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Asthma, Allergy Flashcards

1
Q

type of allergic reaction (immune mediated pathway) involved in hemolytic anemia

A

Type II

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2
Q

first line therapy for eczema

A

emollients and moisturizers

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3
Q

Type I hypersensitivity mediated by what?

A

IgE

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4
Q

What three things are released with Type I hypersensitivity

A

histamine, leukotriene, prostaglandin

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5
Q

histamine responsible for what?

A

bronchoconstriction, bronchial smooth muscle contraction vasodilation, local pain/pruritis (immediate)

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6
Q

leukotrienes responsible for what?

A

Powerful bronchoconstricton, sustains inflammation (more long term)

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7
Q

prostaglandins responsible for what?

A

smooth muscle constriction, inflamm. mediation

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8
Q

Types of type I HS reactions

A 
atopic dermatitis
urticaria
allergic rhinitis
anaphylaxis
food allergies
PCN allergy
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9
Q

Type II HS reactions involve what

A

antibody response

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10
Q

Type II HS mediated by

A

IgM, IgG, IgA

binds to patients own cells

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11
Q

What gets activated by type II reactions

A

complement pathway and B cell response

lysis of cells releases anaphylactoxins, which trigger mast cell degranulation

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12
Q

Examples of type II reactions

A

hemolytic anemia, thrombocytopenia, graves disease, rheumatic fever, myasthenia gravis, idiopathic thrombocytopenic purpura

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13
Q

type III reactions involve what

A

antigen-antibody complexes form (immune complex)

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14
Q

examples of type III HS reactions

A

serum sickness, Henoch-Schonlein purpura, post streptococcal glomerulonephritis, SLE

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15
Q

Type IV reactions involve what

A

cellular immune mediated or delayed hypersensitivity

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16
Q

In type IV sensitivity, what recognizes antigens?

A

sensitized T cells

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17
Q

This type of HS is usually seen with contact allergies, but can be autoimmune (DM I, hashimoto, MS, celiac disease)

A

type IV

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18
Q

Over 80% of patients with atopic dermatitis will develop these two things:

A

asthma and allergic rhinitis (ATOPIC TRIAD)

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19
Q

the majority of patients with atopic derm have elevated levels of this

A

IgE

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20
Q

Presence of atopic derm in young kids vs toddlers

A

younger- face, neck folds, EXTENSOR surfaces

older- FLEXOR lichenification

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21
Q

kid comes in with pruritic, erythematous papules with associated excoriations and vesiculations

A

atopic dermatitis

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22
Q

pt comes in with erythematous papules over groin and axillary, with linear lesions

A

scabies

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23
Q

kis comes in with yellow scales on the scalp that didnt itch

A

seborrheic dermatitis

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24
Q

kid comes in with coin shaped lesions

A

nummular eczema

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25
Q

treatment for atopic dermatitis

A

rehydration therapy: moisturizers and occlusives (emollients, ointments- NOT lotion)
topical corticosteroids: fluticasone, tacrolimus

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26
Q

what type of HS reaction can cause urticaria

A

type I HS

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27
Q

Raised, red, itchy lesions on the skin that often come and go and can coalesce together in to larger, red, itchy areas. Unlike other rashes, these come and go and move about the skin. Superficial dermis.

A

urticaria

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28
Q

edema extending into deep dermis or subcutaneous tissues

A

angioedema

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29
Q

Angioedema resolves faster than urticaria. T or F

A

False… Ang takes 72 hours, urticar takes 24 hours

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30
Q

serious complication of type I HS. Rapid onset, serious allergic reaction in a previously sensitized patient

A

anaphylaxis

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31
Q

Patient comes in withGeneralized pruritus, anxiety, urticaria (very common), angioedema, throat fullness, dyspnea, hypotension, and collapse. May present with severe abdominal cramps, vomiting.

A

anaphylaxis

32
Q

Anaphylaxis ia a systemic response. T or F

33
Q

First line treatment for anaphylaxis

A

epinephrine
Other options after epi:
diphenhydramine, corticosteriods, vasopressors

34
Q

three most common antibiotic causes of cutaneous drug reactions

A

amox, bactrim, ampicillin

35
Q

How do you distinguish between serum sickness and anaphylaxis?

A

FEVER and delayed response (7-21 days after if new, 1-4 days after if sensitized)

36
Q

Pt comes in with fever, rash, lymphadenopathy, myalgias and arthralgias. What do you think?

A

serum sickness

37
Q

treatment for serum sickness

A

corticosteroids (MAINSTAY), antihistamines, epi (if severe)

38
Q

Patient comes in with a papular, rough, sandpaper rash. What do you think?

A

contact dermatitis

39
Q

what type of HS reaction is a latex allergy?

40
Q

Patients with this condition have a unique sensitivity to latex

A

spina bifida

41
Q

food allergy is what type of HS

42
Q

Food allergies- who has the highest prevalence

A

children with moderate to severe atopic dermatitis

43
Q

Most common food allergens in young children

A

eggs, milk, peanuts, tree nuts, soy and wheat

44
Q

most common food allergens in adolescents and older children

A

fish, shellfish, nuts- may be lifelong

45
Q

how long does it take for food allergy reactions to occur

A

minutes to 2 hours

46
Q

cutaneous reactions to insect bites include

A

urticaria, papulovesicular eruptions - mosquitos, fleas, bedbugs

47
Q

what can you prescribe to someone with allergic rhinitis

A

zyrtec, allegra

48
Q

Transient wheezing is common in infancy and during preschool. True or false?

A

TRUE. associated with viral infections, smaller airways

49
Q

which area of the respiratory tract does asthma affect?

A

lower respiratory tract- a bronchiole problem

50
Q

Causes of cough in the first months of life

A 
CF
Resp tract infection
Aspiration
Dyskinetic cilia
Lung or airway malformations
Edema (heart failure, CHD)
51
Q

the narrowing that occurs in asthma is caused by three major factors:

A

inflammation
bronchospasm
hyperreactivity

52
Q

most common chronic illness in children

53
Q

is asthma reversible? is COPD reversible?

A

asthma yes COPD no

54
Q

Pt comes in with intermittent dry cough, expiratory wheezing, shortness of breath, chest tightness, limited exercise tolerance. What do you suspect

55
Q

PE on pt revealed expiratory wheezing and prolonged expiration. Tachypnea, retractions, distress. What do you think

A

Asthma (acute)

56
Q

To document asthma, lung function testing should show what

A

diurnal variation

57
Q

Asthma symptoms may be differentiated into which three categories?

A

daytime (cough, dyspnea due to allergens, cold, heat)
exercise
nocturnal (tussive spells, nocturnal dyspnea/chest tightness)

58
Q

CXR reveals hyperinflation, flattening of the diaphragm, peribronchial thickening, prominence of pulm arteries, areas if patchy atelectasis

59
Q

this pt has daytime asthma symptoms less than 2 days a week and nighttime symptoms less than 2 times a month. How will you treat her?

A

no daily meds, give her a bronchodilator PRN

she has mild intermittent asthma

60
Q

this patient has daytime asthma symptoms more than 2 days a week (but not everyday) and nighttime symptoms more than 2 times a month. How will you treat her?

A

daily low-dose inhaled corticosteriods, plus the rescue bronchodilator PRN
she has mild persistent asthma

61
Q

this patient has daytime asthma symptoms everyday and nighttime symptoms more than 1 time a week. How will you treat this?

A

A daily low dose inhaled corticosteroid plus a LABA or medium dose inhaled corticosteroid, plus the rescue bronchodilator PRN
Moderate persistant

62
Q

This pt has continual daytime asthma symptoms and frequent symptoms at night. How do you treat

A

daily high dose inhaled corticosteroid, LABA, oral corticosteroids, plus their resue inhaler PRN
Pulm/allergy consults are VITAL
severe persistant

63
Q

asthma severity and control are assessed based on 2 domains

A

impairment (present) and risk (future)

64
Q

ACT score below 19 means what

A

uncontrolled asthma

65
Q

first choice treatment for all initial persistent forms of asthma

A

ICS, azmacort, vanceril, AeroBid, Flovent, pulmicort

66
Q

these drugs can be used as a second indication for asthma with allergies

A

leukotriene inhibitors (singulair and accolate)

67
Q

You can add these to ICS to relax airway smooth muscle. Not to be used as monotherapy

A

LABA (serevent)

fluticasone/salmeterol= advair

68
Q

these two drugs can be used for long term asthma control, but are not used very often

A

aminophylline or theophylline

69
Q

Rescue treatments for asthma can include

A

SABA (albuterol, levalbuterol)
Anticholinergics (inhaled- ipratropium bromide)
Corticosteroids

70
Q

how long should asthma be controlled before stepping down therapy

71
Q

At which step of therapy should you consider referral to an asthma specialist?

A

step 4 or higher, step 3 for children 0-4 years of age

72
Q

T or F: every patient with intermittent asthma should have a written home management plan

A

FALSE. persistant asthma should

73
Q

severe complication of asthma, not responsive to treatment, FEV1 and peak expiratory flow less than 50%

A

status asthmaticus

74
Q

pt comes in with severe bronchospasm, excessive mucus secretion, inflammation, and edema of airways. Won’t respond to treatment

A

status asthmaticus

75
Q

first line treatment for status asthmaticus

A

humidified O2
inhaled b2 agonist
(systemic corticosteroids, inhaled anticholinergic bronchodilators, IV beta agonists)

76
Q

use epi to treat status epilepticus, yes or no?

A

NO, unless associated with anaphylaxis

Pediatrics (15 decks)

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