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laughing your way peds > AI > Flashcards

AI Flashcards

1
Q

Clinical description for intermittent asthma

A

2 or less days a week

Zero night time

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2
Q

Tx of intermittent asthma

A

Albuterol prn

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3
Q

Classification for mild persistent asthma

A

More than 2 days a week

Night time 1-2 a month

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4
Q

Tx of mild persistent asthma

A

Low dose inhaled steroids + albuterol prn

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5
Q

Classification of moderate persistent asthma

A

Every day

Night time 3-4 per month

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6
Q

Tx for moderate persistent asthma

A

Low medium dose inhaled steroid and long acting bronchodilator or monteleukast.

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7
Q

Classification of severe persistent asthma

A

Daily symptoms

Night time > 1/wk

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8
Q

Tx for severe persistent asthma

A

High dose inhailed steroid + long acting bronchodilator or monteleukast

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9
Q

Signs of hypercapnia in an asthmatic patient

A

Agitation, flushing, mental status change, headache, tachycardia

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10
Q

Risk factors for hospitalization for asthma

A

Chronic steroid use

Hospitalization within past year

Low socioeconomic status/low educational level

Previous life threatening episode

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11
Q

Risk factors for asthma persisting into adulthood

A

Onset before 3 years of age

IgE elevation

Maternal hx of asthma

Eosinophilia

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12
Q

What are the types of hypersensitivity reactions

A

Type I - igE mediated, anaphylactic

Type II - mediated by antibodies

Type III - immune complex

Type IV - delayed hypersensitivity

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13
Q

What is perennial allergic rhinitis d

A

Due to exposure to indoor allergens such as dust mites, animal dander

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14
Q

Which fruits should someone with latex allergy avoid (7)

A

Avocado, banana, chestnut, fig. kiwi, peach, tomato

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15
Q

By what age is milk, egg and soy allergy outgrown?

A

5

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16
Q

Signs of an anaphylactic reaction

A

Respiratory distress, urticaria, general discomfort

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17
Q

How long must urticaria last to be considered chronic?

A

> 6 wks

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18
Q

What is the most likely cause of chronic urticaria

A

Food

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19
Q

What is pretreatment with prednisone and Benadryl indicates prior to contrast media?

A

With a hx of adverse reaction to radiocontrast media

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20
Q

What are sings of systemic reactions to stings

A

Hypotension, wheezing and laryngeal edema

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21
Q

You have a child with a systemic reaction to bee stings. What’s is the next step?

A

Allergy referral and epipen

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22
Q

How does parental hx affect allergic components

  • 1 parent
  • both parents
  • 1 sibling
A
  • 50 percent risk
  • 70 percent risk for atopic disease
  • 20-35 percent risk
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23
Q

Buzz words for ataxia telangiectasia

A

Ataxia, discoloration of conjunctivae, frequent sinus infections, developmental regression

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24
Q

A deletion in the long arm of chromosome 22 is what disorder

A

DiGeorge

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25
Q

What is the presentation if DiGeorge syndrome

A

CATCH-22

Cardiac, abnormal facies (low set ears), thymic hypoplasia, cleft palate, hypocalcemia (tetany)

  • no parathyroid
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26
Q

What causes SCID

A

Complete absence of b and T cells

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27
Q

Buzz words for SCID

A

Failure to thrive
Chronic diarrhea
Recurrent opportunistic infection including thrush

Presents within the first 3 months of life

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28
Q

How do you SCREEN for SCID

A

CBC may have a low WBC

No matter the white count there will be a complete absence of T cell function (a low lymphocyte count would correlate with T cell dysfunction)

A normal lymphocyte count does not rule out SCID

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29
Q

Treatment for SCID

A

Initially supportive. Bone marrow transplant is curative.

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30
Q

What is the presentation for Wiskott-Aldrich syndrome

A
  • male (x linked)
  • eczema
  • recurrent sinopulmonary infection (cellular immunodeficiency, WBC)
  • unusual bleeding (low platelet count AND small platelets)
31
Q

Most common cause of death for boys with wiskott-Aldrich

32
Q

What are the cellular immune deficiencies? (4)

A

T cell dysfunction (low lymphocytes)

*present due to infections from opportunistic organisms (candida, CMV, pneumocystis jiroveci)

  • ataxia telangiectasia
  • DiGeorge
  • SCID
  • wiskott-Aldrich
33
Q

What are the humoral immune deficiencies? (6)

A

Due to antibody deficiencies (b cells)

  • symptoms do not appear until 4-6 months due to initial protection by maternal antibodies
  • IgA deficiency
  • Brutton’s x linked agammaglobulinemia
  • common variable immunodeficiency
  • x linked hyper IgM syndrome
  • Job syndrome (hyper IgE)
  • transient hypogammaglobulinemia of infancy
34
Q

How does IgA deficiency present?

A

Recurrent sinopulmonary infections with encapsulated bacteria (step pneumonia and h. Flu)

35
Q

How does Britton x linked agammaglobulinemia present

A

Baby boy with recurrent infections with encapsulated progenie bacteria (strep pneumonia and h. Flu)

NOTE: will have elevated T cell count

36
Q

What is the result of the absence of B cells?

A

Low levels of IgG, IgA, IgM and IgE

Lymphoid tissue such as tonsils, adenoids, peyers patches, peripheral lymph nodes as well as the spleen are reduced in size

37
Q

What are boys with brutton x linked agammaglobulinemia at risk for?

A

Bronchiectasis and chronic pulmonary insufficiency

38
Q

How do you diagnose and treat B cell deficiencies?

A

Measuring immunoglobulin levels and if low measuring b and T cell sunsets

IVIG

39
Q

What is the most common primary immunodeficiency?

40
Q

What is the most common clinically significant primary immunodeficiency?

A

Common variable immunodeficiency

41
Q

How does common variable immunodeficiency present

A

Recurrent infections of the upper and lower respiratory tract and frequent GI symptoms

Recurrent heroes and zoster infections are common

*NOTE: B and T cell defect

42
Q

Kids with common variable immunodeficiency may also have associated illnesses like -

A

Autoimmune diseases

Lymphoma

43
Q

How does x linked hyper IgM present

A

Male with frequent otitis and sinopulmonary infections as well as diarrhea

44
Q

Lab studies for x linked hyper IgM

A

Low levels of all antibodies except IgM

High IgM

45
Q

What is the hallmark of hyper IgM syndrome

A

Lymphoid hypertrophy despite antibody deficiency

46
Q

How does job syndrome present

A

Eosinophilia, eczema and elevated IgE

Infections usually with staph a. Kids can also get chronic thrush and will have multiple fractures or other skeletal abnormalities

47
Q

Treatment for job syndrome

A

Antibiotic and steroids

Not IVIG

48
Q

What does the lab finding for transient hypoagammaglobulinemia of infancy show? And tx?

A

Severely low levels of IgG, low IgA and normal IgM

Kids outgrow by 3-6 years

49
Q

Laboratory finding for CVID

A

Low IgG AND

Low IgA or IgM

50
Q

What’s a form of SCID due to enzyme deficiency

A

ADA - adenosine deaminase def which leads to accumulation of toxic levels of deoxyadenosine which inhibits T cell maturation and function

absolute neutrophil count is very low <500

51
Q

Presentation for chronic granulomatous disease

A

Deep abscesses, pneumonia, lymphadenitis, osteo, systemic infections

Present before 5 yrs of age, x linked most common

52
Q

Diagnostic test for chronic granulomatous disease

A

Nitriblue tetrazolium test (NBT)

Normal turns blue and abnormal stays colorless

53
Q

How does leukocyte adhesion deficiency present

A

Boards - delayed umbilical separation with omphalitis

Real life - high WBCs with absence of neutrophils. Infected area has no puss and minimal swelling.

Perirectal abscess, indolent skin infections, omphalitis

54
Q

Diagnostic test for LAD

A

Flow cytometry for CD18

55
Q

Presentation of chediak-Higashi syndrome

A

Frequent infections of lung and skin, easy bruisability and oculocutaneous albanismn

(Very fair skinned blonde, blue eyed with frequent skin infections)

56
Q

What will you find in a blood smear that is diagnostic of chediak-higashi

A

Giant lysosomal granules in neutrophils (WBC).

The wbcs also have abnormal chemotaxis

57
Q

How do you screen for complement deficiency

A

CH50 assay

58
Q

What are deficiencies affecting the terminal components (c5-c9) associated with

A

Recurrent neisseria infections and increased risk for meningitis

59
Q

What is c3 deficiency associated with

A

Recurrent sinopulmonary infection and sepsis with encapsulated bacteria

60
Q

Triggers for non allergic rhinitis

A

Cold air, strong odors, spicy foods

61
Q

How is the arthritis in Lyme disease

A

Pauciaetucular involving large joints

62
Q

How do you diagnose Lyme disease

A

Lyme antibody titer and then a western blot to confirm

63
Q

Tx for Lyme disease

A

Doxy for over 8 yrs

Amox for under 8 yrs

Course 14-21 days

64
Q

Presentation for sarcoidosis

A

Weight loss and fatigue with hilar adenopathy, chronic cough in afebrile pt

Noncaseating granulomas and bilateral peribronchial on CXR

Granulomas secrete vit d leading to hypercalcemia and hypercalcuria resulting in renal disease and eye disease

65
Q

Triad of sarcoidosis

A

Arthritis, rash, uveitis

66
Q

How do you differentiate sarcoidosis from TB

A

Sarcoidosis involves the heart

Ekg with rhythm disturbance would distinguish sarcoidosis from TB

67
Q

Criteria for diagnosis of lupus (10) and how many required for diagnosis

A 
Malar rash
Discoid lesions
Photo sensitivity 
Oral ulceration
Arthritis and serositis
Hematological abnormalities
Renal abnormalities 
Anti ds DNA, anti DNA, anti smith antibodies
Psychosis or neurological abnormalities 
Positive ANA

4

68
Q

How do you track severity of disease flare ups in lupus

A

Anti-ds DNA high when flare up low when not.

C3 and c4 inversely correlate. Low in active or acute disease

69
Q

What must you think of in a newborn with bradycardia

A

Neonatal lupus and third degree heart block

70
Q

What maternal antibodies are associated with neonatal lupus

A

Anti SSA and anti SSB antibodies

71
Q

Synovial fluid WBCs in septic arthritis

A

50,000-300,000 and low glucose and bacteria

72
Q

Synovial fluid WBC in normal

73
Q

Synovial fluid WBC in lupus, rheumatic fever and arthritis due to trauma

A

5,000 for first 2

2,000

74
Q

Synovial fluid WBC in JIA and reactive arthritis

A

15,000-20,000

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