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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
what % of pt with atopic dermatitis will develop asthma and allergic rhinitis
>80%
26
where is eczema common in infants?
faces, neck folds, extensor surfaces
27
where is eczema common in toddlers?
flexor surfaces, neck folds
28
what is the triad with atopic dermatitis?
allergies eczema asthma
29
Pruritis! Erythematous papules assoc with excoriations, vesiculations.
Atopic dermatitis
30
Ddx for atopic dermatitis?
Scabies seborrheic dermatitis (dandruff) allergic contact dermatitis (only where irritant present) nummular eczema (coin shaped lesions)
31
what can older kids with atopic dermatitis get?
Flexural lichenification
32
what can lead to severe infections in atopic dermatitis?
Colonization with staph aureus
33
treatments for atopic dermatitis?
hydration- baths followed by occlusive agent moisturizeds and occlusives topical corticosteroids (reduce inflammmation)
34
Raised, red, itchy lesions on the skin that often come and go and can coalesce together in to larger, red, itchy areas
Urticaria "hives"
35
where do hives occur?
superficial dermis
36
edema extending into deep dermis or subcutaneous tissues
Angioedema
37
most common cause of hives in children
viral infections
38
Rapid onset, serious allergic reaction in previously sensitized pt
anaphylaxis
39
when do you see angioedema by itself
injected allergens (bee stings, ant bites)
40
what do you give for HPOTN associated w/ anaphylaxis
vasopressors
41
what are the most common causes of cutaneous drug rxns?
Amox, Bactrim, Ampicillin
42
characterized by fever, rash, lymphadenopathy, myalgias and arthralgias usually due to injected allergen.
serum sickness
43
how do you tx serum sickness?
antihistamines, epi, corticosteroids depending on sx
44
if it is a known allergic exposure how fast will serum sickness occur?
1-4 days after
45
how long after exposure will serum sickness appear after first receiving the drug?
7-21 days
46
Papular and rough rash, almost eczema like. Raised and look like sand paper.
contact dermatitis
47
latex allergies are an _________ hypersensitivity rxn.
immediate
48
latex results in allergic contact dermatitis _______ days after exposure
1-2 days
49
who is more sensitive to latex allergy.
people with spina bifida
50
when do food allergies commonly show up?
First 3 years of life
51
what are some common food allergies in children?
``` Eggs milk peanuts tree nuts soy wheat ```
52
what are common allergies in older children?
Fish shellfish nuts
53
when do food allergy rxns occur?
Minutes to 2 hours after ingestion | will get hives, facial angioedema, mouth throat itches
54
what allergies do most children outgrow?
milk eggs soy
55
what allergies are usually not outgrown?
peanuts tree nuts shellfish
56
what are most insect allergies due to?
almost exclusively hymenoptera stings | bees, wasps, yellow jackets, fire ants
57
is a bee sting or a fire ant bite worse?
Bee sting because stinger stays in there
58
why is allergic rhinitis more common when you get older?
Don't get sensitized until you are older since it is seasonal
59
when does asthma usually peak?
around age 5 (can occur along w/ allergic rhinitis)
60
Does eczema get worse or better with age?
better
61
when do food allergies peak
first three years of life
62
what is an allergic shiners?
black and puff below eyes due to allergic rhinitis
63
good meds for itchy eyes w/ allergic rhinitis
Zyrtec | Allegra
64
what is good for nasal congestion
intranasal steroids
65
Transient Wheezing is common in __________ and ____________
infancy and during preschool
66
what is wheezing a symptom of?
lower airway obstruction
67
who are more affected by asthma
children females african Americans
68
what are upper respiratory tract issues?
Allergic Rhinitis Adenoid/tonsillar hypertrophy Foreing body Sinusitis
69
what problems can occur in lower respiratory tract
``` Asthma BPD Chronic aspiration CF FB GER Viral bronchiolitis Pneumonia ```
70
if asthma associated w/ wheezing in an infant?
No
71
3 major factors of asthma
Inflammation Bronchospasm Hyperreactivity
72
intermittent dry cough, expiratory wheezing, shortness of breath, chest tightness, limited exercise tolerance
asthma
73
what do you find on the PE for asthma?
``` Expiratory wheezes prolonged expiration tachypnea retractions distress ```
74
3 categories of asthma symptoms
daytime exercise nocturnal
75
asthma is a ________ airway obstruction
lower
76
If asthma isn't treated what can it lead to?
chronic airway remodeling and lead to chronic complications
77
what do you want to look for on spirometry for asthma?
FEV or tidal volume
78
Are FEVs done before age 5?
No
79
does all asthma wheeze?
No | >50% of coughs lasting longer than 3 weeks can be asthma
80
what meds can cause asthma exacerbations?
NSAIDs
81
what are you looking for on chest x-ray
hyper-inflation of the lungs (more ribs than normal)
82
what is the yellow zone?
child is a PEFR 50-80%
83
what is PEFR?
peak expiratory flow rate
84
what is the red zone?
PEFR below 50%- medical emergency
85
what will a chest x-ray often show on a kid w/ asthma
``` Hyperinflation Flattening of diaphram peribronchial thickening prominence of pulmonary arteries areas of patchy atelectasis( may be misdiagnoses as pneumonia) ```
86
what are the 4 components of asthma management?
1. measures of asthma assessment and moniotring 2. education 3. control of environmental factors and comoribd conditions 4. medications
87
symptoms < 2day/wk or 2 nights/mo | peak flows > 80% of personal best
Mild intermittent asthma
88
Symptoms > 2 day/wk but < qday, or > 2 nights/mo
Mild persistent asthma
89
tx for mild intermittent asthma
no daily med | bronchodilators PRN
90
tx for mild persistent asthma
daily low dose inhaled corticosteroids cromolyn leukotriene modifiers nedocromil
91
Daily symptoms or > 1 night/week | peak flows 60-80%
Moderate persistent
92
tx for moderate persistent asthma
Daily low-dose inhaled corticosteroids AND long acting inhaled beta2-agonist , or medium-dose inhaled corticosteroids Consider pulmonology/allergy referral
93
Continual daytime symptoms and frequent symptoms at night | Peak flows < 60%
Severe persistent asthma
94
tx for severe persistent asthma
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
what is a side effect of a long acting inhaled beta 2 agonist
if you have an acute asthma attack, your mortality risk is higher
96
what else do you want to ask for severe asthma?
how many times they have had an acute attack/ hospitalized
97
``` what is frequency and intensity of symptoms functional limitations (quality of life) ```
impariment
98
what is a form used to screen for specific recent history of distinct asthma symptoms.
ACT forms
99
the lower the score on the ACT form indicates what?
Not controlled or more severe asthma
100
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
inhaled corticosteroids
101
potent mediators of inflammation and smooth muscle bronchoconstriction
leukotriene inhibitors
102
relax airway smooth muscle ( never monotherapy) | adding this to an inhaled corticosteroid therapy is more beneficial than doubling the dose of the inhaled corticosteroid
Long-acting beta agonists
103
what is an inhaled anticholinergic, usually used in clinic. relieves bronchoconstriction, decreases mucus hypersensitivity
Ipratropium bromide
104
how long should asthma be controlled before stepping down therapy?
3 months
105
when do you give treatment for exercise-induced bronchospasm
SABAs and LABA | encourage them to warm up prior to exercise
106
Severe bronchospasm, excessive mucus secretion, inflammation, and edema of airways Not responsive to treatment
Status asthmaticus
107
what is the most important lab determination of status asthmaticus?
ABGs
108
how do you tx status asthmaticus
``` high flow O2 inhaled B2 agonist (albuterol) systemic corticosteroids (IV) inhaled anticholinergic bronchodilators IV beta agonists ```
109
what can be administered to decrease nighttime episodes and prevent asthma attacks.
leukotriene modifiers
110
first line therapy for relief of an acute asthma attack?
beta 2 adrenergic agonist (ie albuterol)
111
do inhaled steroid help acute exacerbation?
No
112
what type of corticosteroids are indicated for acute asthma?
oral/ IV
113
can cromolyn be used for acute asthma?
No, usually for allergies, not for acute exacerbations
114
how do inhaled corticosteroids work?
reduce airway inflammation
115
what does a leukotriene antagonist help with
allergic rhinitis | asthma
116
what may be the only presenting symptom in patients with asthma?
cough
117
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?
Leukoetriene modifiers
118
What are 6 typical causes of cough in infants?
``` CF RTI Aspiration Dyskinetic cilia Lung of airway malformations Edema ```

Old Peds (15 decks)

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