pediatric allergy

Question 1

what is the most common chronic respiratory disorder in childhood?

Answer 1

asthma

Question 2

define asthma3

Answer 2

it is a heterogeneous disease, usually characterized by chronic airway inflammation. history of respiratory symptoms: wheezes, shortness of breath , chest tightness, cough that vary over time and in intensity with expitatory airflow limitation

Question 3

what is the ratio of asthma between boys and girls before and after puberty

Answer 3

2:1 before and equal after

Question 4

what is the age of onset of asthma

Answer 4

at any age mostly before 5 years

Question 5

what is the pathophysiology?

Answer 5

when the child is subjected to a precipitating risk factor , the mast cells release cytokines that leads to: constriction, ++mucus, mucosal edema, cellular inflilitartion and desquamination

Question 6

normall the airways are narrower in expiration

Question 7

airway obstruction may lead to:4

Answer 7

area of hyperinflation
area of segmental atelectasis
alveolar hypoventilation: hypoxia, acidosis
ventilation perfusion mismatch

Question 8

what are the asthma triggers6

Answer 8

1. allergens: house dust………
2. viral infection:respiratiory syncytial virus RSV
3. cold air and exercise induced asthma
   4, emotional and psychological
4. drugs as asprin and nsads
5. pollutants, smoke

Question 9

items in diagnosis of asthma6

Answer 9

history1
2. physical examination: normal in free intervals, prolonged expiration - or + exp rhonchi in symptomatic periods accouding to the severity
3. objective measurment of air flow: PEFM and spirometry
4 . assessment of atopy
5. others: chest x ray, blood eosinophilia
6. DD

Question 10

what is the most common cause of wheezing in children

Answer 10

asthma

Question 11

what do you call the level of treatment required to control symptoms and exacerbations?

Answer 11

assessing severity of asthma as a chronic disease

Question 12

items in assessing acute attacks of asthma 10

Answer 12

talk,look, rate , rate, wheeze,conscious , O2, CO2, pEFM

Question 13

what is the difference in the assessment of asthma control between 5y and 6-11y?2

Answer 13

in older : day time symptoms,
need reliever medications more than twice a week

Question 14

what are the objectives in management asthma?4

Answer 14

1.Treat: of the acute attacks
2.Prevent: by controllers
3. Avoid the triggers
4. educate:patient and family

Question 15

see page 111

Question 16

what are the goals and primary therapies for asthma excacerbations?4

Answer 16

1. Oxygen:maintenance of adequate o saturation
2. Relief: the obstruction by rapid acting beta agonist
3. inflammation: reduction with early systemic corticosteroides
4. monitor: response to treatment with clinical assessment of lung functions

Question 17

mild and moderate managing of acute exacerbations : lines 3+consider

Answer 17

1. short acting beta2 agonist
   consider ipratropium bromide
2. controlled o to maintain saturation 93-95 children :94-95
   3.oral corticosteroides

Question 18

while asthma acute in severe

Answer 18

if drowsy and confused =ICU or
good mentality: same as mild and moderate but1. i will use ipratropium
2. consider IV magniesium
3.consider high dose of ICS

Question 19

both cases of acute finaally iw

Answer 19

Assessment :1. clinical progress 2.lung function after one hour of initial treatment

Question 20

management of acute severe asthma: life threatening condition5

Answer 20

1. Hospitalization in ICU 2. Oxygen: to correct hypoxemia
2. IV fluid therapy: maintenance therapy 4. drug therapy : separete question
3. mechanical ventilation: WHen?? withA. marked CO2 retention above 55mmhg
   B.severe hypoxemia, C.severe acidosis orD. disturbed consciousness

Question 21

what is the drug therapy in life threatening asthma5

Answer 21

1. Nebulized salbutamol: 0.25-0.5 ml added to 2-3 ml saline every 1-2 hours
2. IV salbutamol: by infusion under continuous monitor
3. IV methyl prednisolone 2mg\kg first dose followed by 2mg\kg\24 divided \6h
   or IV hydrocortisone:5-10mg\kg every 6hours
4. IV magnesium sulphate:25-75 mg\kg once slowly by infusion over 60min
5. IVaminophylline: 5mg\kg slow every 6 hours or 1mg\kg\hour

Question 22

when the asthma controllers are indicated

Answer 22

in persistent asthma

Question 23

what are the long term control medications for asthma 8

Answer 23

leukotriene receptor antagonist : montelukast
anti-IgE , anti interleukin-5
anti-cholenergic
cromones
immunotherapy:NOT more than THREE allergen…NOT under FIVE years

Question 24

stepwise for long term sthma in 5 y:
infrequent viral wheezing or few interval symptoms??

Answer 24

NOthing

Question 25

5y:symptoms not well controlled or exacerbations in 3y and up which step

Answer 25

step 2:preferred : daily low dose ICS other: LTRA or intermittent ICS

Question 26

symptoms not well controlled on low dose ICS step??

Answer 26

step 3:preferred: Double low dose ICS other: low dose+ LTRA

Question 27

symptoms not well controlled on double dose of ics step??

Answer 27

4 preferred:continue and refer to specialist other; add ltra or increase ics frequency or intermittent ics

Question 28

symptoms less twice \onth for 6-11 step

Answer 28

1 pr:no oth:daily low Ics or low ics with saba

Question 29

symptoms twice or more \month but not daily step?

Answer 29

2 p:daily low ics other:daily ltra or low ics with saba

Question 30

symptoms most days or waking from as once or more \week step

Answer 30

3 pref:low ics - laba or medium ics oth:low ics+ltra

Question 31

low lung function

Answer 31

4 prf:medium ics-laba and refer for advice oth: high dose ics-laba or add on tiotropium or add on ltra

Question 32

short course of ocs

Answer 32

5 p: refer for phenotypic +\- anti IgE oth: add on anti-IL5 or add on low ocs

Question 33

what should you consider in stepping up?4

Answer 33

1. uncontrolled symptoms 2. exacerbations or risks 3. check: diagnosis, inhaler technique , adherence first

Question 34

what should you do when stepping down2

Answer 34

1. symptoms controlled for 3 months + low risk for exacerbations 2. stopping ics is not advised

Question 35

etiology of allergic rih and conjunctivitis

Answer 35

seasonal allergic: pollens perennial: house mite pets

Question 36

what is CP of allergic rhi

Answer 36

coryza conjunctivitis sneezing itching of nose......assoctioation : eczem.asth. sinust

Question 37

whaat si th e trtt of allergic rhi

Answer 37

1. 2nd antihistamicns:topical or systemic .2. leukoterine antagonis , topicl corticosterid 3, immunotherapy

Question 38

food allergy is rare 6-8% may be igE or non igE

Question 39

what the cp of food allergy:5

Answer 39

1.skin ; itching , eczema , swelling of lips , face , tongue , throat 2. respiratory: wheezing , nasal congestion , bad breathing 3. abdomen: distension , diarrhea, nausea vomiting 4, cns:dizziness 5,cvs: anaphylaxis

Question 40

what is the onset of food allergy symptoms?

Answer 40

few minutes to 2 hours even after 1st time of ingestion

Question 41

symptoms of food allergy 5 : skin, res. cvs, cns, abo

Answer 41

itching swelling lip......throt wheezing bad breath, nasal pain. diarrhea, nause vomiting dizzines anaphylaxis

Question 42

how to diagnosis the food allergy4

Answer 42

1. typical history of exposure 2. gold stander: double blind placebo controlled food challenge 3.skin prick test 4. measurment of specific IgE

Question 43

ttt of food allergy:2

Answer 43

avoide epinephrine IM in severe

Question 44

incidence of atopic eczema or atopic dermatitis is very common

Question 45

cp of atop derma: onset of it:?

Answer 45

almost always before 5 years

Question 46

all ages can be affected by atopic derma

Question 47

treatment of derma atop:general , medications

Answer 47

1.avoid hot baths medications:1.corticosteriod cream 2. oral antihistaminces 3. some case oral cortesione 2.soft cotton clothes 3. moisturizing ointments .4.cool compresses of areas

Question 48

urticaria may be acute or chronic more than 6 weeks which usually non allergic in orgin

Question 49

what is the etiology of urticaria?5

Answer 49

q1idiopathic 2. infection 3. igE mediatied: food, blood , drugs:pencillin 4. pharmacological: foods containing histamine releasing sub:strawbe,egg,white cheese asprin non ster 5.physical: heat , cold , pressure

Question 50

acute urticaria is self limited , adrenalin insevere, short course oral cotrt for sever

Answer 50

insect bite:mild local, mod:generlized swelling or severt. :systemic child with only mild mod are UNlikely to severe who had severe carry adrenalin