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Step III
Step III - Imm
| Question | Answer |
|---|---|
| What is the treatment for anaphylaxis | SUBQ epi 1:1000, H1 antihistamine, corticosteroids |
| What causes angioedema | Minor trauma to face/hands or ingestion of ACEI |
| How does angioedema present | Sudden swelling of face, palate, lips, tongue, airway |
| Where should you consider admitting pts with angioedema | ICU |
| What causes hereditary angioedema | C1 esterase inhibitor deficiency |
| What lab finding diagnoses angioedema | Low C2 and C4 (C1 esterase uses them up) |
| What is the tx for acute angioedema | FFP |
| What is the tx for chronic angioedema | Danazol/stanazol (androgens raise C1 esterase inhibitor) |
| Pt presents w/ paroxymal sneezing, itchy eyes, rhinorrhea, wheezing, recurrent nasal stuffiness. Dx | Allergic rhinitis |
| What is the first line tx of allergic rhinitis | Intranasal glucocorticoid |
| What if patient with allergic rhinitis can not avoid allergen | Desensitization |
| Adult pt c/o recurrent bronchitis, pneumonia, pharyngitis along with sprue-like abdominal complaints. Dx | Common variable immunodeficiency (CVID) |
| Male child c/o recurrent bronchitis, pneumonia, pharyngitis w/o GI complaints. Dx | X linked agammaglobulinemia (Bruton’s) |
| 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 |
| What does diagnostic testing show in CVID | low total IgG |
| What is the tx for CVID | IV infusion of Igs |
| 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 |
| What is the pathophys of Bruton’s | B cells are missing therefore NO Igs are made |
| What is the tx for Bruton’s | same as CVID, IV Ig |
| What is the MC primary immunodeficiency | IgA |
| 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 |
| Atopy, sprue-like GI complaints, recurrent sinopulmonary infections, anaphylaxis after blood transfusion. Dx | IgA deficiency |
| 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 |
| Pt has recurrent skin infections from STAPH. Dx | HYPER IgE syndrome |
| Tx for HYPER IgE syndrome | Tx the infection as it comes |
Created by:
DrINFJ
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