Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

16 Immuno > Urticaria and Angioedema > Flashcards

Urticaria and Angioedema Flashcards

1
Q

3 typical features of urticaria

A
  • central swelling
  • pruritus or burning sensation
  • fleeting nature (returns to normal in 1-24 hrs)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is angioedema

A
  • sudden swelling of lower dermis and subcutis
  • painiful > itchy
  • sites: eyelids, mouth, genitals
  • slower resolution
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

urticaria vs angioedema histology

A

urticaria: upper and middle dermis
angioedema: lower and subcutaneous tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

pathophysio of urticaria and angioedema

A

mast cell degranulation

  • histamine = itch neuronal pathway
  • vasodilation, increased blood flow, pruritus = wheals
  • neuropeptides = wheal and flare response
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

primary mediator of wheal and flare reaction

A

histamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

acute vs chronic urticaria

A

acute <6 wks

chronic >6 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

t/f atopic individuals are at increased risk for acute urticaria, while non-atopic individuals are at risk for chronic urticaria

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

t/f progressive acute urticaria should be periodically reevaluated

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

most common cause of acute urticaria

A

transient viral infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

t/f empiric elimination diets are always recommended in acute urticaria

A

false

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

causes of acute urticaria

A

immunologic: ige and non-ige mediated

non-immunologic: radiocontrast, viral, opiates, nsaids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

t/f etiologic agents in chronic urticaria are usually identifiable, while agents in acute are more diverse

A

false, baliktad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

classification of urticaria subtypes

A

read

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

diagnosis of cold contact urticaria

A

suspect: rapid onset local pruritus and erythema after exposure to cold stimulus

dx: challenge testing with ice cube for 10-15 mins
(+) = reaction when rewarming chilled skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

manifestation of delayed pressure urticaria

A
  • 4-6 hrs after pressure
  • more angioedema
  • perivascular mononuclear infiltrate
  • sites of tight clothing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

dx for delayed pressure urticaria

A

challenge testing by pressure applied perpendicular to skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

manifestation of solar urticaria

A
  • 1-3 mins after sun exposure (pruritus –> edema)

- confined to sun exposed areas

18
Q

rare inborn error of metabolism confused with solar urticaria

A

eryhtropoietic protoporphyria

19
Q

dx of dermatographism

A
  • can come with cholinergic or cold urticaria
  • stroke skin with tongue depressor

cause: reflex vasoconstriction followed by pruritus, erythema, and linear wheal

20
Q

pathogenesis of cholinergic urticaria

A
  • associated with exercise, hot showers, sweating
  • mediated by cholinergic nerve fibers on muscle and sweat glands
  • elevated histamine triggered by changes of body temp
21
Q

most common cause of chronic urticaria

A

idiopathic (but diagnosed by exclusion)

22
Q

erythema multiforme

A
  • ringed/target lesions
  • persistent sx
  • no prominent pruritus
23
Q

urticarial vasculities

A
  • palpable purpura/discoloration usually in lower extremities
  • hives >24 hrs
  • poor response to antihistamines
24
Q

possible pe results

A
  • linear wheals = dermographism
  • small wheals with erythema = cholinergic urticaria
  • wheals in exposed areas = solar/cold
  • wheals on lower extremities = urticarial vasculitis
25
Q

t/f acute and chronic urticaria always requires specific diagnostic tests

A

false, depends on history and pe

26
Q

routine diagnostic tests for acute and chronic urticaria

A

acute: none
chronic: cbc, esr/crp, omission of drugs

27
Q

diagnostic tests for subtypes of urticaria

A

read

28
Q

principles of skin prick test

A
  • site: volar surface of the forearm
  • agents: positive control histamine, negative control saline or extract diluent
  • immediate response is seen after 15-20 mins
  • diameter more/= 3x3 mm is positive
29
Q

t/f medications like antihistamine should be stopped one to several days prior to skin testing

A

true

30
Q

diagnostic test for chronic urticaria

A

autologous skin test

- serum from patient is intradermally injected into skin

31
Q

what is autoimmune urticaria

A

patients have anti-ige antibodies instead of anti-ige receptor antibodies (more severe)

32
Q

first line treatment for urticaria

A

antihistamines/h1 receptor antagonists

  • first gen for children
  • can give 2nd gen, best routinely
33
Q

indications for use of corticosteroids

A
  • urticarial vasculitis
  • delayed pressure urticaria

always use lowest effective dose!!

34
Q

+ and - of cyclosporine

A

+: inhibits basophil histamine release (mast cell degranulation)

-: red swollen gums, abnormal hair growth

35
Q

other medications for urticaria

A
  • phototherapy: reduces mast cells for dermographism and chronic idiopathic urticaria
  • omalizumab: chronic idiopathic, cholinergic, solar, cold
  • leukotriene receptor antagonist
  • h2 antagonists
36
Q

step 1 of approach to chronic urticaria

A

monotherapy with 2nd gen antihistamine, avoid triggers

37
Q

step 2 of approach to chronic urticaria

A

one or more of:

  • dose adjustment of 2nd gen ah
  • add another 2nd gen ah
  • add h2 antagonist
  • add leukotriene receptor antagonist
  • add 1st gen ah @ bedtime
38
Q

step 3 of approach to chronic urticaria

A

dose advancement of a potent antihistamine

39
Q

step 4 of approach to chronic urticaria

A

add alternative:

  • omalizumab or cyclosporine
  • immunosuppressants, biologics
40
Q

eaaci treatment algorithm for urticaria

A
  • nsah -> 2 wks -> step up
  • nsah updosing up to 4x -> 1-4 wks -> step up
  • add leukotriene antagonist or change nsah -> 1-4 wks -> step up
  • add cyclosporine a, h2-ah, dapsone, omalizumab

for exacerbations (step 3 and 4) use systemic steroid for 3-7 days

16 Immuno (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions