NBME 21 Answers : Block 1 : #43 = A 52-year-old man is brought to the emergency ...

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NBME 21 Answers

nbme21/Block 1/Question#43

A 52-year-old man is brought to the emergency ...

Histamine

+11 upvote downvote
submitted by neonem(372),

Morphine is a mu opioid agonist - one adverse effect of opioids is mast cell degranulation that is IgE-independent. Release of histamine is akin to an anaphylactic reaction --> pruritis, etc.

sympathetikey Never had heard of that one. Just a good guess. Thanks! +

yb_26 IgE-independent mast cell degranulation can also be caused by radiocontrast agents, some antibiotics (vancomycin) +3

temmy it was a u world question +

mambaforstep FA 2019 pg 400 +

mannywillsee i'm in FA 2019 and pg 400 is blood groups and hemolytic diseases of the newborn. I found this info in page 535 +

mannywillsee i'm in FA 2019 and pg 400 is blood groups and hemolytic diseases of the newborn. I found this info in page 535 +1

mambaforstep under mast cells "IgE-independent mast cell degran"! FA 2019 pg 400 +

+2 upvote downvote
submitted by fatboyslim(5),

(From UW 11852) Some medications including opioids, radiocontrast dyes, and some antibiotics (e.g. vancomycin) can induce and IgE-INDEPENDENT mast cell degranulation by activation of protein kinase A and PI3 kinase, which results in release of histamine, bradykinin, and other chemotactic factors -> diffuse itching, pain, bronchospasm, and localized swee=lling (urticaria).

almondbreeze just to add : more agents causing such reaction - beta-lactams, sulfonamide, aminoglycoside +

drzed Are those IgE dependent, or just allergic reactions (asking because the sketchy for beta-lactam penicillins mention acute interstitial nephritis as an allergic reaction)? +

+0 upvote downvote
submitted by dorsomedial_nucleus(1),

Is this just red-man syndrome? Direct mast-cell degranulation caused by vancomycin....and also morphine?

drschmoctor Yes, this is red man syndrome. Mast-cell degranulation directly due to Vancomycin: https://www.ncbi.nlm.nih.gov/books/NBK482506/ +