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Old Peds > Asthma and Allergies > Flashcards

Asthma and Allergies Flashcards

1
Q

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

A

Type II

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2
Q

What is first line therapy for eczema?

A

Emollients and moisturizers

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3
Q

Powerful bronchoconstrictor, sustains inflammation

A

Leukotriene

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4
Q

what does smooth muscle constriction, inflamm. mediation

A

Prostaglandins

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5
Q

– Receptors in smooth muscle, endothelium and CNS tissue lead to bronchoconstriction, bronchial smooth muscle contraction vasodilation, local pain/pruritis

A

Histamine

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6
Q

3 things involved in type I hypersensitivity? released by IgE antibodies

A

Histamine
Leukotriene
Postaglandins

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7
Q

what are 4 ways to be exposed to allergenes in type I hypersensitivity?

A

Ingestion
Inhalation
Injection
Contract

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8
Q

How soon after exposure to the allergen does a type I hypersensitivity rxn occur?

A

Immediate or late

late is 2-4 hours after exposure

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9
Q

what are some type I hypersensitivity rxns?

A 
atopic dermatitis (eczema)
urticaria
hay fever (allergic rhinitis)
anaphylaxis
food allergies
PCN allergies
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10
Q

Does your first rxn to an allergen indicate how bad the response will be?

A

No, can get a more severe rxn the second time

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11
Q

What is a blood test used to determine to what substances a person is allergic. This is different from a skin allergy test, which determines allergy by the reaction of a person’s skin to different substances.

A

A radioallergosorbent test (RAST)

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12
Q

an antibody response (IgM, IgG or IgA) bind to own cell surface and activating the complement pathway though the B cell response.

A

Type II sensitivity rxn

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13
Q

what can cause a type 2 rxn?

A

previous viral infection

another allergic rxn

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14
Q

how long does type II rxn take?

A

hours to 1 day

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15
Q

what are some type II hypersensitivity rxns?

A 
hemolytic anemia
thrombocytopenia
graves dz
rheumatic fever
myasthenia graves
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16
Q

Antigen-antibody complex forms and via circulation deposit in tissue, blood vessels, filtering organs ( spleen, liver,kidney)

A

Type III hypersensitivity rxn

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17
Q

Post viral vasculitis. Commonly affects highly vascularized parts of body (kidneys), abdominal pains. rura is a purplish rash, typically on the lower legs and buttocks.

A

Henoch-Schonlein purpura

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18
Q

Glomeruli become inflamed after strep. Can lead to renal failure.

A

Post streptococcal glomerulonephritis

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19
Q

Allergic rxn to an injected antigen.

A

Serum sickness

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20
Q

( cellular immune mediated or delayed hypersensitivity)

Recognition of antigen by sensitized T cells

A

Type IV hypersensitivity rxn

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21
Q

what are some contact allergies that are type IV rxns?

A

nickel
poison ivy
lotions
detergents

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22
Q

what are some autoimmune conditions that are Type IV rxns?

A

DM1, hashimotos, MS, celiac dz

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23
Q

why does a Type IV rxn take so long?

A

Takes awhile to recruit the T cells

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24
Q

Chronic, relapsing, inflammatory skin condition

A

Atopic Dermatitis (eczema)

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25
Q

what % of pt with atopic dermatitis will develop asthma and allergic rhinitis

A

> 80%

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26
Q

where is eczema common in infants?

A

faces, neck folds, extensor surfaces

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27
Q

where is eczema common in toddlers?

A

flexor surfaces, neck folds

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28
Q

what is the triad with atopic dermatitis?

A

allergies
eczema
asthma

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29
Q

Pruritis! Erythematous papules assoc with excoriations, vesiculations.

A

Atopic dermatitis

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30
Q

Ddx for atopic dermatitis?

A

Scabies
seborrheic dermatitis (dandruff)
allergic contact dermatitis (only where irritant present)
nummular eczema (coin shaped lesions)

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31
Q

what can older kids with atopic dermatitis get?

A

Flexural lichenification

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32
Q

what can lead to severe infections in atopic dermatitis?

A

Colonization with staph aureus

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33
Q

treatments for atopic dermatitis?

A

hydration- baths followed by occlusive agent
moisturizeds and occlusives
topical corticosteroids (reduce inflammmation)

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34
Q

Raised, red, itchy lesions on the skin that often come and go and can coalesce together in to larger, red, itchy areas

A

Urticaria “hives”

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35
Q

where do hives occur?

A

superficial dermis

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36
Q

edema extending into deep dermis or subcutaneous tissues

A

Angioedema

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37
Q

most common cause of hives in children

A

viral infections

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38
Q

Rapid onset, serious allergic reaction in previously sensitized pt

A

anaphylaxis

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39
Q

when do you see angioedema by itself

A

injected allergens (bee stings, ant bites)

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40
Q

what do you give for HPOTN associated w/ anaphylaxis

A

vasopressors

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41
Q

what are the most common causes of cutaneous drug rxns?

A

Amox, Bactrim, Ampicillin

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42
Q

characterized by fever, rash, lymphadenopathy, myalgias and arthralgias
usually due to injected allergen.

A

serum sickness

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43
Q

how do you tx serum sickness?

A

antihistamines, epi, corticosteroids depending on sx

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44
Q

if it is a known allergic exposure how fast will serum sickness occur?

A

1-4 days after

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45
Q

how long after exposure will serum sickness appear after first receiving the drug?

A

7-21 days

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46
Q

Papular and rough rash, almost eczema like. Raised and look like sand paper.

A

contact dermatitis

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47
Q

latex allergies are an _________ hypersensitivity rxn.

A

immediate

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48
Q

latex results in allergic contact dermatitis _______ days after exposure

A

1-2 days

49
Q

who is more sensitive to latex allergy.

A

people with spina bifida

50
Q

when do food allergies commonly show up?

A

First 3 years of life

51
Q

what are some common food allergies in children?

A 
Eggs
milk
peanuts
tree nuts
soy
wheat
52
Q

what are common allergies in older children?

A

Fish
shellfish
nuts

53
Q

when do food allergy rxns occur?

A

Minutes to 2 hours after ingestion

will get hives, facial angioedema, mouth throat itches

54
Q

what allergies do most children outgrow?

A

milk
eggs
soy

55
Q

what allergies are usually not outgrown?

A

peanuts
tree nuts
shellfish

56
Q

what are most insect allergies due to?

A

almost exclusively hymenoptera stings

bees, wasps, yellow jackets, fire ants

57
Q

is a bee sting or a fire ant bite worse?

A

Bee sting because stinger stays in there

58
Q

why is allergic rhinitis more common when you get older?

A

Don’t get sensitized until you are older since it is seasonal

59
Q

when does asthma usually peak?

A

around age 5 (can occur along w/ allergic rhinitis)

60
Q

Does eczema get worse or better with age?

A

better

61
Q

when do food allergies peak

A

first three years of life

62
Q

what is an allergic shiners?

A

black and puff below eyes due to allergic rhinitis

63
Q

good meds for itchy eyes w/ allergic rhinitis

A

Zyrtec

Allegra

64
Q

what is good for nasal congestion

A

intranasal steroids

65
Q

Transient Wheezing is common in __________ and ____________

A

infancy and during preschool

66
Q

what is wheezing a symptom of?

A

lower airway obstruction

67
Q

who are more affected by asthma

A

children
females
african Americans

68
Q

what are upper respiratory tract issues?

A

Allergic Rhinitis
Adenoid/tonsillar hypertrophy
Foreing body
Sinusitis

69
Q

what problems can occur in lower respiratory tract

A 
Asthma
BPD
Chronic aspiration
CF
FB
GER
Viral bronchiolitis
Pneumonia
70
Q

if asthma associated w/ wheezing in an infant?

A

No

71
Q

3 major factors of asthma

A

Inflammation
Bronchospasm
Hyperreactivity

72
Q

intermittent dry cough, expiratory wheezing, shortness of breath, chest tightness, limited exercise tolerance

A

asthma

73
Q

what do you find on the PE for asthma?

A 
Expiratory wheezes
prolonged expiration
 tachypnea
retractions
 distress
74
Q

3 categories of asthma symptoms

A

daytime
exercise
nocturnal

75
Q

asthma is a ________ airway obstruction

A

lower

76
Q

If asthma isn’t treated what can it lead to?

A

chronic airway remodeling and lead to chronic complications

77
Q

what do you want to look for on spirometry for asthma?

A

FEV or tidal volume

78
Q

Are FEVs done before age 5?

A

No

79
Q

does all asthma wheeze?

A

No

>50% of coughs lasting longer than 3 weeks can be asthma

80
Q

what meds can cause asthma exacerbations?

A

NSAIDs

81
Q

what are you looking for on chest x-ray

A

hyper-inflation of the lungs (more ribs than normal)

82
Q

what is the yellow zone?

A

child is a PEFR 50-80%

83
Q

what is PEFR?

A

peak expiratory flow rate

84
Q

what is the red zone?

A

PEFR below 50%- medical emergency

85
Q

what will a chest x-ray often show on a kid w/ asthma

A 
Hyperinflation
Flattening of diaphram
peribronchial thickening
prominence of pulmonary arteries
areas of patchy atelectasis( may be misdiagnoses as pneumonia)
86
Q

what are the 4 components of asthma management?

A
  1. measures of asthma assessment and moniotring
  2. education
  3. control of environmental factors and comoribd conditions
  4. medications
87
Q

symptoms < 2day/wk or 2 nights/mo

peak flows > 80% of personal best

A

Mild intermittent asthma

88
Q

Symptoms > 2 day/wk but < qday, or > 2 nights/mo

A

Mild persistent asthma

89
Q

tx for mild intermittent asthma

A

no daily med

bronchodilators PRN

90
Q

tx for mild persistent asthma

A

daily low dose inhaled corticosteroids
cromolyn
leukotriene modifiers
nedocromil

91
Q

Daily symptoms or > 1 night/week

peak flows 60-80%

A

Moderate persistent

92
Q

tx for moderate persistent asthma

A

Daily low-dose inhaled corticosteroids AND
long acting inhaled beta2-agonist , or medium-dose inhaled corticosteroids
Consider pulmonology/allergy referral

93
Q

Continual daytime symptoms and frequent symptoms at night

Peak flows < 60%

A

Severe persistent asthma

94
Q

tx for severe persistent asthma

A

Daily high-dose inhaled corticosteroids AND
Long-acting inhaled beta2agonists AND
Oral corticosteroids with repeated attempts to wean when able.
Pulmonology/allergy consults vital

95
Q

what is a side effect of a long acting inhaled beta 2 agonist

A

if you have an acute asthma attack, your mortality risk is higher

96
Q

what else do you want to ask for severe asthma?

A

how many times they have had an acute attack/ hospitalized

97
Q 
what is  frequency and intensity of symptoms
 functional limitations (quality of life)
A

impariment

98
Q

what is a form used to screen for specific recent history of distinct asthma symptoms.

A

ACT forms

99
Q

the lower the score on the ACT form indicates what?

A

Not controlled or more severe asthma

100
Q

these are the first choice of treatment for all persistent forms of asthma - *early use does not alter natural history of asthma or prevent dev of persistent asthma

A

inhaled corticosteroids

101
Q

potent mediators of inflammation and smooth muscle bronchoconstriction

A

leukotriene inhibitors

102
Q

relax airway smooth muscle ( never monotherapy)

adding this to an inhaled corticosteroid therapy is more beneficial than doubling the dose of the inhaled corticosteroid

A

Long-acting beta agonists

103
Q

what is an inhaled anticholinergic, usually used in clinic. relieves bronchoconstriction, decreases mucus hypersensitivity

A

Ipratropium bromide

104
Q

how long should asthma be controlled before stepping down therapy?

A

3 months

105
Q

when do you give treatment for exercise-induced bronchospasm

A

SABAs and LABA

encourage them to warm up prior to exercise

106
Q

Severe bronchospasm, excessive mucus secretion, inflammation, and edema of airways
Not responsive to treatment

A

Status asthmaticus

107
Q

what is the most important lab determination of status asthmaticus?

A

ABGs

108
Q

how do you tx status asthmaticus

A 
high flow O2
inhaled B2 agonist (albuterol)
systemic corticosteroids (IV)
inhaled anticholinergic bronchodilators
IV beta agonists
109
Q

what can be administered to decrease nighttime episodes and prevent asthma attacks.

A

leukotriene modifiers

110
Q

first line therapy for relief of an acute asthma attack?

A

beta 2 adrenergic agonist (ie albuterol)

111
Q

do inhaled steroid help acute exacerbation?

A

No

112
Q

what type of corticosteroids are indicated for acute asthma?

A

oral/ IV

113
Q

can cromolyn be used for acute asthma?

A

No, usually for allergies, not for acute exacerbations

114
Q

how do inhaled corticosteroids work?

A

reduce airway inflammation

115
Q

what does a leukotriene antagonist help with

A

allergic rhinitis

asthma

116
Q

what may be the only presenting symptom in patients with asthma?

A

cough

117
Q

A patient is bothered with nighttime episodes of bronchoconstriction related to asthma. Which of the following medications can be administered to decrease the nighttime episodes and prevent asthma attacks?

A

Leukoetriene modifiers

118
Q

What are 6 typical causes of cough in infants?

A 
CF
RTI
Aspiration
Dyskinetic cilia
Lung of airway malformations
Edema

Old Peds (15 decks)

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