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1
Q

Clinical description for intermittent asthma

A

2 or less days a week

Zero night time

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2
Q

Tx of intermittent asthma

A

Albuterol prn

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3
Q

Classification for mild persistent asthma

A

More than 2 days a week

Night time 1-2 a month

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4
Q

Tx of mild persistent asthma

A

Low dose inhaled steroids + albuterol prn

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5
Q

Classification of moderate persistent asthma

A

Every day

Night time 3-4 per month

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6
Q

Tx for moderate persistent asthma

A

Low medium dose inhaled steroid and long acting bronchodilator or monteleukast.

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7
Q

Classification of severe persistent asthma

A

Daily symptoms

Night time > 1/wk

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8
Q

Tx for severe persistent asthma

A

High dose inhailed steroid + long acting bronchodilator or monteleukast

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9
Q

Signs of hypercapnia in an asthmatic patient

A

Agitation, flushing, mental status change, headache, tachycardia

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10
Q

Risk factors for hospitalization for asthma

A

Chronic steroid use

Hospitalization within past year

Low socioeconomic status/low educational level

Previous life threatening episode

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11
Q

Risk factors for asthma persisting into adulthood

A

Onset before 3 years of age

IgE elevation

Maternal hx of asthma

Eosinophilia

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12
Q

What are the types of hypersensitivity reactions

A

Type I - igE mediated, anaphylactic

Type II - mediated by antibodies

Type III - immune complex

Type IV - delayed hypersensitivity

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13
Q

What is perennial allergic rhinitis d

A

Due to exposure to indoor allergens such as dust mites, animal dander

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14
Q

Which fruits should someone with latex allergy avoid (7)

A

Avocado, banana, chestnut, fig. kiwi, peach, tomato

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15
Q

By what age is milk, egg and soy allergy outgrown?

A

5

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16
Q

Signs of an anaphylactic reaction

A

Respiratory distress, urticaria, general discomfort

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17
Q

How long must urticaria last to be considered chronic?

A

> 6 wks

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18
Q

What is the most likely cause of chronic urticaria

A

Food

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19
Q

What is pretreatment with prednisone and Benadryl indicates prior to contrast media?

A

With a hx of adverse reaction to radiocontrast media

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20
Q

What are sings of systemic reactions to stings

A

Hypotension, wheezing and laryngeal edema

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21
Q

You have a child with a systemic reaction to bee stings. What’s is the next step?

A

Allergy referral and epipen

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22
Q

How does parental hx affect allergic components

  • 1 parent
  • both parents
  • 1 sibling
A
  • 50 percent risk
  • 70 percent risk for atopic disease
  • 20-35 percent risk
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23
Q

Buzz words for ataxia telangiectasia

A

Ataxia, discoloration of conjunctivae, frequent sinus infections, developmental regression

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24
Q

A deletion in the long arm of chromosome 22 is what disorder

A

DiGeorge

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25
What is the presentation if DiGeorge syndrome
CATCH-22 Cardiac, abnormal facies (low set ears), thymic hypoplasia, cleft palate, hypocalcemia (tetany) - no parathyroid
26
What causes SCID
Complete absence of b and T cells
27
Buzz words for SCID
Failure to thrive Chronic diarrhea Recurrent opportunistic infection including thrush Presents within the first 3 months of life
28
How do you SCREEN for SCID
CBC may have a low WBC No matter the white count there will be a complete absence of T cell function (a low lymphocyte count would correlate with T cell dysfunction) A normal lymphocyte count does not rule out SCID
29
Treatment for SCID
Initially supportive. Bone marrow transplant is curative.
30
What is the presentation for Wiskott-Aldrich syndrome
- male (x linked) - eczema - recurrent sinopulmonary infection (cellular immunodeficiency, WBC) - unusual bleeding (low platelet count AND small platelets)
31
Most common cause of death for boys with wiskott-Aldrich
Lymphoma
32
What are the cellular immune deficiencies? (4)
T cell dysfunction (low lymphocytes) *present due to infections from opportunistic organisms (candida, CMV, pneumocystis jiroveci) - ataxia telangiectasia - DiGeorge - SCID - wiskott-Aldrich
33
What are the humoral immune deficiencies? (6)
Due to antibody deficiencies (b cells) * symptoms do not appear until 4-6 months due to initial protection by maternal antibodies - IgA deficiency - Brutton's x linked agammaglobulinemia - common variable immunodeficiency - x linked hyper IgM syndrome - Job syndrome (hyper IgE) - transient hypogammaglobulinemia of infancy
34
How does IgA deficiency present?
Recurrent sinopulmonary infections with encapsulated bacteria (step pneumonia and h. Flu)
35
How does Britton x linked agammaglobulinemia present
Baby boy with recurrent infections with encapsulated progenie bacteria (strep pneumonia and h. Flu) NOTE: will have elevated T cell count
36
What is the result of the absence of B cells?
Low levels of IgG, IgA, IgM and IgE Lymphoid tissue such as tonsils, adenoids, peyers patches, peripheral lymph nodes as well as the spleen are reduced in size
37
What are boys with brutton x linked agammaglobulinemia at risk for?
Bronchiectasis and chronic pulmonary insufficiency
38
How do you diagnose and treat B cell deficiencies?
Measuring immunoglobulin levels and if low measuring b and T cell sunsets IVIG
39
What is the most common primary immunodeficiency?
IgA
40
What is the most common clinically significant primary immunodeficiency?
Common variable immunodeficiency
41
How does common variable immunodeficiency present
Recurrent infections of the upper and lower respiratory tract and frequent GI symptoms Recurrent heroes and zoster infections are common *NOTE: B and T cell defect
42
Kids with common variable immunodeficiency may also have associated illnesses like -
Autoimmune diseases Lymphoma
43
How does x linked hyper IgM present
Male with frequent otitis and sinopulmonary infections as well as diarrhea
44
Lab studies for x linked hyper IgM
Low levels of all antibodies except IgM High IgM
45
What is the hallmark of hyper IgM syndrome
Lymphoid hypertrophy despite antibody deficiency
46
How does job syndrome present
Eosinophilia, eczema and elevated IgE Infections usually with staph a. Kids can also get chronic thrush and will have multiple fractures or other skeletal abnormalities
47
Treatment for job syndrome
Antibiotic and steroids Not IVIG
48
What does the lab finding for transient hypoagammaglobulinemia of infancy show? And tx?
Severely low levels of IgG, low IgA and normal IgM Kids outgrow by 3-6 years
49
Laboratory finding for CVID
Low IgG AND | Low IgA or IgM
50
What's a form of SCID due to enzyme deficiency
ADA - adenosine deaminase def which leads to accumulation of toxic levels of deoxyadenosine which inhibits T cell maturation and function absolute neutrophil count is very low <500
51
Presentation for chronic granulomatous disease
Deep abscesses, pneumonia, lymphadenitis, osteo, systemic infections Present before 5 yrs of age, x linked most common
52
Diagnostic test for chronic granulomatous disease
Nitriblue tetrazolium test (NBT) Normal turns blue and abnormal stays colorless
53
How does leukocyte adhesion deficiency present
Boards - delayed umbilical separation with omphalitis Real life - high WBCs with absence of neutrophils. Infected area has no puss and minimal swelling. Perirectal abscess, indolent skin infections, omphalitis
54
Diagnostic test for LAD
Flow cytometry for CD18
55
Presentation of chediak-Higashi syndrome
Frequent infections of lung and skin, easy bruisability and oculocutaneous albanismn (Very fair skinned blonde, blue eyed with frequent skin infections)
56
What will you find in a blood smear that is diagnostic of chediak-higashi
Giant lysosomal granules in neutrophils (WBC). The wbcs also have abnormal chemotaxis
57
How do you screen for complement deficiency
CH50 assay
58
What are deficiencies affecting the terminal components (c5-c9) associated with
Recurrent neisseria infections and increased risk for meningitis
59
What is c3 deficiency associated with
Recurrent sinopulmonary infection and sepsis with encapsulated bacteria
60
Triggers for non allergic rhinitis
Cold air, strong odors, spicy foods
61
How is the arthritis in Lyme disease
Pauciaetucular involving large joints
62
How do you diagnose Lyme disease
Lyme antibody titer and then a western blot to confirm
63
Tx for Lyme disease
Doxy for over 8 yrs Amox for under 8 yrs Course 14-21 days
64
Presentation for sarcoidosis
Weight loss and fatigue with hilar adenopathy, chronic cough in afebrile pt Noncaseating granulomas and bilateral peribronchial on CXR Granulomas secrete vit d leading to hypercalcemia and hypercalcuria resulting in renal disease and eye disease
65
Triad of sarcoidosis
Arthritis, rash, uveitis
66
How do you differentiate sarcoidosis from TB
Sarcoidosis involves the heart Ekg with rhythm disturbance would distinguish sarcoidosis from TB
67
Criteria for diagnosis of lupus (10) and how many required for diagnosis
``` Malar rash Discoid lesions Photo sensitivity Oral ulceration Arthritis and serositis Hematological abnormalities Renal abnormalities Anti ds DNA, anti DNA, anti smith antibodies Psychosis or neurological abnormalities Positive ANA ``` 4
68
How do you track severity of disease flare ups in lupus
Anti-ds DNA high when flare up low when not. C3 and c4 inversely correlate. Low in active or acute disease
69
What must you think of in a newborn with bradycardia
Neonatal lupus and third degree heart block
70
What maternal antibodies are associated with neonatal lupus
Anti SSA and anti SSB antibodies
71
Synovial fluid WBCs in septic arthritis
50,000-300,000 and low glucose and bacteria
72
Synovial fluid WBC in normal
WBC < 200
73
Synovial fluid WBC in lupus, rheumatic fever and arthritis due to trauma
5,000 for first 2 2,000
74
Synovial fluid WBC in JIA and reactive arthritis
15,000-20,000

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