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Patient comes in to ER, SOB, facial swelling, lip swelling 30 min after a bee sting. There was no response to epi-pen in the field. 6hrs after bolus of steriods and diphen, the patient is still SOB and still has lip swelling. Where is the patient plac
ICU, placement is based on responce to therapy.
A man comes in with neurosyphilis. He has a history of life-threatening anaphylaxis to penicillin. He has a history of essential tremor is on propanolol. He has asthma and is on an inhaled beta agonist and inhaled steriods. What do you do?
Stop propanolol prior to desensitizing him. Neurosyph is only effectively tx with penicillin. Epinepherine may have to be used in the event of anaphylaxis whe you desensitize the px.
3 year old male child comes in with recurrent sinopulmonary infections. There are no nodes palpated in the cervical area and no tonsils seen on oral exam. the child has been treated for an infection nearly every 1-2mths since birth. There are no skin i
X linked gamaglobulinemia, occurs in male children. CVID in adults. Hyper IgE has skin infections. Manage with IV immunoglobulin infustion and abx for infections.
hymodynamic instability, hypotension, tachy and difficulty breathing
How does anaphylaxis present?
how do you tx anaphylaxis?
SubQ epinepherine 1:1000 conc, corticosteriods and H1 inhibiting antihis - diphenhydramine or hydroxyzine
sudden swelling of the face, palat, tongue and airway after minor trauma to face (hit by a pillow!) or hands or after an ACE inhibitor. or may be hereditary. May have stridor, abd pain, lack of responce to steriods
How does angioedema present? or C1 esterase inhibitor deficiency
Angioedema diagnosis?
Low levels of C2 C4
treatment angioedema?
1 acute episode -infusion of fresh frozen plasma. GIVE BACK THE C1 ESTERASE 2 chronic -DOC for hereditary Ecallantide (kallikrein inhibitor). Androgens are also used Danazol and Stanazol
recurrent episodes of nasal itching, stuffiness, rhinorrhea, and paroxysms of sneezing. May have eye itching, wheeze and dermatitis
How does allergic rhinitis present?
how do you tx allergic rhinitis?
avoidance of allergen! however possible
drug therapies for allergic rhinitis?
Most effective: Intranasal corticosteriods. Antihistamines (loratadine, fexofenadine, cetirizine) intranasal antihistamine (azelastine), cromolyn, ipratropium bromide, leukotriene inhibitors (montelukast) saline nasal spray
immunotherapies for allergic rhinitis?
desensitization
recurrent episodes of sinopulmonary infections (bronchitis, sinusitis, pneumonia, pharyngitis)
CVID- adults men/women with spruelike abdominal disorder (constipation/diarrhea). X-linked agammaglobulinemia - male chilren
how do you test for agammaglobulinemia?
Total igG levels are low, machinery and immunoglobulins are there, just dont make enough.
how do you test for x-linked agammaglobulinemia?
no immunoglobulins, no b cells. no machinery no immg
tx of CVID and X linke aggama
IV immunglobulins, just replace them.
recurrent sinopulmonary infections, sprue like malabsorption and atopic conditions
IgA deficiency
anaphylaxis when recieving a blood transfusion
IgA deficiency
tx of IgA def
abx tx as infections arise, NO IV Immuno - has little IgA in it
recurrent skin infections from staphylococcus
hyper IgE syndrome
tx of Hyper IgE
abx tx as infections arise
Errythema Nodosum causes?
Bechet's, Drugs (OCP's, Iodine, Sulfa's) Strep/TB, Autoimmune (sarcoid) Fungal