Step 3 Ch 2 Allergy 1-0

Front 1

1.Presentation of Anaphylaxis?

Back 1

a. Hemodynamic instability with:
1. Hypotension
2. Tachycardia
b. Difficult breathing.

Front 2

2.Anaphylaxis treatment?

Back 2

a. Subcutaneous epinephrine 1:1,000 concentration (KNOW it’s SUBQ)
b. Corticosteroids
c. H1-inhibiting antihistamines, such as diphenhydramine or hydroxyzine.

Front 3

3.Presentation Angioedema?

Back 3

a. A sudden swelling of the face, palate, tongue, and airway in association w/minor trauma to the face or hands
b. Or
c. The ingestion of ACE inhibitors.
d. The question may describe a person hit in the face w/a pillow, or wood chips hitting the arm.

Front 4

4.Other symptoms of angioedema?

Back 4

1. Stridor
2. Abdominal pain
3. Lack of response to steroids

Front 5

5.Cause of Hereditary angioedema?

Back 5

a. C1 esterase inhibitor deficiency.

Front 6

6. Note: Consider placing people w/angioedema in the ICU

Back 6

6. Note: Consider placing people w/angioedema in the ICU

Front 7

7.Diagnostic testing for angioedema?

Back 7

a. The diagnosis of angioedema is based on finding low levels of C2 and C4 in the complement pathway.
b. They are chronically depleted because of the deficiency of C1 esterase inhibitor. An elevated white cell count is not specific.

Front 8

8.Treatment of acute Angioedema?

Back 8

a. Infusion of Fresh Frozen Plasma (acute episodes)

Front 9

9.Treatment of chronic angioedema (hereditary angioedema)?

Back 9

a. Ecallantide is the DOC for hereditary angioedema.
b. Androgens are also used for chronic therapy.
c. Androgens, for unknown reasons, raise the levels of C1 esterase inhibitor.
d. The most frequently used androgens are danazol and stanozol

Front 10

10.MOA and use of Ecallantide?

Back 10

a. Inhibitor of Kallikrein.
b. It is the best initial therapy for angioedema.
c. Ecallantide blocks bradykinin production.

Front 11

11.A patient comes to the ER w/SOB, facial swelling, and lip swelling 30 minutes after a bee sting. There was no response to epi-pen injection in the field. 6 hours after a bolus of steroid and diphenhydramine, the pt is still short of breath and still has lip swelling. Where should the pt be placed?

Back 11

a. ICU.
b. If the pt comes w/anaphylaxis from any cause, the placement of the pt for CCS is based entirely on the response to therapy that occurs after treatment. In this case, the source of the allergic reaction, an insect sting, is irrelevant. What matters is that after moving the clock forward, the symptoms do not resolve.
c. Any persistent lip, facial, or hemodynamic involvement after initial therapy should place the patient in the ICU.

Front 12

12.A man comes in w/neurosyphilis. He has a hx of life-threatening anaphylaxis to pcn. He has a hx of essential tremor and is on propranolol. He has asthma and is on an inhaled beta agonist and inhaled steroids. What is the next step?

Back 12

a. Stop propranolol prior to desensitizing him
b. Neurosyphilis is only effectively treated with pcn. The pt must be desensitized. Prior to desensitization, it is important to stop propranolol and all beta blockers. This is because epi may have to be used in the event of anaphylaxis when you desensitize the pt. Bolusing with steroids is inappropriate, bc anaphylaxis is first treated w/epi.

Front 13

13.Allergic Rhinitis?

Back 13

a. Presents w/recurrent episodes of nasal itching, stuffiness, rhinorrhea, and paroxysms of sneezing.
b. There is also often eye itching and dermatitis.
c. Allergic rhinitis may be associated w/the development of asthma.
d. Many pts present w/wheezing as well.

Front 14

14.Tx of Allergic rhinitis?

Back 14

a. Avoidance of allergens: Mainstay of therapy.
b. It is important to close windows and stay in air-conditioned rooms to avoid pollen.
c. In addition, an allergy to animal dander may mean avoiding a pet.
d. Mattresses and pillows must be covered w/mite and dust-proof casings.

Front 15

15.Rx for drug therapy?

Back 15

a. Intranasal steroids
b. Antihistamines such as loratadine, fexofenadine, and cetirizine.
c. Intranasal antihistamines (azelastine)
d. Cromolyn
e. Ipratropium bromide
f. Leukotriene inhibitors (e.g., Montelukast)
g. Nasal saline spray and wash.

Front 16

16.Single most effective treatment for allergic rhinitis?

Back 16

a. Intranasal steroids.

Front 17

17.Immunotherapy for allergic rhinitis?

Back 17

a. For extrinsic allergens that cannot be avoided, desensitization therapy may work.

Front 18

18.Primary immunodeficiency syndromes?

Back 18

1. Common variable immunodeficiency (CVID)
2. X-linked Agammaglobulinemia (Bruton’s)
3. IgA Deficiency
4. Hyper IgE syndrome

Front 19

19.Presentation of Common Variable Immunodeficiency (CVID)?

Back 19

a. CVID presents in BOTH men and women and may only present when the patient is an adult.
b. Both CVID and X-linked agammaglobulinemia present with RECURRENT EPISODES of SINUPULMONARY INFECTIONS, such as bronchitis, sinusitis, pneumonia, and pharyngitis.
c. In addition, CVID causes a spruelike abdominal disorder.
d. There is malabsorption, steatorrhea, and diarrhea.
e. Lymph nodes, adenoids, and the spleen are present and may be enlarged.

Front 20

20.Diagnostic testing for CVID?

Back 20

a. The machinery to make immunoglobulins is intact.
b. The nodes and both B and T cells are present, but they do not make enough antibody.
c. Hence total IgG levels are low!!!!!