אלרגיה

Question 1

what are the 2 major risks for asthma?

Answer 1

• parents with asthma
• Allergy (atopic kids)

Question 2

How to dgx Asthma?

Answer 2

FEV1/FVC < 0.8
then:
metacholine test with decrease FEV1 < 20%
after:
Bronchodilators improvment of FEV1 in > 12% or > 200ml

**Diagnostic **Bronchodilators improvment of FEV1 in > 12% or > 200ml

Question 3

How do we Dgx Exresice induce asthma?

Answer 3

מבחן תיגר מאמץ
see if there is decrease > 15% in FEV1

Question 4

What is the changes expected to see in peak expiratory flow in asthma?

btwn morning and evening

Answer 4

changes > 20% from morning to evening
are typical to asthma

Question 5

Which test can assist is Dgx of allergic asthma?

Answer 5

FeNO- NO measurment in inspirium

Question 6

איזו תרופה ניתן לשקול בחולים עם אסטמה אלרגית מעל גיל 12?

Answer 6

omalizumab- step 5

Question 7

איזו תרופה ניתן לשקול בחולים עם אסתמה אאוזינופילית מעל גיל 12

Answer 7

Mepolizumab- step 6

Question 8

What are the medications for the 6 step approch of asthma menegment?

Answer 8

1. SABA
2. low dose ICS
3. Medium dose ICS or Low dose ICS + LABA/LATRA
4. medium dose ICS + LABA /LTRA / theophylline (for age > 4 )
5. High dose ICS+ LABA /LTRA / theophylline age > 6 - consider omalizumab if allergic
6. High dose ICS+ LABA /LTRA / theophylline + OCS + age > 12 - consider mepolizumab if eosinophils or omalizumab

from Step 4 only 0-4 could change LABA in LTRA

Question 9

מה הגישה באסתמה מאוזנת למשך יותר מ-3 חודשים

Answer 9

לשקול ירידה בשלב הטיפול תחת מעקב צמוד

Question 10

Which conditions are a/w asthma?

Answer 10

GERD
renitis
sinusitis

Question 11

What will be the blood gases in acute severe episode of asthma?

Answer 11

PaO2 < 60
PCO2 > 42 - tiredness of breathing muscles

Question 12

What we will hear in life threating episode of asthma excacervation?

Answer 12

Abscent of wheezing due to no air coming in

Question 13

inital tx of acute asthma attack in ER?

Answer 13

SABA every 20min for 1 hr > OCS > epinephrin IM > monitor + hydration

if no response- add SABA impratropium > epinephrin IM

Question 14

What is a possible side effect of reccurent use of SABA with eleveted dose?

how can we prevent it?

Answer 14

Hypoxemia- due to flow of blood in obstucted areas in the lung = flow/ perfusion mismtach

**prevention- ** O2 supply at least 20 min after Tx with SABA

Question 15

Risk factor for allergic rhinitis?

Answer 15

family Hx of atopia
serum IgE > 100 before age of 6

Dgx- תבחין עורי למציאת האלרגן

Question 16

What are eleveted pruritic lesions that tend to migrate?

Answer 16

urticaria

Question 17

What is the lesion seen in the picture?

Answer 17

Urticaria

Tx- anti histamin against receptor 1

Question 18

Which type of urticaria is presented after exresice, sweatinh or hot shower?

when they will pass?

Answer 18

Chollenergic urticaria

might also present with tearing, wheezing, and even syncope

Tx- anti histamin against receptor 1

Question 19

Which Abs are higly a/w chronic autoimmune urticaria?

Answer 19

anti- thyorid ab (in normal thyroid function)

Tx- anti histamin against receptor 1

Question 20

A girl after running competiton is presented with prurtus, angioedema , urticaria , wheezing and hypotension.

what is most likely the dgx?

Answer 20

**Exresice induce anapylasxis
**

think about presentation anaphylxis but with Hx of recent exresice

Tx- anti histamin against receptor 1

Question 21

how is this reaction call?

Answer 21

Dermatographism- skin reaction after putting pressure on the skin

Question 22

Herditery angioedema

which enzyme is missing, what is a strong risk ?
and Tx?

Answer 22

C1 esterase inhibitor def.
risk- larynx edema&raquo_space; need to intubate
Tx- PPx and in episodes with recombinant C1 enzyme. EACA

Question 23

Galatosemia

which enzyme is def?
Tx?

Answer 23

GALT enzyme
Tx- based soy formula

Question 24

תינוק בן מספר ימים מגיע למיון עם היפוגליקמיה, קטרקט דו”צ, צהבת, הפטוספלנומגליה וספסיס מ-אי קולי מגיע למיון. בבדיקת השתן חומרים מחזרים

איזו מחלה יש לתינוק בסבירות גבוהה?

Answer 24

גלקטוזמיה- GALT def.

Also hyperchloremic MA, Excessive brusing

Question 25

מהי השיטה הרגישה ביותר לזיהוי אלרגן ספיציפי ל- IgE?

Answer 25

תבחין עורי (הזרקה מקומית ואחרי 15 דק’ נמדדת התגובה)- Wheal and flare

Question 26

באיזה מקרים נעדיף תבחין סרום ל- IgE (ELISA)

Answer 26

באנשים שישנה העדפה להימנע מדקירת העור- דרמיטיטיס קשה או דרמטוגרפיזם
או
אנשים שאינם יכולים להפסיק טיפול באנטי-היסטמינים

לצורך אבחנה צריך לשלב תמונה קלינית.

הבדיקה מעדיה רק על ריגוש אל לא מספקת לאבחנת אלרגיה

Question 27

Hypersensetivty reactions
which cells or Ig are mediators in each type (I-IV)?

Answer 27

ACID
I- Allergic&raquo_space; IgE > basophils and mast. rapid reaction- Skin test is Dgx tool
II- Cytotoxic- IgM or IgG. Hemolytic reaction, goospasture
III- Immune complex- IgM, IgG. immune complexs lies in blood vessels wall and activate complement and PMN
IV- Delayed T lymp. Contact Dermatitis

Question 28

Def. of anaplyaxis?

Answer 28

Severe allergy reaction involving > 2 sstems

Question 29

Which type of hypersensetiviy is serum sickness?

Answer 29

III- immune complex

Question 30

Tx for anaphylaxis?

Answer 30

Epinephrine IM
2nd line- anti-histamines and steorids

Question 31

what is the reccurent rate of anaphylaxis shock?

Answer 31

90% of reccurence will be within4 hours.

לכן מומלצת השגחה של 4 שעות במיון

Question 32

Clinical menefstation of serum sickness?

Answer 32

symptoms onset 7-21 days after vaccine or forgein serum:

fever, arthralgia, lymphadenpathy, skin involvment

Question 33

What we will se in biopsy of serum sickness?

Answer 33

immune complex (type III)
with IgM / IgG + complement

in serum:
high ESR
low complement levels

Question 34

Tx and prognosis of Serum sickness

Answer 34

reslove within 2 wks.
if need supportive care.
in severe cases- steorids