PREP Self Assessment Flashcards
8 y/o boy who comes for a new patient visit. He has poor eye contact, odd intonation, and rapid hand movements. He repeatedly talks about baseball trading cards. His mother states that he is a strong math student, but struggles with reading comprehension. She is concerned that he is not interested in interacting with children his age. What is the most appropriate dx?
ASD; autism spectrum disorder
Weakness in verbal/nonverbal communication, limited social engagement, and restricted/repetitive interests and behavior.
A 13 y/o girl is struggling in her eighth grade classes. She has IQ testing that puts her in the verbal 95 and nonverbal 100; both of which are normal for the population, and not significantly different. In school, she is reading at a 6th grade level, and doing math at an 8th grade level. What is her diagnosis?
Learning disability; she has a significant discrepancy between her achievement in school and her ability (IQ). She should have a psychoeducational evaluation of cognitive and academic ability. Most commonly, learning disability is subsequent to a language-based learning issue, though non-verbal deficits are not uncommon. She does not have an intellectual disability because she has normal IQ.
Vision training exercises are useful for what disorder(s)?
Possibly convergence-insufficiency disorder, though increased comfort with reading does not correlate to better decoding or comprehension.
Do kids outgrow allergies to peanuts?
No - it is considered a lifelong food allergy. Studies suggest that 20% can outgrow the food allergy, specifically those with only a cutaneous reaction.
What is the treatment for a severe food allergy?
Injectable Epinephrine.
Is there cross reactivity to other legumes when a patient has a peanut allergy?
No - soy and beans are usually well tolerated, and there is very little cross-reactivity of IgE epitopes.
A 14 year-old girl presents with symptoms of an itchy, raised rash that have persisted since a viral illness 2 months ago. The rash consists of multiple erythematous, well-circumscribed wheals that range in diameter from a dime to a golf ball; the lesions resolve in a few hours without bruising or discoloration. She also has swelling of her lips, tongue, and eyelids, and does not attend school because of the disfiguration. What does she have and what medication could be used to treat it?
This patient has chronic urticaria-angioedema. It is characterized by raised, erythematous, markedly pruritic evanescent lesions and angioedema (swelling of deeper layers of skin and soft tissue). It can occur with or without urticaria, and is arbitrarily considered chronic after 6 weeks. Antihistamines (specifically non-drowsy, second generation) are first-line for this patient, though first generation (hydroxazine, diphenhydramine) can be useful at bedtime. H2 blockers (cimetidine) can be added to a patient who is poorly controlled, as can anti-leukotrienes (montelukast/zileuton). Systemic steroids are limited to several weeks to control systemic symptoms. This patient was treated with fexofenadine.
A patient is being controlled well on anti-histamine therapy (levocetirizine). What common cause of overdosing is an important counseling point for patients?
Remember that cough and cold remedies have antihistamines in them. People often do not know this, and inadvertently overdose, leading to paradoxical agitation and possibly anti-cholinergic.
7 year-old girl comes in with her family with a history of worsening asthma. In the past, she has experienced asthma with viral infections in the winter. The parents have recently noticed that her asthma also worsens during the summer soccer season, although she was fine playing indoor soccer in the winter. What do you need to advise them to do?
This patient needs skin testing for seasonal allergens. It seems that her summer activity (outside sports) are more contributory to inside sports. This suggests that it is the allergens (seasonal allergies) that are most contributory, and this patient should be evaluated to understand the causes of her allergy. Allergies and asthma are strongly linked.
Exercise-induced bronchoconstriction (EIB) is a transient narrowing of the lower airway following exercise in the presence or absence of clinically recognized asthma. What treatments (pharm and non-pharm) can help relieve the symptoms?
Pretreatment with inhaled B-agonists are pharmacological therapy. Non-pharmacologic therapies include pre-exercise warmup, decreased sodium intake, ingestion of fish oil, and ascorbic acid supplementation are all supported by category A evidence.
An 18 month-old child presents with his mother, who is concerned that the child has had recurrent wheezing episodes since a hospitalization with RSV at 6 months. These episodes often, but not always respond to bronchodilators. There is no maternal history of asthma or allergies. What is the cause of the wheezing?
Up to 50% of babies with RSV bronchiolitis (lower respiratory tract infections) can have recurrent wheezing. RSV infections are a potential contributor to the development of asthma, though it is not understood if children with RSV have airway changes that contribute to later wheezing or if they would have had these manifestations anyways. About 50% respond to inhaled B-agonists.
A 14 year-old boy presents with sneezing, nasal itching, and eye redness in the spring and fall. He has been taking multiple allergy medications for the past 5 years, as well as ADHD medications, but has not been well controlled for his allergy symptoms. If he were to get allergy skin testing, what medication would be important to stop?
Antihistimines for 1 week prior; first-generation antihistamines generally suppress skin reactivity for 1-3 days, whereas second generation can suppress for up to 7 days. H2 blockers need stopped for at least 48hrs. ADHD drugs (methylphenidate), leukotriene receptor antagonists, inhaled B-agonists, decongestants, cromolyn sodium, and inhaled or intranasal glucocorticoids do not affect skin testing.
8 year old boy was recently treated in the emergency department for chronic sinusitis. He has at least 2-3 episodes of sinusitis each year in the spring and fall, as well as 2-3 episodes of otitis media. Mom denies snoring. On physical exam, he has swollen nasal turbinates, moderate mucoid drainage, and effusions in bilateral TMs.There is no redness, exudate, or nasal polyps. What is the most appropriate next step?
Allergy skin testing; when they point to seasonality, it is allergies until proven otherwise.
What signs point to B-cell dysfunction and warrant a work-up in patients with a history of ear infections and chronic sinus infections?
4 or more new infections in 1 year, 2 or more serious sinus infections in 1 year, 2 or more months of abx without effect, 2 or more cases of PNA within 1 year, failure to gain weight or grow, need for IV abx to clear infection, or a family history of primary immune disease.
An 8 year old boy was recently treated in the emergency department for chronic sinusitis. The patient complains of a chronic, intractable cough and nearly constant use of cough suppressants. He has had several episodes of sinusitis each year, and never seems to fully clear the infection with antibiotics. Mom denies snoring. On physical exam, he has swollen nasal turbinates, heavy mucoid drainage, and an erythematous nasal cavity with several nasal polyps. What is the next step for this patient?
Ciliary biopsy for primary ciliary dyskinesia (PCD or immotile-cilia syndrome). It is characterized by congenital impairment of mucociliary clearance and can present as a chronic cough, chronic chants, and chronic sinusitis. Definitive diagnosis is with a ciliary biopsy. Since CF can also present with polyposis (up to 1/3), CF is a possibility, but no GI symptoms were elucidated (steatorrhea), nor persistent pulmonary infection. Diagnostic testing would be completed with sweat chloride testing.
