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Cells involved in a type I sensitivity reaction
- IgE antibodies
- Mast cells
- Basophils
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Examples of Type I hypersensitivity reaction
- Anaphylaxis
- Rubber glove allergy
- hay fever
- urticaria
- allergic rhinitis
- some asthma
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How does C1 esterase inhibitor deficiency present
- Hereditary angioedema (swelling of lips, eyelids, airway or bowel)
- C4 is low
- Autosomal Dominant
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Causes of autoimmune hemolytic anemia
- Methyldopa
- Penicillin
- Sulfa drugs
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Examples of Type II hypersensitivity reaction
- Autoimmune hemolytic anemia
- ITP
- Transfusion reactions
- Rh compatibility
- Goodpastures syndrome
- Myasthenia Gravis
- Graves disease
- Pernicious anemia
- Hyperacute transplant rejection
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What causes type II hypersensitivity reaction
IgG and IgM react with antigen and cause inflammation
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What causes Type III hypersensitivity reaction
Immune-complexes deposit in tissues causing inflammation
-
Examples of Type III hypersensitivity reactions
- Serum sickness
- Lupus
- RA
- Polyarteritis Nodosa
- Chronic hepatitis
- Glomerulonephritis
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What causes Type IV hypersensitivity reactions?
Sensitized T cells release inflammatory mediators
-
Examples of Type IV hypersensitivity reactions
- TB skin test
- Contact dermatitis
- Chronic transplant rejection
- granulomas
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Patient with recurrent respiratory and GI infections
Develops anaphylaxis after Ig exposure
IgA deficiency
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Male patient, Low B-cells, recurrent Strep and Haemophilus infections of lungs and sinuses starting after 6 months of age
X-linked agammaglobulinemia
-
Hypocalcemia and tetany in newborn, Absent hypoplastic thymus, heart defects
DiGeorge Syndrome from hypoplasis of third and fourth pharyngeal pouches
-
Severe infections first few months of life, B and T-cell defects, absent or dysplastic thymus and lymph nodes
- SCID (autosomal recessive or X-linked)
- Caused by adenosine deaminase deficiency
-
Male patient with eczema, thrombocytopenia, and recurrent respiratory infections
Wiskott-Aldrich syn
-
Male patient with recurrent Staph and Pseudomonas infections
Deficient nitroblue tetrazolium dye reduction
Positive superoxide production testing
- Chronic Granulomatous disease
- (decreased NADPH activity so no repiratory burst)
-
Patient with oculocutaneous albinism and giant granules in neutrophils
- Chediak-Higashi syndrome
- (Defect in microtubule polymerization)
-
Patient with recurrent Neisseria infections
C5-C9 deficiencies
-
Patient with recurrent thrush, scalp, skin, and nail infections; anergy to Candida skin test; Often has hypothyroid
Chronic mucocutaneous candidiasis
-
Fair-skinned, red haired patient with recurrent staph infections, esp skin infections and eczema; High IgA levels
Hyper IgE syndrome (Job-Buckley syn)
-
At what CD 4 levels should action be taken for HIV pts?
- @ diagnosis: MMR, Pneumococcal, hep B, inactive polio, annual influ
- CD4 count < 350 start Antiretroviral therapy
- 200 start TMP-SMX or pentamadine for Pneumocystis jiroveci
- 100 start azithro, clarithro, or rifabutin for Mycobacterium Avium
- also fluconazole for cryptococcal and candida
-
What should be given to a pregnant woman with HIV?
Zidovudine (AZT) and child for six weeks
-
Common malignancies seen in HIV pts?
- Kaposis sarcoma
- Non-Hodgkin lymphoma (B cell lymphoma of CNS)
-
Positive India ink stain of CNS on HIV pt
Cryptococcus Neoformans meningitis
-
Ring enhancing lesion in brain of HIV pt?
- Toxoplasmosis or lymphoma
- Taenia solium in pts from S america
-
Rx for CMV retinitis in HIV pt
Acyclovir or gancyclovir
-
Differential dx in adult with thrush
-
Young adult with herpes zoster?
Consider HIV
-
What diarrhea infections are almost uniquely seen in HIV patients
-
PNA symptoms in pt with HIV
- Coccidioidomycosis
- S PNA, H Influ, Nocardia
- Pneumocystis Carinii
- TB
-
Diarrhea in pt with HIV. DDx?
- Isospora, Strongyloides, Cryptosporidium
- Wasting syndrome
- Histoplasmosis
- CMV
- Mycobacterium Avium
-
CNS or Neurologic issues seen in pt with HIV?
- Dementia
- Toxoplasmosis
- Lymphoma
- Progressive multifocal leukoencephalopathy
- Cryptococcal meningitis
- CMV (vision loss)
-
HIV patient presents with Fever, Dyspnea, and diarrhea, or severe mono-like fatigue with no pharyngitis or lymphadenopaty. Causitive agent?
CMV
-
What are the common life threatening reactions to HIV medications?
- 1. Didanosine - Pancreatitis
- 2. Abacavir - Hypersensitivity reaction
- 3. NRTI - Lactic Acidosis
- 4. NNRTI - Steven-Johnson Syn
- 5. Nevirapine - Liver failure
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