Chapter 5 Immunology

Chapter 5 Immunology 1) 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? A) Epinephrine 1:1000 SC B) Ranitidine 50 mg IV C) Solu-Medrol 125 mg IV D) 100 percent oxygen via nonrebreather mask 15 lpm Answer: A Diff: 2 Page Ref: 272 Standard: Medicine (Immunology) Objective: 3, 4, 5 2) Which treatment would best halt the urticaria associated with an allergic reaction? A) Solu-Medrol B) Oxygen C) Dopamine and albuterol D) Epinephrine and diphenhydramine Answer: D Diff: 2 Page Ref: 270, 271 Standard: Medicine (Immunology) Objective: 4, 7, 9 3) 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: A) laryngeal edema. B) bronchospasm. C) cyanosis. D) hypertension. Answer: D Diff: 1 Page Ref: 267-268 Standard: Medicine (Immunology) Objective: 3, 4 4) Which sign associated with an allergic reaction should concern a caregiver the most? A) Urticaria B) Wheezing C) Warm, flushed skin D) GI distress Answer: B Diff: 2 Page Ref: 271-272 Standard: Medicine (Immunology) Objective: 3, 4 97 5) Which of the following best describes why the secondary response to an antigen is faster than the primary response? A) The secondary response uses memory cells, which immediately release antibodies specific to the antigen. B) The secondary response uses memory cells, which immediately release antigens specific to the antibodies. C) The primary response uses B and T cells specific to the antigens. D) The secondary response has fewer steps than the primary response, allowing it to progress faster. Answer: A Diff: 2 Page Ref: 264 Standard: Medicine (Immunology) Objective: 2 6) Which of the following treatment regimens for anaphylaxis lists the medications in the correct order of administration following oxygen? A) Dexamethasone, diphenhydramine, epinephrine B) Epinephrine, diphenhydramine, dexamethasone C) Epinephrine, dexamethasone, diphenhydramine D) Diphenhydramine, epinephrine, dexamethasone Answer: B Diff: 2 Page Ref: 270-271 Standard: Medicine (Immunology) Objective: 5, 6 7) The first medication administered to a patient experiencing an anaphylactic reaction should be: A) epinephrine. B) diphenhydramine. C) high-concentration oxygen. D) glucagon. Answer: C Diff: 2 Page Ref: 270-271 Standard: Medicine (Immunology) Objective: 5, 6 98 8) 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: A) 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. B) IV as soon as possible with a crystalloid solution. C) 15 lpm oxygen by nonrebreather, epinephrine 1:1000 0.3 mg SC, diphenhydramine 25 mg IV, transport. D) transport only. Answer: B Diff: 3 Page Ref: 270 Standard: Medicine (Immunology) Objective: 4, 5, 6 9) Which of the following statements about corticosteroid use in anaphylaxis treatment is TRUE? A) Administration of high-dose corticosteroids results in peripheral vasoconstriction. B) Corticosteroids stabilize mast cell and basophil membranes, preventing degranulation and histamine release. C) Corticosteroids can reduce the inflammation associated with anaphylaxis. D) Corticosteroids can help reverse bronchospasm associated with anaphylaxis. Answer: C Diff: 2 Page Ref: 271 Standard: Medicine (Immunology) Objective: 3, 5, 6 10) Epinephrine administration results in all of the following EXCEPT: A) hypotension. B) increased cardiac contractile force. C) increased peripheral vasoconstriction. D) tachycardia. Answer: A Diff: 2 Page Ref: 270 Standard: Medicine (Immunology) Objective: 3, 5 99 11) 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: A) administer high-concentration oxygen with a nonrebreather mask or similar device. B) administer epinephrine 1:1000 SC. C) start an IV of NS wide open and administer epinephrine 1:10,000 IV. D) intubate the patient. Answer: A Diff: 2 Page Ref: 270 Standard: Medicine (Immunology) Objective: 4, 5, 6 12) 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? A) Oxygen via nasal cannula, IV crystalloid solution, 5 mg epinephrine IV, 25 mg diphenhydramine IV B) Transport only C) Oxygen via nonrebreather mask, IV crystalloid solution, 25 mg diphenhydramine IV D) Oxygen via nonrebreather mask, IV crystalloid solution, 0.3 mg epinephrine SC, 25 mg diphenhydramine IV, albuterol 2.5 mg via nebulizer Answer: D Diff: 3 Page Ref: 268-271 Standard: Medicine (Immunology) Objective: 4, 5, 6 13) Which medication would be the best choice for reducing the bronchospasm and laryngeal edema associated with anaphylaxis? A) Albuterol B) Solu-Medrol C) Oxygen D) Dexamethasone Answer: A Diff: 2 Page Ref: 271 Standard: Medicine (Immunology) Objective: 3, 5, 6 100 14) Upon identifying an antigen in the bloodstream, B cells launch a chemical attack by producing antigens specific to the antibody. This is an example of ________ immunity. A) secondary B) humoral C) antibody D) cellular Answer: B Diff: 2 Page Ref: 263 Standard: Medicine (Immunology) Objective: 1, 2 15) Diphenhydramine is administered in anaphylaxis because it: A) blocks histamine receptors. B) is nonselective. C) reduces histamine release from mast cells and basophils. D) produces all of the above. Answer: D Diff: 2 Page Ref: 270 Standard: Medicine (Immunology) Objective: 3, 5, 6 16) Which of the following is the desired physiologic reaction that occurs after the administration of a vaccine that contains live, attenuated viruses? A) The antibodies in the vaccine multiply in the body. B) The immune system will create specific antibodies to the viruses in the vaccine. C) The immune system will create specific antigens to the viruses in the vaccine. D) The viruses in the vaccine act as an antigen, resulting in a nonspecific immune response. Answer: B Diff: 3 Page Ref: 264 Standard: Medicine (Immunology) Objective: 2 101 17) 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? A) The tetanus immune globulin provides immediate protection, while the tetanus vaccination provides passive immunity by producing tetanus-specific antibodies. B) The tetanus immune globulin provides passive immunity, while the tetanus vaccination provides active immunity. C) The tetanus immune globulin provides IgE antibodies for immediate protection, while the tetanus vaccination provides natural immunity by producing tetanus-specific antibodies. D) The tetanus immune globulin provides IgG and IgM antibodies for immediate protection, while the tetanus vaccination provides passive immunity by producing tetanus-specific antibodies. Answer: B Diff: 2 Page Ref: 264 Standard: Medicine (Immunology) Objective: 2, 6 18) Which of the following statements about the use of vasopressors in the treatment of anaphylaxis is TRUE? A) A norepinephrine infusion can correct the peripheral vasodilation that occurs secondary to SRS-A release by basophils and mast cells. B) A norepinephrine infusion encourages a net movement of plasma from the intravascular space to the vascular space, raising blood pressure. C) An epinephrine infusion can correct the peripheral vasodilation that occurs secondary to SRSA release by basophils and mast cells. D) A dopamine infusion can correct the peripheral vasodilation that occurs secondary to histamine release by basophils and mast cells. Answer: D Diff: 3 Page Ref: 271 Standard: Medicine (Immunology) Objective: 3, 5, 6 19) Which medication is best for improving hypotension secondary to anaphylactic shock? A) Diphenhydramine B) Epinephrine C) Hydrocortisone D) Oxygen Answer: B Diff: 2 Page Ref: 270 Standard: Medicine (Immunology) Objective: 5 102 20) 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: A) epinephrine 1:1000 0.3 mg SC. B) administration of an IV beta-blocker. C) IV of crystalloid solution such as lactated Ringer’s or normal saline. D) high-concentration oxygen via nonrebreather mask. Answer: B Diff: 2 Page Ref: 270 Standard: Medicine (Immunology) Objective: 4, 5, 6 21) 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: A) IV of NS wide open, epinephrine 1:1000 SC, diphenhydramine IV. B) IV with crystalloid solution such as lactated Ringer's or normal saline. C) IV with crystalloid solution such as lactated Ringer's or normal saline, epinephrine 1:1000 SC, diphenhydramine IV. D) IV with crystalloid solution such as lactated Ringer's or normal saline, epinephrine 1:1000 SC, diphenhydramine IV, nebulized albuterol. Answer: C Diff: 3 Page Ref: 270 Standard: Medicine (Immunology) Objective: 4, 5, 6 22) 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? A) Intubate, Solu-Medrol IV, 250 cc NS fluid challenge, transport. B) Intubate, administration of dopamine IV infusion, rapid transport. C) Continue administering fluids and transport to the nearest facility. D) Initiate a second IV of NS wide open, intubate and hyperventilate, transport. Answer: B Diff: 3 Page Ref: 268-271 Standard: Medicine (Immunology) Objective: 4, 5, 6 103 23) 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? A) Hypotension leading to cardiovascular collapse; administer fluids wide open and initiate a dopamine infusion B) Increased bronchospasm leading to respiratory arrest; administer albuterol via nebulizer C) Laryngeal edema leading to total airway occlusion; intubate D) Increased bronchospasm leading to respiratory arrest; administer epinephrine IV Answer: C Diff: 3 Page Ref: 267-268, 270 Standard: Medicine (Immunology) Objective: 4, 5, 6 24) The two most common causes of fatal anaphylaxis are ________ and ________. A) shellfish, tree nuts B) hymenoptera stings, tree nuts C) hymenoptera stings, injected penicillin D) shellfish, sulfa drugs Answer: C Diff: 1 Page Ref: 263 Standard: Medicine (Immunology) Objective: 3 25) An allergen's most common route of entry in an anaphylactic reaction is: A) absorption. B) ingestion. C) injection. D) inhalation. Answer: C Diff: 1 Page Ref: 265 Standard: Medicine (Immunology) Objective: 1, 3 104 26) Which of the following statements about using antihistamines in the treatment of anaphylaxis is TRUE? A) Antihistamines displace histamine, then block histamine receptors. B) Antihistamines block histamine receptors and reduce histamine release from mast cells and basophils. C) Blocking of H1 receptors results in mild vasoconstriction, while the blocking of H2 receptors results in bronchodilation. D) Antihistamines block H1 and H2 receptors and prevent further release of histamine from B and T cells. Answer: B Diff: 2 Page Ref: 270 Standard: Medicine (Immunology) Objective: 2 27) The administration of a vaccine results in ________ immunity. A) induced passive B) natural passive C) natural induced D) active Answer: D Diff: 1 Page Ref: 264 Standard: Medicine (Immunology) Objective: 1, 2 28) Which of the following best explains the cause of the histamine and heparin release in response to exposure to an antigen? A) Humoral cells have initiated a chemical attack on the antigens. B) IgE antibodies have attached themselves to the membranes of basophils and mast cells, resulting in degranulation. C) IgG and IgM antibodies have activated basophils and mast cells, resulting in degranulation. D) IgE antibodies have activated the membranes of B and T cells, resulting in release of histamine and heparin. Answer: B Diff: 2 Page Ref: 265-266 Standard: Medicine (Immunology) Objective: 2 29) Which of the following is the best route for administering epinephrine to patients in severe anaphylactic shock refractory to initial interventions? A) SC B) ET C) IM D) IV Answer: D Diff: 1 Page Ref: 270 Standard: Medicine (Immunology) Objective: 5, 6 105 30) Immunity resulting from a direct attack on a foreign substance by specialized cells in the immune system is: A) primary immunity. B) humoral immunity. C) cellular immunity. D) secondary response. Answer: C Diff: 2 Page Ref: 263 Standard: Medicine (Immunology) Objective: 1, 2 31) 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? A) Oxygen via nonrebreather mask 15 lpm, cardiac monitor, IV of NS KVO, epinephrine SC, diphenhydramine IM B) Oxygen via nasal cannula 4 lpm, cardiac monitor, IV of NS KVO, epinephrine IV, diphenhydramine IM C) Advise the dispatcher you will be going out of service D) Diphenhydramine IM Answer: D Diff: 3 Page Ref: 271-272 Standard: Medicine (Immunology) Objective: 5 32) Which of the following is a potentially life-threatening condition involving the head, neck, face, and upper airway? A) Hives B) Angioedema C) Urticaria D) Wheals Answer: B Diff: 1 Page Ref: 266 Standard: Medicine (Immunology) Objective: 1, 3 106 33) 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? A) "It looks like the infection in your hand has spread to the bloodstream. The toxins from the bacteria are causing a rash." B) "These look like hives. They occur during an allergic reaction. You may have developed an allergy to the antibiotic you are taking." C) "I cannot say what this is, but it is not an allergic reaction. Hives do not come and go as you have described." D) "This is a typical side effect of Keflex. It happens in most patients who take it." Answer: B Diff: 2 Page Ref: 263 Standard: Medicine (Immunology) Objective: 3, 4 34) The ________ system is a complicated body system responsible for combating infection. A) immune B) nervous C) respiratory D) cardiovascular Answer: A Diff: 1 Page Ref: 263 Standard: Medicine (Immunology) Objective: 1, 2 35) The initial exposure of an individual to an antigen is referred to as what? A) Allergy B) Sensitization C) Hypersensitivity D) Active immunity Answer: B Diff: 1 Page Ref: 264 Standard: Medicine (Immunology) Objective: 1 36) The immune response is a cascade that reacts to a: A) pathogen. B) toxin. C) bacteria. D) virus. Answer: A Diff: 1 Page Ref: 263 Standard: Medicine (Immunology) Objective: 1 107 37) Following exposure to an allergen in which IgE antibodies are released, mast cells degranulate, releasing: A) histamine. B) epinephrine. C) insulin. D) T cells. Answer: A Diff: 1 Page Ref: 266 Standard: Medicine (Immunology) Objective: 1, 2 38) Histamine causes the all of the following EXCEPT: A) bronchoconstriction. B) vasodilation. C) increased vascular permeability. D) increased intracranial pressure. Answer: D Diff: 1 Page Ref: 266 Standard: Medicine (Immunology) Objective: 1, 2 39) You respond to a report of a patient with shortness of breath. Upon arrival, you find a patient who has been stung by a bee. The patient is displaying urticaria and wheezing. You suspect: A) anaphylaxis. B) asthma. C) meningitis. D) ARDS. Answer: A Diff: 2 Page Ref: 266-268 Standard: Medicine (Immunology) Objective: 4 40) 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: A) SQ epinephrine 1:1000 0.3-0.5 mg. B) IM epinephrine 1:1000 0.3-0.5 mg. C) diphenhydramine 75 mg. D) albuterol 5 mg. Answer: B Diff: 3 Page Ref: 269 Standard: Medicine (Immunology) Objective: 5, 6 108 41) The standard dose of diphenhydramine for anaphylaxis is: A) 10-20 mg. B) 30-40 mg. C) 50-100 mg. D) 25-50 mg. Answer: D Diff: 2 Page Ref: 270 Standard: Medicine (Immunology) Objective: 6 109