Pulmonology

Question 1

Asthma Severity Scale

Answer 1

• Intermittent - symptoms and SABA use < 2x/wk, night awakenings < 2x/mo, no interference w/ activity
• Mild - symptoms and SABA use > 2x/wk, night awakenings 3-4x/mo, minor limitation
• Moderate - daily symptoms and SABA use, nightly awakenings > 1x/wk, some limitation
• Severe - symptoms and SABA use mult times a day, nightly awakenings every night, extremely limited

Question 2

Asthma Tx by Severity

Answer 2

• Intermittent = SABA (albuterol) prn
• Mild = (>2 SABA uses a wk) add low dose inhaled steroid
• Moderate = add LABA (salmeterol or formoterol)NEVER USE ALONE - may also use leukotriene receptor agonist (montelukast) or theophylline or zileutan
• Severe = switch to high dose inhaled steroid and consider trial of omalizumab (monoclonal antibody injection every 2-4 wks)

Question 3

3 Poss Time Courses for Anaphylaxis

Answer 3

• Uniphasic: 1-2 hrs
• Biphasic: relapse after hrs to days (why its admitted for observation)
• Protracted: lasts days despite aggressive tx

Question 4

Tx Anaphylaxis

Answer 4

• 1- epinephrine (IM); may need to repeat epi if not improved
  
  • 2- anti histamines
  • 3- systemic steroids
  • 4- albuterol if needed
  • 5- if severe shock intubation and vasoactive drugs

Question 5

Classic PE Findings in Allergic Rhinitis

Answer 5

• Rhinorrhea, congestion
• Itchy nose, throat, eyes
• Transverse nasal crease (form rubbing nose)
• Allergic salute (push up nose w/ hand)
• Blue or boggy nasal turbinates
• Cobblestoned pharynx
• Allergic shiners - infraorbital edema and darkening
• Dennie Morgan Lines - folds below lower eyelid

Question 6

Tx Allergic Rhinitis

Answer 6

• 1 - intranasal steroids (Flonase)
• 2- Anti-histamines (second gen&raquo_space; first generation because less sedation and anti-cholinergic)
  • Loratadine v. diphenhydramine, hydroxyzine

Question 7

3 Categories of Food Allergy

Answer 7

• 1- IgE Mediated
  
  • urticaria, andioedema, conjunctivitis, GI upset, anaphylaxis
  • most commonly milk protein and eggs
• 2- Non IgE
  
  • Celiac, food protein induced enterocolitis
  • Vomiting, diarrhea and bloody stools
• 3- Eosinophilic GI disorders
  
  • Eosinophilic esophagitis or gastroenteritis
  • pain, dysphagia, nausea

Question 8

What is urticaria? What is the most common cause in kids? What is the first line tx?

Answer 8

• transient, erythematous, pruritic, well-delineated pink to red papules or plaques (AKA wheal or hives); NOT painful
• Most common cause of acute urticaria in kids is a viral infection
• Tx - first line is first generation anti-histamines