reports that the patient “broke out in hives and lost consciousness.” The patient is being ventilated by bag-valve mask and has an IV of normal saline running wide open. A nurse practitioner on the scene informs you that, before your arrival, he administered 2 doses of 0.5 mg of epinephrine SC, 50 mg of diphenhydramine IV, and 1 L of NS. HR = 138; BP = 84/60; RR = 12/min, assisted with BVM; SaO2 = 94%. Of the following, which is the most appropriate continued treatment of this patient?
Question options:

A)

Intubate, administration of dopamine IV infusion, rapid transport.

B)

Intubate, Solu-Medrol IV, 250 cc NS fluid challenge, transport.

C)

Continue administering fluids and transport to the nearest facility.

D)

Initiate a second IV of NS wide open, intubate and hyperventilate, transport.

A

intubate, administration of dopamine IV infusion, rapid transport

23
Q

Your patient is a 31-year-old female complaining of dizziness and difficulty breathing after being stung by a bee. You note that she is extremely anxious, and your physical examination reveals a rapidly developing urticaria to her shoulders, neck, and face. Your partner has administered oxygen via a nonrebreather, initiated IV access, placed the patient on the cardiac monitor, and administered epinephrine SC and diphenhydramine IV. Despite this, you also note that her voice is quickly becoming more hoarse and she has developed expiratory wheezes in all lung fields. HR = 128, BP = 100/70, RR = 20, SaO2 = 99%. What should be your major concern at this point, and what is the most appropriate treatment?
Question options:

A)

Increased bronchospasm leading to respiratory arrest; administer albuterol via nebulizer

B)

Increased bronchospasm leading to respiratory arrest; administer epinephrine IV

C)

Hypotension leading to cardiovascular collapse; administer fluids wide open and initiate a dopamine infusion

D)

Laryngeal edema leading to total airway occlusion; intubate

A

Laryngeal edema leading to total airway occlusion; intubate

24
Q

The two most common causes of fatal anaphylaxis are ________ and ________.
Question options:

A)

shellfish, tree nuts

B)

Hymenoptera stings, injected penicillin

C)

Hymenoptera stings, tree nuts

D)

shellfish, sulfa drugs

A

Hymenoptera stings, injected penicillin

25
Q

An allergen’s most common route of entry in an anaphylactic reaction is:
Question options:

A)

ingestion.

B)

absorption.

C)

inhalation.

D)

injection.

A

injection

26
Q

Which of the following statements about using antihistamines in the treatment of anaphylaxis is TRUE?
Question options:

A)

Blocking of H1 receptors results in mild vasoconstriction, while the blocking of H2 receptors results in bronchodilation.

B)

Antihistamines block H1 and H2 receptors and prevent further release of histamine from B and T cells.

C)

Antihistamines displace histamine, then block histamine receptors.

D)

Antihistamines block histamine receptors and reduce histamine release from mast cells and basophils.

A

antihistamines block histamine receptors and reduce histamine release from mast cells and basophils

27
Q

The administration of a vaccine results in ________ immunity.
Question options:

A)

natural passive

B)

induced passive

C)

active

D)

natural induced

A

active

28
Q

Which of the following best explains the cause of the histamine and heparin release in response to exposure to an antigen?
Question options:

A)

IgE antibodies have attached themselves to the membranes of basophils and mast cells, resulting in degranulation.

B)

IgE antibodies have activated the membranes of B and T cells, resulting in release of histamine and heparin.

C)

IgG and IgM antibodies have activated basophils and mast cells, resulting in degranulation.

D)

Humoral cells have initiated a chemical attack on the antigens.

A

IgE antibodies have attached themselves to the membranes of basophils and mast cells resulting in degranulation

29
Q

Which of the following is the best route for administering epinephrine to patients in severe anaphylactic shock refractory to initial interventions?
Question options:

A)

SC

B)

IV

C)

ET

D)

IM

A

IV

30
Q

Immunity resulting from a direct attack on a foreign substance by specialized cells in the immune system is:
Question options:

A)

humoral immunity.

B)

primary immunity.

C)

secondary response.

D)

cellular immunity.

A

cellular immunity

31
Q

Your partner experiences an itchy, red rash on her hands that stops at the wrists after using a new brand of glove your service purchased. Her skin is warm, dry, and nondiaphoretic; the rash is isolated to her hands; and her lung sounds are clear bilaterally. She has no other complaints. HR = 88, RR = 12, BP = 122/80. Of the following treatments, which is most appropriate?
Question options:

A)

Oxygen via nasal cannula 4 lpm, cardiac monitor, IV of NS KVO, epinephrine IV, diphenhydramine IM

B)

Diphenhydramine IM

C)

Oxygen via nonrebreather mask 15 lpm, cardiac monitor, IV of NS KVO, epinephrine SC, diphenhydramine IM

D)

Advise the dispatcher you will be going out of service

A

diphenhydramine IM

32
Q

Which of the following is a potentially life-threatening condition involving the head, neck, face, and upper airway?
Question options:

A)

Urticaria

B)

Hives

C)

Angioedema

D)

Wheals

A

angioedema

33
Q

Your patient is a 19-year-old female who called EMS because she awoke with “itchy red patches” on her chest, back, and arms that “seem to come and go.” As you obtain the history, you learn that she started taking Keflex, an antibiotic, two days ago to prevent infection in a laceration to her hand. In explaining to your patient what is going on, which of the following statements would be the most accurate?
Question options:

A)

“This is a typical side effect of Keflex. It happens in most patients who take it.”

B)

“I cannot say what this is, but it is not an allergic reaction. Hives do not come and go as you have described.”

C)

“These look like hives. They occur during an allergic reaction. You may have developed an allergy to the antibiotic you are taking.”

D)

“It looks like the infection in your hand has spread to the bloodstream. The toxins from the bacteria are causing a rash.”

A

“These look like hives. They occur during an allergic reaction. You may have developed an allergy to the antibiotic you are taking.”

34
Q

The ________ system is a complicated body system responsible for combating infection.
Question options:

A)

nervous

B)

cardiovascular

C)

immune

D)

respiratory

A

immune

35
Q

The initial exposure of an individual to an antigen is referred to as what?
Question options:

A)

Active immunity

B)

Sensitization

C)

Hypersensitivity

D)

Allergy

A

sensitization

36
Q

The immune response is a cascade that reacts to a:
Question options:

A)

virus.

B)

pathogen.

C)

toxin.

D)

bacteria.

A

pathogen

37
Q

Following exposure to an allergen in which IgE antibodies are released, mast cells degranulate, releasing:
Question options:

A)

insulin.

B)

histamine.

C)

epinephrine.

D)

T cells.

A

histamine

38
Q

Histamine causes the all of the following EXCEPT:
Question options:

A)

increased intracranial pressure.

B)

increased vascular permeability.

C)

bronchoconstriction.

D)

vasodilation.

A

increased intercranial pressure

39
Q

You respond to a report of a patient with shortness of breath. Upon arrival, you find a patient who has been stung by a bee. The patient is displaying urticaria and wheezing. You suspect:
Question options:

A)

meningitis.

B)

ARDS.

C)

asthma.

D)

anaphylaxis.

A

anaphylaxis

40
Q

You respond to a patient who presents with shortness of breath after he took a dose of an antibiotic. You find your patient with audible stridor and urticaria. You should administer:
Question options:

A)

albuterol 5 mg.

B)

SQ epinephrine 1:1000 0.3-0.5 mg.

C)

diphenhydramine 75 mg.

D)

IM epinephrine 1:1000 0.3-0.5 mg.

A

IM epinephrine 1:1000. 0.3-0.5 mg

41
Q

The standard dose of diphenhydramine for anaphylaxis is:
Question options:

A)

30-40 mg.

B)

50-100 mg.

C)

25-50 mg.

D)

10-20 mg.

A

20-40

Medical Emergencies (19 decks)

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