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US Pediatric Boards Edited > allergy > Flashcards

Flashcards in allergy Deck (79):
1

Breast feeding reduces the risk for what diseases?

Nothing!!! It only delays onset of allergies

2

What is the most important risk factor for development of allergic disease ?

One parent with atopy = 50% risk
Two parents with atopy = 70% risk

3

What 2 environmental exposures increase asthma risk?

Dust mites and smoking

4

You suspect allergic rhinitis, How can you confirm the diagnosis?

Nasal smear shows eosinophils

5

What condition presents with eosinophils on nasal smear but negative skin test?

Non allergic rhinitis with eosinophilia syndrome (NARES)

6

What is the first step in treating allergic rhinitis and the first line treatment?

Eliminate offending agent
Nasal steroid

7

What is the diagnosis in a patient with nasal congestion, rhinorrhea and post nasal drainage triggered by emotions or weather?

Vasomotor rhinitis

8

What is rhinitis medicamentosa?

Rebound nasal congestion after adrenergic nose drops

9

What is required for the diagnosis of hay fever?

Repeated exposure to pollen , child usually > 3 y/o

10

Which childhood allergies are typically NOT outgrown?

Peanuts
Tree nuts
Seafood

11

What type of oils are okay for patients with peanut allergy?

Hot pressed peanut oil
Sunflower oil

12

What is the dose for epinephrine in anaphylaxis?

If >30 kg, 0.3 mg
If <30 kg, 0.15 mg

13

How do you treat a child with hx milk allergy who complains of stomach ache after lunch?

Epinephrine

14

When is urticaria considered chronic?

6 weeks

15

How should you manage chronic urticaria?

2nd/3rd generation antihistamines
Benadryl for breakthrough
No allergy testing or steroids

16

A patient with chronic urticaria has positive skin test for dogs , what should you do?

Nothing. Skin test does not predict cause of chronic urticaria

17

What should you do in a patient with shrimp allergy who needs IV contrast ?

Nothing. There is no correlation between shellfish allergy and contrast

18

What is the mechanism of an allergic reaction to contrast media?

Osmolality hypertonicity triggers de granulation of mast cells (not IgE mediated)

19

What do you do for a patient with radio contrast allergy who needs contrast?

Premedicate with antihistamines and prednisone

20

What should you do for a child with a mild systemic reaction to bee sting?

Referral to allergist

21

What should you do for a child with life threatening reaction to a bee sting and why?

Venom immunotherapy is 98% effective in preventing future reactions

22

What type of allergic reaction is antibody mediated ?(type 1-4)

Type 2

23

What type of allergic reaction is immune complex mediated ?

Type 3

24

How should penicillin allergy be tested for?

skin igE testing which must show reaction within 24 hours

25

In what situations is skin testing falsely negative?

Antihistamines
Antidepressants

26

What is the difference between management of a milk allergy that develops urticaria vs eczema rash?

Urticarial rash needs referral to allergist but eczema rash is T cell related and does not require referral

27

What is RAST testing and what is te benefit ?

In vitro and not impacted by antihistamines

28

What disease may be the diagnosis in a patient with awkward gait and frequent sinus infections?

Ataxia telangiectasia

29

What should you consider in a child with a new infection every month?

Reassure the mother - unless recurrent infections are coupled with poor growth

30

What type of immunodeficiency is being presented in a patient with recurrent Pyogenic infections?

B cell dysfunction

31

What type of immunodeficiency presents with recurrent candida infection?

T cell dysfunction

32

What condition causes eczema and thrombocytopenia?

Wiskott-Aldrich syndrome

33

What is the genetic defect associated with digeorge syndrome?

Deletion of the long arm of chromosome 22

34

What are the signs of digeorge syndrome?

Cardiac defects
Abnormal facies
Thymic hypoplasia
Cleft palate
Hypocalcemia (no parathyroid)

35

What is the best therapeutic approach to treatment of digeorge syndrome?

Thymic transplant

36

How night a child with digeorge syndrome present?

With infections
Diarrhea
Tetany

37

What may be the presenting signs in a child with SCID and what defect do they have?

Defect in B and T cell function causes dermatitis, diarrhea, FTT and life threatening infection

38

What is the treatment for SCID?

Bone marrow transplant

39

What might labs show in a patient with SCID?

WBC can be low, normal or high
B cell count might be normal
Absent T cell function

40

How is wiskott Aldrich inherited?

X linked

41

What is the cause of immunodeficiency in Wiskott-Aldrich syndrome ?

Low IgM causing humoral and cellular immunodeficiency

42

What condition has a lack of B cells with decrease lymphoid tissue?

Briton disease (x linked agamnaglobulinemia)

43

What is the typically presentation of a child with bruton disease?

Infant male with recurrent infection from encapsulated Pyogenic bacteria (pseudomonas, h flu or strep pneumo)

44

How do you diagnose bruton disease?

Low immunoglobulin levels - confirmed by B and T cell subsets (t calls may be elevated)

45

How do you treat brutons disease?

IVIG to protect from recurrent bacterial infections

46

What are children with brutons disease at increased risk for?

Bronchiectasis and chronic pulmonary insufficiency

47

What is the treatment for CVID?

IVIG

48

What diseases are children with CVID at increased risk for?

Autoimmune conditions (RA, thyroid dz) and lymphoma

49

What types of infections are recurrent in children with CVID?

Upper and lower respiratory tract infx, herpes and zoster

50

What is the pathophysiology of CVID?

Defective antibody response - B cells do not differentiate into plasma cells ; also T cell defect in most patients

51

What is the genetic inheritance of hyper IgM? What is the cellular defect?

X linked / absence of CD40 ligand and T cell abnormality which prevents conversion of IgM to IgG

52

What are the presenting signs of hyper IgM syndrome ?

Frequent otitis and sinopulmonary infx, diarrhea and opportunistic infections

53

What lab findings are present in hyper IgM?

Low IgA, IgG and IgE
High IgM

54

In what immunodeficiency is Ig replacement appropriate?

X linked hyper IgM syndrome

55

A patient without HIV presents with pcp pneumonia, what syndrome should you consider?

Hyper IgM

56

What's the most common immunodeficiency and what does it cause?

IgA deficiency - recurrent sinopulmonary infections

57

What is job syndrome and it's symptoms ?

Hyper IgE - eosinophilia, eczema and recurrent sinopulmonary infections, skeletal abnormalities and abnormal facies

58

In what condition does decreased helper T cell function lead to low IgG and IgA?

Transient hypogammaglobulinemia of infancy

59

What is the genetic transmission of chronic granulomatous disease?

2/3 are x linked and 1/3 autosomal recessive

60

What is the disorder in which phagocyte dysfunction prevents respiratory burst?

Chronic granulomatous disease

61

What organs are involved in chronic granulomatous disease?

Skin, GI, lungs, liver, lymph nodes and spleen

62

What are common infections in patients with chronic granulomatous disease?

Staph aureus Abscess
Serratia UTI
Fungal infection

63

How do you diagnose chronic granulomatous disease?

Nitro blue tetrazolium which assays phagocytic oxidase activity

64

How would you treat a patient who presents with chronic granulomatous disease and an infection?

Aggressive antibiotics and interferon gamma

65

What are common infections/problems found in leukocyte adhesion deficiency?

Peri-rectal abscess
Indolent skin infections
Omphalitis
Delayed umbilical separation

66

What is characteristic of the wound infections found in patients with LAD?

Delayed wound healing
No pus and little inflammation (poor chemo taxis of wbc)

67

How do you treat leukocyte adhesion deficiency?

Bone marrow transplant

68

How are complement deficiencies inherited?

Autosomal recessive except properdin deficiency which is x linked

69

What should you consider in a patient with overwhelming meningococcal infection?

Complement deficiency

70

What immunological labs would be abnormal in a child with HIV ?

Decreased C4 but infants may present with elevated immunoglobulin

71

What 3 conditions should you consider in a child with fever, weight loss, night sweats and malaise ?

HIV, malignancy and TB

72

Which T cells are helper cells and which are suppressor cells?

Cd4 = helper T cell
Cd8 = suppressor T cell

73

What type of medication is zidovudine?

Nucleoside analog reverse transcriptase inhibitor (NRTI)

74

What type of medication is nevirapine?

Non-nucleoside reverse transcriptase inhibitor (NNRTI)

75

What type of medication is indinavir?

Protease inhibitor

76

What test would you get in an infant with recurrent infections that started after age 6 months?

Immunoglobulin levels

77

What is considered a normal nitroblue tetrazolium test?

If normal neutrophil activity the test turns blue

78

What test is specific for leukocyte adhesion deficiency?

rebuck skin window - tests the ability of cells to migrate

79

What is the proper way to diagnos a toddler with atopic dermatitis ?

Food allergy testing