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Immunity and Infections Flashcards

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1
Q

What immunoglobulin is associated with first response adaptive immunity?

A

IgM

IgG for second response

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2
Q

What is included in the ‘5 in 1’ and when is it given?

A

DTaP (diptheria, tetenuss and pertussis), IPV and HiB
2 months, 3 months and 4 months

HiB also given at 12-13 months
DTaP and IPV also given at 2-3yrs (‘4 in 1’)
DT and IPV also given in teen years

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3
Q

When are Men C and Men B vaccines given?

A

Men B - 2 months, 4 months and 12-13 months

Men C - 2 months, 12-13 months

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4
Q

When is PCV (pneumococcal conjugate vaccine) given?

A

2 months, 4 months, 12-13 months

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5
Q

When is the MMR vaccine given?

A

12-13months, 2-3yrs

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6
Q

What is the Gardisil vaccine?

A

Vaccine against HPV 11 + 16 give to girl in their teen years

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7
Q

Why are some vaccines given several times and others not?

A

Live attenuated vaccines give good, long-term immuntiy e.g. MMR
Inactivated/sub-unit need ‘boosters/top-ups’

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8
Q

What are the bacterial causes on meningitis?

A 
Streptococci Pneumoniae (gram +ve diplococci)
Haemophilus Influenzae (gram -ve rods)
Neisseria Meningitis (gram -ve diplococci)
TB
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9
Q

What are the prodromes for viral/bacterial meningitis and what is meningism?

A

Viral - gi upset, pharyngitis
Bacterial - drowsiness
Meningism = stiff neck, photophobia, headache

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10
Q

Signs of raised ICP?

A

Irritability, drowsy/lethargic, high-pitched cry

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11
Q

What sign would indicate that meningitis has progressed to meningococcal septicaemia?

A

Non-blanching rash

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12
Q

What signs can you elicit from an infant with meningitis?

A

Kernings sign - resistance to knee extension with hip flexed (children>infants)
Brudninski’s sign - head flexion –> hip flexion
Tense fontanelle

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13
Q

What would you find when analysing the CSF in bacterial meningitis?

A 
Cloudy appearance
Opening pressure increased
Low glucose
Very high protein
Some RBCs
>WBCs (c/mm3)
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14
Q

When should you not do a LP in suspected meningitis?

A

Raised ICP is a contraindication

Can lead to coning - herniation of the brain stem through the foramen magnum –> paralysis and respiratory inhibition

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15
Q

Management of bacterial meningitis?

A

In GP - gie benzylpenecillin IM (<1yr = 300mg, 1-9yrs = 600mg, 10+ = 1.2g)
In hospital - ceftriaxome (80mg/kg/day) then indicated Abx after culture
Can give steroids (dexamethasone) to reduce inflammation

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16
Q

Complications associated with meningitis?

A

Hydrocephalus
subdural effusion\acute adrenal failure
deafness
cerebral palsy +/- learning difficulties (10%)

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17
Q

What are pupura?

A

Bleeding in the dermis –> purple spots/nodules that do not blanch

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18
Q

Non-thombocytopenic causes of purpura?

A

Meningococcal septicaemia
HSP
Hypertensive states
Trauma

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19
Q

Thrombocytopenic causes of pupura?

A

Immune thombocytopenic pupura (ITP) - often preceded by vrial infection e.g. CMV in <1yr
Coagulation disorders - disseminated intra-vascular coagulation (DIC) and scurvy (vit C difficiency)
Leukaemia

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20
Q

Management of ITP?

A

Steroids and immunoglobulins

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21
Q

What gram +ve cause of septicaemia are babies at risk of when they are <48hrs and >48hrs old?

A

> 48hrs = Staphylococcus - aureus, coagulase -ve

<48hrs = group B streptococci (pneumoniae)

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22
Q

What are the symptom of septicaemia?

A 
Fevers, rigors, sweating
SOB
Poor feeding
Non-blanching rash 
lethargy
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23
Q

Investigations for septicaemia?

A 
Septic screen:
Bloods - FBC, U+E's, culture
LP - culture, glucose, cell count
Urine - MSU, culture
Stool - culture, virology
CXR
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24
Q

Broad spectrum management of specticameia in <3months and >3months?

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A

<3 months - cefotaxime +/- amoxacillin

>3months - ceftriaxone

25
What causes chicken pox?
Varicella zoster virus (VZV) - typically affects 4-10yrs old
26
When is chicken pox infectious?
4 days before rash until it has all scabbed over (~1 week)
27
Symptoms of VZV?
Prodrome - fever, coryza, cough | 2 days later --> Characteristic vesicular rash (macule-->papule-->vesicle) on face and trunk
28
Management of chicken pox?
Supportive - fluids, calpol/paracetamol Advise to not scratch / cut child's nails Use cold baths and calamine ointment to relive itching If immunocompromised give aciclovir and anti VZV immunoglobulin If they have superimposed infection give flucloxacillin
29
What is conjunctivitis?
Inflammation of the conjuctiva - viral, bacterial and allergic Red eyes + discharge: Viral - watery/sticky +/- lymphoid aggregates bacterial - thick yellow/green Allergic - watery/clear, itchy/gritty eyes
30
What specific causes are there for neonates?
Gonoccocal conjunctivitis +/- chlamydia infection = red eyes +/- lid swelling + purulent discharge Complications = corneal rupture/hazing Sticky eyes (staph/pseudomonas/strep) - treat with topical neomycin
31
Management of bacterial conjunctivitis?
Chloramphenicol in most cases (+cefotaxime IM stat in neonatal gonococcal)
32
What is infectious mononucleosis?
Aka glandular fever - caused by Epstein-Barr virus
33
What are the symptoms of glandular fever?
``` Fever, malaise, lethargy Sore throat --> tonsillitis Weight loss/anorexia Cough Nausea Photophobia ```
34
What are the signs for glandular fever?
``` Cervical lymphadenopathy Petechiae on the soft palate maculopapular rash Spleno/hepatomegaly Jaundice ```
35
What investigations can be done in suspected infectious mononucleosis?
Bloods: FBC (atypical lymphocytes) Monospot test (checks for heterophile Abs) is positive in 60% cases (often -ve in infants) Virology - will show IgM early --> IgG
36
Complications of infectious mononucleosis?
Concomitant group A streptococcus tonsillitis - treat with amox/ampicillin Burkitt's lymphoma (if immunocompromised)
37
What age group are usually affected by egg/milk allergy?
Infants - they are likely to grow out of this
38
What are the majority of allergies mediated by?
IgE mediated e.g. peanut allergy Primary = from birth Secondary = acquired (usually milder)
39
What type of allergy is coeliac's?
Non-IgE mediated - delayed presentation, insidious onset
40
Symptoms of mild and severe allergic reactions?
Mild - urticaria, itching, facial swelling | Severe - angioedema, wheeze/stridor, abdo pain/vomiting, collapse
41
Investigations for allergies?
IgE - skin prick test, RAST (blood test for specific IgE groups) Non-IgE - avoidance of food types
42
What are the symptoms of measles?
Prodrome - irritable, conjunctivitis, fever Sign before rash = koplik's spots - white spots on buccal mucosa 3 C's - cough, coryza, conjunctivitis Fever (often >40) Rash - maculopapular (appears behind ear--> rest of body)
43
Management of measles?
A NOTIFIABLE DISEASE Anti-viral = ribavarin MMR vaccine should have been given - to all contacts <72hrs
44
What complications can occur due to measles?
Immediate - Diarrhoea, bronchopneumonia, acute otitis media, febrile convulsion Corneal ulceration, increased incidence of appendicitis, myocarditis Encephalitis ~1 week later (1/5000) - headache, irritability, drowsy - 15% mortality Sub-acute Sclerosing Panencephalitis (SSPE) - 1/100,000 - 4-10yrs after infection - progressive neurological dysfunction
45
What is Kawasaki's disease?
A systemic vasculitis - more common in Japanese/Caribbean
46
Symptoms of Kawasaki's?
Prolonged fever >5 days (characteristically resistant +/- >1 of the following: Non-purulent conjunctivitis Red mucus membranes (can have red swollen tongue = strawberry tongue) Cervical lymphadenopathy Rash Red swollen palms/soles and finger/toe peeling Can also have GI upset - diarrhoea and reduced appetite
47
Investigations in kawasaki's?
Bloods - ESR, CRP Echocardiogram - check for coronary artery aneurysm (complication of kawasaki's) ECG - look for any conduction abnormalities
48
Management of Kawasaki's
High dose aspirin + immunoglobulins: - High dose immunoglobulin stat - 2g/kg (only given within 10 days of onset of symptoms) - Aspirin - high dose until fever subsides, lower anti-platelet dose for 6 weeks Severe = infliximab/ciclosporin
49
Symptoms of peri-orbital cellulitis?
Peri-orbital oedema and erythema | Fever
50
Investigations for peri-orbital cellulitis?
CT head - check infection spread and brain involvement | LP - exclude meningitis
51
Complications of peri-orbital cellulitis?
Orbital cellulitis - proptosis, painful eye movements, reduced visual acuity Meningitis Abscess formation Cavernous sinus thrombosis
52
At what age will Abs to HIV appear in the blood of a baby who has been exposed to HIV at birth?
18 months | Maternal Abs detected prior to 18 months only incurs exposure to the virus
53
What is rubella syndrome?
Congenital infection --> deafness, microcephaly, cataracts and PDA (= reason for vaccination given)
54
Symptoms of rubella -diagnostic?
Child generally well/low-grade fever Maculopapular rash - starts on face then spreads centrofugally (fades 3-5 days) - not itchy in children Not clinically diagnostic - need seroloy
55
Hand, foot and mouth disease
Self-limiting disease common in <10yrs: - Mild systemic upset - oral ulcers - vesicles on palms and soles of feet Management: - Reassurance - no link to cow disease - Hydration and analgesia - Can go to nursery/school if feeling well enough to do so
56
Impetigo management
Localised disease: - Topical fusidic acid - first line - Topical retapamulin - 2nd line - Topical mupirocin - MRSA Systemic disease - Flucloxacillin - Clarithromycin if penicillin allergic
57
Complications of impetigo
``` Cellulitis Lymphadenitis SSSS scarlet fever post-streptococcal glomerulonephritis ```
58
HSP
Florid, non-blanching purpura IgA mediated hypersensitivity vasculitis 50-90% have preceding URTI Rash starts as erythematous macules --> raised and purpuric in 24 hrs Other symptoms: arthralgia/arthritis Abdominal pain - colicky Testicular pain Self-limiting but give NSAIDS +/- steroids
59
Complications of HSP
Renal involvement Intussusception GI bleeding Pulmonary haemorrhage 25% have recurrent symptoms

Paediatrics (14 decks)

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