MKSAP10 Flashcards
What is the best tx for allergic conjunctivitis with recurrent sx refractory to artificial tears?
Long acting antihistamine eydrop with mast-cell stabilizing properties; olapatadine and azelastine
The two pathogens most commonly responsible for post-influenza pneumonia are _______
Streptococcus pneumoniae and Staph aureus
Patients who require contrast-enhanced imaging who have a history of an immediate hypersensitivity rxn to IV contrast should get premedicated with _______
Prednisone and antihistamine and use nonionic low osmolality contrast; Pred/Solumedrol 13 hours, 7 hours, and 1 hour before then 50 of benadryl after
What can be used to reduce the risk of contrast induced AKI? Does this work for hypersensitivity?
NS (isotonic IVF); reduces risk of nephropathy but not useful for hypersensitivity
What is the mots likely cause of chronic cough, fever, and weight loss, in an elderly woman with bronchiectasis and nodularity?
MAC; Lady Windermere disease
Use of what drug class should be ruled out when making a dx of chronic idiopathic urticaria with angioedema?
NSAIDS
Cough, fever, HA and dyspnea with crackles in a cattle farmer should raise concern for ________. Caused by ____________
Farmers lung (Hypersensitivity pneumonitis); Thermophilic Actinomycetes in moldy hay
What should be considered in pt with long standing nasal congestion with loss of taste? Dx?
Chronic sinusitis; CT of sinuses
What should happen after stabilizing a patient who had anaphylaxis to bees?
Refer to allergy for testing and immunotherapy
When looking at asthma PFTs what is considered a low FEV1?
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
The presence of purulent nodules associated with atopic dermatitis suggests ___________
S. aureus superinfection
The ______ phenomenon is the development of skin dz at sites of prior trauma
Koebner phenomenon, seen in Sarcoid, Lichen planus, and Psoriasis (not same as pathergy, seen in Behcets)
Appropriate mgmt of Acute Bronchitis
Symptomatic relief (often due to virus); if wheezing present (and no concern for asthma or COPD exac) then Rx an albuterol inhaler
What are some organisms that can be described as small pleomorphic gram positive rods?
Rhodococcus, Listeria, Corynebacterium, and Propionibacterium
What is Pollen-Associated Oral Allergy Syndrome?
A disorder where when a person with ragweed allergies eats cantaloupe, they get an itchy tongue
What if allergic rhinitis not well controlled with oral antihistamines?
Inhaled nasal glucocorticoid (fluticasone); this is a viable first option as well
What are the trypase levels in Hereditary Angioedema?
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
What is Samters triad?
Asthma, Nasal polyposis, and chronic sinusitis–often have sensitivity to aspirin
What should you think of in patients who have received an antibiotic who develop joint pain and rash 7-10 days later
Serum Sickness; Type III hypersensitivity w/ immune complex formation which activates complement and leads to a SERPIGINOUS RASH on skin
What are some issues with topical steroids on the eyes?
Can have vision-threatening effects such as increased intraocular pressure, corneal melts, cataracts
This disorder has intense pruritis and erythematous excoriated skin at flexural areas
Atopic Dermatitis
What should be included in the diagnostic workup of acute pulmonary TB?
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
What is the best test to identify a rash around the neck, wrist, and earlobes?
Patch testing for Nickel hypersensitivity (Type IV)
What is the preferred 1st line drug for acute bacterial rhinosinusitis?
Amoxicillin Clavulanate (875/125) PO bid; recommended over amoxicillin only due to resistant strains of H. flu and Moraxella
What is the mainstay of Tx of ABPA? What if you cant make dx with skin testing?
Steroids and Itraconazole; check IgE abs to aspergillus fumigatus; serum precipitins
What are the general characteristics of atopic dermatitis?
Intense pruritis, dry excoriated skin on flexural areas; often with other atopic sx like asthma, allergic rhinitis, etc.
What is a diagnosis to be considered in patients with exertional dyspnea and spirometry showing abnormal inspiratory limb? Gold standard for Dx?
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
What should you consider in pts with asthma and foot drop w/ evidence of leukocytoclastic vasculitis (palpable purpura)?
EGPA; foot drop from mononeuritis multiplex; Dx can be w/ skin bx or anti-MPO ab
If a person has an anaphylactic reaction while on a beta blocker what is another consideration?
Should give epinephrine (1:1000) IM as usual but consider glucagon as well bc BB being on board can blunt the effect of epi
What does a real food allergy look like?
Will have urticaria etc. otherwise just feeling diarrhea, upset stomach etc. more consistent with IBS; low level food specific IgE has low predictive value
What should you think of in a patient with a “double sickening” syndrome of URI/Sinus issues?
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
What test would you have to order to check a CD4:CD8 ratio when considering a Dx of hypersensitivity pneumonitis?
Flow Cytometry of BAL fluids; recall BAL should be lymphocytic (lymphocytic stuff implies chronicity)
What are allergies likely due to if: 1) Early spring 2) late spring early summer 3) late summer early fall
1) Tree pollen 2) Grass pollen 3) Weed pollen
What if a person has chronic severe persistent asthma with only IVIG to seasonal aeroallergens and not IgE?
Would not be a good candidate for omalizumab as it is an anti-IgE
What are the 2 major types of reaction to IV contrast?
Vasomotor - related to osmolality feels warm, nausea, and if severe can have seizure; hypersensitivity is allergy-like
In addition to manifesting as bronchiectasis and recurrent infxns, CVID can also cause what hematologic issues?
Autoimmune cytopenias such as AIHA and ITP; Dx is w/ quantitative immunoglobulins
What may be the etiology of acute anemia in patients receiving IVIG?
IVIG- associated AIHA as IVIG has high titers of Anti-A and Anti-B on ABO
What is cold-induced urticaria?
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
The laboratory finding associated with HAE (Hereditary Angioedema) is ___________
Low C1 esterase function; don?t forget it can affect the GI tract; also has low C4
What issue might a person with Ragweed allergy (ask about Hay Fever) have when eating melons?
Pollen Associated Oral Allergy Syndrome; get pruritis of tongue when eating cantaloupe; due to cross-reactivity of pollen with melon allergens
What is the most appropriate tx for a patient with two week history of severe paroxysmal coughing?
Suspect B. pertussis (may have lymphocytosis) and tx is Azithromycin
What is Hay Fever?
Colloquial name for Allergic Rhinitis due to seasonal aeroallergens (Best Tx with nasal steroid); nasal steroids also decrease eye sx
What exposure is the worst for patients with peanut allergy?
Peanut flour (i.e. a bakery) can become aerosolized
What disease is often described as the photographic negative of pulmonary edema?
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)
What are the bacteria usually referred to as “atypicals”?
Mycoplasma pneumoniae, Chlamydophila, Bordatella pertussis, and Legionella pneumophila
What is the definition of chronic idiopathic urticaria w/ angioedema? Tx?
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
What are the appropriate clinical scenarios to use anti-streptococcal abs?
To support a dx of acute rheumatic fever or for post-streptococcal GN (PSGN); not for acute strep pharyngitis
What is the triad of asthma, nasal polyposis, and chronic sinusitis? Sensitivity to what med is common?
Samters triad; Aspirin
Likely dx in person with atypical PNA, target lesions, and AIHA?
Mycoplasma pneumoniae, target lesions = erythema multiforme; Azithromcyin is preferred; FQs and Doxy also options
A person with chronic atopic dermatitis with an acute worsening may have ________
Bacterial superinfection, possibly S. aureus (esp. if purulent, or exfoliative toxin can cause blistering)
