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D2 E1 Shea > Immun/Infectious 2 > Flashcards

Immun/Infectious 2 Flashcards

1
Q

Oral Candidiasis

  • another name for this?
  • Type of infection / etiology?
  • 3 sxs / presentation
A
  • “thrush”
  • yeast infection of oral mucosa - Candida albicans
  1. adherent white plaques (r/o milk residue)
  2. Underlying mucosa reddened & friable
  3. Decreased feeding (due to pain)
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2
Q

Treatment for Oral Candidiasis (Thrush)

A
  • Nystatin suspension (0.5mL into each cheek 4x/day)
  • Tx mom PRN (esp if breastfeeding)
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3
Q

Diagnosis?

A

Oral Candidiasis (Thrush)

  • adherent white plaques
  • underlying mucosa is red/friable
  • pt w/ decreased POs due to pain
  • Tx w/ Nystatin / Mom PRN
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4
Q

Enterobiasis (Enterobus vermicularis)

  • Another name for this?
  • Presentation?
  • How is it transmitted?
  • PE findings?
A
  • “Pinworms”
  • Usually asymptomatic
  • Anal itching (esp at night)
  • Eggs under fingernails –> transmission
  • PE: excoriations in perianal area
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5
Q

Pinworms / Enterobiasis

  • Diagnosed how? (2)
  • Treatment? (3)
  • Prevention? (3)
A
  • Sxs / “scotch tape test”
  • Mebendazole (Vermox) - one 100mg tab, repeat in 2 weeks
    • Treat ENTIRE family
    • Wash bedding in hot water, careful bc eggs can go airborne, so fold linens inward
  • Prevention
    • hand washing
    • clip nails short
    • avoid scratching anus
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6
Q

Diagnosis?

  • Causes flesh colored, dome shaped papules w/ central umbilication
  • Common in childhood
  • Can be transmitted in adults through skin contact (sex / sports / sharing towels)
  • Etiology?
A

Molluscum Contagiosum

  • Poxvirus**
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7
Q

Tx for Molluscum Contagiosum (6)

A
  • Curettage
  • Cryotherapy
  • Cantharidin
  • Podophyllotoxin (Condylox)
  • Retinoids
  • Salicylic acid
  • Lasers

(CCC Sally Recked her Podo stick)

(no great data for any)

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8
Q

Bacterial Meningitis

  • Bacterial infection of meninges of what 2 structures?
  • Suspected bacterial meningitis is an emergency
  • Untreated mortality reaches almost ___%
A
  • Brain & spinal cord
  • 100%
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9
Q

Bacterial Meningitis

  • ***Pathogen for 1 month - 3 month olds***

(ON EXAM)

A
  • Group B Streptococcus
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10
Q

Bacterial Meningitis

  • Pathogen for 3 months - 3 yrs
A
  • S. pneumoniae
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11
Q

Bacterial Meningitis

  • Pathogen for 3 yrs - 10 yrs
A

S. pneumoniae

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12
Q

Bacterial Meningitis

  • Pathogen for 10 yrs - 19 yrs
A

N. meningitidis

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13
Q

Bacterial Meningitis

  • 8 Sxs in pediatric pts? (which is most important?)
A
  1. Fever
  2. N/V
  3. Irritability**
  4. HA
  5. Confusion
  6. Photophobia
  7. Back pain
  8. Nuchal rigidity
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14
Q

4 possible signs of bacterial meningitis?

A
  • seizure
  • increased ICP
  • papilledema
  • altered LOC

(ISA party….) (;

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15
Q
  • Which pathogen of bacterial meningitis causes a rash?
  • Blanching or non-blanching?
A

N. meningitidis (10-19 yrs)

  • non-blanching
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16
Q

Viral meningitis

  • Sxs / presentation?
  • How do you differentiate it from bacterial?
  • What is the BOTTOM LINE?
A
  • similar to bacterial
  • lab studies (CBC , LP)
  • it is bacterial until proven otherwise
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17
Q

What are the 6 Primary Immunodeficiencies on this test?

A
  1. Selective IgA Deficiency
  2. Common Variable Immunodeficiency
  3. Severe Combined Immunodeficiency (SCID)
  4. DiGeorge Syndrome
  5. Wiskott-Aldrich Syndrome
  6. Ataxia-Telangiectasia
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18
Q

Primary Immunodeficiency

  • Disorders resulting from ___ defects of the immune system (both isolated & combined)
  • Defect may be present in which parts of the immune system?
  • Impaired antibody (Ig) production is called what?
A
  • inherited
  • any part (or multiple parts) including the humoral immune system
  • Humoral immunodeficiency
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19
Q

Pediatric presentation of Primary Immunodeficiency

  • Recurrent, severe URI / LRTI including what 3 infections?
  • What type of bacteria?
A
  • OM
  • Sinusitis
  • PNA
  • Encapsulated Bacteria***
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20
Q

4 signs/sxs of Primary Immunodeficiency in peds patients

A
  • Poor growth
  • Failure to Thrive (FTT)
  • Unexplained splenomegaly
  • Chronic diarrhea

(Poor FUCking kid)

21
Q

6 encapsulated bacteria of Primary Immunodeficiency

A
  • Hib
  • S pneumo
  • N menigitidis
  • Group B strep
  • Klebsiella pneumoniae
  • Salmonella typhi
22
Q
  • What is the most common immunodeficiency?
  • This immunodeficiency is less common in what race?
A
  • Selective IgA Deficiency
  • Asian
23
Q

Selective IgA Deficiency

  • What 2 levels are normal in the serum?
  • Child over what age? (kids under this age don’t always have optimized levels of Ig’s)
  • IgA is __% of normal circulating Ig’s
A
  • IgG and IgM are both normal
  • 4 yrs
  • 70%
24
Q

Selective IgA Deficiency signs / sxs

  • Typical presentation?
  • Recurrent infections of what type?
  • What disorders? (3)
  • What type of reaction?
    *
A
  • Most are asymptomatic (<1/3 are actually diagnosed)
  • sinopulmonary infections
  • Autoimmune / GI / Allergic
  • Anaphylactic transfusion rxns
25
Q

What are the 5 indications for a workup of Selective IgA Deficiency?

A
  • Recurrent OM
  • Recurrent Sinusitis
  • Recurrent PNA
  • Giardiasis
  • Family hx of any primary immunodeficiency

Family POGS

26
Q
  • How is Selective IgA Deficiency diagnosed?
  • Treatment/Management?
A
  • Dx: Serum levels of IgA, IgG, IgM
  • Tx: refer to immunology
27
Q

Common Variable Immunodeficiency (CVID)

  • Impaired production of what 3 cells?
  • This leads to impaired production of what?
A
  • B-cell
  • T-cell
  • Dendritic cell
  • –> impaired Ig production**
28
Q

Common Variable Immunodeficiency

  • Common or uncommon?
  • Pts usually present at what age?
  • Peaks around what age?
  • NOT a single disease
  • What are the clinical manifestations?
A
  • Common
  • around puberty
  • 8 yrs
  • “variable” manifestations
29
Q

4 criteria for Common Variable Immunodeficiency

A
  • Reduced serum IgA, IgG, IgM***
  • Poor response/ no response to vaccines***
  • Presence of B cells
  • Absense of other immunodefiency
30
Q

What are the 4 signs/sxs of Common Variable Immunodeficiency?

A
  • Chronic or recurrent URI/LRTI
    • May develop bronchiectasis (even in peds!), watch for abnormal CXRs
  • GI infections
  • Diarrhea, malabsorption, weight loss –> FTT
  • Atopic triad (asthma, allergies, eczema)

(GUFA)

31
Q

Management / Tx of Common Variable Immunodeficiency (CVID)

A
  • Refer to immunologist for further eval / Ig replacement***
  • (may incidentally identify w/ titer screening)
32
Q

Which condition?

  • A severe defect in both the T & B lymphocyte systems, which leads to early death from overhwhelming infection, typically in the first year of life
A

Severe Combined Immunodeficiency

(SCID)

33
Q

Severe Combined Immunodeficiency

  • There are multiple forms, which one is MC?
  • Another name for this disease?
  • Which patients are screened for this?
A
  • X-linked (males only)
  • “bubble boy” disease
  • Part of newborn screening in all states
34
Q

What is the result of Severe Combined Immunodeficiency? (SCID)

A

One or more severe infections in the first few months after birth**

  • PNA
  • Meningitis
  • Bacteremia
35
Q

Severe Combined Immunodeficiency (SCID)

  • Children may become ill from what?
  • Infants might not have what structure visible on CXR?
A
  • live vaccines: varicella, MMR, OPV, RV
  • thymus
36
Q

5 manifestations of Severe Combined Immunodeficiency**

A
  • Persistent mucocutaneous candidiasis (thrush)
  • Death from common viral infections (CMV, VZV, EBV, HSV, flu, etc.)
  • P. jirovecii infection
  • Intrauterine graft-vs-host disease- caused by transplacental maternal T-cells
  • Lymphoma and other malignancies

“Paul died from thrushing intrauterine malignancies”

37
Q

Tx / Management for Severe Combined Immunodeficiency

A

Managed by immunology:

  • Stem cell transplantation
38
Q

Which condition?

  • Chromosomal deletion (22 q 11.2) affecting multiple body systems
  • The most prevalent microdeletion syndrome in the US
A

DiGeorge Syndrome

39
Q

5 results of DiGeorge Syndrome

A
  • Cardiac defects
  • Immune dysfunction (hypoplastic thymus gland)
  • Cleft palate
  • Hypocalcemia (parathyroid hypoplasia)
  • Behavioral/emotional problems

“CHIC Bitch”

40
Q

Infants with signs/sxs associated w/ DiGeorge Syndrome (Cardiac, Immune, Cleft palate, hypocalcemia, behavioral) should be screened with what 2 tests?

A
  • T-cell level
  • genetic screening
41
Q

Signs / Sxs of which condition?

  • Cleft palate
  • Cyanosis
  • Abnormal facial features
  • Learning difficulties
A

DiGeorge Syndrome

42
Q

Which condition?

  • X-linked disorder caused by mutation in WASp protein (boys)
  • Rare (1/100,000)
  • Ranges from mild to more severe forms
A

Wiskott-Aldrich Syndrome

43
Q

What is the classic presentation of Wiskott-Aldrich Syndrome? (3)

A
  • Susceptibility to infections (bacterial, viral, fungal)
  • Thrombocytopenia (platelets also small)
  • Eczema
44
Q

2 conditions which can develop with Wiskott Aldrich Syndrome

A
  • Autoimmune disease (70% of patients)
    • hemolytic anemia, IBD, neutropenia, vasculitis, renal diseases
  • Malignancies
    • B cell lymphoma & leukemia are MC
45
Q

Management/Tx of Wiskott-Aldrich Syndrome (4)

A
  • prophylactic abx & antivirals
  • Platelet transfusion PRN
  • Ig for those w/ deficiency
  • Stem Cell Transplant (is the only curative tx)
46
Q

Ataxia Telangiectasia

  • Autosomal recessive or dominant?
  • Homozygous presentation - what is the first sign?
  • 5 other signs?
A
  • Autosomal recessive
  • 1st sign: progressive cerebellar ataxia
  1. abnormal eye movements
  2. neurologic abnormalities
  3. oculocutaneous telangiectasias
  4. immune deficiency (esp pulm infection)
  5. malignancy
47
Q

Ataxia Telangiectasia - Children

  • Walk at normal age, but don’t develop what?
  • Difficulty coordinating what 2 movements? (saccades)
  • Telangiectasias of what 3 structures?
A
  • fluidity of gait (wobbly)
  • eye & head movements (saccades) –> nystagmus
  • conjunctiva, face, neck
48
Q

Ataxia Telangiectasia in Children

  • 25% develop what after age 10?
A

Malignancy (mostly lymphoma)

49
Q

Management of Ataxia-Telangiectasia (3)

A
  • Manage each disease manifestation individually (multidisciplinary team)
  • Watch for aspiration
  • Vaccinate if they make Ig

D2 E1 Shea (13 decks)

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