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Pediatrics > Immunology and allergies > Flashcards

Immunology 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

Emolients and moisturizers

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3
Q

what is reaction triggered by binding of antigen to high affinity IgE receptor on the surface of mast cells, circulating basophils or both –> Release of histamine, leukotrienes, prostaglandins

A

Type I hypersensitivity

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4
Q

_______ Receptors in smooth muscle, endothelium and CNS tissue–> bronchoconstriction, bronchial smooth muscle contraction vasodilation, local pain/pruritis in type I hypersensitivity

A

histamine

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5
Q

Powerful bronchoconstrictor, sustains inflammation in type I hypersensitivity?

A

leukotriene

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6
Q

in type I hypersensitivity smooth muscle constriction, inflamm. mediation

A

prostaglandin

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7
Q

how are 4 ways allergens can be exposed in type I

A

Ingestion
Inhalation
Injection
Contact

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8
Q

how fast does type I occur

A

immediate or late phase - 2-4 hr past exposure

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9
Q

Reactions of Atopic dermatitis (eczema), urticaria, hay fever (allergic rhinitis), anaphylaxis, food allergies, PCN allergy are al what type of response?

A

type I

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10
Q

what ab mediates type I

A

IgE

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11
Q

what ab mediates type II

A

IgM, IgG or IgA binding to cell surface

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12
Q

what happens after ab binds ones own cells in type II

A

Activates complement pathway and B cell response
Lysis of cell or release of anaphylactoxins
Anaphylactoxins trigger mast cell degranulation

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13
Q

type II against RBC leads to

A

hemolytic anemia

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14
Q

type II against platelets leads to

A

thrombocytopenia

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15
Q

type II against thyroid cells leads to

A

graves disease

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16
Q

what is the rxn time for type II

A

hours to 1 day

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17
Q

ITP, hemolytic anemia, rheumatic fever, graves disease, myasthenia gravis are all what type of rxns

A

Type II

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18
Q

antibody cytotoxicity is what rxn?

A

type II

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19
Q

Immune complex is what type of rxn?

A

type III

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20
Q

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

A

Type III

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21
Q

what type of rxn includes Serum Sickness
Henoch-Schonlein purpura
Post streptococcal glomerulonephritis
SLE

A

type III

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22
Q

Tissue injury by complement cascade and neutrophils that release toxic mediators
is part of what type of rxn

A

type III

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23
Q

what rxn is cellular immune mediated or delayed hypersensitivity

A

type IV

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24
Q

what rxn involves Recognition of antigen by sensitized T cells

A

type IV

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25
Q 
what rxn involves:
Contact allergies-
Nickel, poison ivy, lotions, detergents
Autoimmune-
DM 1, hashimoto, MS, celiac disease
A

type IV

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26
Q

what is Chronic, relapsing, inflammatory skin condition

A

eczema or atopic dermatitis

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27
Q

what is the atopic triad

A

dermatitis allergic rhinitis and asthma

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28
Q

what type of hypersensitivity rxn is eczema

A

type I –> igE elevated

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29
Q

what is pruritis withErythematous papules assoc with excoriations, vesiculations?

A

atopic dermatitis

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30
Q

where is eczema found in young and infants

A

Facial and extensor involvement in infants and young children

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31
Q

whre is eczema found in older and adolescents?

A

Flexural lichenification

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32
Q

what is lesions in groin and axillary, linear

A

scabies

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33
Q

what has lack of pruritis, scalp locations, yellow scales

A

seborrheic dermatitis

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34
Q

what involves- distribution of lesions where substance touched

A

allergic contact dermatitis

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35
Q

how do we treat eczema 3

A

-hydration - baths, washcloths followed by occlusive agent
-moisturizers and occlusives - emolients, ointments (not lotion) , vaseline, olive oil,
-Topical corticosteroids - reduce inflammation and pruritis. Decreases Staph Aureus colonization
(fluticasone 0.05% cream in infants >3mo . stabilze, then twice/week)
(tacrolimus – immune modulator. 0.03% effective 2-15y, 0.1% > 15yr. Second line.)

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36
Q

what are 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

hives - urticaria

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37
Q

what causes hives

A

occur from allergic reactions. These can be to medications but more commonly to something in the environment or a virus. In most situations of hives, we never determine the actual cause

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38
Q

what can be caused by physical changes in body temperature such as exposure to cold, heat or extreme exercise. Some people get when they are nervous. Bug bites can cause and so can the sun

A

hives

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39
Q

what is edema extending into deep dermis or subcutaneous tissues

A

angioedema

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40
Q

how long does it take for urticaria to resolve

A

hours (24hrs)

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41
Q

how long does it take for angioedema to resolve

A

72 hrs

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42
Q

what occurs most often urticaria angioedema or both

A

both>urticaria>angioedema

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43
Q

what is Rapid onset, serious allergic reaction in previously sensitized pt

A

anaphylaxis

44
Q

what presents as Generalized pruritus, anxiety, urticaria, angioedema, throat fullness, dyspnea, hypotension, and collapse. May present with severe abdominal cramps, vomiting.

A

anaphylaxis

45
Q

how do we treat anaphylaxis

A

epi
diphenhydramine IM of IV
Corticosteroids - prevent worsening
Vasopressors - hypotn

46
Q

abx that most commonly cause SJS and TEN

A

Amox, Bactrim, Ampicillin

47
Q

what is fever, rash, lymphadenopathy, myalgias and arthralgias (7-21 days if new, 1-4 if sensitized)

A

serum sickness

48
Q

how do you tx serum sickness

A

antihistamines, epi, corticosteroids depending on sx

49
Q

what is diff bw anaphyl and serum sickness

A

fever and delayed in ss

50
Q

Immediate hypersensitivity reaction.
–>Allergic contact dermatitis 24-48 hrs after exposure
Spina Bifida unique sensitivity

A

latex

51
Q

what is Common in young children epscially in first 3 yrs of life, highest prevalence found in children with moderate to severe atopic dermatitis

A

food allergies

52
Q

what are the most common food allergens in young child

A

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

53
Q

what are most common food allergens in older child and may be life long

A

fish, shellfish, nuts

54
Q

Reactions occur minutes to 2hrs after
hives, flushing, facial angioedema, mouth or throat itching.
GI sx - abdominal discomfort, nausea, vomiting, diarrhea –> what type of allergy?

A

food

55
Q

what may result in urticaria, papulovesicular eruptions

A

cuteneous rxn to bug bites

56
Q

what rxn with insect allergies cause?

A

Respiratory allergy due to inhalation of insect particles
Cutaneaous reactions to insect bites
urticaria, papulovesicular eruptions - mosquitos, fleas, bedbugs
Anaphylaxic reactions to stings

57
Q

what bugs cuz anaphylaxis

A

almost exclusively hymenoptera stings

bees, wasps, yellow jackets, fire ants

58
Q

treatments of insect allergies

A

cold compress, antihistamines, topical steroids, -epi

59
Q

what type rxn is latex allergy

A

I

60
Q

Transient Wheezing is common in infancy and during preschool Assoc with? 2

A

viral infections and smaller airways

61
Q

Wheezing is a symptom what type of obstruction

A

lower airway

62
Q

most common chronic disorders in childhood

A

asthma

63
Q

what is found in asthmatic airways?

A

Inflammatory cells (mast cells, eosinophils, T lymphocytes, neutrophils), chemical mediators (histamine, leukotrienes, platelet-activating factor, bradykinin), and chemotactic factors (cytokines, eotaxin) mediate the underlying inflammation found in asthmatic airways.

64
Q

what is CRADLE?

A

Causes of Cough in the First Months of Life:

C- CF
R – RTI
A- Aspiration (TEF,GER, swallowing dysfuntion)
D- Dyskinetic cilia
L – Lung or airway malformations (Laryngeal Web, vascular rings )
E- Edema ( heart failure, CHD)

65
Q

the narrowing that occurs in asthma is caused by 3 things:

A

inflamm brochospasm and hypersensitivity

66
Q

what is Reversible airway obstruction

A

asthma

67
Q

risks of getting asthma? 4

A

history of atopy, viral infections of airways, exposure to tobacco smoke, family history

68
Q

what are triggers of asthma? 10

A

allergies, pet dander, cold air, exercise, emotions, drugs, food, mold, GER, infection

69
Q

what has Symptoms of intermittent dry cough, expiratory wheezing, shortness of breath, chest tightness, limited exercise tolerance
PE you find Expiratory wheezes, prolonged expiration, tachypnea, retractions, distress

A

asthma

70
Q

what are the 3 categories of symptoms of asthma?

A

daytime exercise and nocturnal

71
Q

what involvestussive spells, nocturnal dyspnea/chest tightness

A

nocturnal asthma

72
Q

what involves cough, dyspnea, wheezing in response to:

Allergens, cold, heat, exercise, illness

A

daytime asthma

73
Q 
on CXR what shows
Hyperinflation
Flattening of diaphram
peribronchial thickening
prominence of pulmonary arteries
areas of patchy atelectasis
A

asthma

74
Q

asthma type: attacks nor more than twice a wk and nighttime attacks no more than twice a mo. attacks last no more than a fe hours to days. severity of attacks varies but no symptoms inbw

A

mild intermittent

75
Q

asthma type: attacks more than twice a wk but not every dat and nighttime symptoms more than twice a mo. attacks are sometimes severe enough to interrupt regular activities

A

mild persistent

76
Q

daily attacks and nighttime attacks more than once a wk. more sever attacks occur at least twice a wk and may last for 2 days. attacks require daily rescue medication and changes in daily activities

A

moderate persistent

77
Q

frequent sever attacks, continual daytime symptoms, and frequent nighttime symptoms. require limits on daily activities

A

severe persistent

78
Q

what has symptoms < 2day/wk or 2 nights/mo
peak flows > 80% of personal best
Treatment: no daily medications; bronchodilators prn

A

mild intermit

79
Q

what has Symptoms > 2 day/wk but < qday, or > 2 nights/mo
peak flows > 80% of personal best
Treatment: daily low-dose inhaled corticosteroids

A

mild persistent

80
Q

what has Daily symptoms or > 1 night/week

peak flows 60-80%

A

moderate persistant

81
Q

what has Treatment: Daily low-dose inhaled corticosteroids AND
long acting inhaled beta2-agonist , or medium-dose inhaled corticosteroids

A

moderate persistent

82
Q

what has Continual daytime symptoms and frequent symptoms at night
Peak flows < 60%

A

severe persistent

83
Q

what hasTreatment: Daily high-dose inhaled corticosteroids AND
Long-acting inhaled beta2agonists AND
Oral corticosteroids with repeated attempts to wean when able

A

severe persistent

84
Q

You see an 8 yr old in your office, with his mother who is concerned that he may have asthma. She also has asthma and his brother has eczema and allergic rhinitis. She has noticed that he has symptoms, mainly a cough, on 3 days of each week and has a night time cough once a week. Which of the following is the initial treatment for this child?

A

A low-dose inhaled corticosteroid

85
Q

these are the first choice of treatment for all persistent forms of asthma

A

ICS

86
Q

ICS prevent what

A

swelling in airways

87
Q

Leukotriene inhibitors do what

A

inhibit mediators of inflammation and smooth muscle bronchoconstriction

88
Q

leukotriene inhibitors also indicated for

A

allergy treatment

89
Q

what are singulair and accolate

A

Leukotriene inhibitors

90
Q

Adding a long-acting bronchodilator to inhaled corticosteroid therapy is more beneficial than

A

doubling dose of ICS

91
Q

what do LABAs do?

A

relax airway smooth muscle ( never monotherapy)

92
Q

Fluticasone/salmeterol =

A

advair

93
Q

what work by relaxing bronchial smooth muscle within 5 to 10 minutes of administration. They last for 4 to 6 hours

A

shortacting bronchodilators - albuterol

94
Q

what relieves bronchoconstriction, decreases mucus hypersecretion, and counteracts cough-receptor irritability

A

anticholinergic - ipratropim bromide

95
Q

Asthma should be well controlled for at least ___months before stepping down therapy

A

3

96
Q

A child with intermittent asthma has asthma symptoms how often

A

2 x/wk

97
Q

daytime symptoms occurring two or more times per week or nighttime awakening two or more times per month implies a need

A

daily antiinflamm

98
Q

preferred initial long-term control therapy for children of all ages

A

ICS

99
Q

0 to 4 years of age, daily long-term control therapy is recommended for those who had

A

four or more episodes of wheezing in the previous year that lasted more than 1 day and affected sleep and who have a positive asthma predictive index

100
Q

older than 5 years of age with moderate persistent asthma, combining long-acting bronchodilators with low-to-medium doses ICS

A

improves lung function and reduces rescue medication use.

101
Q

a high-dose inhaled corticosteroid and a long-acting bronchodilator are the preferred therapy.

A

for children with severe persistent

102
Q

A 3-year old male currently not on any asthma medications has visited your outpatient clinic 3 times in the past 6 months for acute wheezing, each episode lasting 2-3 days. In between episodes, his mother reports nighttime cough about 4 nights per month. This patient’s asthma severity can be BEST classified as:

A

Moderate Persistent Asthma (Step 3)

103
Q

what is Life Threatening-May progress to respiratory Failure without prompt and aggressive treatment
Severe bronchospasm, excessive mucus secretion, inflammation, and edema of airways and not responsive to tx

A

status asthmaticus

104
Q

what is FEV1 and pk flow for status asthmaticus

A

<50%

105
Q

single most important lab determination in status asthmaticus

A

ABG

106
Q

first line tx for status asthmaticus

A

inhaled B2 agonist - continuous neb
and
Humidified O2 (inadequate minute ventilation, V/Q mismatch)

107
Q

what is also used in status asthmaticus?

A

Systemic Corticosteroids - decrease inflammation, stabilize mast cells, increase B2 receptor expression . IV route preferable
Inhaled anticholinergic bronchodilators - with albuterol maybe. Ir Ipatroprium Bromide. variable effectiveness
IV Beta agonists (terbutaline selective B2 agonsit) - smooth muscle relaxation

Pediatrics (9 decks)

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