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PPS 2018 > Immunology > Flashcards

Immunology Flashcards

1
Q

Most common B-cell defect

A

Selective IgA deficiency

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2
Q

Hypocalcemia, unusual facies and ears, heart disease, diagnosis?

A

DiGeorge anomaly

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3
Q

Delayed umbilical cord detachment, leukocytosis, recurrent infections, diagnosis?

A

Leukocyte adhesion defect

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4
Q

Persistent thrush, failure to thrive, pneumonia, diarrhea, diagnosis?

A

Severe combined immunodeficiency

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5
Q

Bloody stools, draining ears, atopic eczema, diagnosis?

A

Wiskott-Aldrich syndrome (excluded if with normal platelet size and count

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6
Q

P. jiroveci pneumonia, neutropenia, recurrent infections, diagnosis?

A

X-linked hyper-IgM syndrome

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7
Q

Severe progressive infectious mononeucleosis, diagnosis?

A

X-linked lymphoproliferative syndrome

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8
Q

Recurrent staphylococcal abscesses, staphylococcal pneumonia with pneumatocele, coarse facial features, pruritic dermatitis, diagnosis?

A

Hyper-IgE syndrome

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9
Q

Persistent thrush, nail dystrophy, endocrinopathies, diagnosis?

A

Chronic mucocutaneous candidiasis

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10
Q

Short stature, fine hair, severe varicella, diagnosis?

A

Cartilage hair hypoplasia with short-limbed dwarfism

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11
Q

Oculocutaneous albinism, recurrent infection, diagnosis?

A

Chediak-Higashi syndrome

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12
Q

Abscesses, suppurative lymphadenopathy, antral outlet obstruction, pneumonia, osteomyelitis, diagnosis?

A

Chronic granulomatous disease

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13
Q

Progressive dermatomyositis with chronic enterovirus encephalitis, diagnosis?

A

X-linked agammaglobulinemia

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14
Q

Sinopulmonary infections, neurologic deterioration, talengiectasia, diagnosis?

A

Ataxia-telangiectasia

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15
Q

Recurrent neisserial meningitis, diagnosis?

A

C6, C7 or C8 deficiency

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16
Q

Sinopulmonary infections, splenomegaly, autoimmunity, malabsorption, diagnosis?

A

Common variable immunodeficiency

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17
Q

T-cell, B-cell, granulocyte or complement defect?

Early onset, usually 2-6 mo of age

A

T-cell

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18
Q

T-cell, B-cell, granulocyte or complement defect?

Onset after 5-7 mo of age

A

B-cell defect (onset after maternal antibodies diminish)

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19
Q

T-cell, B-cell, granulocyte or complement defect?
Pathogens: common gram (+) and (-) bacteria and mycobacteria, CMV, EBV, adenovirus, parainfluenza 3, varicella, enterovirus, Candida and P. jiroveci

A

T-cell

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20
Q

T-cell, B-cell, granulocyte or complement defect?

Pathogens: pneumococci, streptococci, staphylococci, Haemophilus, Campylobacter, Mycoplasma, enteroviruses

A

B-cell defect

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21
Q

T-cell, B-cell, granulocyte or complement defect?

Pathogens: Staphylococci, Pseudomonas, Serratia, Klebsiella, Salmonella, Candida, Nocardia, Aspergillus

A

Granulocyte

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22
Q

T-cell, B-cell, granulocyte or complement defect?

Pathogens: Pneumococci, Neisseria

A

Complement

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23
Q

T-cell, B-cell, granulocyte or complement defect?

Affected organs: mucocutaneous candidiasis, lungs, failure to thrive, protracted diarrhea

A

T-cell

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24
Q

T-cell, B-cell, granulocyte or complement defect?
Affected organs: Sinopulmonary infections, chronic gastrointestinal symptoms, malabsorption, arthritis, enteroviral meningoencephalitis

A

B-cell

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25
Q

T-cell, B-cell, granulocyte or complement defect?

Graft vs. host disease caused by maternal engraftment or nonirradiated blood transfusion

A

T-cell

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26
Q

T-cell, B-cell, granulocyte or complement defect?

Postvaccination disseminated BCG or varicella

A

T-cell

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27
Q

T-cell, B-cell, granulocyte or complement defect?

Autoimmunity, lymphoreticular malignancy, postvaccination paralytic polio

A

B-cell

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28
Q

T-cell, B-cell, granulocyte or complement defect?

Prolonged attachment of umbilical cord, poor wound healing

A

Granulocyte

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29
Q

T-cell, B-cell, granulocyte or complement defect?

Autoimmune disorders: SLE, vasculitis, dermatomyositis, scleroderma, glomerulonephritis, angioedema

A

Complement

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30
Q

Screening tests for phagocytic cell defects

A

Absolute neutrophil count

Respiratory burst assay

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31
Q

Screening test for complement deficiency

A

CH50

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32
Q

Intermittent allergic rhinitis

A

<4 days/week or <4 weeks at a time

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33
Q

Mild allergic rhinitis

A

Not troublesome, sleep is normal, no impairment in daily activities, no incapacity at work or school

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34
Q

Allergic conjunctivitis is reported in __% of patients with allergic rhinitis

A

70

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35
Q

Up to __% of patients with asthma have allergic rhinitis and __% of patients with allergic rhinitis have asthma

A

78, 38

36
Q

To avoid false negatives in epicutaneous skin test, montelukast should be withheld for __ day, most sedating antihistamines for __ day/s and nonsedating antihistamines for __ day/s

A

1, 3-4, 5-7

37
Q

In order to avoid rebound nasal congestion, intranasal decongestants should be used for less than __ days, not to be used more than __ a month

A

5, once

38
Q

Most effective therapy for allergic rhinitis

A

intranasal corticosteroids

39
Q

Beclomethasone (dosing)

A

6-12 yr: 1 spray in each nostril BID

>12 yr: 1 or 2 sprays in each nostril BID

40
Q

Flunisolide (dosing)

A

6-14 yr: 1 spray in each nostril TID daily or 2 sprays in each nostril BID, not to exceed 4 sprays/day in each nostril
≥15 yr: 2 sprays in each nostril BID, may increase to 2 sprays TID, max dose 8 sprays/day in each nostril

41
Q

Triamcinolone (dosing)

A

2-6 yr: 1 spray in each nostril OD
6-12 yr: 1-2 sprays in each nostril OD
≥ 12: 2 sprays in each nostril OD

42
Q

Fluticasone proprionate (dosing)

A

≥ 4 yr: 1-2 sprays in each nostril OD

43
Q

Fluticasone furoate (dosing)

A

2-12 yr: initial dose - 1 spray per nostril OD, may increase to 2 sprays, but once symptoms controlled, reduced to 1 spray (55mcg), max dose 110 mcg/nostril/d
≥12: initial dose - 2 sprays per nostril OD, once controlled, reduce to 1 spray, max dose 110 mcg/nostril/d

44
Q

Mometasone (dosing)

A

2-12 yr: 1 spray in each nostril OD

≥12 yr: 2 sprays in each nostril OD

45
Q

Budesonide (dosing)

A

6-12 yr: 2 sprays in each nostril OD

>12 yr: 4 sprays in each nostril OD (max dose)

46
Q

In asthmatic patients, FEV1 typically decreases by __% after exercise (6-8 min of running)

A

> 15

Onset of xercise-induced bronchospasm is 15 min after exercise challenge and can spontaneously resolve within 30-60 min

47
Q

Diurnal variation in PEF of __% is consistent with asthma

A

20

48
Q

FEV1:FVC __ indicates severe airflow obstruction

A

<0.8

49
Q

Improvement in FEV1 by __ or __ is consistent with asthma

A

> /= 12%, >200 mL

50
Q 
Asthma severity Intermittent
Daytime symptoms: \_\_
Nighttime awakenings: (0-4 yr) \_\_, (≥5) \_\_
SABA use \_\_
Interference with normal activity
FEV1 % predicted \_\_
FEV1:FVC: (5-11) \_\_, (≥12) \_\_
Exacerbations: (0-4) \_\_, (≥5) \_\_
A 
Asthma severity Intermittent
Daytime symptoms: ≤2 days/wk
Nighttime awakenings: (0-4 yr) 0, (≥5) ≤2x/mo
SABA use: ≤2 days/wk
Interference with normal activity: none
FEV1 % predicted: >80%, normal between exarcerbations
FEV1:FVC: (5-11) >85%, (≥12) Normal
Exacerbations: (0-4) 0-1/yr, (≥5) 0-1/yr
51
Q 
Asthma severity Mild
Daytime symptoms: \_\_
Nighttime awakenings: (0-4 yr) \_\_, (≥5) \_\_
SABA use \_\_
Interference with normal activity
FEV1 % predicted \_\_
FEV1:FVC: (5-11) \_\_, (≥12) \_\_
Exacerbations: (0-4) \_\_, (≥5) \_\_
A

Asthma severity Mild
Daytime symptoms: >2 days/wk but not daily
Nighttime: (0-4 yr) 1-2x/mo, (≥5) 3-4x/mo
SABA use: >2 days/wk but not daily and not more than once a day
Interference with normal activity: minor
FEV1 % predicted: ≥80%
FEV1:FVC: (5-11) >80%, (≥12) Normal
Exacerbations: (0-4) ≥2 in 6 mos or
≥4 wheezing episodes/yr lasting >1 day and risk factors for persistent asthma
(≥5): ≥2/yr

52
Q 
Asthma severity Moderate
Daytime symptoms: \_\_
Nighttime awakenings: (0-4 yr) \_\_, (≥5) \_\_
SABA use \_\_
Interference with normal activity
FEV1 % predicted \_\_
FEV1:FVC: (5-11) \_\_, (≥12) \_\_
Exacerbations: (0-4) \_\_, (≥5) \_\_
A

Asthma severity Moderate
Daytime symptoms: Daily
Nighttime: (0-4 yr) 3-4x/mo, (≥5) >1x week but not nightly
SABA use: Daily
Interference with normal activity: some
FEV1 % predicted: 60-80% predicted
FEV1:FVC: (5-11) 75-80%, (≥12) Reduced 5%
Exacerbations: (0-4) ≥2 in 6 mos or
≥4 wheezing episodes/yr lasting >1 day and risk factors for persistent asthma
(≥5): ≥2/yr

53
Q 
Asthma severity Severe
Daytime symptoms: \_\_
Nighttime awakenings: (0-4 yr) \_\_, (≥5) \_\_
SABA use \_\_
Interference with normal activity
FEV1 % predicted \_\_
FEV1:FVC: (5-11) \_\_, (≥12) \_\_
Exacerbations: (0-4) \_\_, (≥5) \_\_
A 
Asthma severity Severe
Daytime symptoms: Throughout the day
Nighttime: (0-4 yr) >1x/wk, (≥5) >7x/wk
SABA use: Several times a day
Interference with normal activity: exteme
FEV1 % predicted: <60% predicted
FEV1:FVC: (5-11) <75%, (≥12) Reduced >5%
Exacerbations: (0-4) ≥2 in 6 mos or 
≥4 wheezing episodes/yr lasting >1 day and risk factors for persistent asthma
(≥5): ≥2/yr
54
Q 
Asthma control: Well-controlled
Symptoms: \_\_
Nighttime awakenings
0-4 yr \_\_
5-11 yr \_\_
≥12 yr \_\_
SABA use \_\_
Interference with normal activity \_\_
Lung function
5-11 yr: FEV1% \_\_; FEV1/FVC \_\_
≥12 yr: FEV1% \_\_
Exacerbation
0-4 yr \_\_
≥5 yr \_\_
A 
Asthma control: Well-controlled
Symptoms: ≤2 days/wk but not more than once a day
Nighttime awakenings
0-4 yr: ≤1x/mo
5-11 yr: ≤1x/mo
≥12 yr: ≤2x/mo
SABA use: ≤2x/wk
Interference with normal activity: none
Lung function
5-11 yr: FEV1%: >80% predicted or personal best; FEV1/FVC: >80%
≥12 yr: FEV1% >80% predicted or personal best
Exacerbation
0-4 yr: 0-1/yr
≥5 yr: 0-1/yr
55
Q 
Asthma control: Not Well-Controlled
Symptoms: \_\_
Nighttime awakenings
0-4 yr \_\_
5-11 yr \_\_
≥12 yr \_\_
SABA use \_\_
Interference with normal activity \_\_
Lung function
5-11 yr: FEV1% \_\_; FEV1/FVC \_\_
≥12 yr: FEV1% \_\_
Exacerbation
0-4 yr \_\_
≥5 yr \_\_
A 
Asthma control: Not Well-Controlled
Symptoms: ≥2 days/wk or multiple times on ≤2 days/wk
Nighttime awakenings
0-4 yr: >1x/mo
5-11 yr: ≥2x/mo
≥12 yr: 1-3x/wk
SABA use: >2 days/wk
Interference with normal activity: some
Lung function
5-11 yr: FEV1%: 60-80% predicted or personal best; FEV1/FVC: 75-80%
≥12 yr: FEV1% 60-80% predicted or personal best
Exacerbation
0-4 yr: 2-3/yr
≥5 yr: ≥2/yr
56
Q 
Asthma control: Very Poorly Controlled
Symptoms: \_\_
Nighttime awakenings
0-4 yr \_\_
5-11 yr \_\_
≥12 yr \_\_
SABA use \_\_
Interference with normal activity \_\_
Lung function
5-11 yr: FEV1% \_\_; FEV1/FVC \_\_
≥12 yr: FEV1% \_\_
Exacerbation
0-4 yr \_\_
A 
Asthma control: Very Poorly Controlled
Symptoms: Throughout the day
Nighttime awakenings
0-4 yr: >1x/wk
5-11 yr: ≥2x/wk
≥12 yr: ≥4x/wk
SABA use: Several times per day
Interference with normal activity: extreme
Lung function
5-11 yr: FEV1%: <60% predicted or personal best; FEV1/FVC: <75%
≥12 yr: FEV1% <60% predicted or personal best
Exacerbation
0-4 yr: >3/yr
57
Q

Asthma pharmacotherapy Step 1
0-4 yr: __
5-11 yr: __
≥12 yr: __

A

Asthma pharmacotherapy Step 1
0-4 yr: SABA prn
5-11 yr: SABA prn
≥12 yr: SABA prn

Intermittent Asthma

58
Q

Asthma pharmacotherapy Step 2
0-4 yr: __
5-11 yr: __
≥12 yr: __

A

Asthma pharmacotherapy Step 2
0-4 yr: Low-dose ICS
OR cromolyn or montelukast

5-11 yr: Low-dose ICS
OR cromolyn, LTRA, nedocromil or theophylline

≥12 yr: Low-dose ICS
OR Cromolyn, LTRA, nedocromil or theophylline

59
Q

Asthma pharmacotherapy Step 3
0-4 yr: __
5-11 yr: __
≥12 yr: __

A

Asthma pharmacotherapy Step 3
0-4 yr: Medium-dose ICS

5-11 yr: Either Low-dose ICS ± LABA, LTRA or theophylline, or Medium-dose ICS

≥12 yr: Either Low-dose ICS + LABA or Medium-dose ICS
OR Low-dose ICS + LTRA, theophylline, or zileuton

60
Q

Asthma pharmacotherapy Step 4
0-4 yr: __
5-11 yr: __
≥12 yr: __

A

Asthma pharmacotherapy Step 4
0-4 yr: Medium-dose ICS + either LABA or LTRA

5-11 yr: Medium-dose ICS + LABA
OR Medium-dose ICS + either LTRA or theophylline

≥12 yr: Medium-dose ICS + LABA
OR Medium-dose ICS + LTRA, theophylline or zileuton

61
Q

Asthma pharmacotherapy Step 5
0-4 yr: __
5-11 yr: __
≥12 yr: __

A

Asthma pharmacotherapy Step 5
0-4 yr: High-dose ICS + either LABA or LTRA

5-11 yr: High-dose ICS + LABA
OR High-dose ICS + either LTRA or theophylline

≥12 yr: High-dose ICS + LABA
and consider omalizumab for patients with allergies

62
Q

Asthma pharmacotherapy Step 6
0-4 yr: __
5-11 yr: __
≥12 yr: __

A

Asthma pharmacotherapy Step 6
0-4 yr: High-dose ICS + either LABA or LTRA
and oral corticosteroid

5-11 yr: High-dose ICS + LABA
and corticosteroid
OR High-dose ICS + either LTRA or theophylline and oral corticosteroids

≥12 yr: High-dose ICS + LABA + oral corticosteroid
and consider omalizumab for patients with allergies

63
Q

Hallmark of atopic dermatitis

A

Severely dry skin

64
Q

Cardinal features of atopic dermatitis

A

Intense pruritus (especially at night) and cutaneous reactivity

65
Q

First-line therapy for atopic dermatitis

A

moisturizers

66
Q

Cornerstone of anti-inflammatory treatment for acute exacerbations fo atopic dermatitis

A

topical corticosteroids

67
Q

Food allergy is comorbid in approximately __ of infants and young children with moderate to severe AD

A

40%

68
Q

Key components to optimal asthma management

A
  1. Assessment and monitoring
  2. Education
  3. Control of environmental factors and comorbid conditions
  4. Medications
  5. Management of exacerbations
69
Q

Recommended number of asthma checkups per year for assessing and maintaining good asthma control __
Lung function testing should be done at least __ (frequency)

A

2-4, annually

70
Q

Gold standard test for sinus disease

A

Coronal “screening” or “limited” CT scan of the sinuses

71
Q

Management of sinusitis

A

Nasal saline irrigation, intranasal corticosteroids, 2-3 week course of antibiotics

72
Q

Second generation ICSs

A

fluticasone propionate, mometasone furoate, ciclesonide, budesonide

73
Q

A good response to asthma rescue medication (inhaled SABA up to 3 treatments in 1 hr) is characterized by:

A

resolution of symptoms within 1 hour
no further symptoms over the next 4 hr
improvement in PEF value to at least 80% of personal best

74
Q

Dose of prednisone for exacerbations

A

0.5-1 mg/kg q6-12 for 48 hr, then 1-2 mg/kg/d BID (not to exceed 60 mg/day)

75
Q

Dose of terbutaline for exacerbations

A

Continuous IV infusion, 2-10 mcg/kg LD, followed by 0.1-0.4 mcg/kg/min
Titrate in 0.1-0.2 mcg/kg/min increments every 30 min

76
Q

Patient may be discharged to home after an exacerbation if:

A 
There has been sustained improvements in symptoms
Bronchodilators are at least 3 hr apart
Physical findings are normal
PEF >70% of predicted or personal best
O2sat >92% on room air
77
Q

Preferred SABA and ICS for pregnant women

A

albuterol, budesonide

78
Q

Gastrointestinal manifestation of food allergy. Manifests in the first several months of life as irritability, intermittent vomiting (occurs 1-3 hr after feeding), protracted diarrhea, bloody diarrhea, abdominal distention, failure to thrive. Provoked by cow’s milk or soy protein-based formulas

A

Food protein-induced enterocolitis syndrome (FPIES)

79
Q

Gastrointestinal manifestation of food allergy.
Presents in the first few months of life as blood-streaked stools in otherwise healthy infants. 60% of cases in breastfed infants.

A

Food protein-induced proctocolitis

80
Q

Gastrointestinal manifestation of food allergy.
Manifests in the first several months of life as diarrhea, often with steatorrhea and poor weight gain, protracted diarrhea, vomiting, failure to thrive, abdominal distention, early satiety, malabsorption.

A

Food protein-induced enteropathy

Examples or Cow’s milk sensitivity and Celiac disease

81
Q

Before a food challenge is initiated, the suspected food should be eliminated from the diet for ___ days for IgE-mediated food allergy and up to ___ for some cell-mediated disorders

A

10-14 days; 8 weeks

82
Q

Drug of choice for cold-induced urticaria

A

Cyproheptadine

83
Q

Most feared complication of hereditary angioedema

A

layrngeal edema

84
Q

Inherited autosomal dominant disease caused by low functional levels of the plasma protein C1 inhibitor presenting with cutaneous nonpitting and nonpruritic edema not associated with urticaria

A

Hereditary angioedma

85
Q

Epinephrine dose for anaphylaxis

A

1:1000, 0.01 mg/kg IM (max 0.5 mg) repeated 2-3 times at intervals of 5-15 min if epi IV drip is not yet started

86
Q

Diagnostic criteria of anaphylaxis

A

Any 1 of 3:

  1. Acute onset with mucocutaneous involvement and at least 1 of the ff:
    a. respiratory compromise
    b. Reduced BP/end-organ dysfunction
  2. At least 2 of the ff that occur rapidly after a likely allergen:
    a. mucocutaneous involvement
    b. respiratory compromise
    c. Reduced BP/end-organ dysfunction
    d. persistent GI symptoms
  3. Reduced BP following exposure to known allergen

PPS 2018 (17 decks)

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