History Taking

Question 1

What are 5 points you want to find out about the infections?

Answer 1

Frequency and Site 
Pathogens
Severity 
Hospital admissions 
Treatment - ABs

Question 2

PMH - 4

Answer 2

Autoimmunity
Malignancy
Immunisation history
Operations

Question 3

FH - what would you ask? - 3

Answer 3

Serious infections
Immunodeficiencies
Autoimmune diseases

Question 4

Medication:

What immunodeficiency can lamotrigine cause?

How does PHENYTOIN effect the immune system? - 2

Answer 4

COMBINED immunodeficiency

Hypogammagloblinaemia (reduced Ig)
Enlarged lymph nodes (pseudolymphoma)

Question 5

What are some warning signs of immunodeficiency

Answer 5

> 4 infections requiring antibiotics within a yr

Recurring infections needing long term antibiotics

2 or more BACTERIAL infections (deep-seated - osteomyelitis, meningitis, septicaemia, cellulitis)

2 or more XR proven pneumonias within 3 yrs

Infection with unusual localization or unusual pathogen

PID in the family

Also remember Failure to Thrive in paediatrics

Question 6

Potential Features of immunodeficiency?

Answer 6

Atypical eczema

Chronic diarrhoea

Failure to thrive

Telangiectasia

Hepatosplenomegaly

Endocrinopathy

Chronic osteomyelitis/deep-
seated abscesses

Mouth ulceration

Autoimmunity

Family history

WATCH VIDEO

Question 7

Examination:

What does ABSENT TONSILS suggest?

Weight and Height is measured

What may you see due to previous infection?

What are some autoimmune features?

Answer 7

XLA

Structural damage from infections (ears, lungs, sinuses)

Vitiligo
Alopecia
Goitre