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ABIM > MKSAP10 > Flashcards

MKSAP10 Flashcards

1
Q

What is the best tx for allergic conjunctivitis with recurrent sx refractory to artificial tears?

A

Long acting antihistamine eydrop with mast-cell stabilizing properties; olapatadine and azelastine

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2
Q

The two pathogens most commonly responsible for post-influenza pneumonia are _______

A

Streptococcus pneumoniae and Staph aureus

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3
Q

Patients who require contrast-enhanced imaging who have a history of an immediate hypersensitivity rxn to IV contrast should get premedicated with _______

A

Prednisone and antihistamine and use nonionic low osmolality contrast; Pred/Solumedrol 13 hours, 7 hours, and 1 hour before then 50 of benadryl after

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4
Q

What can be used to reduce the risk of contrast induced AKI? Does this work for hypersensitivity?

A

NS (isotonic IVF); reduces risk of nephropathy but not useful for hypersensitivity

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5
Q

What is the mots likely cause of chronic cough, fever, and weight loss, in an elderly woman with bronchiectasis and nodularity?

A

MAC; Lady Windermere disease

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6
Q

Use of what drug class should be ruled out when making a dx of chronic idiopathic urticaria with angioedema?

A

NSAIDS

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7
Q

Cough, fever, HA and dyspnea with crackles in a cattle farmer should raise concern for ________. Caused by ____________

A

Farmers lung (Hypersensitivity pneumonitis); Thermophilic Actinomycetes in moldy hay

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8
Q

What should be considered in pt with long standing nasal congestion with loss of taste? Dx?

A

Chronic sinusitis; CT of sinuses

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9
Q

What should happen after stabilizing a patient who had anaphylaxis to bees?

A

Refer to allergy for testing and immunotherapy

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10
Q

When looking at asthma PFTs what is considered a low FEV1?

A

A reduced FEV1 is less than 80% predicted; increase in 12% w/ bronchodilator seals dx; if this finding is not present can do methacholine challenge

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11
Q

The presence of purulent nodules associated with atopic dermatitis suggests ___________

A

S. aureus superinfection

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12
Q

The ______ phenomenon is the development of skin dz at sites of prior trauma

A

Koebner phenomenon, seen in Sarcoid, Lichen planus, and Psoriasis (not same as pathergy, seen in Behcets)

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13
Q

Appropriate mgmt of Acute Bronchitis

A

Symptomatic relief (often due to virus); if wheezing present (and no concern for asthma or COPD exac) then Rx an albuterol inhaler

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14
Q

What are some organisms that can be described as small pleomorphic gram positive rods?

A

Rhodococcus, Listeria, Corynebacterium, and Propionibacterium

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15
Q

What is Pollen-Associated Oral Allergy Syndrome?

A

A disorder where when a person with ragweed allergies eats cantaloupe, they get an itchy tongue

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16
Q

What if allergic rhinitis not well controlled with oral antihistamines?

A

Inhaled nasal glucocorticoid (fluticasone); this is a viable first option as well

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17
Q

What are the trypase levels in Hereditary Angioedema?

A

Should be normal; tryptase is released by mast cells and can be elevated in anaphylaxis and in mastocytosis; however, HAE is due to issues with bradykinin because activated by contact pathway in absence of tryptase from degranulation

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18
Q

What is Samters triad?

A

Asthma, Nasal polyposis, and chronic sinusitis–often have sensitivity to aspirin

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19
Q

What should you think of in patients who have received an antibiotic who develop joint pain and rash 7-10 days later

A

Serum Sickness; Type III hypersensitivity w/ immune complex formation which activates complement and leads to a SERPIGINOUS RASH on skin

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20
Q

What are some issues with topical steroids on the eyes?

A

Can have vision-threatening effects such as increased intraocular pressure, corneal melts, cataracts

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21
Q

This disorder has intense pruritis and erythematous excoriated skin at flexural areas

A

Atopic Dermatitis

22
Q

What should be included in the diagnostic workup of acute pulmonary TB?

A

At least 3 sputum cultures for acid fast bacilli (TST/PPD and IGRA have no utility in acute infxn); can get a BAL if unable to get sputum

23
Q

What is the best test to identify a rash around the neck, wrist, and earlobes?

A

Patch testing for Nickel hypersensitivity (Type IV)

24
Q

What is the preferred 1st line drug for acute bacterial rhinosinusitis?

A

Amoxicillin Clavulanate (875/125) PO bid; recommended over amoxicillin only due to resistant strains of H. flu and Moraxella

25
Q

What is the mainstay of Tx of ABPA? What if you cant make dx with skin testing?

A

Steroids and Itraconazole; check IgE abs to aspergillus fumigatus; serum precipitins

26
Q

What are the general characteristics of atopic dermatitis?

A

Intense pruritis, dry excoriated skin on flexural areas; often with other atopic sx like asthma, allergic rhinitis, etc.

27
Q

What is a diagnosis to be considered in patients with exertional dyspnea and spirometry showing abnormal inspiratory limb? Gold standard for Dx?

A

Vocal Cord Dysfunction; Gold Standard = flexible laryngoscopy showing adduction of vocal cords in inspiration; Tx w/ speech therapy relaxation technique or if severe Heliox and CPAP to stent

28
Q

What should you consider in pts with asthma and foot drop w/ evidence of leukocytoclastic vasculitis (palpable purpura)?

A

EGPA; foot drop from mononeuritis multiplex; Dx can be w/ skin bx or anti-MPO ab

29
Q

If a person has an anaphylactic reaction while on a beta blocker what is another consideration?

A

Should give epinephrine (1:1000) IM as usual but consider glucagon as well bc BB being on board can blunt the effect of epi

30
Q

What does a real food allergy look like?

A

Will have urticaria etc. otherwise just feeling diarrhea, upset stomach etc. more consistent with IBS; low level food specific IgE has low predictive value

31
Q

What should you think of in a patient with a “double sickening” syndrome of URI/Sinus issues?

A

Bacterial sinusitis; first there was likely a viral URI then infxn with bacteria; Tx 5-7 days Augmentin 875-125 BID per IDSA guidelines; levofloxacin if refractory

32
Q

What test would you have to order to check a CD4:CD8 ratio when considering a Dx of hypersensitivity pneumonitis?

A

Flow Cytometry of BAL fluids; recall BAL should be lymphocytic (lymphocytic stuff implies chronicity)

33
Q

What are allergies likely due to if: 1) Early spring 2) late spring early summer 3) late summer early fall

A

1) Tree pollen 2) Grass pollen 3) Weed pollen

34
Q

What if a person has chronic severe persistent asthma with only IVIG to seasonal aeroallergens and not IgE?

A

Would not be a good candidate for omalizumab as it is an anti-IgE

35
Q

What are the 2 major types of reaction to IV contrast?

A

Vasomotor - related to osmolality feels warm, nausea, and if severe can have seizure; hypersensitivity is allergy-like

36
Q

In addition to manifesting as bronchiectasis and recurrent infxns, CVID can also cause what hematologic issues?

A

Autoimmune cytopenias such as AIHA and ITP; Dx is w/ quantitative immunoglobulins

37
Q

What may be the etiology of acute anemia in patients receiving IVIG?

A

IVIG- associated AIHA as IVIG has high titers of Anti-A and Anti-B on ABO

38
Q

What is cold-induced urticaria?

A

When a person develops urticaria from eating cold things; different from Pollen-Associated Oral Allergy syndrome bc there the mc sx are pruritis of tongue

39
Q

The laboratory finding associated with HAE (Hereditary Angioedema) is ___________

A

Low C1 esterase function; don?t forget it can affect the GI tract; also has low C4

40
Q

What issue might a person with Ragweed allergy (ask about Hay Fever) have when eating melons?

A

Pollen Associated Oral Allergy Syndrome; get pruritis of tongue when eating cantaloupe; due to cross-reactivity of pollen with melon allergens

41
Q

What is the most appropriate tx for a patient with two week history of severe paroxysmal coughing?

A

Suspect B. pertussis (may have lymphocytosis) and tx is Azithromycin

42
Q

What is Hay Fever?

A

Colloquial name for Allergic Rhinitis due to seasonal aeroallergens (Best Tx with nasal steroid); nasal steroids also decrease eye sx

43
Q

What exposure is the worst for patients with peanut allergy?

A

Peanut flour (i.e. a bakery) can become aerosolized

44
Q

What disease is often described as the photographic negative of pulmonary edema?

A

Eosinophilic pneumonia (not to be confused with eosinophilic granuloma which is a type of Histocytosis aka Histiocytosis X w/ thin walled cysts in upper middle lobes in young smokers)

45
Q

What are the bacteria usually referred to as “atypicals”?

A

Mycoplasma pneumoniae, Chlamydophila, Bordatella pertussis, and Legionella pneumophila

46
Q

What is the definition of chronic idiopathic urticaria w/ angioedema? Tx?

A

Sx of urticaria and angioedema without clear cause persisting greater than 6 weeks; due to random mast cell degranulation in skin so usually not an aeroallergen issue

47
Q

What are the appropriate clinical scenarios to use anti-streptococcal abs?

A

To support a dx of acute rheumatic fever or for post-streptococcal GN (PSGN); not for acute strep pharyngitis

48
Q

What is the triad of asthma, nasal polyposis, and chronic sinusitis? Sensitivity to what med is common?

A

Samters triad; Aspirin

49
Q

Likely dx in person with atypical PNA, target lesions, and AIHA?

A

Mycoplasma pneumoniae, target lesions = erythema multiforme; Azithromcyin is preferred; FQs and Doxy also options

50
Q

A person with chronic atopic dermatitis with an acute worsening may have ________

A

Bacterial superinfection, possibly S. aureus (esp. if purulent, or exfoliative toxin can cause blistering)

ABIM (18 decks)

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