1
Q
Breath sounds in the physical exam of an asthmatic
A
sounds of wheezing heard during normal breathing
forced exhalation
porlonged phase of forced exhalation
2
Q
Definintion of Atopy
A
- genetic predisposition to develop immunoglobulin E (IgE) mediated response to aeroallergens
The strongest identifiable predisposing factor for developing asthma
3
Q
Definintion of Atopy
A
- genetic predisposition to develop immunoglobulin E (IgE) mediated response to aeroallergens
The strongest identifiable predisposing factor for developing asthma
4
Q
what is eczema aka as? what is is?
A
Atopic dermatitis a chrinic or chronically relapsing pruritic condition with cutaneous hypersensitivity Characterized by very dry skin, eczematou patches (tiny bubbles), and lichenification
5
Q
Risk factors for eczema
A
- Family history
- certain foods
- climate
- stress
- sweating
- aeroallergens
6
Q
Exam findings in eczema: by age group: Infants: age 2-12 adolescents:
A
itching, esp at night in infants:erythema and scaling of the cheeks, chin, scalp, extensor surfaces, generalized re papules, exudative lesions Children 2-12: red papules coalesce into plaques, scratching with lichenification, flexural surfaces are commonly affected Adolescents; flexural surfaces with lichenifcation: neck, foot, and hand dermatitis more common, puberty may trigger exacerbation
7
Q
Airflow limitation in asthma iscaused by a variety of changes in the airway which include:
A
- Bronchoconstriction
- airway edema
- airway hyperresponsiveness
- airway remodeling
8
Q
Airflow limitation in asthma iscaused by a variety of changes in the airway which include:
A
- Bronchoconstriction
- airway edema
- airway hyperresponsiveness
- airway remodeling
9
Q
Airway edema in asthma is caused by
A
- inflammation
- mucus hypersecretion
- mucus plugs
- structural changes: hypertrophy and hyperplasia of the airway smooth muscle
10
Q
What causes airway hyperresponsiveness in asthma?
A
inflammation is the major factor
11
Q
What causes airway remodeling in asthma?
A
- permanent alterations in the airway structure thought to be caused by chronic inflammation
- airflow limitation may only be partially reversible in some people
12
Q
What causes airway remodeling in asthma?
A
- permanent alterations in the airway structure thought to be caused by chronic inflammation
- airflow limitation may only be partially reversible in some people
13
Q
deficit in lung function growth happens in what age group when diagnosed with asthma?
A
children whos symptoms begin in the first 3 years of life
14
Q
Preventable: Asthma risk factors Non: preventable:
A
- allergen exposure
- tobacco smoke exposure
- outdoor and indoor air pollution
- occupational exposures
- genetics
- Hx atopic dermatitis
- viral infections
- airway size (prematurity)
15
Q
Immediate or early Asthma response
A
occurs within minutes of exposure immediate bronchoconstriction (hyperresponsiveness) resolves with B2 agonist use
16
Q
Immediate or early Asthma response
A
occurs within minutes of exposure immediate bronchoconstriction (hyperresponsiveness) resolves with B2 agonist use
17
Q
Three criteria for diagnosing asthma
A
- Episodic sx of airflow obstruction or airway hyperresponsiveness are present (recurrence)
- Airflow obstruction is at lease partially reversible (responds to tx measured by spirometry w/ significant post bronchodilator relief of symptoms
- Alternative diagnoses are excluded
18
Q
measurement of Reversibility by spirometry
A
- Increase in FEV1 of > 12 % from baseline or
* increase in FEV1 > or = 10% of predicted after inhalation of SABA
19
Q
key history indicators of asthma
A
- Wheezing
- hx of cough worse at night
- recurrent wheeze
- recurrent difficulty breathing
- recurrent chest tighness
- sx worsen with exercise, viral infection, allergens, changes in weather, strong emotional expression, airborne chemicals or dust, menstrual cycles
- sx occur, worsen at night/ wake pt up
20
Q
Thoracic findings in physcial exam of asthmatic
A
Hyperexpansion of the thorax
use of accessory muscles
appearance of hunched shoulders
Chest deformity
21
Q
Thoracic findings in physcial exam of asthmatic
A
Hyperexpansion of the thorax
use of accessory muscles
appearance of hunched shoulders
Chest deformity
22
Q
Exam findings of the nose in an asthmatic
A
increased nasal secretion, mucosal swelling, nasal polyps
23
Q
exam findings of the skin in asthmatics
A
atopic dermatitis
24
Q
at what age can you use spirometry?
A
at least not until 5: some say not reliable till age 7
25
what does spirometry test?
one true objective assessment:
| indicates degree of airflow obstruction
26
what is FVC?
forced vital capacity: maximum olume of air forcibly exhaled from the point of maximal inhalation
27
what is FEV1?
forced expiratory volume of air exhaled in 1 sec
28
what should be included on the pedi spirometry measures due to it being a more sensitive marker of impairment than FEV1 in kids?
FEV1/FVC
29
What does a positive methacholine test mean?
asthma med trial: positive is not definitive, can be from other diseases
Neg rules out asthma
30
What does a positive methacholine test mean?
asthma med trial:
31
How is the degree of narrowing determined with a methacholine or histamine test?
Spirometry
32
What is the reversibility test after a methacholine or histamine test?
Going a bronchodilator to counteract the bronchconstrictor then preparing spirometry
33
D/D's of Asthma
```
AR
Sinusitis
Foreign body in trachea or bronchi
Vocal chord dysfunction
Vascular rings or laryngeal webs
Largyngomalacia
Tracheal stenosis
Bronchostenosis
Viral bronchitis or bronchiolitis
BPD
Heart disease
```
34
What are the aspect of asthma impairment?
```
S/S
Night awakenings
Use of SABAs
Work or school missed
Interference w normal activity
Quality of life assessment
PFTs
```
35
What are the aspects of asthma risk?
ED or hospitalizations
| Exacerbations requiring steroid bursts
36
Classifications of control
Well controlled
Not well controlled
Very poorly controlled
37
Step 1 of managing asthma
Needs SABA only occasionally
38
What is important about steps 2-6 in asthma management?
Need a controller med
39
At what step therapy should u consult a specialist?
Step 3 or higher
40
How is severity classified?
Spirometry
| Recall of s/s in previous 2-4 wks
41
What is included in consideration risk of death of asthma
Reduced lung growth measure by failure to obtain PFTs values for age
Progressive loss of pulmonary function
Risk of adverse effects from meds
42
what body position will an asthmatic assume during an emergency?
tripod to try to get more diaphragmatic movement
43
exam findings during asthmatic emergency
```
breath sounds from wheezing to silent chest
suprasternal or intercostal retractions
accessory muscle use
"worried look"
increased RR
SOB
decreased activity tolerance
nasal flaring
may not be able to complete a sentence
```
44
predictors of risk of exacerbations of asthma?
sever airflw obstruction as measured by spirometry
persistent airflow obstruction
2 ED visits or hospitalizations in past year
intubation or ICU admission ever, especially if in last 5 years
pt reports they feel in danger or frightened
femlae
nonwhite
nonuse of ICS
smoker
depression
stress
attitudes/beliefs about taking medicine
45
when to refer to asthma specialist
```
life thratening evernt
2 steroid bursts in one yr or a hosptializations
poor control at 3-6 months of therapy
problems diagnosing
complicating comorbid conditions
need further education
need immunotherapy
if step 3 is required in 0-4 age group
```
46
what is a PFM used for? (Peak Flow Meter?)
measures large airway function, good monitoring device, can be used for self monitoring during exacerbations.
especially good for pts who have difficulty perceiving signs of worsening asthma
47
big prinicples of step therapy in asthma
if not well controlled, step up
go by the most sever syptom or criterion
if they had exacerbations whould probably step up
48
What step does mild persistant ashtma in the 0-4 age group require? What does therapy involve?
Step two:
low dose ICS
alternate: singulair or cromolyn
49
what step does intermittent asthma need in the 0-4 age group?
Step one:
| SABA PRN
50
What step does persistent: moderate or severe asthma need in the 0-4 age group? what does it involve?
```
may need steroid burst
start with step 3:
*Medium dose ICS
Step 4:
* medium dose ICS + either singulair or LABA
```
51
When to start daily control meds in the 0-4 age range
if 4 episodes of wheezing in last year that lasted longer than 1 day AND that affected sleep AND who have risk factors for developing persistent asthma
consistently require symptomatic relief more than two days per week for 4 weeks
have 2nd exacerbation requiring steroid burst within 6 months
52
what are risk factors for developing persistent asthma per the guideline requiring daily controller meds?
a parent w/ asthma or
a physcician dx of atopic dermatitis or
evidence of sensitivity to aeroallergens or
2 of the following:
*evidence of sensitization to foods
* > or = 4% Peripheral blood eosinophilia
* wheezing apart from colds
53
tx of exacerbations due to URI in ages 0-4
mild s/s: SABA q4-6 hoursx 24 hours
moderate-severe: steroid burst
for those with history of sever s/s, consider initiating steroid burst at 1st sign of URI
54
what is the step needed for intermittent asthma in ages 5-11?
Step 1: SABA PRN
55
What is the step needed for persistent mild asthma in ages 5-11?
Step 2:
Perferred: Low dose ICS
alternate; singular, cromolyn, nedocromil, theophylline
56
what is the step needed for moderate or sever persistent in ages 5-11?
start with step three: Low dose ICS + either LABA, singulair or theophylline OR Medium dose ICS
Step 4:
Perferred: medium dose ICS + LABA
alternative: medium dose ICS + either sigular or theophyillin
57
adjusting therapy based on control: Well controlled
Well controlled: maintain tx, follow up in 1- 6 months, step down if well controlled for at least 3 months
58
adjusting therapy based on control: not well controlled
Step up 1 step
follow up in 2-6 weeks
if side effects consider alternative tx options
0-4: if not better adjust therapy again or consider another diagnosis
59
adjusting therapy based on control: very poorly controlled
Consider steroid burst
go up 1-2 steps
follow up in 2 weeks
if side effects: consider alter. tx options
if 0-4: if no benefit in 4-6 weeks consider alter. dx or adjusting therapy again
60
Rules of 2 with using controller meds in asthma
```
uses SABA > or = to 2 times a week
awakens at night > or = 2 times a month
refills SABA > 2 times/ year
has > or = 2 unscheduled visits/ year due to asthma
requires > or = 2 steroid bursts/ year
```
61
Dosages of ICS vary according to what?
whether persistent asthma is mild, moderate, or severe
62
ICS and the effect on linear growth
not significant: approximately 1 cm in first year of threatment, generally does not progress over time after this
63
What is the risk of high dose ICS for prolonged periods, particualarly in association with frequent oral steroid bursts?
what can help?
associated with adverse growth effects
risk of cataracts
reduced bone density
*be sure they get enough calcium and vitamin D
64
what is the primary cell that drives asthma?
eosinophils
65
what happens in early stage of asthma?
FEV drops by 40% in 15 min: mast cells in lungs have antibodies called IgE that are specific to particular antigens: mast cell releases HISTAMINE and causes:
Contraction of smooth muscles of the bronchioles
Mast cell secretes histamine until it is gone, about 3 hours later, after it is gone, pt feels better, FEV1 up to about 80%
66
what happens in late stage of asthma?
Mast cell releases other mediators: PAC, ECF, LRD4, NCF:
4-6 hours later: airway diamerter further decreases from INFLAMMATION, thickening of the bronchiole wall, and mucus production
67
Why does airway remodeling occur?
EOS are designed to fight off parasites, instead they are turned loose in our lungs, causes gradual scarring. used to think this was reverisble...now we think it isnt
68
Fever is normally maintained by what?
the hypothalamus
69
what happens in fever as the setpoint is raised?
```
they hypothalmus signals increase in heat peroduction and conservation
peripheral vasoconstriction
epi relase
muscle tone increses: shivering
person feels cold: bundles
```
70
what happens when fever breaks?
```
hypotalamus signals a decrease in heat porduction and increase in heat reduction
decreased muscle tone
peripheral dilation
flushing of the skin
sweating
person feels warm, stretches out
```
71
benefits of fever:
kills many microorganisms
has adverse effects on the growth and replication of others
decreases serum levels of iron, zinc, and copper, which are needed for bacterial replication in infected cells
increases lymphocytic transformation and motility of PMS: facilitates the immune response
enhances phagocytosis
72
when to treat fever:
to imporve childs overall comfort rather than focus on the normalization of body temp
73
Why do neonates sometimes not have a fever response or become hypothermic during significant infection?
immature liver
74
why is hyperthermia different than fever?
hyperthermia is marked warming of core temperature that is NOT mediated by pyrogens and there is no resetting of the hypothalaic set point
75
Fever of short duration
accompanined by localizing s/s, in which a diagnosis can be established by clnical history or physcial exam
76
Fever without localizing signs (FWS)
AKA fever without source
| H & P fails to establish a cause of fever, frequently occurs in kids < 3 years
77
Fever of Unknown origin (FUO)
fever present for > 14 days that does not have an etiology despite H & P, labs
older kids and adolescents: fever over 38 C for more than 2 weeks that remains udiagnosed despite detailed comprehensive eval for 7 days
78
Bacteremia
positive blood culture
79
sepsis
infection of the blood stream by microorganisms or their toxins: a systemic response to the infection
80
sepsis manefestations
hyperthermia or hypothermia, tachycardia, tachypnea, Shock
| May be irritable or lethargic, poor perfusion, may have DIC (petechiae or ecchymosis)
81
causes of febrile illness in < 3 month olds
most common: common viruses
* Bacteremia: S pneumo, Hib, slamonella, GBS, N. meningitidis
* UTI:E coli
* Pneumonia: S. pneumo, S. aureus, GBS
* Meningits: S. Pneumo, Hib, GBS, meningococcus, HSV, enteroviruses
* Bacterial Diarrhea: slamonella, shigella, E coli
* Osteomyelitis or septic arthritis: S. aureus, GBS
82
Causes of febrile Illness in 3 months to 2 years: at risk for organisms with polysaccharide capsules: which ones?
Strep pneumo
H flu type B
meningococci
Salmonella
83
management in fever infants < 1 month
hospitalize
maintain ABX pending cultures
CBC with diff, cultures, maybe LP. CXR
84
management of fever in infants 1-3 months
if appear well and labs fine: probably ok
| if looks sick: need to admit
85
risk factors for occult bacteremia in children < 3 years of age
Temp > or = 102.2
WBC > or = 15,000
elevateed absolute neutrophil, bands, ESR or CRP
86
How can you change the set point?
antipyretics
87
shift to the left
incrase in numbers of circulating imature cells of the neutrophil series: including band forms, metamyelocytes, and myelocytes
88
what might you see on a WBC in the first 24-48 hours of a viral infection?
transient low lymphocyte count
89
which WBCs are the granulocytes?
neutrophils, basophils, eosinophils
90
which WBCs are the agranulocytes?
lymphocytes and monocytes
91
what is the function of neutrophils
combats pyogenic infections
| most important leukocyte in reaction to inflammation
92
what is the function of eosinophils?
combat allergic disorders and parasitic infections
93
what is the function of basophils
combat parasitic infections, some allergic disorders
94
what is the function of lymphocytes
combat viral infections
95
what is the function Monocytes
combat severe infections
| bodies 2nd line of defense against infections
96
what is a normal WBC for 0-2 weeks of age?
9000 - 30,000
97
what is a normal WBC for 2-8 weeks of age?
5000 - 21,000
98
what is normal WBC in 2 mos to 6 years?
5000-19,000
99
what is normal WBC in 6-18 years
4800 - 10,800
100
what could elevated CRP and TNF be associated with?
bacterial disease
101
two patterns of fever in FUO
Prolonged daily fevers
| repeated discrete febrile episodes over a prolonged period of time
102
most cause of FUO fall into to what 3 categories
Infectious, infalmmatory or rheumatoid, neoplastic
103
definition of a febrile seizure
seizure accompanied by fever w/out cental nervous system infection occuring in infants an children between 6 months and 5 years
104
meds that can cause fever
```
penicillins
cephalosporins
acetaminophen
anticonvulsans
methylphenidate
```
105
noninfectious diseases that present with fever
```
rheumatoid diseases
kawasakis disease
inflammatory bowel disease
poisoning
malignancy
```
106
what is a chronic cough defined as?
lasting longer than 3 weeks
107
type of cough usually seen in a URI
dry hacking cough
108
type of cough usually seen in sinusitis
cough more than 10 days w/ purulent nasal discharge
109
type of cough in asthma
grunting cough
110
type of cough in laryngitis
dry hacking cough with hoarsness
111
type of cough in croup
barking cough and stridor, w/ or w/out fever
112
type of cough in tracheitis
cough and striodr precded onset of respiratory distress
113
type of cough in bronchitis:
hacking cough appears several days after onset of a typical URI
114
type of cough in pertussis
paroxysmal cough: violent, may be staccato like followed by a whoop
115
type of cough in bronchiolitis
rhinorrhea precedes the cough which is persistent and harsh with expiratory wheezing
116
type of cough in pneumonia
associated with rales and wheezes
117
type of cough in Chlamydia pneumonia
in 1-3 months of age: staccato cough w/ conjunctivitis, tachypnea, rales
118
type of cough in mycoplasma
paroxysmal, uncommon before age 5
119
cough associated with bronchiectasis:
chronic productive cough w/ crackles and rhonchi
120
s/s of foreign body aspiration
choking, gagging, followed by persistent coughing and wheezing
121
cough + sore throat + fever =
influenza
122
illnesses that cause paroxysmal cough
pertussis
mycoplasma
chlamydia
123
illnesses that cause bry barking brassy cough
Viral croup
| epiglottitis
124
what causes moist cough
hallmark of supperative lung disease
125
illnesses that cause staccato cough
Pertussis
| chlamydia pneumonia
126
illness that causes loug honking cough
habitual or psychogenic
127
illnesses characterised by nonproductive cough
Viral rhinitis
AR
Asthma
Foreign body
128
illness that cause clear or mucoid productive cough
Asthma
AR
Smoking
129
Illnesses that cause purulent, prodcutive cough
CF
Bronchiectasis
Pneumonia
lung abscess
130
Illnesses that cause blood streaked, productive cough
TB
Diphtheria
Nasopharyngeal irritation
Pneumonia
131
illness that causes malodorous, productive cough
sinusitis
132
What is procutive cough upon awakening attributed to?
Bronchitis or sinusitis
133
illnesses associated with cough and fever
viral or bacterial infection: croup, pneumonia, TB, pertussis
134
illnesses associated with hemoptysis
```
Bronchitis
Foreign body
Lung abscess
Bronchiectasis
CF
```
135
illness associated with cough and stridor
Croup
Foreign body
Epiglottitis
136
illnesses associated with cough and wheezing
Asthma
bronchiolitis
foreign body aspiration
pneumonia
137
illnesses associated witch cough and conjunctivitis
measles
| chlamydia in newborns
138
illnesses associated with cough and feeding problems
congenital malformation
pneumonia
CHD
Aspiration
139
cough associated with cold air
vasomotor rhinitis
140
illness associated with cough and cyanosis
foreign body
bronchiolitis
asthma
141
Dysphagia with coughing suggests
esophageal foreign body
142
dysphonia with coughing suggests
laryngeal or glottis pathology
143
what are the three stages of pertusiss?
catarrhal stage:, paroxysmal stage, and convalescent stage
144
what is the cararrhal stage of pertussis?
```
last 1-2 weeks
mild URI sx
dry cough
low grade fever or afebrile
sneezing
lacrimation
red conjunctiva (suffusion)
```
145
What is the paroxysmal stage of pertussis?
2-4 weeks
paroxysmal coughing, increases in severity and intensity
noram b/t coughing episodes
worseing cough followed by whoop and often vomiting
apnea in young infant
146
What is the convalescent stage of pertussis?
1-2 weeks but my be longer
| number, severity, and duration of coughing diminishes
147
when does a pertussis culture usually not turn positive until?
after 4 weeks of sx
148
CBC results in pertussis
leukocytosis with lymphocytosis and thrombocytosis: most pronounced with unimmunized people
may not be in infants
149
CXR in pertussis
perihilar infiltrates ( butterfly appearance) and atelectasis are common
150
what does pertussis look like in the catarhal stage?
a viral URI
151
DOC in pertussis and dose
emycin: 40mg/kg/day bid for 14 days
152
how long must pt be in isolation with pertussis
until treated with 5 days of ABX for 5 days
153
Stridor is seen in airway obstruction where?
above or below the glottis
154
what illnesses is stridor usually seen in?
```
croup
epiglotitis
laryngitis
bacterial tracheitis
laryngomalacia
```
155
inspiratory stridor with laryngomalacia will get worse when?
```
LYING SUPINE
NECK FLEXION
W/ CRYING
W/FEEDING
AGITIATION
INCREASED ACTIVITY
URI
```
156
when does laryngomalacia usually resolve by?
18 months
157
presentation of tracheomalacia can be delayed until when?
2-3 months
158
what does stridor from tracheomalacia get worse from?
crying
agitiation
feeding
URIs
159
what noise can be heard with tracheomalacia?
inspiratory stidor when extrathoracic
| expiratory wheeze when intrathoracic
160
what is the triad of sx in viral croup?
barking cough, inspiratory stridor and hoarseness
161
what age is viral croup most prevalent?
6 months to 3 years
162
what age is spasmodic croup more prevelant?
3 months - 3 years
163
what X ray finding will you see with croup? how do you find it?
steeples sign : start at 3rd or 4th rib and look up
164
what X ray finding will you see in epiglottits
Thumb sign
165
how does croup present in the beginning?
starts with a cold: 1-4 day cryzal prodrome
166
what pulsus paradoxus?
large inspriatory drop in SBP because of airway obstruction
167
tx of croup
raccemic epi for emergent care
humitiy at home
tent or face mask in hosptial
steroids: in ed (im decadron) or at home: prednisone or pulmocort
168
what organism generally causes epiglottitis?
HIB
169
sx of epiglottitis?
```
sudden onset of high fever
resp distress
sever dysphagia
muffled voice
dooling, can't swallow
```
170
tx of epiglottits?
ceftrioxone and immediate intubation
171
most common cause of tracheitis
Staph aureus
172
sx of tracheitis
```
sx progress over 8-10 hours
fever
appears toxic
lethargy
axiousness
cough
dyspnea
stridor
noisy respirations
cyanosis
retractions
barking cough
air hunger
```
173
comon sequela of tracheitis
tracheal stenosis: even w/out intubation
| maybe pneumonia
174
what is bronchiolitis?
```
acute lower resp. infection:
acute inflammation
edema
necrosis or epithelial cells lining small airways
increased mucus production
bronchospasm
```
175
what is the most commone lower respiratory tract infection in infants?
bronchiolitis
176
manifestations of bronchiolitis
```
rhinorrhea (thick)
watery eyes in RSV
may have otitis
sneezing
hacking cough
may have low grade fever
later:
rapid breathing and wheezing
feed poorly leads to poor hydration
```
177
X ray fidings of bronchiolitis
```
air trapping
flattened diaphragm
peribronchial thickening
atelectasis
diffuse infiltrates
```
178
causes of bronchitis
viral in younbg: RSV, parainfluenza, flu, rhinovirus, adenovirus
Mycoplasma in school age and adolescent
179
what is bronchitis?
inflammation of the trachea and bronchi
180
cough associated with bronchitis?
dry, hacking, nonproductive cough after a URI
181
sx in mycoplasma or influenza bronchitis:
HA, myalgia, anorexia, and letharty
182
lung sounds in bronchitis
rhonchi and no rales
| if wheezing, indicates lower disease or RAD
183
onset of bacterial pneumonia
rapid: fever and resp distress
184
WBC in viral vs bacterial pneumonia
viral: not elevated: lymphocytes predominate
bacterial: 15,-20 thousand, neutrophils predominate
185
most common causes on pneumonia in newborns
Group B strep
E coli
Staph aurus
chlamydia: maybe 1/3 of all pneumonia up to 6 months
186
x ray findings in chlamydia pneumonia
hyperinflation and bilateral insterstitial infiltrates
187
most commone causes of pneumonia in kids < 5
S pneumo and H flu
188
most common causes of pneumonia in kids > 5 years
S. pneumo and mycoplasma
189
manefestations of mycoplasma pneumonia
```
hallmark:
fever
cough (paroxysmal)
fatigue
other:
HA
myalgia
sore throat
m/p rash
```
190
x ray in mycoplasma pneumonia
patchy unilateral segmental consolidation OR diffuse bilateral intersitial infiltrates
191
lobar consolidation on X ray: which organisms?
strep and H flu
192
hilar adenopathy seen in?
TB
193
pneumatoceles seen in which organisms?
Staph Aureus and gram neg
194
manifestions of flu
```
fever
cough
sore throat
runny nose
muscle or body aches
headache
fatigue and malaise
vomiting and diarrhea
```
195
type of flu that has been associated with more illness and more deaths
H3N2
196
when are false positive and tru negative flu test results most likely to occur?
when the disease prevelance is low (usually beginning and end of season)
197
when are false negative and true positive flu test results most likely to occur?
when the disease prevelance is high, typically at the height of the season
198
CXR in flu
usually normal
199
how long does it take for viral flu culture to come back?
2 to 6 days
200
most common complications of the flu
```
OM
sinusitis
pneumonia
dehydrationb
worsening of chronic med conditions
febrile seizures
reyes syndrome
acue myositis
```
201
antiviral meds for flu
neuraminidase inhibitors: Tamiflu or Relenza
start by 2 days of symptoms
can expect one day of shortening
202
side effects of tamiflu
N/V expecially in 2 days of tx; take with food
203
how old must u be to get tamiflu?
1 year
204
important about relenza
is inhaled: cant be given if breathing problems
205
age u must be for relenza
7 years for tx: 5 years for prevention
206
characteristics of type one hypersensitivity reaction
```
due to a previous exposure to an allergen
happens in:
hayfever
asthma
anaphylactic shock
It is IgE mediated
```
207
how soon does a type I HS reaction occur?
it is immediate: within one hour
208
how are classic IgE mediated Type I reactions best tested?
scratch or prick tests
209
What is a type II HS reaction?
antibody is directed against a self antigen or a semi self antigen
they are antibody mediated cytotoxic reactions where cells are attacked (can be RBCs, Platelets, kidney, neuromuscular and thyroid cells
The antigen is usually NONSELF: from a drug, virus or part of a bacterium
210
what is the test for type II HS reaction?
coombs test: test if one is making antibodies against own RBCs
211
What is a type III HS reaction?
antigen attaches to part of an IgG molecule and another and another; forming immune complexes
they happen when there is lots of antibody around and lots of antigen around and clog things up like:
Capillary beds
filtering organs
lungs
212
What can type III HS reactions cause?
```
immune mediated vasculitis: inflammation of the blood vessels: ulcers on legs, feet
erythema multiforme
henoch schonlein purpura
steven johnson syndrom
toxic dermal necrolysis
```
213
what is the time frame of a type III HS reaction?
usually within 12-24 hours
214
What drugs most likely cause type III HS reactions?
cephalosporins
sulfas
CT scan dye
215
example of type III HS reaction?
serum sickness
216
what is a type IV HS reaction?
delayed HS reaction
| occurs and causes inflammation reaction
217
testing for a type IV HS reaction:
patch test: allergen is put on the skin and covered with a patch and checked 48 hours later
218
Examples of type IV HS reactions
```
ppd skin test
poison ivy
nickel allergen
neomycin allergy
topical meds like benadryl cream
latex (can be type I or IV)
```
219
what is the mechanism behind allergy to cold or cold induced urticaria or anaphylaxis?
some protein changes shape when it gets cold and becomes an antigen
220
what causes hives?
vasodilation and increased permeability of capillaries of the skin as the result of mast cell release
221
if no itching during a HS reaction what does that usually mean?
usually not IgE mediated reaction
222
what is the dose of epi pen?
0.01ml/kg: max: 0.3 to 0.5 ml:
| repeat Q15 min until reaction subsides
223
what are most common food allergies attributed to (foods)?
```
peanut
soy
egg
wheat
milk
nuts
fish
shellfish
```
224
before puberty, sebaceous glands are
atrophic
225
what is another name for a closed comedone
whitehead
226
what is another name for an open comedone
blackhead
227
what are characteristics of mild acne ?
comedones without inflammation, no redness to the lesions, no papules, no pustules, no cysts
228
what are characteristics of moderate acne?
comedones + papules + or - local inflammation: no pustules
229
what are characteristics of moderate-severe acne?
comedones + papules + pustules
230
what are characteristics of severe acne?
nodules, cysts
231
which topical acne med should be avoided in dark skinned individuals?
axelacic ace: allergan or azelex
232
side effect in tetracycline, minocycline, and doxycycline?
staining of the teeth, dont use in kids < 8years old
Peds Primary care 2
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