AAP Prep: Chronic Urticaria & Hemolytic Syndrome

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Questions and Answers

What tests should be conducted for a patient with chronic urticaria (>6 wk)?

CBC

ESR/CRP

TSH

All of the above (correct)

What is the first line treatment for urticaria?

H1 antihistamines

What are the two categories of hemolytic uremic syndrome?

Diarrhea-positive and diarrhea-negative

What characterizes Grade 1 - 3 ankle sprains?

Grade 1 is a stretched ligament, Grade 2 is a partial tear, and Grade 3 is a complete tear. Signup and view all the answers

What are the Ottawa ankle criteria for ordering radiographs?

Inability to bear weight or bony tenderness at ankle malleoli. Signup and view all the answers

What is the initial treatment for GAS pharyngitis?

Oral PCN V x10d or IM benzathine PCN G x1 dose. Signup and view all the answers

What is indicated for Na < 120 mEq/L?

IV hypertonic (3%) saline. Signup and view all the answers

What are the indications for renal replacement therapy in renal failure?

Volume overload, hyperkalemia, and uremia. Signup and view all the answers

What triggers paradoxical vocal fold dysfunction (PVFD)?

Exercise. Signup and view all the answers

What indicates insulin management in newly diagnosed T2 diabetics?

Plasma glucose > 250 mg/dL and hemoglobin A1c > 9%. Signup and view all the answers

What are the maternal quadruple screening results associated with Trisomy 21?

Low AFP and estriol, high hCG and inhibin A. Signup and view all the answers

What are the indications for CT after a closed head injury?

GCS ≤ 14, altered mental status, palpable skull fracture. Signup and view all the answers

What symptoms indicate the need for observation vs CT after a closed head injury?

Isolated loss of consciousness, headache, vomiting. Signup and view all the answers

Who should receive passive immunoprophylaxis after exposure to VZV?

Immunocompromised individuals and pregnant women. Signup and view all the answers

What is a common reason for frequent bacterial infections in young children?

Innate immune system dysfunction. Signup and view all the answers

What is the treatment for perichondritis of the ear?

IV antibiotics with activity against pseudomonas. Signup and view all the answers

What does low urine sodium concentration indicate in a patient with low effective circulatory volume?

Low urine sodium concentration suggests advanced dehydration or volume depletion. Signup and view all the answers

Study Notes

Chronic Urticaria Testing

Testing includes CBC, ESR/CRP, and TSH to rule out autoimmune conditions and thyroid diseases.
Food allergies are rarely linked to chronic urticaria lasting over six weeks.

Treatment for Urticaria

First line of treatment: H1 antihistamines.
Second line includes H2 antihistamines and leukotriene modifiers.
Third line treatment consists of systemic steroids.

Hemolytic Uremic Syndrome (HUS) Categories

Diarrhea-positive HUS often caused by STEC (EHEC O157:H7).
Diarrhea-negative HUS associated with worse outcomes due to malignancy, medications, SLE, pregnancy, or genetic factors.

Sprains Classification and Common Ligaments

Grade 1: ligament is stretched.
Grade 2: partial ligament tear.
Grade 3: complete ligament tear.
Most affected ligaments in ankle sprains are the anterior talofibular and calcaneofibular ligaments.

Ottawa Ankle Criteria for Radiographs

Patients unable to bear weight on the affected ankle require radiographic imaging.
Tenderness at the tip or posterior aspect of ankle malleoli indicates the need for further evaluation.

GAS Pharyngitis Treatment

Initial treatment options include oral PCN V or oral amoxicillin for ten days, IM benzathine PCN G as a single dose, or cephalosporins if PCN allergic.
For recurrent cases or PCN anaphylaxis, prescribed oral clindamycin for ten days.

Indications for IV Hypertonic Saline

Recommended when sodium levels are below 120 mEq/L.
Presence of neurological symptoms such as headaches, seizures, or coma strengthens the indication for administration.

Renal Replacement Therapy Indications

Volume overload with complications.
Severe hyperkalemia.
Uremia characterized by BUN exceeding 100 mg/dL or significant acidosis.

Paradoxical Vocal Fold Dysfunction (PVFD)

Exercise is a common trigger.
Diagnosis possible through direct laryngoscopy showing vocal cord adduction with a posterior chinklike opening.
Managed with laryngeal control therapy focusing on diaphragmatic breathing and relaxation techniques.

Insulin Management in Newly Diagnosed T2 Diabetes

Initiated when plasma glucose levels exceed 250 mg/dL.
Also indicated if hemoglobin A1c is greater than 9%.

Maternal Quadruple Screening for Trisomy 21

Results indicate low AFP and estriol levels combined with high hCG and inhibin A levels.

CT Indications After Closed Head Injury

Glasgow coma scale score of 14 or lower.
Presence of alteration in mental status, palpable skull fracture, or signs of basilar fracture warrants a CT scan.

Observation vs. CT After Closed Head Injury

Patients with isolated loss of consciousness, headaches, or vomiting may be observed for 6-8 hours.
CT is necessary if symptoms worsen or do not improve.

Passive Immunoprophylaxis After VZV Exposure

Recommended for individuals with congenital or acquired T-lymphocyte immunodeficiency, certain neoplasms, post-HSCT, or immunosuppressive therapy.
Pregnant women are also eligible for this prophylaxis, which can be administered within 10 days of exposure.

Frequent Bacterial Infections in Young Children

Suggests an innate immune system dysfunction, such as Chronic Granulomatous Disease (CGD) from CYBB mutations or leukocyte adhesion deficiencies (LAD).

Treatment of Perichondritis of the Ear

IV antibiotics effective against pseudomonas, specifically ciprofloxacin, are the treatment of choice.

Urine Sodium Concentration in Low Effective Circulatory Volume

A low urine sodium concentration is indicative in cases of dehydration, nephrotic syndrome, cirrhosis, or congestive heart failure.

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Description

Prepare for the AAP exam with these flashcards focusing on chronic urticaria, treatment options, and hemolytic uremic syndrome. Each card provides crucial information to help clarify definitions and management strategies in pediatric care.