MTB - Allergology/Immunology

Question 1

initial therapy - anaphylaxis

Answer 1

1. subcutaneous Epi. 1:1000 conc
2. corticosteroids
3. H1-antagonist antihistamines (diphenhydramine or hydroxyzine)

Question 2

sudden swelling of the face, palate, tongue and airway in assoc. w/ minor trauma to the face or hands OR ingestion of ACE inhibitors

Answer 2

angioedema

Question 3

hereditary angioedema

Answer 3

C1 esterase inhibitor deficiency

Question 4

assoc. symptoms with angioedema

Answer 4

stridor
abdominal pain
lack of response to steroids

Question 5

diagnosis of angioedema

Answer 5

low levels of C2 and C4 complement

Question 6

Tx. of acute episodes of angioedema

Answer 6

infusion of FFP

Question 7

DOC for hereditary angioedema

Answer 7

ecallantide

Question 8

Ecallantide

Answer 8

inhibitor of kallikrein; blocks bradykinin production

Question 9

what drug class may be used for chronic therapy of angioedema

Answer 9

androgens - danazol, stanazol

- raise levels of C1 esterase inhibitor

Question 10

CCS - patient comes in with signs of anaphylaxis after insect bite w/ no improvement after Epi injection, steroids or H1 blockers - > what do you do?

Answer 10

admit patient to ICU

Question 11

when desensitizing a patient to a drug what other drugs should be stopped?

Answer 11

propranolol and all B-Blockers should be stopped prior to attempting desensitization (in case Epi needs to be used)

Question 12

Symptoms of Allergic Rhinitis

Answer 12

recurrent episodes of nasal itching
nasal stuffiness
rhinorrhea
paroxysms of sneezing
eye itching
dermatitis
wheezing

Question 13

DOC allergic rhinitis

Answer 13

intranasal steroids

- single most effective tx

Question 14

Aside from intranasal steroids, what other therapies may be used for allergic rhinitis?

Answer 14

antihistamines (oral, intranasal)
cromolyn
ipratroprium bromide
LT inhibitors
nasal saline spray and wash

Question 15

older man presents with recurrent episodes of sinopulmonary infections and a sprue-like abdominal disorder; he has enlarged LN and splenomegaly - dx?

Answer 15

Common variable immune deficiency

Question 16

diagnostic testing - CVID

Answer 16

low levels of total IgG

B and T cells are present but do not make enough antibody

Question 17

Tx. CVID

Answer 17

infusion of IV immunoglobulins

Question 18

young male child presents with recurrent sinopulmonary infections - dx?

Answer 18

X-linked agammaglobulinemia

• no B cells = no Ig
• LN, adenoids and spleen are diminished or absent

Question 19

MC primary immunodeficiency

Answer 19

IgA deficiency

Question 20

CF: IgA deficiency

Answer 20

mostly asx
recurrent sinopulmonary infections
sprue-like malabsorption
increased incidence of atopic conditions
anaphylaxis w/ blood products

Question 21

Tx. IgA deficiency

Answer 21

tx. infections as they arise

IVIG will not work as there is little IgA in it

Question 22

patient comes in w/ recurrent skin infections caused by Staphylococcus

Answer 22

hyper IgE syndrome

Question 23

Tx. hyper IgE syndrome

Answer 23

tx. infections as they arise