Immun/Infectious 2 Flashcards
(49 cards)
1
Q
Oral Candidiasis
- another name for this?
- Type of infection / etiology?
- 3 sxs / presentation
A
- “thrush”
- yeast infection of oral mucosa - Candida albicans
- adherent white plaques (r/o milk residue)
- Underlying mucosa reddened & friable
- Decreased feeding (due to pain)
2
Q
Treatment for Oral Candidiasis (Thrush)
A
- Nystatin suspension (0.5mL into each cheek 4x/day)
- Tx mom PRN (esp if breastfeeding)
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
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
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
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**
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)
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%
9
Q
Bacterial Meningitis
- ***Pathogen for 1 month - 3 month olds***
(ON EXAM)
A
- Group B Streptococcus
10
Q
Bacterial Meningitis
- Pathogen for 3 months - 3 yrs
A
- S. pneumoniae
11
Q
Bacterial Meningitis
- Pathogen for 3 yrs - 10 yrs
A
S. pneumoniae
12
Q
Bacterial Meningitis
- Pathogen for 10 yrs - 19 yrs
A
N. meningitidis
13
Q
Bacterial Meningitis
- 8 Sxs in pediatric pts? (which is most important?)
A
- Fever
- N/V
- Irritability**
- HA
- Confusion
- Photophobia
- Back pain
- Nuchal rigidity
14
Q
4 possible signs of bacterial meningitis?
A
- seizure
- increased ICP
- papilledema
- altered LOC
(ISA party….) (;
15
Q
- Which pathogen of bacterial meningitis causes a rash?
- Blanching or non-blanching?
A
N. meningitidis (10-19 yrs)
- non-blanching
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
17
Q
What are the 6 Primary Immunodeficiencies on this test?
A
- Selective IgA Deficiency
- Common Variable Immunodeficiency
- Severe Combined Immunodeficiency (SCID)
- DiGeorge Syndrome
- Wiskott-Aldrich Syndrome
- Ataxia-Telangiectasia
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
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***
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
What are the 5 indications for a workup of Selective IgA Deficiency?
* Recurrent OM
* Recurrent Sinusitis
* Recurrent PNA
* Giardiasis
* Family hx of any primary immunodeficiency
## Footnote
**Family POGS**
26
* How is Selective IgA Deficiency diagnosed?
* Treatment/Management?
* **Dx:** Serum levels of IgA, IgG, IgM
* **Tx:** refer to immunology
27
**Common Variable Immunodeficiency (CVID)**
* Impaired production of what 3 cells?
* This leads to impaired production of what?
* B-cell
* T-cell
* Dendritic cell
* --\> impaired Ig production\*\*
28
**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?
* Common
* around puberty
* 8 yrs
* "variable" manifestations
29
4 criteria for Common Variable Immunodeficiency
* **Reduced serum IgA, IgG, IgM\*\*\***
* **Poor response/ no response to vaccines\*\*\***
* Presence of B cells
* Absense of other immunodefiency
30
What are the 4 signs/sxs of Common Variable Immunodeficiency?
* 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
Management / Tx of Common Variable Immunodeficiency (CVID)
* Refer to immunologist for further eval / **Ig replacement\*\*\***
* (may incidentally identify w/ titer screening)
32
**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
Severe Combined Immunodeficiency
| (SCID)
33
**Severe Combined Immunodeficiency**
* There are multiple forms, which one is MC?
* Another name for this disease?
* Which patients are screened for this?
* X-linked (males only)
* "bubble boy" disease
* Part of newborn screening in all states
34
What is the result of Severe Combined Immunodeficiency? (SCID)
**One or more severe infections in the first few months after birth\*\***
* PNA
* Meningitis
* Bacteremia
35
**Severe Combined Immunodeficiency (SCID)**
* Children may become ill from what?
* Infants might not have what structure visible on CXR?
* **live vaccines:** varicella, MMR, OPV, RV
* thymus
36
5 manifestations of Severe Combined Immunodeficiency\*\*
* 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**
"**P**aul **died** from **thrushing** **intrauterine** **malignancies"**
37
Tx / Management for Severe Combined Immunodeficiency
**Managed by immunology:**
* Stem cell transplantation
38
**Which condition?**
* Chromosomal deletion (22 q 11.2) affecting multiple body systems
* The most prevalent microdeletion syndrome in the US
DiGeorge Syndrome
39
5 results of DiGeorge Syndrome
* Cardiac defects
* Immune dysfunction (hypoplastic thymus gland)
* Cleft palate
* Hypocalcemia (parathyroid hypoplasia)
* Behavioral/emotional problems
"**CHIC B**itch"
40
Infants with signs/sxs associated w/ DiGeorge Syndrome (Cardiac, Immune, Cleft palate, hypocalcemia, behavioral) should be screened with what 2 tests?
* T-cell level
* genetic screening
41
**Signs / Sxs of which condition?**
* Cleft palate
* Cyanosis
* Abnormal facial features
* Learning difficulties
DiGeorge Syndrome
42
**Which condition?**
* X-linked disorder caused by mutation in WASp protein (boys)
* Rare (1/100,000)
* Ranges from mild to more severe forms
Wiskott-Aldrich Syndrome
43
What is the classic presentation of Wiskott-Aldrich Syndrome? (3)
* Susceptibility to infections (bacterial, viral, fungal)
* Thrombocytopenia (platelets also small)
* Eczema
44
2 conditions which can develop with Wiskott Aldrich Syndrome
* **Autoimmune disease (70% of patients)**
* hemolytic anemia, IBD, neutropenia, vasculitis, renal diseases
* **Malignancies**
* B cell lymphoma & leukemia are MC
45
Management/Tx of Wiskott-Aldrich Syndrome (4)
* prophylactic abx & antivirals
* Platelet transfusion PRN
* Ig for those w/ deficiency
* Stem Cell Transplant (is the only curative tx)
46
**Ataxia Telangiectasia**
* Autosomal recessive or dominant?
* Homozygous presentation - what is the first sign?
* 5 other signs?
* 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
**Ataxia Telangiectasia - Children**
* Walk at normal age, but don't develop what?
* Difficulty coordinating what 2 movements? (saccades)
* Telangiectasias of what 3 structures?
* fluidity of gait (wobbly)
* eye & head movements (saccades) --\> nystagmus
* conjunctiva, face, neck
48
**Ataxia Telangiectasia in Children**
* 25% develop what after age 10?
Malignancy (mostly lymphoma)
49
Management of Ataxia-Telangiectasia (3)
* Manage each disease manifestation individually (multidisciplinary team)
* Watch for aspiration
* Vaccinate if they make Ig
