IID & Immuno Flashcards
(212 cards)
1
Q
Congenital syphilis skeletal abnormalities
A
- demineralization of proximal medial tibia (Wimberger sign)
- sawtooth metaphyseal serration (Wegener sign)
- diaphyseal periosteal reaction with new bone formation
- Irregular areas of rarefaction and increased density (moth-eaten appearance)
2
Q
Small stippled epiphyses and cortical thickening
A
congenital hypothyroidism
3
Q
osteopenia with callus formation and pseudo paralysis
A
osteogenesis imperfecta
4
Q
extensive bone resorption and generalized bone radiolucency.
A
Hyperparathyroidism
5
Q
umbilical cord with blue and red stripes interspersed with white areas
A
subacute necrotizing funiculitis; congenital syphilis
6
Q
HIV viral loads checkpoints for baby born to mother with well controlled HIV
A
<48 hours
14 to 21 days after birth
1 to 2 months of age
4 to 6 months of age.
7
Q
GBS facts
A
- encapsulated by a polysaccharide layer rich in sialic acid
- catalase-negative, bacitracin resistant, and forms beta-hemolysin, a pore-forming toxin that destroys the host’s red blood cells resulting in hemolysis
8
Q
Hutchinson triad
A
- Hutchinson teeth
- interstitial keratitis
- SNHL
9
Q
common microbes isolated from peritoneal cultures in cases of spontaneous intestinal perforation.
A
Candida and coagulase-negative staphylococcus epidermidis
10
Q
XR findings and timing of signs in osteomyelitis
A
Diagnosis may be apparent on XR by 7 to 10 days post-infection as evidenced by bony destruction, focal area of metaphyseal necrosis, and soft tissue swelling.
do skeletal survey to assess other bone invovement
11
Q
Cytomegalovirus virus type
A
double-stranded herpes DNA virus passed via secretions, sexual
intercourse, blood products, transplacental, intrapartum or via breastmilk→ standard
12
Q
Rubella type and precautions
A
RNA virus passed via respiratory secretions→ contact and respiratory
droplet
13
Q
Listeria: type and precautions
A
gram-positive rod passed via unpasteurized milk and soft cheeses, uncooked meat
and unwashed raw vegetables→ standard
14
Q
ParvoB19: type and precautions
A
single-stranded DNA passed via respiratory secretions, transplacental→
droplet
15
Q
HSV type and precautions
A
double-stranded herpes DNA virus passed via contact with lesions, or
rarely transplacental→ contact
16
Q
Toxo type and precautions
A
intracellular parasite passed by poorly cooked meat, cat feces or
transplacental→ standard
17
Q
RSV type and precautions
A
RNA paramyxovirus passed by direct contact with secretions,
highly contagious→ contact
18
Q
Varicella type and precautions
A
DNA herpes virus passed via respiratory droplets, contact with rash or transplacental→ airborne and contact
19
Q
HIV type and precautions
A
RNA retrovirus passed via blood, sexual contact,
transplacental or via breastmilk→standard
20
Q
TB type and precautions
A
slow-growing acid-fast bacillus
respiratory secretions
mucous membranes or skin
rarely hematogenous spread from an infected placenta or aspiration of infected amniotic fluid
airborne and contact
21
Q
Risk of stillbirth
A
Listeria, Parvovirus B19, Syphilis, Malaria
22
Q
CMV transmission via BM
A
- CMV transmission via breast milk is more likely to occur among preterm infants
- Freezing and pasteurization reduces CMV transmission
23
Q
Toxoplasmosis Transmission and Severity
A
Transmission increases with GA
Severity decreases with GA
24
Q
Treponema pallidum transmission and severity
A
Transmission can occur at any time
Severity increases with GA
25
Rubella transmission and severity
Transmission most likely in early and late pregnancy (U-shaped
distribution)
Severity decreases with GA
26
CMV transmission and severity
Transmission any time
Severity decreases with GA
27
Timing of HSV surface cultures in asymptomatic exposued in infant
12-24 hours after birth
28
When does IgG disappear?
9 months
29
When does IgG decrease
6 months
30
HIV positive mom breastfeeding concerns
Antiretroviral drugs have differential penetration in human milk, raising concerns about toxicity
to infants receiving breastmilk
31
Definitive rule out of HIV in infant born to HIV positive mother
1) 2+ negative HIV RNA or DNA ≥1 months age (1 ≥4 months)
2) 2+ negative HIV Ab test ≥6 months
32
When does IgA production begin in neonate
After birth
33
Osteomyelitis MC sites
METAPHYSIS
femur > humerus > tibia > radius > maxilla
34
Osteo treatment
21-42 days PCNase resistent penicillin, aminoglycoside or cephalosporin
35
septic arthritis treatment
2-6 weeks PCNase resistent penicillin and aminoglycoside
36
osteo prognosis
joint deformities if epiphyseal plate damage
37
septic arthritis prognosis
greater risk than osteo of permanent abnormality
38
omphalitis treatment
PCNase resistant - use methicillin/nafcillin/oxacillin
vanco if MRSA
gentamicin or cephalosporin
+ anaerobic if black periumbilical region
39
Meningitis spread
hematogenous
40
Duration of treatment for meningitis
10-14 days GBS
14-21 days Listeria
21+ days for GNR
41
if E.coli UTI consider what other disease
galactosemia
42
acute purulent conjunctivitis
s. aureus
43
N.gonorrhea conjunctivitis prevention and treatment
0.5% erythro preventino
treat with 3rd gen cephalosporin
44
Chlamydia treatment
no prevention
treat with 14 days PO erythromycin 20% require 2nd course
45
which is MCC conjunctivitis
chlamydiae
46
which conjunctivitis is more puruluent
gonorrhea
47
Chorioretinitis causes and differences
salt and pepper: syphillis, Rubella
yellow + white lesions: HSV, CMV
atrophic: toxo
fluffy white: candida
48
MCC serotype GBS
III
49
IAP effect on late onset GBS
none
50
GBS mortality EOS and LOS
5-10% and 2-6%
51
MCC serotype listeria EOS
serotype Ia and Ib
52
AF in listeria
chocolate colored
53
LOS
IVB
54
mortality of listeria
EOS 25% and late 15%
55
Syphillis placenta
large
56
Syphilis % symptomatic
33%
57
Nontreponemal screening tests
VDRL and RPR
58
Treponemal confirmatory tests
FTA-ABS, particle agglutination or enzyme immunoassay
59
how long do treponemal tests stay reactive
for life even after treatment
60
What disease leads to false positive treponemal test
Lyme disease with ANA positive; VDRL will show true negative
61
False positive non-treponemal tests
AI, TB, viral, endocarditis, passive maternal IgG
62
False negative non-treponemal tests
early primary, latent, late congenital or if prozone phenomenon (excess Abs prevent complexing - so dilute the sera)
63
when do you repeat a negative treponemal test if non-treponemal screening was positive
2-4 weeks
64
when to retreat infant with syphillis
if titers (obtained 2,4,6,12 mos) are increasing or persistent - LP and treat with PCN 10 days
65
Diagnosis media for gonorrhea
Thayer-Martin (rapid plating)
66
GC conjunctivitis requires emergent treatment bc
corneal ulceration or perforation
67
what is not seen on gram stain
chlamydia trachomatis
68
C.trach treatment
14 days PO erythromycin base or ethylsuccinate
69
untreated maternal chlamydia ppx for infant
none
70
untreated maternal gonorrhea ppx for infant
1 dose ceftriaxone
71
TB transmission congenital and postnatal
congenital:hematogenous and infected AF
postnatal: resp secretions or traumatized MM or skin
72
asymptomatic baby, active TB mom
what is testing plan?
inh for 3-4 months then ppd
**positive** > reassess for TB
if no disease INH 9 months (12 if HIV)
**negative** > dc INH
repeat PPD q2-3mos for 1 year then yearly
isolate baby if mother noncompliant, respiratory symptoms or MDR
73
congenital TB treatment
| what do you add if meningitis?
INH, RIF, pyrazinamide + aminoglycoside
+ CTX if meningitis
typically 9-12 months
74
C.botulinum affects what neurotransmitter
ACh release --> descending paralysis, ocular palsy, poor feeding
75
Dx botulinism
Stool toxin
EMG: incremental response at high fx, abnormal spontaneous activity, abundant & brief small amplitude AP
76
TX botulinism
human derived IV botulism Ig
NOT abx - aminoglycosides can increase NM blockade
77
C.tetani affects what neurotransmitter
blocks **GABA** and **NMJ** --> difficulty swallowing, rigidity, muscle spasms, fever, continuous crying, seizure, lockjaw
78
Tx C.tetani
**tetanus Ig** : neutralize circulating unbound toxin
**PCN G** 10-14 days
**diazepam** for muscle spasms
still need **vaccine** because disease does not confer immunity
79
Use of dexamethasone in H.influenzae
to prevent hearing loss in meningitis - give with or before first dose of antibiotics
80
most common strain of RSV
A
81
Infant > 2000 g what to do based on maternal hep B status
**negative** - hep B after birth
**unknown** - test mom ASAP, hep B to baby < 12 hours; 7 days await moms results
**positive** - hep B vax + HBIg < 12 hours
+2 more doses for all
Breastfeeding does not increase risk
82
Infant < 2000 g what to do based on maternal hep B status
**negative** - hep B when > 2000 g, 30 days or at dc whichever first
**unknown** - test mom ASAP, hep B vax < 12 hours; 12 hours to await moms results
**positive** - hep B vax + HBIg < 12 hours
+3 more doses (unless first given > 2000g then only 2 more)
Breastfeeding does not increase risk
83
maternal hep C positive
test neonate, NAAT at 1-2 months
84
ToRCH highest risk LBW
CMV
85
ToRCH highest risk HSM
CMV
86
ToRCH highest risk jaundice
CMV
87
ToRCH highest risk petechiae
CMV
88
ToRCH highest risk CHD
Rubella (esp if <10 wk GA
89
ToRCH highest risk cataracts
rubella
90
ToRCH highest risk chorioretinitis
toxo
91
ToRCH highest risk microcephaly
CMV
92
ToRCH highest risk cerebral calcifications and locations
toxo cortical > CMV periventricular
93
HIV subtypes
HIV 1: M (major), O (outlier), N (new)
HIV 2 milder
94
PCP infection in HIV infants
at 3-6 months; radiographic diffuse alveolar infiltrative pneumonia
95
Preferred test to diagnose HIV1 and what does timing of positivity tell us about method of transmission?
HIV1 DNA PCR
Positive < 2 days - in utero infection
Positive day 2-6 - intrapartum infection
96
HIV positive mom when to test baby
< 48 hours
14-21 days
1-2 months
4-6 months
97
a nonbreastfeeding baby is considered presumptive negative if
2 negative PCR > 2 weeks and > 4 weeks
1 negative PCR > 8 weeks
1 negative Ab > 6 months
98
Zidovudine is what type of drug
nucleoside analogue reverse transcriptase inhibitor
99
Neviripine is what type of drug
non-nucleoside reverse transcriptase inhibitor
100
How long should HIV exposed babies get bactrim?
start at 4-6 weeks and if determined negative can stop
continue 1 year if positive, longer if abnormal CD4 count
101
Enterovirus diagnosis and management
reverse transcriptase PCR and culture of any body fluid
Tx IVIg if life threatening disease; pleconaril but not currently available
102
difference betweem ampho b and liposomal ampho b
liposomal is less nephrotoxix
103
candida may have resistance to which antifungal
fluconazole
104
how does ampho b and fluconazole work
-_ampho B_ binds sterols disrupting fungal cell wall synthesis
- _fluconazole_ inhibits production of major component of fungal cell wall
105
what is flucytosine used for?
second agent to ampho b in fungal meningitis
106
which fungal infection has an association with intralipid administration
malassezia; requires exogenous long chain fatty acids for growth
107
what medication given to moms decreases transmission of toxo
spiromycin
108
treatment of toxo in infants and duration
**pyrimethamine** and **sulfadiazine** for 1 year
**folinic acid** to prevent neutropenia from pyrimethamine
109
vaccines contraindicated during pregnancy
live: MMR and varicella
110
vaccines contraindicated in HIV babies
oral polio, bCG, MMR-varicella relatively
111
components of breastmilk that are antibacterial
lactoferrin high; bacteriostatic
lactoperoxidase: low; requires hydrogen peroxide and thiocyanate for antibacterial effect
112
contraindications to breastfeeding
HIV, TB, active abscess, HSV lesion on breast
relative: CMV, hep C
113
Diagnosis medium for chlamydia
Giemsa stain
114
Diagnosis medium for pertussis
Bordet-Gengou
115
Diagnosis medium for pseudomonas
Oxidase-positive, catalase-positive
116
Diagnosis medium for rubella
hemagglutination inhibition
117
SE of amikacin
ototoxicity, nephrotoxicity, NMJ blockade
118
Consequence of clindamycin in NEC
post NEC stricture formation
119
Erythromycin effect on other meds
**aminophylline**. : interferes with hepatic metabolism
**carbamazepine, digoxin** : increase effect
**midazolam** : decrease clearance
120
What makes NMJ blockade by gentamicin worse?
hypermagnesemia
121
Which antibiotics are bactericidal?
**PCN/cephalosporins** - PCN binding proteins needed for peptidoglycan of cell wall
**aminoglycosides** : 30S subunit of ribosomes to inhibit protein synthesis
**vancomycin** : inhibit peptidoglycan synthesis
**Quinolones** - inhibit DNA gyrase
122
Which are bacteriostatic?
**erythromycin/clindamycin** - reversibly bind 50S of ribosomes
**chloramphenicol**
**tetracycline** - bind reversibly 30s of ribosomes
**sulfonamides** - inhibit folate synthesis
123
T cell lymphopoeisis in utero timeline
8.5 wk: precursors in fetal liver
10 wk: thymus becomes lymphoid
11-12 wk: t cells from thymus to spleen/nodes
16-18 wk: hasalls bodies in thymus
124
B cell lymphopoeisis embryology
8 wk: pre B cells in fetal liver
8-10wk: fetal bone marrow
18-22wk: liver, lung, kidney
30+ bone marrow only
125
neutrophil functions
chemotaxis
phagocytosis
bacterial killing
126
neonatal neutrophils
decreased migration
normal bacterial killing
longer neutrophilia after infection 3-4 hrs (compared to 1 hr adults)
127
disorders of neutrophil chemotaxis
hyper-IgE (Job's) - coarse facies, eczema, recurrent infections
128
disorders of neutrophil adhesion
LAD (defect in B2 integrin), no pus, omphalitis
129
disorders of neutrophil intracellular killing
**myeloperoxidase deficiency** - fungal infections
**chediak-higashi** - wbc inclusions, partial oculocutaneous albanism, abnormal degranulation
**chronic granulomatous disease** (XL) dysfunctional NADPH oxidase/phagocytosis impaired, abscesses and poor wound healing and granuloma formation
130
disorders of decreased neutrophil production
**Shwachmann-Diamond** - AR, BM dysfunction, malabsorption with steatorrhea and FTT, myelodysplastic syndromes
**Kostmann** - AR, risk myelodysplastic
**Reticular dysgenesis** - lymphopenia, also with SNHL
131
disorders of excessive neutrophil margination
pseudoneutropenia
endotoxemia
meds
132
disorders of accelerated neutrophil usage or destruction
sepsis
chronic benign neutropenia
autoimmune or alloimmune neutropenia
Chediak higashi
133
Functions of monocytes
chemotaxis
phagocytosis
bacterial killing
wound repair
134
monocytes in neonates
decreased migration
135
disorders of monocytes
LAD
histiocytosis
chediak higashi - defective chemotaxis
Wiskott-Aldrich
CGD
136
Function of complement
opsonization
chemoattraction
inflammation
complement (Ag-Ab)
alternative (without Ab)
137
Complement levels in neonates
| when are they normal?
decreased especially in preterm
normal levels at 3-6 months
138
Disorders of complements
**early components C1-C4 deficiency** (C2 most common) --> risk of pneumococcal infections and collagen vascular disease
**late C5-C9** --> risk of neisseria
**hereditary angioedema** (AD) absence of esterase inhibitor, recurrent swelling
**leiner syndrome** - generalized erythematous desquamative dermatitis, FTT, diarrhea, C5 abnormality
139
mediators of vasodilation
histamine, prostaglandin, NO, bradykinin
140
mediators of vascular permeability
histamine, complement, bradykinin, leukotrienes, NO
141
mediators of leukocyte adhesion
cytokines (IL1, TNFa)
complement
eicosanoids (Pgs, leukotrienes)
selectins
142
mediators of chemotaxis
- chemokines
- complement
- eicosanoids (PG, leukotriene)
143
mediators of fever
IL1, TNFa, PGs
144
Mediators of tissue necrosis
neutrophillic granules, free radicals
145
Mediators of platelet aggregation
eicosanoids (PGs, leukotrienes)
146
T cells in neonates
**decreased T cell function**
>>decreased cytotoxicity
>>decreased participation in delayed type hypersensitivity and B cell differentiation
147
Disorders of T cells
SCID
ADA deficiency
Ataxia - telangiectasia
DiGeorge
Wiskott Aldrich - XL, thromboycytopenia, eczema, recurrent infections
chronic mucocutaneous candidiasis
148
B cells in neonates
poor antibody response to infection
149
Disorders of B cells
XL agammaglobulinemia
XL hyper IgM- perirectal or oral abscesses
Selective IgA or IgG deficiency
Job's syndrome - IgE
CVID
150
when does infant start producing IgG
6 months
151
when does neonatal reach 75% of adult level IgM
1 year
152
when does neonate start making IgA
after birth
153
when does neonate start making IgM
in utero - fetal 6 months
154
disadvantages of umbilical cord stem cells
limited cell number
slower neutrophil engraftment --> longer hospitalization
slower immune reconstitution --> increased risk of viral infections
155
test for Ab mediated immunity
quantitative Ig levels
isohemagglutanin titers
Ab response to vaccines
156
test for cell mediated immunity
total t cells and subset cd4/cd8
delayed type hypersensitivity skin tests (mumps, candida, tetanus)
157
test for phagocytosis
quantitative nitroblue tetrazolium test (NBT)
158
test for complement
total hemolytic complement (CH50)
quantitative complement levels
159
test for CGD
NBT - cannot produce superoxide; normally turns colorless liquid blue but will remain clear in CGD
160
test for t cell receptor excision circles
SCID or DiGeorge
161
Role of spleen
* synthesis **Ab** against carb
* clears **microbes**
* site of **IgM & complement** production
* maturation of Abs
* support **T cell proliferation**
* scavenges damaged or senescent **RBCs & platelets**
* recycles **iron** from hemoglobin for hematopoeisis
162
asymptomatic negative testing baby but HSV exposure management
acylovir IV 10 days
163
encapsulated bacteria
H. flu, N. men, S. typhi, S.pneumo
164
Disorders of asplenia
**Ivermark** - AR, dextrocardia or a right-sided aortic arch
**Pearson** BM failure
**Stormorken** STIM1 gene, AD, thyrombocytopenia, dyslexia, myosis, myopathy
**Smith-Meyers-Fineman** (XL), cryptorchidism, and severe NDI
165
Treatment for SNHL CMV
6 months valganciclovir
166
MCC EOS order
Group B Streptococcus, Staphylococcus Aureus, Escherichia Coli, Listeria
167
MCC complication of toxo
chorioretinitis
168
White spots on the umbilical cord and amniotic membranes
candidal chorioamnionitis
169
Vesiculobullous mucocutaneous lesions
syphillis
170
highest risk GA for congenital VZV aquisition
16-20
171
mevalonate kinase gene mutation chr 12q24
hyperIg D syndrome
172
what do antibodies bind to in alloimmune neonatal neutropenia
HNA1a MCC, HNA1b or HNA2a
173
What does deficiency in adenosine deaminase lead to?
excess toxic metabolites in lymphoid cells leading to apoptosis in BM and thymus precursors
174
What does defect in Jak3 do?
failure of development and differentiation of T cells in thymus
175
What does defect in Rag1 or 2 lead to?
failure of Tcell receptor development
176
How do defects in DNA repair enzymes effect Tcell function?
failure of receptor development
177
How do defects in MHCII effect Tcell function?
inappropriate survival signals leading to death
178
22q11.2 deletion effect on t cellls
lymphopenia secondary to abnormal thymus development
179
Forkhead box N1 deletion effect on t cells
lymphopenia secondary to abnormal thymus development
180
symptoms of **primary infantile** lupus
MC glomerulonephritis
others pneumonitis, pulmonary hemorrhage, nephrotic syndrome
181
How does maternal ANA lead to fetal heart block?
maternal Abs bind to fetal cardiomyocytes leading to macrophage attraction and fibrosis
182
symptoms of **neonatal** lupus
rash
thrombocytopenia
cholestasis
183
causes of drug induced neutropenia
decreased production, increased destruction, increased margination
184
lab findings in mevalonic aciduria
elevated CRP
185
subsets of B-cell subtypes and function
**Follicular B2** adaptive response against thymus dependent antigens; create high affinity antibodies
**B1** peritoneal and pleural; thymus independent: low affinity antibodies *predominant in fetus, esp CD5+*
**marginal zone B** spleen, thymus independent and low affinity
186
meds that decrease chemotaxis
theophylline, magnesium, indomethacin
187
meds that increase chemotaxis
GCSF, GM-CSF
188
rate of mortality with invasive Candida
20%
189
rate of NDI in invasive Candida <1000g
60%
190
first abnormality on XR with osteomyelitis
soft tissue swelling
191
rate of EOS in VLBW
10/1000
192
route of HCV acquisition
intrauterine and intrapartum
193
treatment for routine varicella and severe varicella in pregnant mothers
PO in routine and IV in severe; acyclovir
194
nutritional roles of intestinal micobes
increase genes:
absorb carbs and lipids
synthesize biotin, folate, vit K
fermentation
195
which common bacteria penetrate BBB the transcellar route?
GBS, e.coli, listeria
196
skull osteomyelitis MCC
e coli
197
SIRS
Sense abnormal temps
eIther increased or decreased HR
Respiration abnormal
Some abnormal cells
198
MC symptom congenital syphillis
hepatomegaly
199
MC symptom congenital TB
HSM
200
risk of the different types of maternally acquire HCV
20% acute resolving
50% chronic asymptomatic
30% chronic active infection
201
infection with highest mortality
pseudomonas
202
food most related to listeria outbreaks
soft cheese
203
risk of LOS in VLBW
20%
204
bacterial vs viral meningitis CSF markers
bacteria has higher lipocalin2, lactate, CRP in CSF
205
neonatal TB acquisition
fetal rare bc hard to cross placenta
acquired from household contacts
206
MC presentation of invasive candida infection
endocarditis (15%)
207
MCC neonatal neutropenia
pregnancy induced hypertension
208
MC manifestation neonatal SLE
thrombocytopenia
209
incidence of invasive candidiasis in 24 week GA
20%
210
highest sensitivity and specificity for LOS
IL6 +/- CRP/procal
211
time to total intestinal reconstitution
5days
212
MC manifestation of LOS from listeria
meningitis
