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US Pediatric Boards Edited COPY > allergy > Flashcards

allergy Flashcards

1
Q

Breast feeding reduces the risk for what diseases?

A

Nothing!!! It only delays onset of allergies

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2
Q

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

A

One parent with atopy = 50% risk

Two parents with atopy = 70% risk

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3
Q

What 2 environmental exposures increase asthma risk?

A

Dust mites and smoking

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4
Q

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

A

Nasal smear shows eosinophils

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5
Q

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

A

Non allergic rhinitis with eosinophilia syndrome (NARES)

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6
Q

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

A

Eliminate offending agent

Nasal steroid

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7
Q

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

A

Vasomotor rhinitis

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8
Q

What is rhinitis medicamentosa?

A

Rebound nasal congestion after adrenergic nose drops

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9
Q

What is required for the diagnosis of hay fever?

A

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

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10
Q

Which childhood allergies are typically NOT outgrown?

A

Peanuts
Tree nuts
Seafood

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11
Q

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

A

Hot pressed peanut oil

Sunflower oil

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12
Q

What is the dose for epinephrine in anaphylaxis?

A

If >30 kg, 0.3 mg

If <30 kg, 0.15 mg

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13
Q

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

A

Epinephrine

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14
Q

When is urticaria considered chronic?

A

6 weeks

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15
Q

How should you manage chronic urticaria?

A

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

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16
Q

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

A

Nothing. Skin test does not predict cause of chronic urticaria

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17
Q

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

A

Nothing. There is no correlation between shellfish allergy and contrast

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18
Q

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

A

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

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19
Q

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

A

Premedicate with antihistamines and prednisone

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20
Q

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

A

Referral to allergist

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21
Q

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

A

Venom immunotherapy is 98% effective in preventing future reactions

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22
Q

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

A

Type 2

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23
Q

What type of allergic reaction is immune complex mediated ?

A

Type 3

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24
Q

How should penicillin allergy be tested for?

A

skin igE testing which must show reaction within 24 hours

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25
Q

In what situations is skin testing falsely negative?

A

Antihistamines

Antidepressants

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26
Q

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

A

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

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27
Q

What is RAST testing and what is te benefit ?

A

In vitro and not impacted by antihistamines

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28
Q

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

A

Ataxia telangiectasia

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29
Q

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

A

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

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30
Q

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

A

B cell dysfunction

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31
Q

What type of immunodeficiency presents with recurrent candida infection?

A

T cell dysfunction

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32
Q

What condition causes eczema and thrombocytopenia?

A

Wiskott-Aldrich syndrome

33
Q

What is the genetic defect associated with digeorge syndrome?

A

Deletion of the long arm of chromosome 22

34
Q

What are the signs of digeorge syndrome?

A 
Cardiac defects
Abnormal facies
Thymic hypoplasia
Cleft palate
Hypocalcemia (no parathyroid)
35
Q

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

A

Thymic transplant

36
Q

How night a child with digeorge syndrome present?

A

With infections
Diarrhea
Tetany

37
Q

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

A

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

38
Q

What is the treatment for SCID?

A

Bone marrow transplant

39
Q

What might labs show in a patient with SCID?

A

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

40
Q

How is wiskott Aldrich inherited?

A

X linked

41
Q

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

A

Low IgM causing humoral and cellular immunodeficiency

42
Q

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

A

Briton disease (x linked agamnaglobulinemia)

43
Q

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

A

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

44
Q

How do you diagnose bruton disease?

A

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

45
Q

How do you treat brutons disease?

A

IVIG to protect from recurrent bacterial infections

46
Q

What are children with brutons disease at increased risk for?

A

Bronchiectasis and chronic pulmonary insufficiency

47
Q

What is the treatment for CVID?

A

IVIG

48
Q

What diseases are children with CVID at increased risk for?

A

Autoimmune conditions (RA, thyroid dz) and lymphoma

49
Q

What types of infections are recurrent in children with CVID?

A

Upper and lower respiratory tract infx, herpes and zoster

50
Q

What is the pathophysiology of CVID?

A

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

51
Q

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

A

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

52
Q

What are the presenting signs of hyper IgM syndrome ?

A

Frequent otitis and sinopulmonary infx, diarrhea and opportunistic infections

53
Q

What lab findings are present in hyper IgM?

A

Low IgA, IgG and IgE

High IgM

54
Q

In what immunodeficiency is Ig replacement appropriate?

A

X linked hyper IgM syndrome

55
Q

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

A

Hyper IgM

56
Q

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

A

IgA deficiency - recurrent sinopulmonary infections

57
Q

What is job syndrome and it’s symptoms ?

A

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

58
Q

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

A

Transient hypogammaglobulinemia of infancy

59
Q

What is the genetic transmission of chronic granulomatous disease?

A

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

60
Q

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

A

Chronic granulomatous disease

61
Q

What organs are involved in chronic granulomatous disease?

A

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

62
Q

What are common infections in patients with chronic granulomatous disease?

A

Staph aureus Abscess
Serratia UTI
Fungal infection

63
Q

How do you diagnose chronic granulomatous disease?

A

Nitro blue tetrazolium which assays phagocytic oxidase activity

64
Q

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

A

Aggressive antibiotics and interferon gamma

65
Q

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

A

Peri-rectal abscess
Indolent skin infections
Omphalitis
Delayed umbilical separation

66
Q

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

A

Delayed wound healing

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

67
Q

How do you treat leukocyte adhesion deficiency?

A

Bone marrow transplant

68
Q

How are complement deficiencies inherited?

A

Autosomal recessive except properdin deficiency which is x linked

69
Q

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

A

Complement deficiency

70
Q

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

A

Decreased C4 but infants may present with elevated immunoglobulin

71
Q

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

A

HIV, malignancy and TB

72
Q

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

A 
Cd4 = helper T cell
Cd8 = suppressor T cell
73
Q

What type of medication is zidovudine?

A

Nucleoside analog reverse transcriptase inhibitor (NRTI)

74
Q

What type of medication is nevirapine?

A

Non-nucleoside reverse transcriptase inhibitor (NNRTI)

75
Q

What type of medication is indinavir?

A

Protease inhibitor

76
Q

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

A

Immunoglobulin levels

77
Q

What is considered a normal nitroblue tetrazolium test?

A

If normal neutrophil activity the test turns blue

78
Q

What test is specific for leukocyte adhesion deficiency?

A

rebuck skin window - tests the ability of cells to migrate

79
Q

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

A

Food allergy testing

US Pediatric Boards Edited COPY (23 decks)

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