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119 Cards in this Set
- Front
- Back
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Number 1 lung cancer non smokers get?
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Adenocarcinoma
(non-small cell) |
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Complications of Squamous cell carcinoma of lung?
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Bronchial Obstruction
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Nerves commonly compressed in Lung cancers?
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Recurrant Laryngeal
- Horsness Superior Cervical Ganglion -Horners syndrome |
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Horners Syndrome symptoms?
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Horney PAM
Pitosis Anhydrosis Miosis |
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Lymphones should always be palpated in smokers?
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Supraclavicular (bad if found)
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Innate Immunity Cells include
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Macrophages, NK, PMNs, monocytes
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Powerfull compliment opsinizer
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C3b
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Difiecincy in C3 can lead to severe__and___infections along with increase susceptability to ____type hypersensitivity rxns?
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Pyogenic sinus and Respiratory tract infections
Type III hypersensititivy |
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4 general levels of immune system
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Compliment
Phagocytosis Humoral Cell Mediated |
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What activates classical compliment pathway?
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Ag-Ab complex
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What Ig is a powerful opsinizer?
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IgG
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Alternative Compliment pathway activated by?
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Molecules on microbes surface, especially endotoxin
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COmpliment Inflamatory proteins
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C5a,C4a, C3a
Most potent inflamm. in body - bind to mast cells and degranulate them -PMN chemotaxis also |
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Most potent Mast cell degranulator in COMPLIMENT?
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C5
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Compliment B-cell activator?
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C3d
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NK Cell surface marker
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CD 16
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Th17 cells Produce?
- - |
IL-17 and TNF
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Th2 cells produce?
- - - |
IL-4
IL-5 IL-13 |
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Th1 Cells produce?
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IFN gamma
TNF |
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Atopy patiens onset of sx 90% by age?
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10
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To do Skin testing patients must be off what meds?
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Antihistamines
Tricyclics Beta blockers |
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Most Common Chronic disease in children?
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Asthma
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Asthma airway gung buzzwords (3)?
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Charcot-Leyden crystals (lysophosopholipase)
Curschmann spirals (mucous plugs) Creola bodies (desquamated epithelial cells) |
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Status Asthmaticus Common causes?
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Aspirin
Infection Rapid steroid withdrawal Severe prolonged expososure to trigger (pets, smoke etc.) |
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Postitive spirometry test for asthmatic pt post beta 2 agonist?
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FEV increases of 12% and 200mL improvement!
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Baby vulnerable infection time?
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about 6mo to 2 years bc moms IgG gone by about month 6... baby very susceptable to Encapsulated bacteria
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Primary Anitbody deficiency will presnet when in life?
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7mo to 2y
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Methacholine Challenge
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Gold Standard Diagnositic if Spirometry is negative
-Must have a 20% drop in FEV1 |
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Interluikins that stimulate the B cell to produce IgE?
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IL-4
IL-13 |
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IL that stimulates eosinophils?
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IL-5
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Cell that produces IL-4
IL-5 IL-13 |
Th2 cell
(the Allergic T helper cells) |
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Creola Bodies
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Asthma micro buzzword
Sloughed off cilliated epithelial cells in the sputum. |
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Most Comomon Asthma SX
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Nighttime cough
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50% of poeple have asthma by age?
80% by the time of? |
50% by age 2
80% by preschool |
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Sex higher asthma?
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Males
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Which parent are you more likely to inherit asthma from?
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Maternal gene
(not always but linked more with mom) |
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corticosteriod tx in asthma, how long do they take to work?
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hours so NOT an immidiate tx
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When can anticholinergics be used in asthma tx?
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In an Acute reaction, especially if SABAs are not tollerated
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Status Asthmatacis
caused most often by? More likely to be? |
Asprin and Other NSAIDS most common
Fatal |
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Young Female who has difficulty breathing in? Inspiratory stridor
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Vocal Cord Dysfunction
- The Cricoids move the wrong way and close the airway in breathing |
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Churg-Strauss Syndrome
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Small Vessell vasculitis
Autoimmune Often begins as severe asthma |
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SABAs you should know
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Albuterol
Levalbuterol Pirbuterol *EVery asthamtic patient should have one** ***NEVER taken on A regular Basis** |
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When to use a LABA?
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NEVER EVER EVER ALONE
Always try ICS first and if thats not enough add a LABA on |
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Long Term asthma Tx
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ICS first
Then increase the dose or Add a LABA |
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Nebulizer
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An air compressor, that uses compressed air to add meds
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Intermittent Asthma Qualifiers
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Less than 2 time a week sx
Less than 2 times a MONTH waking up at night FEV1 >80 on spirometry |
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MIld Asthma Qualifiers
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>2 days a week but not daily sx
3-4 night time wakings per MONTH Using SABA >2days a year but not daily FEV1 Greater than or equal to 80 |
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MOderate Asthma Qualifiers
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Daily Sx
Daily SABA use Wake up >1x per WEEK FEV1 between 60-80 |
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Severe Asthma Qualifiers
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Daily Sx throughout the day
Night time sx 7x a week often SABA use multiplex/day FEV1 <60 |
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Asthma TX
Intermittent Mild Moderate Severe |
Intermittant- SABA
Mild- ICS THE REST ARE COMBO Moderate- Low dose ICS + LABA, increase ICS as needed SEVERE- High dose ICS + LABA + Oral Corticosteroid |
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LABA drugs
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Salmeterol
Formoterol Arformoterol |
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ICS drugs
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Fluticasone
Beclomethasone Budesonide Ciclesonide |
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LT antagonist rx?
- - - |
Montelukast
Zafirlukast Zileuton (actaully - AA prod) |
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Anti IgE drug?
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Omalizumab
for severe asthma responding poorly to ICS (Inhaled Corticosteroids) Must have elevated IgE to prescribe |
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Asthma is curable?
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NO but its treatable
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Exercise induced asthma tx?
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Only need a SABA and take before excercise
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Most common Primary immunodeficiency problem?
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B-cell deficiney
-lots of bacterial infxns |
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When to suspect immunodeficiency?
CRUISe |
Infections are?
Chronic Recurrent Invasive Severe |
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Compliemetn terminal compent deficiency results often with?
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Nisserial infxns
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Primary Immunodeficiency
Low B-cell diseases? |
Common Variable immunodeficiency
IgA X-Linked Agammaglobulinemia Transient Hypogammaglobulinemia of infancy |
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Hypogammaglobulinemia two general causes?
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Low B-Cells
Destruction or excretion of Antibodies |
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Bacterial infections think?
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B-Cell problems
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Phagocytes in non specfic immunity?
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Attack Cat + bacteria
- Staph Serratia Marcescens Kelbseilla E. Coli |
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If you think there is a b-cell problem the test you should run is?
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Quantitative Serum Immunoglobulins test
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Isohemaglutinins tests blood how?
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IgM to ABO
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TCell Dependent proteins?
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Tetanus Toxid and Diptheria Toxoid
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B-Cell quantification with phenotyping?
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Flow Cytometry tests CD 19, 20 21
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X-Linked Agammaglobulinemia
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Absence of B-Cells so low Igs
Btk gene mutant Lots of encapsulated infections Tx N0 IVIG!! WILL REACT! |
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Primary IgA deficiency
-Prevalence? -Most common cause of? -Do NOT treat with? |
- Common 1/333
-MCC of Blood Transfusion Rxns - NO IVIG therapy! Bc anti-IgA |
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Common Variable Immunodeficiency
-What is it? -Same sx as XLA but with? -Test picks it up? |
-hypogammaglobulinemia due to Bc and Tc messed up leads to no class switch
-ENLARGED TONSILS -CBC |
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Common Variable Immunodeficiency typical infections?
___deiseases associtated? |
OM, Sinusitis, Pneumonia, Bronchiectasis
Autoimmune |
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Anergy Panel
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Like a TB skin test.... but you want to be postive.
Shows that your T-cells working well and creating memory bc they respond to antigen. |
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DiGeorge Syndrome
-Etiology -Sx |
Malformed 3rd and 4th pharyngeal pouches
SX: -CATCH 22 Cardiac anomaly, Abnormal facies, Thymic hypoplasia, Cleft palate, HYPOcalcemia*** on Chromasome 22 - NO THYMIC SHADOW on CXR -Hypocalcemic Tetany |
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Wiskott-Aldrich Syndrome
Triad? |
-Eczema
-Thrombocytopenia -Recurrent pyogenic Infectinos |
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SCID
-Deficiencies in ? -Sx? -Test how? |
-T, B, NK cells in any combination
-FTT, Chronic diarrhea, Candida -CBC Tx: Bone Marrow Trans. |
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Allergic Rhinits rarely occurs before Age?
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3
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___ is 5th most common chronic illness
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Allergic Rhinits
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Allergic Rhinits Seasonal
-Spring -Summer Fall |
Spring-Tree pollen
Summer- Grass Fall-Weeds |
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MOST COMMON Allergy is to?
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Cats
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Allergic Rhinits vs. Non
Allergic? |
ITCHING** = Allergic*
-Allergic - Itchy eyes, Sneezing, Pale blue nasal mucosa - Alergic Salute |
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Where should skin testing be don on body?
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Center of spine, or forearm bc have very little mast cells
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Wheal and Flair caused by?
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Histamine
Wheal- Raided edema histamine makes vessels leaky Flare- Increased bloodflow to area |
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Most efficacous tx for Allergic rhinits?
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Intranasal corticosteroids
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Second Gen. Antihitamines?
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Loratadine (claritin)
Fexofenadine (Allegra) Cetirizine |
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Immunotherapy induces tolerance how?
- - - |
Decreases IgE
Decreased Mast Cell # Switches from Th2 to Th1 |
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Anaphylaxis Most Common sx?
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Urticaria/Angioedema (88%)
Upper Airway Edema (56) Dyspnea Flush Hypotension -usual case of death GI sx |
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Proper Anaphylaxis treatment?
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EPI EPI EPI EPI****
Every doc should carry an epi pen many ERs incorrectly tx with antihistamines |
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Anaphylactic triggers
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Food #1
Drugs (#1 in hospital) |
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Most common anaphal. foods?
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Peanuts
Tree nuts Seafood |
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DDX of Anaphalaxis like things?
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VasoVagal rxn
-HR will be key! Anaphylaxis will be tachycardia! Flush-red face embarrased Mastocytosis- lots of mast cells in skin Carcinoid Syndrome Hyperventiliation syndrome Globus Hystaricus Heridaty Angioedema |
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Latex Allergy common high risk groups?
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Healthcare Workers
Spinabifida Kids -lots of latex caths Rubber workers Multiple surgeries |
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Never do immunotherapy for what allergies?
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FOOD
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Anaphylaxis Lab Diagnosis
-if within three hours? |
Serum Tryptase
if postive then positive if neg doesnt necessarily ro |
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Epi Injections for anaphylaxis
-Where given/route -Dilution/dose |
-IM injection to the anterolateral thigh
-***1:1000 dilution (0.3-0.5mL)*** -Peds: (0.01mg/kg) IF not helping in a few minutes, then DO another dose! |
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Anaphylaxis what do you do?
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ABC's then EPI
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Other Than Epi what else can you do to Tx anaphylaxis?
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-Lateral Recombant postion
-O2 suppliment -Antihistamines -Steroieds to prevent the LAte phase reaction -DA or NE incase hypotensive |
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How long do epi pens last?
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about a year!!!!
FOLLOW THIS Expiratoin date! |
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Kid with creases on arms and behind knees?
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Atopic Dermatitis
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Most common allergic foods in kids?
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Milk
Egg Soy Wheat |
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MCC of allergic foods in adults?
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Peanut
Nuts Shellfish Fish |
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The itch that rashes?
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Atocpic Eczeama
T-cell problem |
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Allergies to ____often induced by mellons
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Ragweed
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Allergic Eosinophilic esophagitis sx and Dx?
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-Dysphagia, Abdominal pain, poor reponse to antacids
-Dx: Edoscopy and Biopsy >20 eosinophils/hpf |
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Non-IgE mediated GI food induced entrocolitis syndrome
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- before 1 yo
-to milk or soy |
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celiac disease
what is it? Associated with___ peptides? Sx? Tx? |
Extensive enteropathy leading to malabsorption. Wheat gluten allergy basically
-Gliadin peptides -HLA-DRQ2 -Diarrea often -AVOID GLUTEN |
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Acute URticaria
time Fram? Common causes? |
< than 6weeks
-Drugs -(include, vitamins OTC etc) Food Insect Latex Infections- very common especially young kids Physical *all should occur close to time of exposure |
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Chronic Urticaria
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More common in adults
80% idiopathic MCC cause found is Autoimmune |
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Common causes of Chronic Urticaria?
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Autoimmune **
Physical urticaria-(pressure ,sun etc.) Urticarial vascultis Emotional |
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Management of Urticaria?
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Avoidance
H1,H2 antagonists Tricyclics -Dioxepin may help night sx (blocks H1 and H2) Corticosteroids |
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TCA that helps with chronic urticaria?
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Dioxepin
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Angioedema Causes
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Food, Drugs
Anaphylaxis Autoimmune ACE inhibiters** C1 INH deficiency (Many Idiopathic) |
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Angioedema Symptoms
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NON-pitting edema, well demarcated
-Often around Face, tongue, lips, eyelids, extremities |
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Most common cause of angioedema seen in ER?
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ACE inhibiters
due to increased bradykinin |
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Heriditary Angioedema Etiology
-Sx? |
Lack C1INH
Autosomal Dominant so fam Hx will be + Sx: Subcutaneous tissue swellin in extremities, genitalia, face and trunk =Common of larynx also -which is most common cause of death in HAE |
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Testing for HAE?
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C4 fisrt just to see compliment problem then
C1 INH qualitative and Quantitative (type 1= decreased amount Type 2= decreased action C2 will be decreased during an attack |
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C1q in HAE vs Aquired AE?
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normal in heriditary
Aquired will have a low C1q |
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Acute HAE treatment?
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-C1 inhibiter concentrate
or -FFP Fresh Frozen Plasma (most places have) ANd -Be prepared to stabilize airway -And give EPI to prevent from being sued if you are wrong. |
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Long term HAE tx?
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Attenuated androgens
(Danazol) |
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Aquired C1 INH deficiency?
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Typical 80 yo lady with cancer
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