Pedi ALLERGIC, IMMUNODEFICIENCY, AND NEURO Flashcards
What 3 components make up allergic Atopy?
Asthma, allergic rhinitis, and atopic dermatitis
What type of Ig__ is involved in allergies?
IgE
What is the most common allergic disease, and is often known as hay fever?
Allergic rhinoconjunctivitis
What might a child complain of with allergic rhinoconjunctivitis?
Itching of nose, eyes, palate, or pharynx
Loss of smell of taste, sneezing, and sleepiness
What is intermittent allergic rhinoconjunctivitis vs. persistent?
Intermittent= less than 4 days/week
Persistent = greater than 4 days/week
What would you look for on exam with allergic rhinoconjunctivits?
“Allergic salute”; mouth breathing; snoring
Nasal turbinates – pale, boggy, blue, edematous
Clear, thin nasal secretions & cobblestoning of the throat
Conjunctival injection, tearing, and “allergic shiners”
What if a kid had several nasal polyps with allergic sxs?
Often connected with cerebral palsy
What labs can be done to help confirm the diagnosis of allergic rhinoconjunctivits?
Eosinophilia (serum or nasal secretions for IgE)
Skin testing
In vitro test (RAST)
…but you don’t have to do any of these tests
What are some non-pharm treatments for allergic rhinoconjunctivitis?
Identify & avoid cause
Nasal saline irrigation
Cold compresses for the eyes
What are some pharm treatments for allergic rhino conjunctivitis?
Antihistamines – control itching, sneezing, and rhinorrhea (Loratadine, approved at age 2)
Mast cell stabilizers – prophylactic
Decongestants – temporary relief (Sudafed – for short term only)
Intranasal corticosteroids – Prophylactic (Flonase approved at age 2)
What must you always remind parents of with allergic rhinoconjunctivitis?
That this is a long term diagnosis
How can you treat severe cases of allergic rhinoconjunctivits?
Immunotherapy
If a child presents with a rash on the face and extensor surfaces of the elbows and knees and mom tells you this is the second time they’ve had this, what might you think?
Atopic dermatitis
What is atopic dermatitis often associated with?
Allergies & asthma (atopy)
How can you treat a child with atopic dermatitis?
Avoid irritants (soaps & detergents); hydration; moisturizers, topical steroid for flares
If you prescribe a steroid for a child what should you always put on their prescription?
Start with a medium potency dose. Always tell them a time to discontinue (no longer than 2 weeks)
How do you hydrate a diffuse atopic dermatitis rash on a child?
Set the child in a temperate bath for 10 minutes, possibly twice a day. Then lock in the moisture with an ointment like Vaseline
A young child is given some peanut butter and within a few minutes the mother notes the face is starting to swell and difficulty breathing, what is occurring?
Anaphylaxis!
What is the typical cause of anaphylaxis in children, middle-aged adults, and elderly?
Children = food Adults = Venom Elderly = medications
How do you treat an anaphylactic reaction?
Epinephrine
What’s the dosing for peds epinephrine?
0.15mg
What are the most common food allergies?
Tree nuts, soy, fish, peanuts, shellfish, eggs, wheat, and dairy
By what age is a food allergy often diagnosed?
Age 2
What two types of food allergies can be outgrown?
Cow’s milk & eggs
If a child just has a food allergy what sxs would you look for?
Within 2 hours of ingestion; hives, flushing, facial angioedema, and mouth/throat itching
How do you work-up a food allergy? What’s gold standard?
Food specific IgE testing; Prick skin testing; Blinded food challenge = GOLD STANDARD
How do you manage a food allergy?
Strict dietary restriction & carry self-injectable epinephrine along with a fast acting antihistamine
If a child presents with recurrent, severe, persistent, or resistant infection(s) with failure to thrive, what must you consider?
Primary immunodeficiency
What does the work up involve if you suspect primary immunodeficiency?
CBC with diff & measuring of Ig levels
If a baby has recurrent URI’s, otitis media, or bronchitis within the first 3-6 months, what diagnosis should you think of?
Transient hypogammaglobulinemia (THI)
What is the progression of THI?
Usually recovers by 9-15 months with IgG levels normalizing by 2-4 years
If a brand new baby is born without lymphoid tissue (tonsils, or lymph nodes) what is it known as?
Severe combined immunodeficiency (SCID)
How do we treat SCID?
BMT (bone marrow transplant) may be curative We now screen for SCID at birth
If a child has a seizure, what does the workup consist of?
EEG and consider a brain MRI (if there is cognitive or motor impairment
What types of behaviors are often misdiagnosed as seizures in children?
breathing holding spells & staring spells
What type of treatment can we offer for seizure disorders in children?
Benzo’s for first aid & antiepileptic Rx
What age group has the highest incidence of epilepsy?
Newborns
What is the most common neurologic disorder in infants and young children?
Febrile seizure
What are the criteria to diagnose febrile seizures?
Age 3mo – 6 years; fever >38; and non-CNS infection/inflammation
What is the workup for a febrile seizure?
CBC, blood, lumbar puncture (for meningitis)
How would you treat a febrile seizure?
Reassurance
What is status epilepticus?
Seizure lasting 15 minutes or longer or recurrent seizures without complete recovery in 30 minute period
What do we need to be concerned about with status epilepticus?
Medical Emergency! Hypoxia, acidosis, cerebral edema, respiratory depression
How do you treat status epilepticus?
Benzo’s, phenytoin, and phenobarbital
Give them O2 (manage airway) and IV glucose!
What does a left shift mean on a CBC?
Most likely bacterial infection
What are the most common types of headaches we see in children?
Migraines & tension
How do we treat a child’s headache?
Self-management, simple analgesics
What are some red flags for headaches in a child under the age of 5?
New or explosive headache, worst HA of life, unexplained fever, night time or early morning awakening with HA & vomiting, posterior HA, neurological deficit, postural HA (worse with lying or standing)
In children, what type of HA is photo or phonophobia associated with?
Tension type HA
If a child has spasticity of the limbs, with hyperreflex, and involuntary movements, what diagnosis?
Cerebral palsy
What would also be present in the patient with cerebral palsy?
Speech, vision, hearing (problems), seizures, or mental retardation
How would you workup cerebral palsy?
MRI to identify lesion
What is the diagnostic criteria for Tourette’s?
Must have it occur almost everyday for a year & must R/O all other causes
What does a child often have in association with Tourette’s?
ADD & OCD
When would you treat Tourette’s?
If it is interfering with life
What must you always measure during the neuro portion of an exam with a baby?
Their head circumference
What is considered an abnormal head size?
2 standard deviations above/below normal
What is it known as when the head it 2 standard deviations below normal?
Microcephaly
When should you suspect microcephaly?
When chest circumference is greater than head circumference
How would you confirm microcephaly?
CT or MRI, genetic, and neuro
What can macrocephaly cause?
Rapid growth & increased intracranial pressure, hydrocephalus, and neoplasms
How do you diagnose macrocephaly?
CT or MRI
How do you treat macro vs. microcephaly?
Macro = operable if needed
Micro = support and neuro consult
