Allergic, immunodeficiency and neurologic DO Flashcards
Asthma, allergic rhinitis, and atopic dermatitis
Atopy
Atopy is mediated by ??
IgE
What is the most common allergic disease?
Allergic rhinoconjunctivitis
Allergic rhinoconjunctivitis frequently coexists with?
Asthma
80% of patients develop symptoms of allergic rhinoconjunctivitis by ??
20
What is primarily responsible for allergic rhino conjunctivitis symptoms?
Inhalant allergens
Allergic rhinoconjunctivitis symptoms present less than 4 days/week
Intermittent
Allergic rhinoconjunctivitis symptoms present more than 4 days/week for greater than 4 weeks
Persistent
Allergic rhinoconjunctivitis w/o impairment or disturbance of sleep, ADLs, sports/school/work or w/o troublesome sx
Mild
“Allergic salute”
Nasal obstruction w/ mouth breating, nasal speech, snoring
Nasal turbinates – pale blue, edematous
Clear, thin nasal secretions w/ PND & “cobblestoning”
Conjunctival injection, tearing, “allergic shiners”
Things you might find on PE of patients with allergic rhinoconjunctivitis
What might you find on labs in a patient with allergic rhinoconjunctivitis?
Eosinophilia
What are some tests you can do to test children for allergies?
Skin testing - will identify specific allergen-specific IgE; In-vitro tests (radioallergosorbent test or RAST)
Which test is the most sensitive/specific for inhalant allergens?
Skin testing
Control itching, sneezing, and rhinorrhea
Antihistamines
Prophylactic adjunctive therapy for allergens
Mast cell stabilizers
Temporary relief of allergies
Decongestants
Prophylactic therapy that may be 1st line therapy
Corticosteroids
Chronically relapsing inflammatory skin d/o, many outgrow. Typically associated with allergies and asthma
Atopic dermatitis
Rash on face, scalp, and extensor surfaces of elbows/knees, pruritic, red papules, secondary excoriations (can progress to plaques and lichenification)
Atopic dermatitis
How do you manage atopic dermatitis
Avoid irritants (detergents), hydration, moisturizers, topical steroid for flares
Acute, life-threatening medical emergency that occurs when large quantities of histamine rapidly release from mast cells and basophils after exposure to allergens
Anaphylaxis
Which age group typically has food-induced anaphylaxis?
Children & adolescents
Onset within minutes after exposure, skin-mucosal swelling, respiratory compromise, low systolic BP, +/- GI sx
Anaphylaxis
What is the treatment for anaphylaxis?
Epinephrine 0.15mg
When do food allergies begin in children?
First 2 years of life
What are the most common food allergens?
Cows milk, eggs, peanuts
Hives, flushing, facial angioedema, mouth/throat itching that occurs minutes to less than 2 hours after ingestion of food
Food allergies
What is the gold standard for working up food allergens?
Blinded food challenge
What is the mainstay of management with food allergies?
Avoidance of allergens; Carry self-injectable epinephrine and fast acting antihistamine
How often should you follow up with food-specific IgE testing?
Yearly, offer supervised food challenge test
Commonly presents with recurrent/severe bacterial infections, FTT, and/or developmental delay
Primary immunodeficiency (PID)
What do you need to diagnose PID?
Clinical patterns + immunologic lab tests + gene mutation
Recurrent infections, severe infections, persistent infections, infections resistant to standard tx or caused by opportunistic organisms
PID
Prolongation of physiologic hypogammaglobulinemia of infancy, which is normally observed during the first 3-6 months
Transient hypogammaglobulinemia (THI)
Typically presents w/ recurrent URIs +/- otitis media and bronchitis
Transient hypogammaglobulinemia (THI)
When does THI usually spontaneously recover?
9-15 months of age with IgG levels normalizing by 2-4 yo
Presents with recurrent infection (bacteria, viruses, fungi and opportunistic pathogens), chronic diarrhea and FTT
Severe combined immunodeficiency (SCID)`
How is SCID classified?
Based on the presence/absence of T, B, and NK cells
What will you find on exam in a SCID patient?
Lack of lymphoid tissue (no tonsils or lymph nodes, CXR w/ absent thyme shadow)
What is the treatment for SCID?
BMT
Sudden, transient disturbance of brain function manifested by involuntary motor, sensory, autonomic or psychic phenomena, alone or in any combination, often accompanied by altered or LOC
Seizure
What are some of the causes of seizures?
Metabolic, traumatic, anoxic, infectious, genetic mutations, spontaneous
What is the workup for seizures?
EEG, consider brain MRI if significant cognitive or motor impairment
What is the treatment for seizures?
First aid (benzodiazepines), antieplieptic Rx
Repeated seizures without evidence of acute cause or provocation
Epilepsy
When is incidence of epilepsy highest?
Newborn period
Risk of recurrence after single seizure?
50%
Risk of recurrence after 2 seizures?
85%
Most common neurologic d/o of infants and young children
Febrile seizures
What are the 3 criteria for febrile seizures?
Age 3mo to 6 years, fever greater than 38C, non-CNS infection/inflammation
Greater than 90% of febrile seizures are?
Generalized, less than 5 minutes and occur early in illness
What do you want to check for when working up febrile seizures?
Meningitis
What is the treatment for febrile seizures?
Reassurance (prophylactic AED NOT recommended)
Seizure lasting at least 15 minutes or series of seizures w/o complete recovery greater than 30-minute period
Status epilepticus
Can result in hypoxia & acidosis; Depletion of energy stores, cerebral edema & structural damage; Eventually high fever, hypotension, respiratory depression & even death can occur
Status epilepticus
What are the typical causes of status epilepticus in children?
Infection and metabolic disorders
85% of cases of status epilepticus occurs in children under?
5 years old
Treatment for status epilepticus?
Benzodiazepines - Phenytoin - Phenobarbitol
Most common types of headaches in children and adolescents?
Migraine and tension type
Abortive treatments for headaches?
Simple analgesics (caution medication overuse HA), triptans in adolescents
Headache for 1-72 hours, throbbing/pounding, moderate to severe, unilateral OR bilateral, physical activity worsens headache, nausea or vomiting, phono/photophobia
Migraine without aura
Lasts 30min to 7 days, “Pressure tight band”, mild to moderate severity, bilateral, physical activity causes no effect, no N/V, photo OR phonophobia but not both
Tension headache
Heterogeneous group, nonprogressive, characterized by motor & postural dysfunction
Cerebral Palsy
What is the most common form of cerebral palsy?
Spasticity of limbs (75%)
How do you workup cerebral palsy?
Brain MRI to identify lesion
How do you treat CP?
Multidisciplinary
Neurologic d/o manifested by motor & phonic tics; Onset in childhood (typically between 2-11 yrs old) ; Inherited d/o (genetic mutations identified)
Tourettes syndrome
What are the hallmark tics of tourettes?
Motor tics
Vocal or phonic tics
Sudden, brief, intermittent movements
Motor tics
Sudden, brief, intermittent utterances
Vocal or phonic tics
Common comorbidities with tourettes?
ADHD, OCD
What is the treatment for tourettes?
Education, Rx only if interfering with school or job, dopamine blockers
What is an abnormal head size?
2 standard deviation above/below normal
Head circumference greater than 2stdev BELOW mean
Microcephaly
What should make you suspect microcephaly?
Chest circumference is greater than head circumference
DD, neuro problems, sloped forehead, closed fontanelle, prominent sutures
Symptoms of microcephaly
What should you order tow workup microcephaly?
CT or MRI to look for calcifications, malformations, atrophic patterns
Head circumference GREATER than 2 standard deviations above the mean
Macrocephaly
What is a sign/symptom of macrocephaly?
Transillumination of the skull
What can cause macrocephaly?
Rapid growth (increase in intracranial pressure) - hydrocephalus/neoplasms
