immunology quiz
Your patient is a 19-year-old female who called EMS because she awoke with "itchy red patches" on her chest, back, and arms that "seem to come and go." As you obtain the history, you learn that she started taking Keflex, an antibiotic, two days ago to prevent infection in a laceration to her hand. In explaining to your patient what is going on, which of the following statements would be the most accurate? "This is a typical side effect of Keflex. It happens in most patients who take it." "These look like hives. They occur during an allergic reaction. You may have developed an allergy to the antibiotic you are taking." "It looks like the infection in your hand has spread to the bloodstream. The toxins from the bacteria are causing a rash." "I cannot say what this is, but it is not an allergic reaction. Hives do not come and go as you have described."
"These look like hives. They occur during an allergic reaction. You may have developed an allergy to the antibiotic you are taking."
The standard dose of diphenhydramine for anaphylaxis is: 30-40 mg. 10-20 mg. 25-50 mg. 50-100 mg.
25-50mg
Which of the following statements about the use of vasopressors in the treatment of anaphylaxis is TRUE? A norepinephrine infusion can correct the peripheral vasodilation that occurs secondary to SRS-A release by basophils and mast cells. A norepinephrine infusion encourages a net movement of plasma from the intravascular space to the vascular space, raising blood pressure. An epinephrine infusion can correct the peripheral vasodilation that occurs secondary to SRS-A release by basophils and mast cells. A dopamine infusion can correct the peripheral vasodilation that occurs secondary to histamine release by basophils and mast cells.
A dopamine infusion can correct the peripheral vasodilation that occurs secondary to histamine release by basophils and mast cells.
Which of the following statements about using antihistamines in the treatment of anaphylaxis is TRUE? Antihistamines block H1 and H2 receptors and prevent further release of histamine from B and T cells. Antihistamines displace histamine, then block histamine receptors. Antihistamines block histamine receptors and reduce histamine release from mast cells and basophils. Blocking of H1 receptors results in mild vasoconstriction, while the blocking of H2 receptors results in bronchodilation
Antihistamines block histamine receptors and reduce histamine release from mast cells and basophils.
Which of the following statements about corticosteroid use in anaphylaxis treatment is TRUE? Corticosteroids can help reverse bronchospasm associated with anaphylaxis. Corticosteroids stabilize mast cell and basophil membranes, preventing degranulation and histamine release. Administration of high-dose corticosteroids results in peripheral vasoconstriction. Corticosteroids can reduce the inflammation associated with anaphylaxis.
Corticosteroids can reduce the inflammation associated with anaphylaxis.
Your partner experiences an itchy, red rash on her hands that stops at the wrists after using a new brand of glove your service purchased. Her skin is warm, dry, and nondiaphoretic; the rash is isolated to her hands; and her lung sounds are clear bilaterally. She has no other complaints. HR = 88, RR = 12, BP = 122/80. Of the following treatments, which is most appropriate? Diphenhydramine IM Oxygen via nonrebreather mask 15 lpm, cardiac monitor, IV of NS KVO, epinephrine SC, diphenhydramine IM Advise the dispatcher you will be going out of service Oxygen via nasal cannula 4 lpm, cardiac monitor, IV of NS KVO, epinephrine IV, diphenhydramine IM
Diphenhydramine IM
Your patient is experiencing dyspnea and urticaria after ingesting penicillin. Auscultation of his lungs reveals diffuse expiratory wheezes. Which of the following medications will best help correct your patient's bronchospasm? Ranitidine 50 mg IV 100 percent oxygen via nonrebreather mask 15 lpm Solu-Medrol 125 mg IV Epinephrine 1:1000 SC
Epinephrine 1:1000 SC
Which treatment would best halt the urticaria associated with an allergic reaction? Epinephrine and diphenhydramine Oxygen Solu-Medrol Dopamine and albuterol
Epinephrine and diphenhydramine
Which of the following treatment regimens for anaphylaxis lists the medications in the correct order of administration following oxygen? Diphenhydramine, epinephrine, dexamethasone Dexamethasone, diphenhydramine, epinephrine Epinephrine, diphenhydramine, dexamethasone Epinephrine, dexamethasone, diphenhydramine
Epinephrine, diphenhydramine, dexamethasone
You respond to a patient who presents with shortness of breath after he took a dose of an antibiotic. You find your patient with audible stridor and urticaria. You should administer: albuterol 5 mg. diphenhydramine 75 mg. IM epinephrine 1:1000 0.3-0.5 mg. SQ epinephrine 1:1000 0.3-0.5 mg.
IM epinephrine 1:1000 0.3-0.5 mg.
Your patient is a conscious and alert 22-year-old female who was stung by a hornet. She states that she has "allergies to bee stings" and has been told that she could die if stung. Your physical examination reveals a 1-cm-diameter, red, edematous area where she was stung on the left forearm. Her skin is warm and dry, and her lung sounds are clear and equal bilaterally. HR = 12 and regular, BP = 122/82, RR = 12 and regular, SaO2 = 98%. The most appropriate treatment for this patient would include : transport only. IV as soon as possible with a crystalloid solution . 100 percent oxygen via nonrebreather mask 15 lpm, IV of NS 1-2 L, epinephrine 1:1000 0.3 mg SC, diphenhydramine 25 mg IV. 15 lpm oxygen by nonrebreather, epinephrine 1:1000 0.3 mg SC, diphenhydramine 25 mg IV, transport.
IV as soon as possible with a crystalloid solution
Your patient is a 43-year-old female with a history of peanut allergy. She is complaining of dizziness after eating a casserole that she later discovered contained peanuts. Your physical examination reveals warm, diaphoretic skin; a blotchy, red rash covering her chest and arms; and lung sounds that are clear and equal bilaterally. HR = 122, BP = 124/76, RR = 15 and regular, SaO2 = 97%. In addition to providing oxygen, appropriate treatment for this patient includes: IV with crystalloid solution such as lactated Ringer's or normal saline, epinephrine 1:1000 SC, diphenhydramine IV, nebulized albuterol. IV with crystalloid solution such as lactated Ringer's or normal saline, epinephrine 1:1000 SC, diphenhydramine IV. IV with crystalloid solution such as lactated Ringer's or normal saline. IV of NS wide open, epinephrine 1:1000 SC, diphenhydramine IV.
IV with crystalloid solution such as lactated Ringer's or normal saline, epinephrine 1:1000 SC, diphenhydramine IV.
Which of the following best explains the cause of the histamine and heparin release in response to exposure to an antigen? Humoral cells have initiated a chemical attack on the antigens. IgE antibodies have attached themselves to the membranes of basophils and mast cells, resulting in degranulation. IgE antibodies have activated the membranes of B and T cells, resulting in release of histamine and heparin. IgG and IgM antibodies have activated basophils and mast cells, resulting in degranulation.
IgE antibodies have attached themselves to the membranes of basophils and mast cells, resulting in degranulation.
Your patient is a 48-year-old female who is supine on the floor of a neighborhood health clinic. She became unconscious after receiving 250 mg of IM doxycycline. Clinic staff reports that the patient "broke out in hives and lost consciousness." The patient is being ventilated by bag-valve mask and has an IV of normal saline running wide open. A nurse practitioner on the scene informs you that, before your arrival, he administered 2 doses of 0.5 mg of epinephrine SC, 50 mg of diphenhydramine IV, and 1 L of NS. HR = 138; BP = 84/60; RR = 12/min, assisted with BVM; SaO2 = 94%. Of the following, which is the most appropriate continued treatment of this patient? Initiate a second IV of NS wide open, intubate and hyperventilate, transport. Intubate, Solu-Medrol IV, 250 cc NS fluid challenge, transport. Continue administering fluids and transport to the nearest facility. Intubate, administration of dopamine IV infusion, rapid transport.
Intubate, administration of dopamine IV infusion, rapid transport.
Your patient is a 31-year-old female complaining of dizziness and difficulty breathing after being stung by a bee. You note that she is extremely anxious, and your physical examination reveals a rapidly developing urticaria to her shoulders, neck, and face. Your partner has administered oxygen via a nonrebreather, initiated IV access, placed the patient on the cardiac monitor, and administered epinephrine SC and diphenhydramine IV. Despite this, you also note that her voice is quickly becoming more hoarse and she has developed expiratory wheezes in all lung fields. HR = 128, BP = 100/70, RR = 20, SaO2 = 99%. What should be your major concern at this point, and what is the most appropriate treatment? Laryngeal edema leading to total airway occlusion; intubate Increased bronchospasm leading to respiratory arrest; administer albuterol via nebulizer Hypotension leading to cardiovascular collapse; administer fluids wide open and initiate a dopamine infusion Increased bronchospasm leading to respiratory arrest; administer epinephrine IV
Laryngeal edema leading to total airway occlusion; intubate
Your patient is a 36-year-old female, conscious and alert, sitting at her desk and complaining of a rash and itchiness after taking a sulfa antibiotic. Physical examination reveals warm and dry skin, urticaria on her chest and back, lung sounds that are clear and equal bilaterally. HR = 100, BP = 132/78, RR = 14, SaO2 = 98%. Which of the following is the most appropriate treatment for this patient? Transport only Oxygen via nonrebreather mask, IV crystalloid solution, 0.3 mg epinephrine SC, 25 mg diphenhydramine IV, albuterol 2.5 mg via nebulizer Oxygen via nonrebreather mask, IV crystalloid solution, 25 mg diphenhydramine IV Oxygen via nasal cannula, IV crystalloid solution, 5 mg epinephrine IV, 25 mg diphenhydramine IV
Oxygen via nonrebreather mask, IV crystalloid solution, 0.3 mg epinephrine SC, 25 mg diphenhydramine IV, albuterol 2.5 mg via nebulizer
Which of the following is the desired physiologic reaction that occurs after the administration of a vaccine that contains live, attenuated viruses? The viruses in the vaccine act as an antigen, resulting in a nonspecific immune response. The antibodies in the vaccine multiply in the body. The immune system will create specific antibodies to the viruses in the vaccine. The immune system will create specific antigens to the viruses in the vaccine.
The immune system will create specific antibodies to the viruses in the vaccine.
Which of the following best describes why the secondary response to an antigen is faster than the primary response? The secondary response uses memory cells, which immediately release antibodies specific to the antigen. The primary response uses B and T cells specific to the antigens. The secondary response uses memory cells, which immediately release antigens specific to the antibodies. The secondary response has fewer steps than the primary response, allowing it to progress faster.
The secondary response uses memory cells, which immediately release antibodies specific to the antigen.
A male patient presents with a puncture wound to his heel from stepping on a nail. He informs you that he is visiting from El Salvador and has never received a tetanus vaccination. At the emergency room he is administered tetanus immune globulin, as well as a tetanus vaccination. Which of the following best describes the rationale for this treatment? The tetanus immune globulin provides passive immunity, while the tetanus vaccination provides active immunity. The tetanus immune globulin provides IgE antibodies for immediate protection, while the tetanus vaccination provides natural immunity by producing tetanus-specific antibodies. The tetanus immune globulin provides IgG and IgM antibodies for immediate protection, while the tetanus vaccination provides passive immunity by producing tetanus-specific antibodies. The tetanus immune globulin provides immediate protection, while the tetanus vaccination provides passive immunity by producing tetanus-specific antibodies.
The tetanus immune globulin provides passive immunity, while the tetanus vaccination provides active immunity.
The administration of a vaccine results in ________ immunity. induced passive active natural induced natural passive
active
Your patient is a 46-year-old male who is unconscious on his front lawn after being stung by a bee. You note angioneurotic edema. HR = 132, BP = 76/40, RR = 24 and shallow. You should first: start an IV of NS wide open and administer epinephrine 1:10,000 IV. administer epinephrine 1:1000 SC. administer high-concentration oxygen with a nonrebreather mask or similar device. intubate the patient.
administer high-concentration oxygen with a nonrebreather mask or similar device.
You are called to the home of a 28-year-old male who is complaining of hoarseness, a scratchy sensation in the back of his throat, and palpitations. The symptoms began about 30 minutes ago and have grown steadily worse ever since the patient ingested prescribed penicillin 1 hour ago. Patient management should include all of the following EXCEPT: administration of an IV beta-blocker. epinephrine 1:1000 0.3 mg SC. IV of crystalloid solution such as lactated Ringer's or normal saline. high-concentration oxygen via nonrebreather mask.
administration of an IV beta-blocker.
Which of the following is a potentially life-threatening condition involving the head, neck, face, and upper airway? Hives Urticaria Wheals Angioedema
angioedema
Your patient is experiencing profuse hives, itching, dyspnea, coughing, tachycardia, and dizziness after eating seafood 5 minutes ago. You might also expect to see all of the following additional signs EXCEPT : hypertension. bronchospasm. laryngeal edema. cyanosis.
hypertension
Epinephrine administration results in all of the following EXCEPT: tachycardia. increased cardiac contractile force . increased peripheral vasoconstriction. hypotension.
hypotension
An allergen's most common route of entry in an anaphylactic reaction is: inhalation. ingestion. absorption. injection.
injection
Diphenhydramine is administered in anaphylaxis because it: blocks histamine receptors. is nonselective. produces all of the above. reduces histamine release from mast cells and basophils.
produces all of the above
The initial exposure of an individual to an antigen is referred to as what? Hypersensitivity Sensitization Active immunity Allergy
sensitization
