Nineteen of the top board alerts for Allergy & Immunology – pearls, tips, memory aids, and “secrets” from experts in the field.

1. Intranasal steroids are the single most effective drug for treatment of allergic rhinitis. Decongestion with topical adrenergic agents may be needed initially to allow corticosteroids access to the deeper nasal mucosa.

2. ACE inhibitors can cause dry cough and angioedema.

3. Beta blockers should be avoided whenever possible in patients with asthma because they may accentuate the severity of anaphylaxis, prolong its cardiovascular and pulmonary manifestations, and greatly decrease the effectiveness of epinephrine and albuterol in reversing the life-threatening manifestations of anaphylaxis.

4. Patients with persistent fever of unknown origin should first be evaluated for infections, malignancies, and autoimmune diseases.

5. Viruses are the most common causes of acute sinusitis; therefore, antibiotics are ineffective.

6. Most cases of Rocky Mountain spotted fever (RMSF) do not occur in the Rocky Mountain region but in the south Atlantic and south central regions. Patients with febrile illnesses and a rash who have been in these regions in the summer (May to September) should receive empirical doxycycline therapy for presumptive RMSF.

7. Asplenic patients (either anatomic or functional) are susceptible to infections with encapsulated organisms (Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitides) and should receive appropriate vaccinations.

8. Allergic bronchopulmonary aspergillosis (ABPA) occurs in asthmatics and is evident by recurrent wheezing, eosinophilia, transient infiltrates on chest x-ray, and positive serum antibodies to aspergillus.

9. Chagas’ disease, caused by Trypanosoma cruzi, can cause cardiomyopathy and conduction abnormalities.

10. Human immunodeficiency virus (HIV) infection is preventable and treatable but not curable.

11. Routine HIV testing should be considered for all patients older than 13 years.

12. Nucleic acid–based testing (NAT) is needed for diagnosis of acute primary HIV infection.

13. HIV-infected patients with undetectable viral loads can still transmit HIV.

14. HIV-infected patients with tuberculosis are more likely to have atypical symptoms and present with extrapulmonary disease.

15. All patients with HIV infection should be tested for syphilis, and all patients diagnosed with syphilis (and any other sexually transmitted disease) should be tested for HIV.

16. The presence of thrush (oropharyngeal candidiasis) indicates significant immunosuppression in an HIV-infected patient.

17. Ferritin is an effective screening test for hemochromatosis.

18. Methylmalonic acid can be helpful in the diagnosis of vitamin B12 deficiency in patients with low normal B12 levels.

19. Pneumococcal polysaccharide, Haemophilius influenzae B (HiB), and meningococcal vaccines should be given to patients before elective splenectomy, preferably 14 days before the procedure.

These top board alerts are compiled from the Secrets Series®. They summarize the most important concepts, principles, and salient details of internal medicine. Download Top 100 Secrets for Physicians to access all 100 secrets!

ISBN: 978-0-323-52832-0 Copyright © 2016 by Elsevier Inc.