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AU '18 - Peds III exam II > Asthma and Allergy > Flashcards

Asthma and Allergy Flashcards

1
Q

upper airway

A

nasal cavity –> pharynx –> larynx

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2
Q

lower airway

A

trachea –> primary bronchi –> lungs

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3
Q

classification of airway diseases

A
  1. infectious diseases
  2. obstructive lung diseases
  3. chronic obstructive pulmonary disease (COPD)
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4
Q

what are the two subtypes of infectious diseases?

A
  1. upper respiratory tract infections

2. lower respiratory tract infections

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5
Q

upper respiratory tract infections

A
  1. common cold

2. sinusitis

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6
Q

lower respiratory tract infections

A
  1. respiratory syncytial virus (RSV)
  2. tuberculosis (TB)
  3. pneumonia
  4. cough
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7
Q

obstructive lung diseases

A
  1. lung cancer

2. asthma

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8
Q

COPD

A
  1. emphysema

2. bronchitis

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9
Q

asthma

A

chronic inflammatory disease of the airways with the following clinical features…

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10
Q

what are the clinical features of asthma?

A
  1. episodic or chronic symptoms of airway obstruction
  2. bronchial hyper-responsiveness to triggers
  3. evidence of at least partial reversibility of airway obstruction
  4. alternative diagnoses have been excluded
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11
Q

etiology of asthma

A

specific cause of childhood asthma is unknown but it appears to be multifactorial

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12
Q

environmental exposures that causes asthma

A
  1. allergens
  2. infections
  3. microbes
  4. pollutants
  5. stress
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13
Q

biologic and genetic risks that causes asthma

A
  1. immune system

2. lung

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14
Q

which is the most common chronic medical condition of childhood, causing significant morbidity?

A

asthma

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15
Q

approximately how many children have asthma?

A

6.3 million children (9%)

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16
Q

T/F: females have more childhood asthma

A

false, males > females

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17
Q

T/F: females have more adult asthma

A

true, females > males

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18
Q

T/F: higher SES people have more asthma

A

false, low SES > high SES

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19
Q

T/F: people in urban areas have more asthma

A

true, urban > suburban

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20
Q

which race has more people with asthma?

A

African-American

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21
Q

what percent of asthmatics report onset of asthma prior to age 5?

A

80%

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22
Q

what is the leading cause of hospitalizations?

A

asthma

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23
Q

what are the two main types of childhood asthma?

A
  1. Type 1

2. Type 2

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24
Q

type 1 childhood asthma

A

recurrent wheezing in early childhood

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25
Q

what triggers type 1 childhood asthma?

A

primarily triggered by common viral infections of the respiratory tract

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26
Q

type 2 childhood asthma

A

chronic asthma associated with allergy that PERSISTS into late childhood and often adulthood

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27
Q

pathogenesis of asthma

A
  1. airflow obstruction from bronchoconstriction
  2. inflammation (mixed with eosinophils), edema, and mucus
  3. production of pro-allergic, pro-inflammatory cytokines
  4. mediation of inflammatory process by chemokines
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28
Q

what are the 2 trigger types?

A
  1. extrinsic (allergic) asthma

2. intrinsic (non-allergic/idiopathic) asthma

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29
Q

extrinsic (allergic) asthma

A

triggered activation of mast cells and histamine degranulation following exposure to allergens (dust, pollen, pet, dander, mold, food allergies)

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30
Q

intrinsic (non-allergic/idiopathic) asthma

A
  1. tobacco smoke
  2. air pollution
  3. strong fumes/odors
  4. chemicals in air
  5. respiratory infections
  6. exercise
  7. cold air
  8. anxiety
  9. stress
  10. gastroesophageal reflux disease
  11. aspirin
  12. NSAID meds
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31
Q

what percent of asthmatics have both tigger types?

A

10%

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32
Q

type of medications for asthmatics

A
  1. rescue medications

2. controller medications

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33
Q

rescue medications

A
  1. short-acting beta-agonist

2. anticholinergics

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34
Q

short-acting beta-agonist

A

albuterol (Proventil)

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35
Q

T/F: rescue medications should ALWAYS be brought to a dental appointment

A

true

36
Q

controller medications

A
  1. corticosteroids inhalers
  2. systemic steroids
  3. leukotriene receptor antagonists
  4. oral xanthine
37
Q

signs and symptoms of asthma attack

A
  1. intermittent dry coughing
  2. expiratory wheezing
  3. shortness of breath
  4. tightness of chest
  5. symptoms often worse at night or early morning
  6. daytime symptoms often linked to physical activities or play
  7. hx of limitation of physical activities, fatigue
38
Q

comorbidities of asthma

A
  1. allergic rhinitis (hay fever)
  2. chronic sinusitis
  3. gastroesophageal reflux disease (GERD)
  4. food allergies
  5. atopic dermatitis, eczema
39
Q

oral conditions and astham

A
  1. candidiasis
  2. gingivitis
  3. chapped lips, coated tongue
  4. decreased salivary flow rates
  5. tooth erosion
  6. possible dental caries
  7. traumatic lesions
  8. halitosis
40
Q

what causes candidiasis in asthmatic pts?

A

steroid inhalers

41
Q

what causes gingivities in asthmatic pts?

A

mouth breathing

42
Q

what causes decreased salivary flow rates in asthmatic pts?

A

beta-adrenergic inhalers

43
Q

what causes tooth erosion in asthmatic pts?

A

reflux disease

44
Q

what causes traumatic lesions in asthmatic pts?

A

from inhalers, coughing, vomiting

45
Q

what causes halitosis in asthmatic pts?

A

sinusitis, rhinitis

46
Q

what factors can cause candida albicans in asthmatic pts?

A
  1. immature immune system
  2. abx
  3. steroid inhalers
  4. maternal infection
  5. pacifiers
47
Q

clinical features of candida albicans

A
  1. creamy white plaques able to be wiped off

2. red patches that burn

48
Q

tx for candida albicans

A

antifungal agents

49
Q

different type of candidiasis

A
  1. erythematous candidiasis
  2. burning, fissured tongue
  3. angular cheilitis
50
Q

key questions to ask an asthmatic patient

A
  1. what type of asthma do you have?
  2. how severe is the asthma?
  3. if drug-induced, which medicines are triggers?
  4. when was your last attack?
  5. do you have a cold or have you been sick recently?
  6. were you hospitalized for the attacks? when?
  7. what treatment are you receiving?
  8. do you have a bronchodilator with you?
  9. have you ever needed epinephrine to stop the attack?
51
Q

key questions to ask the physician

A
  1. are the medications that should be avoided as triggers?
  2. what is the severity level of the patient’s asthma?
  3. have the attacks been so bad that the child needed epinephrine or had to go to the emergency department?
  4. is the patient on corticosteroids? is the patient likely to be adrenal suppressed?
52
Q

oral disease prevention

A
  1. good oral hygiene
  2. age-appropriate use of fluorides
  3. healthy non-cariogenic diet
  4. avoidance of acidogenic drink consumption following inhaler, especially at night-time when salivary flow rate is negligible
  5. drink or rinse with water after inhaler use
53
Q

T/F: meds should be taken prior to dental appointment

A

true

54
Q

T/F: you should consult and MD if the asthmatic pt is on systemic steroids

A

true

55
Q

when should you postpone tx for a asthmatic pt?

A
  1. frequent severe attacks
  2. nocturnal wheezing
  3. sick
  4. poor pulmonary fxn
56
Q

what percent of asthmatics are allergic to aspirin or NSAIDS?

A

4%

57
Q

T/F: aspirin or NSAIDS can be given to asthmatics

A

false, can’t

58
Q

what should be prescribed for pain for asthmatics?

A

acetaminophen

59
Q

T/F: nitrous oxide analgesis is useful for mild to moderate cases

A

true

60
Q

T/F: dental procedures, materials may trigger an asthma attack

A

true

61
Q

what can be used to decrease aerosols during a dental procedure?

A

rubber dam

62
Q

T/F: you should always be prepared to manage an acute asthma attack

A

true

63
Q

how many children have food allergies?

A

6 million children

64
Q

etiology of a food allergy

A

aberrant immune response caused by exposure to specific food protein

65
Q

T/F: food allergies may be IgE-mediated, cell mediated or both

A

true

66
Q

what are the common food allergens in children?

A
  1. eggs
  2. peanuts
  3. cow’s milk
  4. soy
  5. tree nuts
  6. fish
  7. shellfish
67
Q

the common food allergen in children list accounts for what percent of food allergens?

A

90%

68
Q

which common food allergens can persist to adulthood?

A
  1. peanuts
  2. tree nuts
  3. fish
  4. shellfish
69
Q

gastrointestinal signs of food allergies

A
  1. nausea, vomiting
  2. diarrhea
  3. abdominal pain
70
Q

respiratory signs of food allergies

A
  1. sneezing
  2. rhinorrhea
  3. nasal pruritus
  4. bronchoconstriction
  5. laryngeal edema
71
Q

oral and cutaneous rxns to food allergies

A
  1. urticaria (hives)
  2. atopic dermatitis (eczema)
  3. angioedema
  4. oral allergy syndrome (edema and pruritus)
72
Q

angioedema

A

diffuse soft tissue swelling

73
Q

cause of angioedema

A

Ig-E mediated hypersensitivity due to foods or drugs

74
Q

common sites for angioedema

A
  1. extremeties

2. face (lips, tongue, eyelids)

75
Q

serious sites for angioedema

A
  1. oropharynx

2. larynx

76
Q

clinical features of angioedema

A
  1. rapid swelling
  2. eryhema and itching
  3. dyspnea
  4. dysphagia
  5. hoarseness
77
Q

tx for angioedema

A
  1. antihistamines
  2. epinephrine
  3. steroids
78
Q

T/F: angioedema may be fatal

A

true

79
Q

what is oral allergy syndrome (OAS) also referred to as?

A

pollen associated FA syndrome

80
Q

what causes OAS

A

localized IgE mediated allergy usually to raw fruits and vegetables

81
Q

OAS most commonly affects what type of patients?

A

patients who are allergic to pollens

82
Q

T/F: OAS is usually restricted to the oral cavity

A

true

83
Q

clinical manifestation of OAS`

A

after contact of fruit or vegetable…

  1. rapid onset of itching with or without swelling, and/or tingling
  2. occasionally a sensation of pruritus in the ear and/or tightness in the throat
84
Q

T/F: symptoms of OAS are long-lived

A

false, short-lived

85
Q

diagnosis of OAS

A
  1. thorough hx taking
  2. temporal association
  3. clinical features
  4. reproducibility of symptoms on every exposure
  5. skin-prick-tests or blood test confirmation
86
Q

temporal association time association

A

within 2-6 hours of ingestion

87
Q

dental considerations for OAS

A
  1. discuss major food allergens when making dietary recommendations
  2. dental products may contain allergens
  3. severe peanut allergies may develop to air-borne food allergens, including dental office
  4. patient should carry epi-pen at all times

AU '18 - Peds III exam II (9 decks)

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