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Pediatrics > Pedi ALLERGIC, IMMUNODEFICIENCY, AND NEURO > Flashcards

Pedi ALLERGIC, IMMUNODEFICIENCY, AND NEURO Flashcards

1
Q

What 3 components make up allergic Atopy?

A

Asthma, allergic rhinitis, and atopic dermatitis

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2
Q

What type of Ig__ is involved in allergies?

A

IgE

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3
Q

What is the most common allergic disease, and is often known as hay fever?

A

Allergic rhinoconjunctivitis

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4
Q

What might a child complain of with allergic rhinoconjunctivitis?

A

Itching of nose, eyes, palate, or pharynx

Loss of smell of taste, sneezing, and sleepiness

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5
Q

What is intermittent allergic rhinoconjunctivitis vs. persistent?

A

Intermittent= less than 4 days/week

Persistent = greater than 4 days/week

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6
Q

What would you look for on exam with allergic rhinoconjunctivits?

A

“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”

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7
Q

What if a kid had several nasal polyps with allergic sxs?

A

Often connected with cerebral palsy

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8
Q

What labs can be done to help confirm the diagnosis of allergic rhinoconjunctivits?

A

Eosinophilia (serum or nasal secretions for IgE)

Skin testing

In vitro test (RAST)

…but you don’t have to do any of these tests

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9
Q

What are some non-pharm treatments for allergic rhinoconjunctivitis?

A

Identify & avoid cause

Nasal saline irrigation

Cold compresses for the eyes

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10
Q

What are some pharm treatments for allergic rhino conjunctivitis?

A

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)

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11
Q

What must you always remind parents of with allergic rhinoconjunctivitis?

A

That this is a long term diagnosis

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12
Q

How can you treat severe cases of allergic rhinoconjunctivits?

A

Immunotherapy

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13
Q

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?

A

Atopic dermatitis

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14
Q

What is atopic dermatitis often associated with?

A

Allergies & asthma (atopy)

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15
Q

How can you treat a child with atopic dermatitis?

A

Avoid irritants (soaps & detergents); hydration; moisturizers, topical steroid for flares

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16
Q

If you prescribe a steroid for a child what should you always put on their prescription?

A

Start with a medium potency dose. Always tell them a time to discontinue (no longer than 2 weeks)

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17
Q

How do you hydrate a diffuse atopic dermatitis rash on a child?

A

Set the child in a temperate bath for 10 minutes, possibly twice a day. Then lock in the moisture with an ointment like Vaseline

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18
Q

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?

A

Anaphylaxis!

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19
Q

What is the typical cause of anaphylaxis in children, middle-aged adults, and elderly?

A 
Children = food
Adults = Venom 
Elderly = medications
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20
Q

How do you treat an anaphylactic reaction?

A

Epinephrine

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21
Q

What’s the dosing for peds epinephrine?

A

0.15mg

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22
Q

What are the most common food allergies?

A

Tree nuts, soy, fish, peanuts, shellfish, eggs, wheat, and dairy

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23
Q

By what age is a food allergy often diagnosed?

A

Age 2

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24
Q

What two types of food allergies can be outgrown?

A

Cow’s milk & eggs

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25
Q

If a child just has a food allergy what sxs would you look for?

A

Within 2 hours of ingestion; hives, flushing, facial angioedema, and mouth/throat itching

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26
Q

How do you work-up a food allergy? What’s gold standard?

A

Food specific IgE testing; Prick skin testing; Blinded food challenge = GOLD STANDARD

27
Q

How do you manage a food allergy?

A

Strict dietary restriction & carry self-injectable epinephrine along with a fast acting antihistamine

28
Q

If a child presents with recurrent, severe, persistent, or resistant infection(s) with failure to thrive, what must you consider?

A

Primary immunodeficiency

29
Q

What does the work up involve if you suspect primary immunodeficiency?

A

CBC with diff & measuring of Ig levels

30
Q

If a baby has recurrent URI’s, otitis media, or bronchitis within the first 3-6 months, what diagnosis should you think of?

A

Transient hypogammaglobulinemia (THI)

31
Q

What is the progression of THI?

A

Usually recovers by 9-15 months with IgG levels normalizing by 2-4 years

32
Q

If a brand new baby is born without lymphoid tissue (tonsils, or lymph nodes) what is it known as?

A

Severe combined immunodeficiency (SCID)

33
Q

How do we treat SCID?

A

BMT (bone marrow transplant) may be curative We now screen for SCID at birth

34
Q

If a child has a seizure, what does the workup consist of?

A

EEG and consider a brain MRI (if there is cognitive or motor impairment

35
Q

What types of behaviors are often misdiagnosed as seizures in children?

A

breathing holding spells & staring spells

36
Q

What type of treatment can we offer for seizure disorders in children?

A

Benzo’s for first aid & antiepileptic Rx

37
Q

What age group has the highest incidence of epilepsy?

A

Newborns

38
Q

What is the most common neurologic disorder in infants and young children?

A

Febrile seizure

39
Q

What are the criteria to diagnose febrile seizures?

A

Age 3mo – 6 years; fever >38; and non-CNS infection/inflammation

40
Q

What is the workup for a febrile seizure?

A

CBC, blood, lumbar puncture (for meningitis)

41
Q

How would you treat a febrile seizure?

A

Reassurance

42
Q

What is status epilepticus?

A

Seizure lasting 15 minutes or longer or recurrent seizures without complete recovery in 30 minute period

43
Q

What do we need to be concerned about with status epilepticus?

A

Medical Emergency! Hypoxia, acidosis, cerebral edema, respiratory depression

44
Q

How do you treat status epilepticus?

A

Benzo’s, phenytoin, and phenobarbital

Give them O2 (manage airway) and IV glucose!

45
Q

What does a left shift mean on a CBC?

A

Most likely bacterial infection

46
Q

What are the most common types of headaches we see in children?

A

Migraines & tension

47
Q

How do we treat a child’s headache?

A

Self-management, simple analgesics

48
Q

What are some red flags for headaches in a child under the age of 5?

A

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)

49
Q

In children, what type of HA is photo or phonophobia associated with?

A

Tension type HA

50
Q

If a child has spasticity of the limbs, with hyperreflex, and involuntary movements, what diagnosis?

A

Cerebral palsy

51
Q

What would also be present in the patient with cerebral palsy?

A

Speech, vision, hearing (problems), seizures, or mental retardation

52
Q

How would you workup cerebral palsy?

A

MRI to identify lesion

53
Q

What is the diagnostic criteria for Tourette’s?

A

Must have it occur almost everyday for a year & must R/O all other causes

54
Q

What does a child often have in association with Tourette’s?

A

ADD & OCD

55
Q

When would you treat Tourette’s?

A

If it is interfering with life

56
Q

What must you always measure during the neuro portion of an exam with a baby?

A

Their head circumference

57
Q

What is considered an abnormal head size?

A

2 standard deviations above/below normal

58
Q

What is it known as when the head it 2 standard deviations below normal?

A

Microcephaly

59
Q

When should you suspect microcephaly?

A

When chest circumference is greater than head circumference

60
Q

How would you confirm microcephaly?

A

CT or MRI, genetic, and neuro

61
Q

What can macrocephaly cause?

A

Rapid growth & increased intracranial pressure, hydrocephalus, and neoplasms

62
Q

How do you diagnose macrocephaly?

A

CT or MRI

63
Q

How do you treat macro vs. microcephaly?

A

Macro = operable if needed

Micro = support and neuro consult

Pediatrics (12 decks)

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