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Nicu Brodsky+Pediatrix+NeoReview Questions > ID + Immunology > Flashcards

ID + Immunology Flashcards

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1
Q

CMV is a ____ stranded _____ virus

A

DS herpes DNA virus

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2
Q

In VLBW infants, ____ is the most common bacteria

A

E coli

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3
Q

Which TORCH-like infections increase risk of stillbirth or fetal loss?

A

Listeria, parvovirus, syphillis. Varicella and toxo do not

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4
Q

At birth, most infants with CMV are symptomatic or asymptomatic? What are routes of transmission?

A

Most are asymptomatic regardless of route of transmission. Transplacentally (all trimesters), intrapartum, BM, blood transfusions

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5
Q

Progression of maternal IgG, IgA, IgM

A

During fetal period, IgG from mother following placental transport but endocytosis, maternal IgG disappears by 9 mo

IgM: 75% of adult levels are reached by 1 year of age, some fetal IgM production

IgA: NO fetal IgA production, levels at 1 year are 20% of adult levels

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6
Q

Both term and preterm toxo are symptomatic or asymptomatic at birth?

A

ASYMPTOMATIC. 80% of infants will have both learning AND visual disabilities

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7
Q

Risk of transmission of HIV through breastmilk is ____%

A

9-15%. Viral load in human milk may not be same as that in plasma. Different antiretroviral drugs have different penetration in milk vs plasma.

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8
Q

Betamethasone is NOT recommended for gestational age ____ weeks

A

> 34 weeks

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9
Q

Kostmann Syndrome

A

congenital neutropenia that results from mutations in neutrophil elastase gene

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10
Q

What % of CONS is resistant to methicillin?

A

90%

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11
Q

Most common complication of omphalitis is ____? Risk factors for omphalitis?

A

sepsis (not nec fasc). Risk factors for omphalitis? RF: low BW, prolonged labor, PROM, maternal infection, non-sterile delivery

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12
Q

when does IgA and IgM get produced? Levels at 1 year?

A

NO fetal IgA production. Increase after birth, 20% of adult levels at 1 year.
Some fetal IgM production, levels are 75% of adult levels at 1 year

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13
Q
A
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14
Q

B cell production in fetus

A

Pre-b cells in liver at 7 weeks GA
“” “” bone marrow by 12 weeks
at 30 weeks, no detectable pre-B cells in fetal liver, and bone marrow becomes exclusive site for B-cell maturation
Birth: proportion of B cells is similar to that of adults, but absolute # of B cells I significantly higher
3-4 months: # of B cells peaks
6-7 years: declines to adult levels

Preterm infants have B-cell #’s that are comparable to those in term infants

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15
Q

Compared to neutrophils of adults, those of neonates ____

A

adhere poorly to endothelium and have poor chemotactic response

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16
Q

Neutrophils from preterm neonates vs adult neutrophils?

A

defects in phagocytosis that corrects by late 3rd trimester / term

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17
Q

What is function of complement system?

A

Principal component of natural immune system. Neutralize foreign substances in circulation or mucous membranes. Needs antibodies against particular antigen –> formation of immune complexes

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18
Q

What is early vs late complement?

A

Early (C1-C4); deficiency = increased risk of pneumococcal infections and collagen vascular dz. C2 is MC deficiency
Late complement C5-C9 leads to increased risk of Neisseria

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19
Q

septic arthritis - mobilize or no? Need bone biopsy?

A

YES to immobilize. Bone biopsy not indicated

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20
Q

what type of bacteria is clostridium botulinum

A

gram positive bacillus

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21
Q

What type of bacteria is GBS

A

gram positive diplococcus in chains

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22
Q

How has maternal GBS swabbing affected sepsis rates

A

early onset GBS has gone down, but late onset sepsis has not been affected

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23
Q

Function of neutrophils?

A

chemotaxis, phagocytosis, bacterial killing

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24
Q

Compared to adults, neonates neutrophils have _____

A

decreased migration, NORMAL killing, majority of neutrophils in BM instead of plasma. HIGHER baseline proliferation rate

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25
Placental pathologies of syphillis vs CMV
Syphillis: hydrops, marked round cell infiltration caused by maternal immunocytes CMV: villous damage with thrombosis and villitis with some villi containing inclusion body cells and hemosiderin deposits
26
osteomyelitis incidence in neonates vs older children
more common in neonates
27
Which bones are commonly affected in neonatal osteo
Long bones of lower limb, followed by long bones in upper limb. Bone marrow involvement is rare
28
Which type of HSV infection (recurrent vs primary) has higher rate of transmission?
primary infection - 57%. If mother had previous infection with different serotype, 25% risk. If recurrent infection with same serotype, 2%.
29
Suppressive acyclovir therapy decreases need for CS in women with hx of genital herpes. When to start?
36 weeks. However does NOT completely prevent viral shedding
30
If mom has primary HSV-1, but baby workup is negative, how to treat baby?
IV acyclovir x 10 days (transmission risk 57%~!)
31
What is the molecular basis for newborn screening of SCID?
detection of PCR of DNA fragments that are excised during T cell receptor rearrangement / T cell receptor excision circles
32
Partial diGeorge syndrome symptoms
Eczematous rash + lymphadenopathy --> oligoclonal expansion of peripheral T-cells. Need steroids to suppress oligoclonal T-cells and thymus transplant
33
DiGeorge syndrome IgG levels and T cells
Can have low Ig levels bc dependent on CD4% cell signals. precursor T-cells can form in bone marrow but cannot undergo maturation process in thymus
34
Mutation in leukocyte adhesion deficiency?
mutation in beta-2 integral gene leading to neutrophil dysfunction
35
Enterobacter is resistant to cefotaxime due to ______
inherited AmpC type beta lactamases (SPACE organisms - Serratia, Pseudomonas, Acinetobacter, Citrobacter, Enterobacteer)
36
Encapsulated bacteria
Hflu, neisseria meningitidis, salmonella, strep pneumo
37
Spleen function
produces IgM and complement, matures antibodies, supports proliferation of T-cells. Scavenges damaged or senescent RBCs and platelets from circulation and serves as reservoir of extra blood
38
What hematologic histology seen for non-functioning spleen?
Howell jollly bodies - small round nuclear remnants
39
What are Heinz bodies?
denatured hemoglobin and Pappenheimer bodies are granules of iron
40
Highest risk of CLABSI is in infants with _____
low birth weight and premature GA
41
If infant > 37 weeks, membrane rupture < 18 hours, GBS+ with inadequate tx, what is plan?
No labs or abx, but monitor for 48 hrs
42
What is order of most common infections in EOS
BEESL GBS, E coli, enterococcus, staph aureus, listeria
43
Blood serums HSV PCR is or is not necessary to dx disseminated dz?
is NOT
44
Most common complication of subclinical congenital toxo?
chorioretinitis. Symptomatic toxo causes intellectual disability, seizures, spasticity, deafness
45
What do white spots on umbilical cord indicate?
candida chorioamnionitis
46
Which ethnicity has highest rates of HIV transmission?
African American mothers
47
What is CGD? How to dx?
Chronic granulomatous disease - phagocytic cells (neutrophils) cannot generate superoxide that is necessary to kill bacteria. Absent or decreased neutrophil respiratory burst (nitro blue tetrazolium test) - if does not turn blue, neutrophil respiratory burst is impaired
48
Chediak Higashi syndrome
Decrease in phagocytosis. pigment dilution of skin, hair, eyes. Abnormally large granules in cells, LYST gene (lysosomal tracking regulator)
49
What are collectins?
family of soluble oligomeric proteins that play a part in host defense of neonate --> related in structure to complement protein C1q. Mannose-binding lectin SP-A, SP-D
50
Which of rubella and CMV have cataracts?
RUBELLA. both can have blueberry muffin rash. CMV has chorioretinits.
51
Next best step in Asymptomatic infant born to woman with untreated gonorrheal infection
tx with both topical ophthalmic erythromycin and IV/IM CTX
52
Which TORCH infections increase risk of stillbirth?
Listeria, parvo, syphillis
53
How to tx mom who gets varicella in pregnancy?
VZIG only! (Vaccine is live)
54
How to reduce CMV transmission in BM?
freezing or pasteurization. CMV more likely to occur among preterm bc term infants receive more passively transferred maternal ab
55
Transmission time for CMV, syphillis, rubella, toxo
CMV - transmission can occur anytime, but more severe if earlier Syphillis - can transmit at any time but more severe if acquired LATER Rubella - transmission is U-shaped (RU-bella) but more severe if acquired earlier Toxo - transmission INCREASES with gestation, but more severe if acquired earlier
56
How long do you wait to swab baby's skin if concerned for HSV and why do we wait?
12-24 hrs - make sure not contamination
57
Manifestations of early vs late-onset listeria? Method of transmission?
Early-onset listeria = transplacental; late-onset = contact during delivery with vaginal flora. Early-onset: PNA and sepsis Late-onset: Meningitis
58
How to definitively tell HIV negative
1)Two negative HIV RNA or DNA viral test results, from separate specimens, both of which were drawn at ≥2 weeks of age and one of which was drawn at ≥4 weeks of age 2)One negative HIV RNA or DNA viral test result from a specimen drawn at ≥8 weeks of age 3)One negative HIV antibody test result drawn at ≥6 months of age
59
What is pleconaril
antiviral capsid binding drug that inhibits viral attachment to host cells; can be useful for enterovirus
60
IgA and IgM production for neonate
IgA is produced after birth. 20% of adult levels at 1 year of age IgM is 75% of adult levels by 1 year of age
61
B-cell production in neonates
At birth, proportion of B cells is similar to adults, but absolute # is significantly higher - # peaks at 3-4 months of age 12 weeks - BM produces B-cells 30 weeks - BM becomes exclusive site for B-cell maturation
62
Neutrophils in babies; term vs preterm
***Neutrophils from term/preterm adhere poorly to endothelium and have impaired chemotaxis. NORMAL killing. Neutrophils from preterm are bad at phagocytosis, correct by late 3rd trimester or term Neutrophils from term have granule contents + degranulation similar to adults Baseline Higher proliferation rate; does not increase production as rapidly as adult
63
What is classic complement? where do they converge? What does complement do?
Classic complement - C1, C4, C2, C3 Classic and alternative converge at C3 Complement plays role as natural immune system - facilitates neutralization of foreign substances in circulation or in MM Requires specific ab against particular Ag, leading to formation of immune complexes
64
Electromyography of clostridium
Clostridium EMG - Incremental response at high-frequency *Abnormal spontaneous activity
*Abundant, brief, small-amplitude action potentials
65
Placental path of syphillis
hydrops and round cell infiltration caused by maternal immunocytes
66
Osteomyelitis facts; neonates vs children
osteomyelitis is more common in neonates than children Neonates - hematogenous spread; more likely to have new bone formation and bone remodeling. Children - contiguous spread Vascular anatomy of neonates = more likely to have septic arthritis. BOny destruction less common in neonates bc thin periostea tissues allows for spontaneous drainage of bony abscess. The thin periostea llayer is good for protecting the BM though.
67
Does recurrent HSV increase risk of infection?
no!
68
DiGeorge syndrome and precursor T-cells
Patients with DiGeorge syndrome have absent or hyoplastic thymuses. Therefore, the precursor T-cells formed in the bone marrow cannot undergo their maturation process in the thymus
69
Spleen function
Spleen does NOT excrete extra iron It saves as site of IgM and complement production Maturation of ab Supports proliferation of T-cells Scavenges damaged RBC and platelets; recycles iron from hemoglobin for use in hematopoiesis
70
Greatest risk for CLABSI?
infant's GA and BW
71
MC complication of untreated toxo?
chorioretinits
72
Transmission of HBV to infant is associated with
maternal HBV load If HB e+, then risk of transmission higher than if negative
73
characteristic rash of congenital syphillis
vesicular or bullous skin lesions; usually rupture to form spuperficial crusted erosions or ulcerations. Generalized, involves palms + soles

Nicu Brodsky+Pediatrix+NeoReview Questions (14 decks)

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