PAEDIATRICS - 1 Flashcards

Question

HSV: treatment

Answer 1

Aciclovir (viral DNA polymerase inhibitor)

Answer 2

1. ) Gingivostomatitis 2. ) Eczema herpeticum 3. ) Herpetic whitlows 4. ) Blepharitis/ conjunctivitis

Answer 3

* Vesicular lesions on lips, gums, tongue and hard palate --> ulceration and bleeding * Fever + miserable child * Eating and drinking are painful --> dehydration

Answer 4

Treat symptoms + IV Aciclovir ( if severe)

Answer 5

* Widespread vesicular lesions * Develop on eczematous skin * Can lead to septicaemia

Answer 6

* Painful, erythematous, oedematous white pustules on site of broken skin * Typically, on fingers

Answer 7

• Spread from gingivostomatitis and infected adults kissing children’s fingers

Answer 8

Herpetic lesions near or involving eye | --> Requires URGENT ophthalmic assessment (slit lamp assessment)

Answer 9

* Respiratory droplets * Highly infectious * Incubation period around 2 weeks

Answer 10

Papules --> vesicles --> pustules --> crusts

Answer 11

* 50-500 lesions on head and trunk * Appear as crops of papules, vesicles and pustules * Itchy * Scratching --> permanent, depigmented scar

Answer 12

* Bacterial superinfection (staph, strep) * CNS (cerebellitis, encephalitis, meningitis) * Immunocompromised (pneumonitis, disseminated infection, DIC)

Answer 13

* Usually self-limiting so NO treatment required | * For immunocompromised patients --> IV aciclovir or HZV immunoglobulin

Answer 14

Reactivation of latent VZV --> vesicular eruption

Answer 15

* Lesions appear in a dermatomal distribution of sensory nerves * Unilateral - sharp cut-off at anterior and posterior midlines * Commonly in thoracic region * Begins as a crop of red papules --> vesicles/ pustules --> crusts * Fever * Neuralgic pain

Answer 16

1. ) Oral aciclovir 800mg 5 times daily for 7 days 2. ) Analgesia 3. ) Protective ointment applied to rash 4. ) Oral antibiotics for secondary infection

Answer 17

EBV --> B lymphocytes + epithelial cells of oropharynx

Answer 18

• Oral contact

Answer 19

* Fever * Malaise, fatigue * Tonsillitis/ pharyngitis * Lymphadenopathy * Petechiae * Splenomegaly * Hepatomegaly * Maculopapular rash * Jaundice

Answer 20

1. ) Atypical lymphocytes - Numerous large T cells seen on blood film 2. ) Positive monospot test - Tests for presence of heterophile antibodies (these are a/w EBV) 3. ) Seroconversion antibodies - Viral capsid antigen antibodies (VCA) - IgG and IgM - EB nuclear antigen antibodies (EBNA)

Answer 21

1. ) Self-limiting 2. ) For secondary bacterial tonsillitis --> penicillin - DO NOT given amoxicillin --> maculopapular rash in those infected with EBV

Answer 22

* Saliva * Genital secretions * Breast milk

Answer 23

``` • Causes mild or subclinical infection in normal paediatric and adult hosts – presents as mononucleosis-like: - Mild pharyngitis - Mild lymphadenopathy • In the immunocompromised: - Retinitis - Pneumonitis - Bone marrow failure - Encephalitis - Hepatitis - Oesophagitis ```

Answer 24

1. ) Blood film - Atypical lymphocytes 2. ) Negative monospot test 3. ) CMV IgM raised

Answer 25

1.) IV ganciclovir

Answer 26

* Fever + malaise * Exanthema subitem (roseola infantum) * Generalised macular rash

Answer 27

``` Slapped cheek syndrome • Erythema infectiosum/ slapped cheek - Fever - Malaise - Headache - Myalgia - Slapped-cheek rash - Maculopapular ‘lace’ like rash on trunk and limbs ```

Answer 28

* Common during spring * Respiratory secretions * Vertical transmission

Answer 29

* Faecal-oral * Respiratory droplets * Outbreaks in summer and autumn

Answer 30

1. ) Hand, foot and mouth disease 2. ) Herpangina 3. ) Pleurodynia (Bornholm disease)

Answer 31

* Painful vesicular lesions on hands, feet, mouth and tongue | * Mild systemic features

Answer 32

• Disease is self-limiting and subsides within a few days

Answer 33

* Vesicular and ulcerated lesions on soft palate and uvula | * Causes anorexia, pain on swallowing and fever

Answer 34

• IV fluids and analgesia required in severe cases

Answer 35

* Pleuritic chest pain * Muscle tenderness * Self-limiting within a few days

Answer 36

Rubeola virus

Answer 37

MMR vaccine

Answer 38

• Droplet spread, highly infectious

Answer 39

``` • Increasing temperature • Cough • Conjunctivitis and coryza • Koplik spots (white spots on buccal mucosa) • Rash - Spreads downwards, from behind ears --> whole body - Initially maculopapular - Becomes blotchy and confluent ```

Answer 40

* Pneumonia * Febrile seizures * Diarrhoea

Answer 41

1. ) Supportive 2. ) For immunocompromised patients --> Ribavirin (antiviral) may be used 3. ) Vitamin A given in low-income countries

Answer 42

Mumps virus

Answer 43

* Respiratory droplets * Common in winter and spring months * Virus gains access to parotid glands * Incubation period is 15 days – 24 days

Answer 44

* Fever, malaise and parotitis | * Bilateral parotid involvement

Answer 45

1. ) Clinical diagnose | 2. ) Raised amylase levels (due to parotid inflammation)

Answer 46

Rubella virus

Answer 47

* Occurs in winter and spring * Can cause SEVERE damage to FETUS * Incubation period is 15-20 days * Respiratory droplets

Answer 48

* Low grade fever * Maculopapular rash * Spreads centrifugally to cover the whole body * Prominent lymphadenopathy

Answer 49

* MMR to prevent * Usually self-limiting * No effective antiviral treatment available

Answer 50

1.) Meningococcal 2.) Pneumococcal 3.) Staphylococcal and group A streptococcal • Impetigo • Boils • Periorbital cellulitis • Staphylococcal scalded skin syndrome

Answer 51

Infection caused by streptococcus pneumoniae or pneumococcus

Answer 52

* Streptococcus pneumoniae is carried in nasopharynx of healthy children * Asymptomatic carriage is prevalent among young children * Transmitted --> respiratory droplets

Answer 53

* Pharyngitis * Otitis media * Conjunctivitis * Sinusitis * Invasive disease (pneumonia, bacterial sepsis, meningitis)

Answer 54

• Pneumococcal conjugate vaccine (PCV) is given to babies at 12 weeks and 1 year --> brand name = Prevenar 13 (covers 13 different serotypes) • Pneumococcal polysaccharide vaccine (PPV) is given to people >65

Answer 55

• Those with hyposplenism (e.g. sickle cell disease) or asplenism are given daily prophylactic penicillin

Answer 56

Highly infectious skin lesions caused by staphylococcus or group A streptococcus

Answer 57

* Infection usually results from direct invasion of organism * These organism can also release toxins --> these toxins act as superantigens --> superantigens bind to T-cells and stimulate MASSIVE T-cell proliferation + cytokine release

Answer 58

* Commonly occurs in infants and young children | * More common in children with pre-existing skin disease e.g. atopic eczema

Answer 59

* Localised * Highly contagious * Staphylococcal or streptococcal skin infection * Lesions usually on face, neck and hands * Begin as erythematous macules * Progresses into vesicles/ pustules/ bullae * When these rupture --> honey-coloured crusted lesions

Answer 60

1. ) Topical antibiotics e.g. mupirocin (mild cases) 2. ) Narrow spectrum antibiotics e.g. flucloxacillin (severe cases) 3. ) Broad spectrum antibiotics e.g. co-amoxiclav (taste better --> better adherence, but not as effective) 4. ) Affected children should NOT go to nursey or school until LESIONS HAVE DRIED OUT

Answer 61

Infections of hair follicles or sweat glands, caused by staphylococcus aureus

Answer 62

Systemic antibiotics + surgical incision (occasionally)

Answer 63

* Fever * Erythema, oedema and tenderness of eyelid * Unilateral * Proptosis * Painful or limited ocular movement * May have reduced visual acuity

Answer 64

1. ) IV ceftriaxone | 2. ) CT or MRI head (to assess posterior spread of infection)

Answer 65

* Abscess * Meningitis * Cavernous sinus thrombosis

Answer 66

Staphylococcal TOXIN

Answer 67

Staphylococcal toxin --> causes separation of the epidermal layer

Answer 68

* Fever, malaise * Purulent, crusting and localised infection * Around eyes, nose and mouth * Widespread erythema * Tenderness of skin * Areas of epidermis separate on gentle pressure (Nikolsky sign)

Answer 69

Areas of epidermis separate on gentle pressure --> characteristic of scaled skin syndrome

Answer 70

1. ) IV flucloxacillin 2. ) Analgesia 3. ) Fluid balance monitoring

Answer 71

``` 6-in-1 vaccine (1st done) Rotavirus vaccine (1st dose) MenB (1st dose) ```

Answer 72

``` 6-in-1 vaccine (2nd dose) Pneumococcal (PCV) vaccine (1st dose) Rotavirus vaccine (2nd dose) ```

Answer 73

6-in-1 vaccine (3rd dose) | MenB (2nd dose)

Answer 74

Hib/MenC (1st dose) MMR (1st dose) PCV (2nd dose) MenB (3rd dose)

Answer 75

Flu vaccine annually

Answer 76

MMR (2nd dose) | 4-in-1 pre-school booster

Answer 77

HPV vaccine

Answer 78

3-in-1 teenage booster | MenACWY

Answer 79

1. ) Diphtheria 2. ) Hepatitis B 3. ) Haemophilus influenzae type b (Hib) 4. ) Polio 5. ) Tetanus 6. ) Whooping cough (pertussis)

Answer 80

* Lack of parental education * Low income * Poor access to health facilities * Traditional beliefs

Answer 81

* Difficulties securing transportation to a health care provider * Inability to pay or vaccination * Mistakenly believe that vaccinations are for others and not for their own children * Believe that a few nonvaccinating parents will have no impact on an outbreak likelihood or management * Mandatory vaccines for school entry in USA

Answer 82

Systemic vasculitis

Answer 83

Coronary artery aneurysms

Answer 84

1.) Fever (>38.5) present for at least 5 days 2.) PLUS 4/5 of: • Bilateral congestion of the ocular conjunctivae: non-purulent (not discharging pus) • Changes of lips + oral cavity with at least one of: - Dryness - Erythema - Fissuring of lips - Strawberry tongue - Diffuse erythema of oral and pharyngeal mucosa without discrete lesions • Changes of extremities with at least one of: - Erythema of palms and soles - Indurative oedema - Peeling of fingers and toes • Polymorphous exanthem (rash) • Non-suppurative cervical lymphadenopathy >1.5cm N.B misery is a VERY common feature too

Answer 85

• Inflammation of BCG scar

Answer 86

1. ) FBC - Raised WBC - Raised neutrophils 2. ) Platelets - raised 3. ) ESR/ CRP - raised 4. ) Echocardiogram - Performed at 6 weeks - To check for aneurysms

Answer 87

1.) IV immunoglobulin - Give within 10 days - Lowers risk of coronary artery aneurysms 2.) Aspirin - To reduce risk of thrombosis For persistent inflammation: 3.) Corticosteroid 4.) Infliximab (TNF-alpha monoclonal antibody) 5.) Cyclosporin

Answer 88

• 1-2% due to myocardial ischaemia or MI

Answer 89

Electronic thermometer in axilla

Answer 90

Electronic/ chemical dot thermometer in axilla or infrared tympanic thermometer

Answer 91

>37.5 Degrees Celsius

Answer 92

1. ) Septic screen | 2. ) Broad-spectrum antibiotics

Answer 93

1. ) Blood culture 2. ) FBC including differential WCC 3. ) Acute phase reactant (e.g. CRP) 4. ) Urine sample

Answer 94

5. ) Chest x-ray 6. ) LP 7. ) Rapid antigen screen on blood/ CSF/ urine 8. ) Meningococcal and pneumococcal polymerase chain reaction (PCR) on blood/ CSF 9. ) PCR for viruses in CSF (e.g. HSV and enteroviruses)

Answer 95

1. ) Infection (40%) 2. ) Prematurity (18%) 3. ) Congenital anomalies (13%) 4. ) Intrapartum-related complications (11%)

Answer 96

* Illness of other family members * Illness prevalent in community * Lack of immunization * Recent travel abroad (malaria, typhoid, viral hepatitis) * Contact with animals (brucellosis, Q fever, haemolytic uremic syndrome – E.coli) * Secondary immunodeficiency (nephrotic syndrome, splenectomy)

Answer 97

* Fever >38 degrees and <3 months old * Fever >39 degrees and 3-6 months old * Colour – pale, mottled or cyanosed * Reduced consciousness * Neck stiffness * Bulging fontanelle * Status epilepticus * Focal neurological signs * Seizures * Significant respiratory distress * Bile-stained vomiting * Severe dehydration/ shock

Answer 98

Bradycardia, hypertension and abnormal pattern of breathing

Answer 99

Hyperextension of head and back (think tetanus image)

Answer 100

1. ) Manage at home 2. ) Regular review by parents 3. ) Provide clear instructions e.g. safety net for red flags 4. ) Give paracetamol or ibuprofen for fever

Answer 101

1. ) Hospital admission 2. ) Investigations and observation or treatment 3. ) Septic screen 4. ) Parenteral antibiotics administered - Cefotaxime + ampicillin for <1-month-old - Ceftriaxone for >1-month-old - Aciclovir if HSV encephalitis suspected 5. ) Give paracetamol or ibuprofen for fever

Answer 102

1. ) Sepsis 2. ) Bacterial meningitis 3. ) Viral meningitis 4. ) Encephalitis 5. ) Toxic shock syndrome 6. ) Necrotizing fasciitis/ cellulitis

Answer 103

Bacteria --> focal infection --> proliferate in bloodstream --> host response causes release of inflammatory cytokines --> activation of endothelial cells --> sepsis

Answer 104

Causative microorganism enters blood stream and cause blood poisoning

Answer 105

Overwhelming and life-threatening response, triggered by septicaemia or viral infection

Answer 106

1. ) Staphylococcus (coagulase negative) - CoNS 2. ) Staphylococcus aureus 3. ) Non-pyogenic streptococci 4. ) Streptococcus pneumonia (pneumococcus) 5. ) Neisseria meningitidis (meningococcus) 6. ) Escherichia coli 7. ) Haemophilus influenzae

Answer 107

Group B streptococcus and E.coli

Answer 108

* Fever * Poor feeding * Miserable, irritable, lethargic * History of focal infection (meningitis, osteomyelitis, gastroenteritis, cellulitis) * Predisposing conditions (sickle cell disease, immunodeficiency) * Tachycardia, tachypnoea, hypotension * Purpuric rash (meningococcal septicaemia) * Shock * Multiorgan failure

Answer 109

1. ) Admission to paediatric intensive care if infant has multiorgan failure, otherwise admit to paediatric ward 2. ) Antibiotic therapy 3. ) Fluid resuscitation 4. ) Mechanical ventilation may be required 5. ) Inotropes for hypotension 6. ) If bleeding occurs, administer: - Fresh frozen plasma - Cryoprecipitate - Platelet transfusion

Answer 110

Vasoactive mediators released (NO, leukotrienes, prostaglandins) --> loss of intravascular proteins and fluid --> capillary leak --> circulating plasma moves to interstitial fluid Capillary leak in lungs --> pulmonary oedema --> respiratory failure

Answer 111

Inflammatory cytokines and circulating toxins --> depress myocardial contractility

Answer 112

Abnormal blood clotting --> widespread microvascular thrombosis --> consumption of clotting factors

Answer 113

Inflammation of meninges, confirmed by presence of WBC in CSF

Answer 114

Viral, bacterial, TB meningitis, non-infectious meningitis (malignancy, autoimmune)

Answer 115

• Bacteraemia --> bacterial infection of the meninges • Host response to the infection causes more damage than the actual causative organism • Host response: - Release of inflammatory mediators (histamine, prostaglandins, leukotrienes, NO) - Activation of leucocytes - Endothelial damage • Leads to cerebral oedema --> raised ICP --> decreased cerebral blood low • Cerebral cortical infarction • Fibrin deposits --> block resorption of CSF by arachnoid villi --> hydrocephalus

Answer 116

Group B streptococcus E coli Listeria monocytogenes

Answer 117

Neisseria meningitides Streptococcus pneumonias Haemophilus influenza

Answer 118

Neisseria meningitides | Streptococcus pneumonias

Answer 119

* Fever * Headache * Photophobia * Lethargy * Poor feeding * Vomiting * Irritability * Hypotonia * Drowsiness * Loss of consciousness * Seizures

Answer 120

* Fever * Purpuric rash (meningococcal disease) * Neck stiffness * Bulging fontanelle * Opisthotonos * Positive Brudzinski sign * Positive Kernig sign * Signs of shock (pale, cold, sweating, rapid shallow breathing, weakness) * Focal neurological signs * Altered conscious level * Papilloedema (rare)

Answer 121

1. ) FBC with differential WCC 2. ) Blood glucose and blood gas (acidosis) 3. ) Coagulation screen 4. ) CRP 5. ) U&E’s 6. ) LFT’s 7. ) Culture of blood, throat swab, urine and stool for bacteria 8. ) Throat swab, nasopharyngeal aspirate, conjunctival swab, stool sample for viral PCR 9. ) Rapid antigen test for meningitis organisms (blood, CSF or urine) 10. ) LP for CSF unless CI 11. ) If TB suspected --> CXR, Mantoux test ± interferon-gamma release assay, gastric aspirates or sputum for MC&S 12. ) Consider CT/MRI brain and EEG

Answer 122

* Cardiorespiratory instability * Focal neurological sings * Signs of raised ICP (coma, high BP, low HR, papilloedema) * Coagulopathy * Thrombocytopenia * Local infection at site of LP * If it causes delay in starting antibiotics

Answer 123

Clear 0-5/mm^3 WBC 0.15-0.4g/L protein >50% of blood is glucose

Answer 124

Turbid Increased polymorphs Increased protein Decreased glucose

Answer 125

Clear Increased lymphocytes Normal or increased protein Normal or decreased glucose

Answer 126

Turbid/ clear/ viscous Increased lymphocytes HUGE Increase protein HUGE decrease in glucose

Answer 127

Clear Normal or increased lymphocytes Normal or increased protein Normal or reduced glucose

Answer 128

1.) Antibiotic therapy, depending on causative organism  Ceftriaxone (3rd generation cephalosporin) covers the most common bacterial causes so can be started before results come back 2.) Fluid resuscitation

Answer 129

``` • Hearing impairment - Inflammatory damage to cochlear hair cells • Local vasculitis - Can lead to CN palsies • Local cerebral infarction - Can lead to seizures • Subdural effusion - a/w Haemophilus influenzae B and pneumococcal meningitis - Most resolve spontaneously • Hydrocephalus due to: - Impaired resorption of CSF - Blockage of cerebral aqueduct - Blockage of ventricular outlets by fibrin • Cerebral abscess ```

Answer 130

1. ) Rifampicin or ciprofloxacin is given to all household contacts for meningococcal meningitis or Hib infection 2. ) Meningococcal group C vaccine given to household contacts for group C meningococcal meningitis infection

Answer 131

1. ) Enteroviruses 2. ) Epstein-Barr virus (EBV) 3. ) Adenoviruses 4. ) Mumps

Answer 132

1. ) Culture or PCR of CSF, stool, urine, nasopharyngeal aspirate and throat swabs 2. ) Viral serology

Answer 133

Inflammation of the brain

Answer 134

* Mortality rate for untreated encephalitis is >70% | * Survivors of untreated encephalitis usually have severe neurological sequelae

Answer 135

* Herpes Simplex Virus (HSV - neurotoxic) infection of brain * Postinfectious encephalopathy e.g. following chickenpox, a delayed brain swelling can occur * Slow virus infection e.g. HIV or SSPE (subacute sclerosing panencephalitis) following measles

Answer 136

1. ) Enterovirus 2. ) Respiratory virus (Hib) 3. ) HSV (herpes simplex virus) 4. ) VZV (varicella zoster virus) 5. ) HHV-6 (human herpesvirus) 6. ) Microplasma 7. ) B. burgdorferi (Lyme disease) 8. ) Bartonella henselae (cat scratch disease)

Answer 137

* PCR of CSF * EEG (electroencephalogram) * CT/ MRI (gross atrophy in temporoparietal regions from loss of neural tissue) * HSV antibody production in the CSF

Answer 138

1. ) High-dose IV Aciclovir | - -> Aciclovir treatment continued for 3 weeks

Answer 139

1. ) Fever >39 degrees 2. ) Hypotension 3. ) Diffuse erythematous, macular rash

Answer 140

Toxin-producing staphylococcus aureus and Group A streptococci

Answer 141

1. ) Toxin-producing organism 2. ) Toxin released from infection at any site 3. ) Toxin acts as a superantigen 4. ) Causes organ dysfunction

Answer 142

* Mucositis (conjunctivae, oral mucosa, genital mucosa) * GI dysfunction (vomiting/ diarrhoea) * Renal impairment * Liver impairment * Clotting abnormalities * Thrombocytopenia * Altered consciousness

Answer 143

1.) Intensive care support to manage shock 2.) Surgical debridement of infected areas 3.) Ceftriaxone + clindamycin  clindamycin acts on bacterial ribosome and switches off toxin production 4.) IV Ig to neutralize circulating toxin

Answer 144

* PVL (Panton-Valentine leucocidin) is produced by <2% of staphylococcus aureus strains * It causes recurrent skin and soft-tissue infections * Can also cause necrotizing fasciitis/ necrotizing haemorrhagic pneumonia --> both have high mortality rate * Frequently results in VTE

Answer 145

• Rare, severe subcutaneous infection

Answer 146

* Often involves fascia and muscle * Area enlarges rapidly --> poorly perfused necrotic areas * Severe, painful and systemic illness requiring intensive care

Answer 147

Staphylococcus aureus or group A streptococcus

Answer 148

• Surgical intervention + debridement of necrotic tissue + IV antibiotics + IVIg

Answer 149

Spirochaete B burgdorferi

Answer 150

Transmitted by hard ticks Hosts include deer and mouse More common in summer

Answer 151

- erythematous macule at site of tick bite - enlarges to form erythema migrant (painless red expanding lesion with a bright red outer spreading edge) - fever - headache - malaise - myalgia - lymphadenopathy - CN palsies

Answer 152

- Meningoencephalitis - Cranial and peripheral neuropathies - Myocarditis - Heart block - Monoarthritis - Oligoarthritis

Answer 153

1. ) Clinical diagnosis | 2. ) Serology

Answer 154

1. ) Doxycycline (>12 years) 2. ) Amoxicillin (<12 years) 3. ) IV ceftriaxone (carditis or neurological disease

Answer 155

1. ) Primary | 2. ) Secondary (more common)

Answer 156

X - linked or autosomal recessive | FH of consanguinity or unexplained death

Answer 157

Severe, prolonged, unusual or recurrent infection

Answer 158

``` Severe combined immunodeficiency (SCID) HIV infection Wiskott-Aldrich syndrome DiGeorge syndrome Duncan disease Ataxia telangiectasia ```

Answer 159

Severe or unusual viral and fungal infections

Answer 160

Severe bacterial infections

Answer 161

Recurrent bacterial infections

Answer 162

Delayed separation of umbilical cord | Delayed wound healing

Answer 163

Recurrent bacterial infections | SLE-like illness

Answer 164

X-linked agammaglobulinaemia CVID (common variable immune deficiency) Hyper IgM syndrome Selective IgA deficiency

Answer 165

Chronic granulomatous disease

Answer 166

Leucocyte adhesion deficiency (LAD)

Answer 167

Triad of immunodeficiency, thrombocytopenia and eczema

Answer 168

1. ) T cells 2. ) B cells (antibodies) 3. ) Neutrophils 4. ) Complement/ mannose-binding lectin

Answer 169

1. ) Antimicrobial prophylaxis 2. ) Antibiotic treatment 3. ) Screening for end-organ disease 4. ) Ig replacement therapy 5. ) Bone marrow transplant

Answer 170

Objectively reproducible symptoms or signs following exposure to a defined stimulus (e.g. food, drug, pollen) at a dose that is usually tolerated by most people

Answer 171

A hypersensitivity reaction initiated by specific immunological mechanisms.

Answer 172

``` IgE mediated (e.g. peanut allergy) Non-IgE mediated (e.g. coeliac disease) ```

Answer 173

Personal or familial tendency to produce IgE antibodies in response to ordinary exposures to potential allergens, usually proteins. Strongly a/w asthma, allergic rhinitis and conjunctivitis, eczema and food allergy.

Answer 174

Serious allergic reaction Bronchial, laryngeal and CV involvement Rapid onset and can lead to death

Answer 175

The developing immune system must be sensitised to an allergen before an allergic immune response develops.

Answer 176

Inhalant allergens (house-dust mite, plant pollens, pet dander and moulds) Ingestant allergens (cow's milk, nuts, soya, egg, wheat, seeds, legumes, seafood and fruits) Insect stings/ bites, drugs and natural rubber latex

Answer 177

Early phase (minutes) - Caused by release of histamine and other mast cell mediators - Causes urticaria, angiodema, sneezing, vomiting, bronchospasm +/or cardiovascular shock Late phase (4-6 hours) - Nasal congestion - Cough - Bronchospasm

Answer 178

Allergy and autoimmune disease is associated with: - Small family size - Low exposure to parasites - Few infections - High antibiotic exposure - Low farming exposure - -> Low microbial exposure

Answer 179

Presence of eczema or food allergy in infancy is predictive of asthma and allergic rhinitis in later life

Answer 180

Non-immunological hypersensitivity reaction to a specific food

Answer 181

Milk Egg Peanut

Answer 182

Peanut Trent Fish Shellfish

Answer 183

A child previously not allergic to apples, develops an allergy to birch trees, and subsequently develops an allergy to apples due to the fact that the apple and birch pollen are similar proteins Leads to itchy mouth with NO systemic symptoms

Answer 184

Urticaria Itchy skin Facial swelling

Answer 185

``` Wheeze Stridor Abdominal pain Vomiting Diarrhoea Shock Collapse ```

Answer 186

1. ) AVOIDANCE 2. ) Written management plan for acute attack - non-sedating antihistamines - epinephrine (EpiPen)

Answer 187

1. ) 2nd generation non-sedating antihistamines 2. ) Topical or nasal corticosteroid 3. ) Cromoglycate eye drops 4. ) Leukotriene receptor antagonists e.g. montelukast

Answer 188

• Inflamed red, dry thickened (lichenified) patches • Flexural • Infected – weepy, crusted Extremely itchy

Answer 189

``` Wrists Elbows Ankles Knees Genitalia ```

Answer 190

``` Flexural surfaces Eyelids Ears Neck Scalp ```

Answer 191

* Discoid eczema (circular, well-defined patches) * Eczema herpeticum * Hand eczema * Pompholyx eczema (water blisters on palms and soles, very itchy)

Answer 192

``` EASI score (eczema area and severity index score) 1.) Erythema and inflammation (redness) 2.) Induration (thickness and swelling) 3.) Excoriation (scratching) 4.) Lichenification (thickened dry skin) 5.) Body surface area ```

Answer 193

- Emollients - Soap substitutes - Intermittent topical steroids (risk of tachyphylaxis where skin gets used to steroid and steroid stops working) - Calcineurin inhibitors e.g. tacrolimus and pimercolimus

Answer 194

- Phototherapy (narrow band UVB or PUVA) | - Systemic immunosuppressive therapy (methotrexate, ciclosporin, azathioprine, mycophenolate)

Answer 195

- Biological therapy (IL4/IL13 inhibitor = dupilumab)

Answer 196

- Short course of oral steroid - Antibiotics oral for infected flares - For herpeticum – oral antivirals

PAEDIATRICS - 1 Flashcards

(225 cards)