Immunology - Exam 2 Complete

Front 1

What are the differences between percutaneous and intradermal skin tests?

Back 1

Percutaneous (= "scratch" = "prick"): ↑concentration, ↑false negative, ↓false positive; Intradermal: ↓concentration, ↓false negative, ↑false positive

Front 2

What are the types of adverse food reactions?

Back 2

Intolerance (= physiologic; toxicity = poisoning, pharmacologic, metabolic, idiosyncratic); hypersensitivity (= immunologic; may be type I, II, III, or IV; one of the sparsest food reactions)

Front 3

At what age is the prevalence of allergic disease the highest?

Back 3

≈ 1yo (before 3yo); the child never grows out of atopy, but the symptoms may go away

Front 4

What is the major food component that is responsible for hypersensitivity?

Back 4

Proteins (proteases break down → peptides presented under influence of T cell → mast cell releases mediators)

Front 5

What are the primary manifestations of reaginic food sensitivity?

Back 5

Anaphylaxis; dermatologic (rash, allergic dermatitis, urticaria, angioedema); also some abdominal pain, vomiting, diarrhea, rhinitis, & asthma

Front 6

What are the primary manifestations of non-reaginic food sensitivity?

Back 6

Enteropathies (vomiting, diarrhea, occult bleeding, protein losing, malabsorption); also some asthma, urticaria (less), allergic dermatitis, pneumonitis, hemosiderosis

Front 7

With respect to reaginic food sensitivity, what is its onset & duration?

Back 7

Onset = all ages; duration = transient or permanent

Front 8

With respect to reaginic food sensitivity, what are the results of skin tests & what do the mucosa look like?

Back 8

Skin tests = positive; mucosa = erythema, edema, mucous

Front 9

With respect to non-reaginic food sensitivity, what are the results of skin tests & what do the mucosa look like?

Back 9

Skin tests = negative (serum antibodies are elevated); mucosa = villous atrophy & infiltration

Front 10

What is the most likely cause of celiac disease?

Back 10

There is a problem with secretory IgA (also leads to respiratory, urinary, & other gut infections)

Front 11

What does the intestine look like in a non-IgE enteropathy (e.g. celiac disease)?

Back 11

Atrophic with lots of cells

Front 12

What are the differential diagnoses for food hypersensitivity?

Back 12

GI diseases (structural abnormalities, enzyme deficiencies, malignancy); contaminants (dyes, flavoring, toxins); pharmacological agents (endogenous or exogenous); psychological reactions

Front 13

What foods are a major source of allergens in adults?

Back 13

Fish, shellfish, tree nuts, peanuts (& eggs)

Front 14

What foods are a major source of allergens in children?

Back 14

Fish, peanuts, eggs, milk, soy, & wheat

Front 15

What foods are allowed in a basic food elimination diet?

Back 15

Rice (including _ wafers, puffed _, _ flakes, & _ Krispies); lamb; cooked fruits (apricots, cranberries, peaches, pears); cooked vegetables (beets, carrots, chard, oyster plant, lettuce = not cooked)

Front 16

What are the symptoms of oral allergy syndrome?

Back 16

It is a contact allergy with pruritus of the lips, tongue, & palate; there are usually no other symptoms of a systemic reaction.

Front 17

What is the major difference between urticaria & angioedema?

Back 17

Location (depth)

Front 18

What is the difference between acute & chronic urticaria?

Back 18

Chronic: lesions persist ≥ 6 weeks; acute: causal relationship is often evident

Front 19

What do the lesions for cholinergic urticaria look like?

Back 19

Smaller, intensely pruritic lesions; no massive release of histamine; does NOT deal with cold (usually heat)

Front 20

With respect to angioedema, what is a major consequence of ACE inhibitors?

Back 20

They don't allow for the breakdown of bradykinin (causes big problems in angioedema)

Front 21

How can you distinguish between hereditary angioedema & acquired angioedema?

Back 21

Age of onset (HAE ≈ 6-20yo, acquired > 50yo); family history (usually with HAE, not with acquired); underlying disease process (with acquired but not with HAE)

Front 22

How do you differentiate HAE (types I & II) from acquired C1 inhibitor deficiency (I & II)?

Back 22

In HAE, C1 levels (C1q) are normal; in acquired, C1 levels are decreased (& treating underlying condition may result in resolution)

Front 23

What is the best screening test for HAE?

Back 23

C4 levels

Front 24

What is mastocytosis, and how do you test for it?

Back 24

It is a tremendous amount of mast cells in the skin; Darers line is found after stroking skin; condition is benign if it only involves the skin, but it often involves other organs and can be malignant

Front 25

What three drugs do NOT work to counteract the effects of HAE?

Back 25

Epinephrine, diphenhydramine (Benadryl), & corticosteroids

Front 26

What is the major cause of urticaria & angioedema?

Back 26

Idiopathic

Front 27

When must urticaria be biopsied & why?

Back 27

If it doesn't clear in 48h, leaves petechiae, or leaves an ecchymotic area; it may be vasculitis

Front 28

What category of test is an immediate hypersensitivity skin test? Histamine release?

Back 28

Both are tests of reagin (IgE) hypersensitivity = type I; they test the tissue-damaging = tertiary immune response.

Front 29

What category of test is rheumatic factor (RF)? Antinuclear factor (ANF)?

Back 29

Both are tests of Ag-Ab complex injury = type III; they test the tissue-damaging = tertiary immune response

Front 30

What category of test is natural killer (NK) cell activity? Antibody-dependent cellular cytotoxicity (ADCC) or killer (K) cell activity?

Back 30

Both are in vitro tests of cell-mediated (delayed hypersensitivity) function; they test the specific = secondary immune response

Front 31

What category of test is the measurement of effector molecules (MIF) using PPD? The mixed lymphocyte culture (MLC)?

Back 31

Both are in vitro tests of cell-mediated (delayed hypersensitivity) function; they test the specific = secondary immune response

Front 32

What category of test is the red cell agglutinins test? The antiglobulin test (COOMBS)?

Back 32

Both are tests of cytotoxic injury (type II); they test the tissue-damaging = tertiary immune response

Front 33

What category of test is serum complement (C1q, C3, C5)? Tissue biopsy (localization of IgG & C components by immunofluorescence)?

Back 33

Both are tests of Ag-Ab complex injury = type III; they test the tissue-damaging = tertiary immune response

Front 34

What category of test is prior sensitization? Isohemagglutinins (IgM)? DPT, poliovirus, or measles (IgG)?

Back 34

All are tests of humoral (antibody) function for specific antibody responses; they test the specific = secondary immune response

Front 35

What category of test is C-reactive protein? Complement activity (serum complement)? Rebuck skin window technique? NBT test (quantitative or histochemical)?

Back 35

All are tests of inflammatory response & phagocytic cell function; they are tests of the non-specific = primary immune response

Front 36

What category of test is a tissue biopsy (infiltration of lymphocytes in areas of injury)? Skin tests (patch) in contact hypersensitivity)?

Back 36

Both are tests of injury due to delayed hypersensitivity (type IV); they are tests of the tissue-damaging = tertiary immune response

Front 37

What category of test is quantitation of immunoglobulins and IgG subclass? Schick & dick tests (IgG)?

Back 37

Both are tests of humoral (antibody) function; they are tests of the specific = secondary immune response

Front 38

What category of test is a phagocytic index? Phagocytic cell adherence?

Back 38

Both are tests of inflammatory response & phagocytic cell function; they are tests of the non-specific = primary immune response

Front 39

What category of test is de novo sensitization? Salmonella O (IgM) & H (IgG)?

Back 39

Both are tests of humoral (antibody) function; they are tests of the specific = secondary immune response

Front 40

What category of test is a WBC count & differential? An ordinary blood count? A peripheral blood smear? A sedimentation rate?

Back 40

All are tests of inflammatory response & phagocytic cell function; they are tests of the non-specific = primary immune response

Front 41

What category of test is bactericidal activity? Measurement of specific WBC enzymes?

Back 41

Both are tests of inflammatory response & phagocytic cell function; they are tests of the non-specific = primary immune response

Front 42

What category of test is chemiluminescence? Chemotactic assay (= Boyden chamber)?

Back 42

Both are tests of inflammatory response & phagocytic cell function; they are tests of the non-specific = primary immune response

Front 43

What category of test is a skin test for prior sensitization to Candida or Trichophyton? A skin test of de novo sensitization to DNGB?

Back 43

Both are in vivo tests of cell-mediated (delayed hypersensitivity) function; they are tests of the specific = secondary immune response

Front 44

What category of test is the PRIST (direct measurement of total IgE globulins)? The RAST (IgE-specific antibody)?

Back 44

Both are tests of reagin (IgE) hypersensitivity = type I; they test the tissue-damaging = tertiary immune response.

Front 45

What category of test are EA (Fc receptor) & EAC (complement receptor) rosettes? SMIg (= membrane immunoglobulin)? Monoclonal antibodies?

Back 45

All are enumeration of B lymphocytes; they test the specific = secondary immune response

Front 46

What category of test is immunoelectrophoresis? Radial immunodiffusion?

Back 46

Both are tests of humoral (antibody) function; they are tests of specific = secondary immune response

Front 47

What category of test is nonspecific lymphocyte stimulation (PHA)? Specific lymphocyte stimulation (antigen)?

Back 47

Both are in vitro tests of cell-mediated (delayed hypersensitivity) function; they test the specific = secondary immune response (tests of mitotic index)

Front 48

What category of test is E rosette? Monoclonal antibodies?

Back 48

Both are enumerations of T lymphocytes & subtests; they are tests of specific = secondary immune response

Front 49

What category of test is a lymph node biopsy?

Back 49

It is a test of specific = secondary immune response

Front 50

Which types of rhinitis are associated with itching? Sneezing? Eye symptoms? Positive skin tests?

Back 50

For these symptoms, seasonal allergic rhinitis > perennial allergic rhinitis > perennial non-allergic rhinitis > vasomotor rhinitis

Front 51

For which types of rhinitis is itching a symptom?

Back 51

Seasonal allergic: usually; perennial allergic: occasional; perennial non-allergic & vasomotor: uncommon

Front 52

For which types of rhinitis is sneezing a symptom?

Back 52

Seasonal allergic: frequent; perennial allergic: variable; perennial non-allergic: occasional; vasomotor: rare

Front 53

For which types of rhinitis are there eye symptoms?

Back 53

Seasonal allergic: frequent; perennial allergic: occasional; perennial non-allergic: uncommon; vasomotor: rare

Front 54

For which types of rhinitis are skin tests positive?

Back 54

Seasonal allergic: positive; perennial allergic: variable; perennial non-allergic & vasomotor: negative

Front 55

Which types of rhinitis are associated with congestion? Anosmia? Mucoid secretions? Infection? Swelling? Polyps?

Back 55

For these symptoms: perennial (allergic & non-allergic) > seasonal allergic > vasomotor

Front 56

For which types of rhinitis is congestion a symptom?

Back 56

Seasonal allergic: moderate; perennial allergic & non-allergic: marked; vasomotor: moderate

Front 57

For which types of rhinitis is anosmia a symptom?

Back 57

Seasonal allergic: occasional; perennial allergic & non-allergic: frequent; vasomotor: rare

Front 58

What sort of secretions are associated with each type of rhinitis?

Back 58

Seasonal allergic: watery; perennial allergic & non-allergic: mucoid; vasomotor: watery

Front 59

For which types of rhinitis is infection a symptom?

Back 59

Seasonal allergic: occasional; perennial allergic & non-allergic: frequent; vasomotor: rare

Front 60

For which types of rhinitis is swelling a symptom?

Back 60

Seasonal allergic: variable; perennial allergic & non-allergic: marked; vasomotor: moderate

Front 61

For which types of rhinitis are polyps a symptom?

Back 61

Seasonal allergic: occasional; perennial allergic & non-allergic: frequent; vasomotor: absent

Front 62

What is the age of onset for each type of rhinitis?

Back 62

Seasonal & perennial allergic: childhood; perennial non-allergic & vasomotor: adulthood

Front 63

For which types of rhinitis is rhinorrhea a symptom?

Back 63

This is profuse for all types

Front 64

For which types of rhinitis is sore throat a symptom?

Back 64

This is moderate for all types EXCEPT it is slight for seasonal allergic

Front 65

For which types of rhinitis is postnasal drip a symptom?

Back 65

This is marked for all types EXCEPT it is moderate for seasonal allergic

Front 66

What is the expected response found in a nasal smear for rhinitis?

Back 66

Many eosinophils EXCEPT vasomotor has few eosinophils

Front 67

How does each type of rhinitis respond to drug therapy in general?

Back 67

Seasonal & perennial allergic: good; perennial non-allergic: fair; vasomotor: poor

Front 68

For each type of rhinitis, how does it respond to antihistamines?

Back 68

Seasonal & perennial allergic: good; perennial non-allergic: fair; vasomotor: poor

Front 69

For each type of rhinitis, how does it respond to decongestants?

Back 69

All are fair EXCEPT vasomotor has a poor response

Front 70

For each type of rhinitis, how does it respond to steroids?

Back 70

All are excellent EXCEPT vasomotor has a poor response

Front 71

For each type of rhinitis, how does it respond to cromolyn?

Back 71

Seasonal allergic: excellent; perennial allergic: good; perennial non-allergic: fair; vasomotor: poor

Front 72

For each type of rhinitis, how does it respond to immunotherapy?

Back 72

Seasonal allergic: excellent; perennial allergic: good; perennial non-allergic & vasomotor: none

Front 73

Which medications work on the rhinorrhea of allergic rhinitis?

Back 73

+++: topical steroids; ++: antihistamines; ±: cromolyn, decongestants, antileukotrienes

Front 74

Which medications work on the nasal blockage of allergic rhinitis?

Back 74

+++: decongestants; ++: topical steroids, antileukotrienes; ±: antihistamines, cromolyn; -: anticholinergics

Front 75

Which medications work on the late reaction of allergic rhinitis?

Back 75

++: topical steroids; +: antileukotrienes; ±: cromolyn; -: antihistamines, decongestants, anticholinergics

Front 76

With reference to autoimmune hemolytic anemia, what is true of cold hemolysins?

Back 76

IgG antibodies affix to RBCs at cold temperatures (~4°C); antibodies usually fix complement (autoantibodies attack RBC membrane proteins); e.g. Donath-Landsteiner antibody (variable infections)

Front 77

With reference to autoimmune hemolytic anemia, what is true of warm agglutinins?

Back 77

IgG antibodies affix to RBCs at body temperature (rarely agglutinate); antibodies rarely fix complement (autoantibodies attack RBC membrane proteins); e.g. idiopathic (>50%), secondary (tumors, viral diseases, drugs)

Front 78

With reference to autoimmune hemolytic anemia, what is true of cold agglutinins?

Back 78

IgM antibodies agglutinate RBCs at cold temperatures (~4°C); antibodies frequently fix complement (autoantibodies attack RBC membrane proteins); e.g. infectious mononucleosis (anti-I), M. pneumoniae (anti-I)

Front 79

What is the classical test for cold agglutinins?

Back 79

Ice cube test (ice on skin causes swelling)

Front 80

List some organ-specific autoimmune diseases of the thyroid.

Back 80

Hashimoto's thyroiditis (TDTH cells & autoantibodies → thyroid protein & cells); Graves' disease (autoantibody stimulates thyroid stimulating hormone (TSH) receptor); Primary myxedema, Thyrotoxicosis, Subacute thyroiditis

Front 81

List some organ-specific autoimmune diseases of the stomach.

Back 81

Pernicious anemia (autoantibody → gastric parietal cells & intrinsic factor)

Front 82

List some organ-specific autoimmune diseases of the adrenal glands.

Back 82

Addison's disease (autoantibody → adrenal cells)

Front 83

List some organ-specific autoimmune diseases of the pancreas.

Back 83

Type I (= insulin-dependent = juvenile) diabetes mellitus (TDTH cells & autoantibodies → pancreatic β cells in the Islets of Langerhans); type II (= insulin-resistant = adult-onset) diabetes mellitus

Front 84

List some organ-specific autoimmune diseases of the kidneys & lungs.

Back 84

Goodpasture's syndrome (autoantibodies → renal & lung basement membranes); poststreptococcal glomerulonephritis (antigen-antibody complexes → kidney)

Front 85

List some non-organ-specific autoimmune diseases that affect the kidneys.

Back 85

Systemic lupus erythematosus (SLE; autoantibodies & immune complexes → DNA, nuclear protein, RBC, & platelet membranes); Sjögren's syndrome (autoantibodies → salivary gland, liver, kidney, thyroid)

Front 86

List some non-organ-specific autoimmune diseases that affect the vertebrae.

Back 86

Ankylosing spondylitis (immune complexes → vertebrae)

Front 87

List some non-organ-specific autoimmune diseases that affect the white matter.

Back 87

Multiple sclerosis (TDTH & TC cells & antibodies → brain or white matter)

Front 88

List some organ-specific autoimmune diseases of the platelets. Of the heart. Of the sperm.

Back 88

Idiopathic thrombocytopenia (autoantibodies → platelet membrane protein); myocardial infarction (autoantibodies → heart); spontaneous infertility (autoantibodies → sperm)

Front 89

List some non-organ-specific autoimmune diseases that affect the muscles.

Back 89

Dermatomyositis

Front 90

List some non-organ-specific autoimmune diseases that affect the skin.

Back 90

Scleroderma (autoantibodies → nuclei, heart, lungs, GI tract, & kidneys)

Front 91

List some non-organ-specific autoimmune diseases that affect the joints.

Back 91

Rheumatoid arthritis (autoantibodies & immune complexes → connective tissue & IgG)

Front 92

What is the most important antigen in autoimmunity?

Back 92

The major histocompatibility antigens (MHC class I binds to CD8+, MHC class II binds to CD4+)

Front 93

What does a typical physical exam & histology of Hashimoto's thyroiditis look like?

Back 93

Pt. has significant goiter; the thyroid is infiltrated with many mononuclear cells (crowds out the normal function)

Front 94

What does a typical physical exam for Graves' disease look like?

Back 94

Exophthalmos, sweating, rapid heart rate (& fine tremor, weight loss, goiter, …)

Front 95

What is the mechanism of myasthenia gravis?

Back 95

Autoantibody blocks acetylcholine receptors → acetylcholine receptors are internalized & degraded → muscle contraction is impaired

Front 96

What is the mechanism of pernicious anemia?

Back 96

Autoantibody attacks intrinsic factor (& gastric parietal cells) → B12 doesn't bind to intrinsic factor, so it can't be taken up in the terminal ileum

Front 97

What does the histology of SLE look like?

Back 97

Under immunofluorescence, there are rings of nuclear material fluorescing

Front 98

What does the physical exam for rheumatoid arthritis look like?

Back 98

There may be ulnar deviation at the MP joints (& morning stiffness, typically symmetric)

Front 99

What is hemolytic disease of the newborn?

Back 99

Type II reaction of Rh– mother to Rh+ fetus; mother is sensitized to antigens on fetus RBCs (usually RhD) → mother makes IgG antibodies that cross the placenta → IgG reacts with & destroys fetus RBCs

Front 100

With respect to ABO blood typing, who is a universal donor? Who is a universal recipient?

Back 100

Type O is a universal donor (RBCs have no A- or B-antigens); Type AB is a universal recipient (serum has no anti-A or anti-B antibodies)

Front 101

What is the Coombs' test?

Back 101

It tests for antibodies against self-antigens on the RBCs (autoimmune hemolytic anemia); To perform, draw blood & remove RBCs, then add anti-human immunoglobulin; if RBCs agglutinate or clump, test is positive

Front 102

What occurs in a type III reaction resulting from subcutaneous inoculation?

Back 102

Immune complexes are deposited in the perivascular area, resulting in the Arthus reaction (palpable purpura)

Front 103

What occurs in a type III reaction resulting from inhalation?

Back 103

Immune complexes are deposited in the alveolar-capillary interface, resulting in Farmer's lung

Front 104

What occurs in a type III reaction resulting from intravenous inoculation?

Back 104

Immune complexes are deposited in the blood vessel walls (vasculitis), the renal glomeruli (nephritis), and/or in the joint spaces (arthritis)

Front 105

How can you differentiate a mast cell from a basophil?

Back 105

Both have granules and can be involved in a type I reaction, but a mast cell is surrounded by tissue & a basophil is surrounded by blood

Front 106

What is passive cutaneous anaphylaxis?

Back 106

(= "Prausnitz-Kustner" reaction); animal given sensitized serum intradermally → (after latent period) antigen + Evans blue dye intravenously; vasodilation & albumen (+ dye) leakage make a blue dot (localized anaphylaxis)

Front 107

In a type I reaction, what effects are due to prostaglandins?

Back 107

Vasodilation, contraction of pulmonary smooth muscle, and platelet aggregation

Front 108

In a type I reaction, what effects are due to serotonin?

Back 108

Increased vascular permeability & smooth muscle contraction

Front 109

In a type I reaction, what effects are due to cytokines IL-1 & TNF-α?

Back 109

Systemic anaphylaxis; increased expression of CAMs on venular endothelial cells

Front 110

In a type I reaction, what effects are due to bradykinin?

Back 110

Increased vascular permeability & smooth muscle contraction

Front 111

In a type I reaction, what effects are due to histamine?

Back 111

Increased vascular permeability & smooth muscle contraction

Front 112

In a type I reaction, what effects are due to ECF-A?

Back 112

Eosinophil chemotaxis (ECF-A = eosinophil chemotactic factor)

Front 113

In a type I reaction, what effects are due to proteases?

Back 113

Bronchial mucus secretion, degradation of blood vessel basement membrane, & generation of complement split products

Front 114

What mechanisms contribute to immunological self tolerance?

Back 114

Negative selection (bone marrow & thymus); expression of tissue-specific proteins in thymus; no lymphocyte access to some tissues; ↓ autoimmune response by regulatory T cells; anergy in autoreactive B & T cells

Front 115

What causes stimulation of T effector cells?

Back 115

The presence of TH cells (TS = suppression, TCS = counter-suppression, & B cells are always present)

Front 116

What does the histology of a type IV reaction look like?

Back 116

Mononuclear cells (lymphocytes, monocytes, macrophages, dendritic cells); contact hypersensitivity (e.g. poison ivy) → blistering towards surface; tuberculin-type hypersensitivity → giant multinucleated cells (granulomatous)

Front 117

How can you distinguish between a type II and a type III reaction?

Back 117

Type II (e.g. Goodpasture's syndrome): antigen = basement membrane → smooth, linear pattern; type III (e.g. from Strep): lumpy, bumpy distribution of immune complexes along the basement membrane

Front 118

What is vasculitis? What do you expect to find in its histology?

Back 118

Type III reaction: blood vessel with thick intima & tiny lumen; many polymorphonuclear cells & nuclear dust

Front 119

In a type I reaction, what effects are due to leukotrienes?

Back 119

Increased vascular permeability of pulmonary smooth muscle

Front 120

In a type I reaction, what effects are due to platelet-activating factor?

Back 120

Platelet activation & degranulation; contraction of pulmonary smooth muscle

Front 121

What does a typical ("classical") type I reaction look like?

Back 121

Hive = erythema around edema (think puffy eye with hymenoptera sting)

Front 122

What is the Schultz-Dale reaction?

Back 122

Smooth muscle from sensitized animal is extracted and placed into a bath with the antigen → prompt muscle contraction

Front 123

Describe a type I hypersensitivity reaction with respect to immune reactant, antigen, mechanism, & examples.

Back 123

IgE reacts with a soluble antigen, causing mast cell activation; e.g. allergic rhinitis, asthma, systemic anaphylaxis

Front 124

Describe a type II hypersensitivity reaction with respect to immune reactant, antigen, mechanism, & examples.

Back 124

IgG reacts with cell- or matrix-associated materials, activating complement & FCR+ cells (phagocytes/NK), e.g. drug allergies; =OR= IgG reacts with cell-surface receptors, altering signaling, e.g. chronic urticaria

Front 125

Describe a type III hypersensitivity reaction with respect to immune reactant, antigen, mechanism, & examples.

Back 125

IgG reacts with a soluble antigen, activating complement phagocytes; e.g. serum sickness, arthus reaction

Front 126

Describe a type IV hypersensitivity reaction with respect to immune reactant, antigen, mechanism, & examples.

Back 126

TH1 cells react with soluble antigens, activating macrophages, e.g. contact dermatitis, tuberculin reaction; =OR= TH2 cells react with soluble antigens, activating eosinophils, e.g. chronic asthma/allergic rhinitis; =OR= CTL reacts with cell-associated antigen, causing cytotoxicity, e.g. contact dermatitis

Front 127

What are the typical levels of a total lymphocyte count for a newborn? For a 6mo? For a 4yo?

Back 127

Newborn: 3500 - 9000; 6mo: 6500 - 12 000; 4yo: 1500 - 3500

Front 128

For which respiratory tract portal diseases do you receive a vaccine via the IM route?

Back 128

Rubeola, rubella, & influenza

Front 129

For which diseases is the vaccine a toxoid?

Back 129

Diphtheria & tetanus

Front 130

For which diseases is the vaccine a purified capsular polypeptide?

Back 130

Meningitis & bacterial pneumonia

Front 131

For which diseases is the vaccine an inactivated virus?

Back 131

Influenza & rabies (human vaccine)

Front 132

For which diseases is the vaccine a killed bacteria?

Back 132

Pertussis, paratyphoid fever, typhus fever, cholera, & plague

Front 133

For which diseases is the vaccine an attenuated virus?

Back 133

MMR (measles, mumps, rubella), yellow fever, polio (Sabin), varicella, & rotavirus

Front 134

For which diseases is the vaccine a subunit of the virus?

Back 134

Hepatitis A & B and human papillomavirus

Front 135

What diseases use pooled human immune gamma globulin for passive immunization?

Back 135

Hepatitis A & B, measles, & rabies

Front 136

For which diseases is the vaccine a killed virus?

Back 136

Polio (Salk)

Front 137

What tests are unnecessary to diagnose allergies?

Back 137

Total IgE, RAST (or modified RAST), bronchial antigen challenge, & nasal antigen challenge

Front 138

What are some examples of unrecognizable aeroallergens?

Back 138

House dust, dander, & minute fungus spores

Front 139

What are the characteristics of Alternaria?

Back 139

House dust; looks like a snowshoe

Front 140

What are the characteristics of Aspergillus fumigatus?

Back 140

Trash mold; chains with connecting collars

Front 141

What are the characteristics of Hormodendrum (Cladosporium)?

Back 141

Flowerpot/garden soil mold; spores in chains with attaching collars

Front 142

What are the characteristics of Penicillium notatum?

Back 142

Closet/basement mold; phialides & chains resembling a bush

Front 143

What are the phases of allergic rhinitis?

Back 143

Early inflammation (minutes due to preformed mediators) → late (hours to days due to cellular inflammation)

Front 144

What are the characteristics of the early inflammation of allergic rhinitis?

Back 144

Inflammation of the nerves (sneezing/itching), glands (rhinorrhea), & blood vessels (some congestion)

Front 145

What are the characteristics of the late inflammation of allergic rhinitis?

Back 145

Congestion (primary symptom); resolution, complications, or cell death

Front 146

For which skin-portal diseases do you receive an IM vaccine?

Back 146

Rabies (neural route) & yellow fever (blood-borne)

Front 147

What are the differential diagnoses for rhinitis?

Back 147

Allergic (seasonal or perennial); infectious (viral or bacterial); neither (rhinitis medicamentosa, NARES, vasomotor, hormonal, gustatory, atrophic, anatomic)

Front 148

What methods of inoculation give passive immunity?

Back 148

Injection or maternal transplacental transfer

Front 149

What methods of inoculation give active immunity?

Back 149

The disease itself (clinical or subclinical) or immunization (vaccines, killed or attenuated, & toxoids)

Front 150

With regards to active immunity, what are its source, effectiveness, & use?

Back 150

Its source is self; it is highly effective; it is used prophylactically

Front 151

With regards to passive immunity, what are its source, effectiveness, & use?

Back 151

Its source is some other human or lower animal; it is moderately effective at best; it is used prophylactically or therapeutically

Front 152

With regards to active immunity, what are its time to develop, duration, & ease of reactivation?

Back 152

It develops in 5-14 days; its duration is long (perhaps years); it is easily reactivated (by booster)

Front 153

With regards to passive immunity, what are its time to develop, duration, & ease of reactivation?

Back 153

It develops immediately (on injection); it duration is relatively short (days to weeks); reactivation is dangerous (could cause anaphylaxis)

Front 154

What diseases use pooled human immune gamma globulin of horse antivenin for passive immunization?

Back 154

Tetanus

Front 155

What diseases use horse antitoxin for passive immunization?

Back 155

Botulism & diphtheria

Front 156

What diseases use horse antivenin for passive immunization?

Back 156

Black widow spider bites & snake bites

Front 157

For which GI-tract-portal diseases do you receive an IM vaccine?

Back 157

Poliovirus (Salk)

Front 158

For which GI-tract-portal diseases do you receive a PO vaccine?

Back 158

Poliovirus (Sabin); *this is the only vaccine that duplicates the real world

Front 159

For which respiratory-tract-portal diseases do you receive a vaccine via the intradermal route?

Back 159

Small pox

Front 160

What vaccines are contraindicated in pregnant patients, immunocompromised patients, & HIV patients (with CD4 < 200)?

Back 160

Live viruses (e.g. varicella, MMR, zoster)

Front 161

Which immunizations begin at 1yo?

Back 161

MMR, varicella, & Hepatitis A

Front 162

Which immunizations begin at 2mo?

Back 162

RV (rotavirus), DTaP, Hib (Haemophilus influenza B), PCV (pneumococcus), IPV (polio)

Front 163

Which immunizations begin at birth?

Back 163

Hepatitis B

Front 164

What is a vaccinia reaction?

Back 164

Herpetic lesions that are caused by giving a live virus to an immunocompromised host

Front 165

What is the treatment for preventing hemolytic disease of the newborn?

Back 165

Passive immunization (Rh-specific IgG) to mother prevents primary immune response

Front 166

What are the signs & symptoms of a child with allergies?

Back 166

Conjunctival irritation; Denny's line; discoloration under eyes; crease on nose; pallor; overbite

Front 167

What is lymphoid hyperplasia?

Back 167

Hypertrophy of lymphoid tissue; stimulating humoral arm of the immune system; it's a sign of allergy

Front 168

What does a high eosinophil count indicate?

Back 168

3-5% = normal; 7-9% indicates allergies; 25-30% indicates a bigger problem (e.g. parasite, leukemia)

Front 169

What is chemosis?

Back 169

When the conjunctiva becomes so edematous that it bulges out; it's a sign of allergies

Front 170

What is the best way to confirm allergic disease?

Back 170

Intradermal tests

Front 171

What battery of tests is sufficient for diagnosing allergies?

Back 171

History, physical examination, selected skin tests, elimination & oral challenge

Front 172

Which drugs are used to treat immediate & late-phase bronchial reactions?

Back 172

Antihistamines (block only primary response); corticosteroids (block only secondary response); sodium cromoglycate (blocks both responses, but not well)

Front 173

What is the purpose of patch testing?

Back 173

Tests a type IV (delayed-type) reaction, e.g. contact dermatitis due to cosmetics, chemicals, polish, metals (e.g. nickel)

Front 174

What is the treatment for angioedema?

Back 174

Secure airway (ensure patent airway); immediate administration of epinephrine

Front 175

What are some examples of distinctive aeroallergens?

Back 175

Pollens & larger fungus spores

Front 176

For an unrecognizable aeroallergen, what is its exposure pattern? Its avoidance potential?

Back 176

It is often perennial; avoidance is often feasible

Front 177

For a distinctive aeroallergen, what is its exposure pattern? Its avoidance potential?

Back 177

It is often seasonal; avoidance is usually difficult

Front 178

For an unrecognizable aeroallergen, what is its site of origin? Its distribution?

Back 178

Its origin is often enclosed spaces; its distribution is determined by domestic & work practices

Front 179

For a distinctive aeroallergen, what is its site of origin? Its distribution?

Back 179

Its origin is primarily outdoor; its distribution is regional with flora

Front 180

Which allergen is expressed most commonly in Spring (mid March to late May)?

Back 180

Trees (esp. elm, oak, birch, cottonwood)

Front 181

Which allergen is expressed most commonly in early Summer (May to July)?

Back 181

Grasses (esp. orchard, red top, timothy, fescue, meadow, June/Kentucky blue)

Front 182

Which allergen is expressed most commonly in late Summer (August to September/first frost)?

Back 182

Weeds (esp. giant & short ragweed)

Front 183

What time of day is pollen the worst allergen?

Back 183

Early in the morning (7-8 AM) and late in the day (8-10 PM); midday, there is very little problem

Front 184

What is the epidemiology of allergic rhinitis?

Back 184

Fifth most common chronic illness; affects 20-40M Americans (primarily older adolescents & young adults)

Front 185

What are the categories of rhinitis?

Back 185

Allergic & nonallergic (nonanatomic or anatomic, including rhinorrhea syndromes & congestion syndromes)

Front 186

What are the categories of allergic rhinitis?

Back 186

Seasonal, perennial, & occupational (may also be nonallergic)

Front 187

If a naïve TH0 cell is stimulated by intracellular pathogens, what happens?

Back 187

If also stimulated by IL-12, it becomes TH1; then with IFN-γ & IL-2, it stimulates cell-mediated immunity

Front 188

What are nasal polyps?

Back 188

Fluid-filled membrane; an extension of allergic rhinitis

Front 189

What type of rhinitis do steroids work poorly on?

Back 189

Vasomotor rhinitis

Front 190

How do you make a diagnosis of allergic rhinitis?

Back 190

The symptoms must match; personal or family history of atopic disease (allergic rhinitis, asthma, food allergy, atopic dermatitis); look at temporal & spatial patterns for clues to type

Front 191

What medications work on the itching/sneezing of allergic rhinitis?

Back 191

+++: antihistamines, topical steroids; +: cromolyn; ±: antileukotrienes; -: decongestants, anticholinergics

Front 192

What is the arthus reaction?

Back 192

A type III reaction causing a bump on the skin; there is no area of erythema; cellular infiltrate is neutrophils

Front 193

What are three approaches to therapy of HAE?

Back 193

Replace the C1 inhibitor; block formation of bradykinin; prevent attachment of bradykinin to cell

Front 194

How do you distinguish between HAE & allergic or histamine-mediated angioedema?

Back 194

HAE: no urticaria, onset 6-20yo, all over, may be due to trauma, lasts 48-72h, no response to drugs; HIS-mediated: usual urticaria, onset any time, on face & lips, not due to trauma, lasts 2-48h, responds to Epi, anti-His, CS

Front 195

What is the classification for cold urticaria?

Back 195

Essential (acquired = most common); familial; secondary (cryoglobulinemia, cryofibrinogenemia, cold hemolysin syndrome)

Front 196

Which drugs typically cause urticaria?

Back 196

Opiates, antibiotics (esp. PCN), & NSAIDS (including ASA)

Front 197

What are the non-immunologic causes of urticaria?

Back 197

Drugs (histamine, ASA, iodine), foods (histamine: blue, black, & strawberries), HAE, angioedema due to C1 esterase deficiency, stress, hyperthyroidism (you cannot skin test for any of these)

Front 198

What are the immunologic causes of urticaria?

Back 198

IgE-mediated: drugs, foods, parasitic infection, insect stings/bites; IgG-mediated: serum sickness, cold hemolysin syndrome, cryoglobulinemia (& IgM); also: transfusion reaction, collagen-vascular disease (can skin test)

Front 199

How are the symptoms of celiac disease manifested?

Back 199

Gluten is degraded → presented to MHC class II → stimulates CD4 → inflammation (produces symptoms)

Front 200

With respect to non-reaginic food sensitivity, what are its onset & duration?

Back 200

It starts in infancy & childhood; its duration is transient (except gluten)

Front 201

If a naïve TH0 cell is stimulated by an allergen, what happens?

Back 201

If also stimulated by IL-4, it becomes TH2; then with IL-4, -5, & -13, it stimulates humoral immunity

Front 202

What are the histologic characteristics of a late-phase allergic reaction?

Back 202

Heavy cellular infiltration by basophils (if it were type II, round cells; if it were type III, neutrophils)