Step III - Imm
Help!
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| What is the treatment for anaphylaxis | SUBQ epi 1:1000, H1 antihistamine, corticosteroids
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| What causes angioedema | Minor trauma to face/hands or ingestion of ACEI
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| How does angioedema present | Sudden swelling of face, palate, lips, tongue, airway
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| Where should you consider admitting pts with angioedema | ICU
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| What causes hereditary angioedema | C1 esterase inhibitor deficiency
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| What lab finding diagnoses angioedema | Low C2 and C4 (C1 esterase uses them up)
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| What is the tx for acute angioedema | FFP
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| What is the tx for chronic angioedema | Danazol/stanazol (androgens raise C1 esterase inhibitor)
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| Pt presents w/ paroxymal sneezing, itchy eyes, rhinorrhea, wheezing, recurrent nasal stuffiness. Dx | Allergic rhinitis
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| What is the first line tx of allergic rhinitis | Intranasal glucocorticoid
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| What if patient with allergic rhinitis can not avoid allergen | Desensitization
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| Adult pt c/o recurrent bronchitis, pneumonia, pharyngitis along with sprue-like abdominal complaints. Dx | Common variable immunodeficiency (CVID)
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| Male child c/o recurrent bronchitis, pneumonia, pharyngitis w/o GI complaints. Dx | X linked agammaglobulinemia (Bruton’s)
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| What is the pathophys of CVID | The machinery to make Igs, from lymph nodes, B and T cells is intact. However, not enough Igs are produced
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| What does diagnostic testing show in CVID | low total IgG
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| What is the tx for CVID | IV infusion of Igs
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| In terms of physical exam findings, what distinguishes CVID from Bruton’s | CVID spleen, lymph nodes, adenoids are PRESENT and may be enlarged whereas in Bruton’s they are small or ABSENT
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| What is the pathophys of Bruton’s | B cells are missing therefore NO Igs are made
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| What is the tx for Bruton’s | same as CVID, IV Ig
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| What is the MC primary immunodeficiency | IgA
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| How do you distinguish it from CVID and Bruton’s | Most pts are ASYMPTOMATIC. But if they show S/S very similar to CVID and Bruton’s (this sucks for me on the exam!). Look for pt w/ atopic conditions or a pt who becomes anaphylactic after blood transfusion
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| Atopy, sprue-like GI complaints, recurrent sinopulmonary infections, anaphylaxis after blood transfusion. Dx | IgA deficiency
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| What is the tx and why is it different from the tx for CVID and Bruton’s | Tx infections as they come; IV Ig has very little IgA in it so won’t help
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| Pt has recurrent skin infections from STAPH. Dx | HYPER IgE syndrome
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| Tx for HYPER IgE syndrome | Tx the infection as it comes
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