אלרגיה Flashcards
(34 cards)
what are the 2 major risks for asthma?
- parents with asthma
- Allergy (atopic kids)
How to dgx Asthma?
FEV1/FVC < 0.8
then:
metacholine test with decrease FEV1 < 20%
after:
Bronchodilators improvment of FEV1 in > 12% or > 200ml
**Diagnostic **Bronchodilators improvment of FEV1 in > 12% or > 200ml
How do we Dgx Exresice induce asthma?
מבחן תיגר מאמץ
see if there is decrease > 15% in FEV1
What is the changes expected to see in peak expiratory flow in asthma?
btwn morning and evening
changes > 20% from morning to evening
are typical to asthma
Which test can assist is Dgx of allergic asthma?
FeNO- NO measurment in inspirium
איזו תרופה ניתן לשקול בחולים עם אסטמה אלרגית מעל גיל 12?
omalizumab- step 5
איזו תרופה ניתן לשקול בחולים עם אסתמה אאוזינופילית מעל גיל 12
Mepolizumab- step 6
What are the medications for the 6 step approch of asthma menegment?
- SABA
- low dose ICS
- Medium dose ICS or Low dose ICS + LABA/LATRA
- medium dose ICS + LABA /LTRA / theophylline (for age > 4 )
- High dose ICS+ LABA /LTRA / theophylline age > 6 - consider omalizumab if allergic
- High dose ICS+ LABA /LTRA / theophylline + OCS + age > 12 - consider mepolizumab if eosinophils or omalizumab
from Step 4 only 0-4 could change LABA in LTRA
מה הגישה באסתמה מאוזנת למשך יותר מ-3 חודשים
לשקול ירידה בשלב הטיפול תחת מעקב צמוד
Which conditions are a/w asthma?
GERD
renitis
sinusitis
What will be the blood gases in acute severe episode of asthma?
PaO2 < 60
PCO2 > 42 - tiredness of breathing muscles
What we will hear in life threating episode of asthma excacervation?
Abscent of wheezing due to no air coming in
inital tx of acute asthma attack in ER?
SABA every 20min for 1 hr > OCS > epinephrin IM > monitor + hydration
if no response- add SABA impratropium > epinephrin IM
What is a possible side effect of reccurent use of SABA with eleveted dose?
how can we prevent it?
Hypoxemia- due to flow of blood in obstucted areas in the lung = flow/ perfusion mismtach
**prevention- ** O2 supply at least 20 min after Tx with SABA
Risk factor for allergic rhinitis?
family Hx of atopia
serum IgE > 100 before age of 6
Dgx- תבחין עורי למציאת האלרגן
What are eleveted pruritic lesions that tend to migrate?
urticaria
What is the lesion seen in the picture?
Urticaria
Tx- anti histamin against receptor 1
Which type of urticaria is presented after exresice, sweatinh or hot shower?
when they will pass?
Chollenergic urticaria
might also present with tearing, wheezing, and even syncope
Tx- anti histamin against receptor 1
Which Abs are higly a/w chronic autoimmune urticaria?
anti- thyorid ab (in normal thyroid function)
Tx- anti histamin against receptor 1
A girl after running competiton is presented with prurtus, angioedema , urticaria , wheezing and hypotension.
what is most likely the dgx?
**Exresice induce anapylasxis
**
think about presentation anaphylxis but with Hx of recent exresice
Tx- anti histamin against receptor 1
how is this reaction call?
Dermatographism- skin reaction after putting pressure on the skin
Herditery angioedema
which enzyme is missing, what is a strong risk ?
and Tx?
C1 esterase inhibitor def.
risk- larynx edema»_space; need to intubate
Tx- PPx and in episodes with recombinant C1 enzyme. EACA
Galatosemia
which enzyme is def?
Tx?
GALT enzyme
Tx- based soy formula
תינוק בן מספר ימים מגיע למיון עם היפוגליקמיה, קטרקט דו”צ, צהבת, הפטוספלנומגליה וספסיס מ-אי קולי מגיע למיון. בבדיקת השתן חומרים מחזרים
איזו מחלה יש לתינוק בסבירות גבוהה?
גלקטוזמיה- GALT def.
Also hyperchloremic MA, Excessive brusing
