2017

Question 1

Rx for Epi in the ED department

Answer 1

Epi 0.01 mg/kg of 1:1000 IM, repeat q5-15 min PRN

Question 2

RFs for severe anaphylaxis to hymenoptera

Answer 2

1. previous severe reaction
2. BB use
3. severe asthma
4. age > 45
5. elevated tryptase
6. multiple sequential stings
7. type of venom (vespid is higher)
8. lack of urticaria and angioedema

Question 3

two most common foods in FPIES

Answer 3

< 6 months = milk and soy

> 6 months = rice and oat

Question 4

what is the specificity for peanut skin testing?

Answer 4

> 8 mm is 95% PPV in the context of a positive history
otherwise

SPT is 61% specific and 90% sensitive

Question 5

4 principles of medical ethics

Answer 5

Autunomy - the ability of a patient to make their own medical decisions. They should be equipped with all the information so they are able to make an informed decision, and be capable.
Beneficence - always do what is best for the patient
Non-malificence - “do no harm”, make sure that all treatments offered do not do more harm than good
Justice - fair and equal treatment

Question 6

what two families of receptors do platelets have? name 2 mechanisms in how IVIG works in increasing plt count in IVIG

Answer 6

1. PAR1 - protease activated receptor 1
2. GPIa/IIa and GPVI collagen receptor

IVIG
- binds the Fc receptor on the mono-mac blocking the interaction of the platelet with the AA that will destroy it

-IVIG induces thrombopoeisis in megakaryocytes which increases production of plts and increases circ. plts

Question 7

mechanisms of IVIG in ITP

Answer 7

• Increase IgG catabolism by increasing total serum IgG
• May contain neutralizing Ab
• Increase Treg activity
• Provide alternative binding area for C3a, leading to decreased complement activation and inflammation
• Prevent activation of C3b and C5b
• Specific to ITP - increase IgG catabolism, and interfering with macrophage uptake of autoantibody-coated platelets

Question 8

which RCTs has Xolair shown to be effective in

Answer 8

1. POLYP1 and POLY2 trials for treatment of CRwNPs

2. ASTERIA1 trial showed effectiveness in CSU

Question 9

sarcoid with hypogamm makes you think of what dx?

Answer 9

CVID with granulomatous inflammation

Question 10

why do people on ritux no develop hypogamm?

Answer 10

Most people do not develop hypogam because antigen-specific IgG is produced by plasma cells, which do not express CD20