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Nurs 648 > Altered Immunity > Flashcards

Altered Immunity Flashcards

1
Q

HIV diagnostic test used for the following: 1. Infants of HIV infected mothers 2. Patients at any age who are suspected of having acute or early detection of HIV HIV exposed infants should be tested with 48 hours; if negative, follow up testing is completed at 2 weeks, 1-2 months, 3-6 months

A

PCR

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2
Q

Therapy recommended for leukemia relapse; treatment of choice for AML

A

Bone Marrow Transplant

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3
Q

CNS treatment for malignant cells using CNS as sanctuary (blood brain barrier)

A

Sanctuary

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4
Q

Monitored in HIV + children every 3 months

A

UA

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5
Q

Diagnostic tests/findings include: 1. Chest x-ray to explore mediastinal involvement and examine airway patency 2. PET scan to evaluate disease involvement 3. Biopsy - tumor giant cells (Reed-Sternberg cells) 4. CBC - anemia (normocytic and normochromic or microcytic and hypochromic) 5. Increased ferritin 6. Increased ESR Treated with chemotherapy and radiation

A

Hodgkin’s

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6
Q

Congenital malignant intraocular tumor that is most common form of intraocular childhood tumor. Majority diagnosed before 5 years are bilateral.

A

Retinoblastoma

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7
Q

Pediatric neoplastic disorders most often arise from ________, resulting in leukemias, lymphomas, sarcomas, or central nervous system tumors

A

Mesodermal and Neuroectodermal

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8
Q

Initial treatment for ALL to eradicate leukemic blast cells

A

Induction

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9
Q

Diagnostic tests/findings include: 1. CT or MRI to determine site and location 2. Tissue biopsy to confirm diagnosis 3. Bone marrow aspiration and biopsy to evaluate infiltrating tumor 4. Serum or urine catecholamine levels - may be increased and followed for tumor response/recurrence

A

Neuroblastoma

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10
Q

A malignant neoplasm of bone marrow characterized by proliferation of immature white cells, peaking between 2 and 5 years of age

A

Leukemia

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11
Q

During the period between host cell infection and host antibody response, an infected person has a _____ HIV antibody test result, but a _____ HIV RNA result

A

Negative; Positive

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12
Q

Presence of HIV antibody that may occur as early as 10-14 days after infection, but usually 3-4 weeks. Nearly all patients will undergo this within 6 months of acquiring infection.

A

Seroconversion

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13
Q

IG should be provided to susceptible HIV-infected children within 6 days of exposure to this condition

A

Measles

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14
Q

Diagnostic tests/findings include: 1. ELISA test is positive (false negative may occur during window period immediately after infection before AB have developed) 2. Western blot confirms diagnosis (used on patients 18 months and older) Definitive diagnosis requires 2 antibody tests or 1 antibody test and 1 RNA test

A

HIV

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15
Q

Prolong remission for leukemia

A

Maintenance

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16
Q

A neoplasm of the primitive cells from the sympathetic nervous system; most common malignancy in infancy and second most common solid tumor in childhood.

A

Neuroblastoma

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17
Q

Management/treatment developed based on stage of involvement: 1. Surgical excision - unilateral: complete nephrectomy; bilateral: nephrectomy of more involved site, excision biopsy/partial nephrectomy of small lesion in remaining kidney; or no surgery with radiation 2. Multiagent chemotherapy 3. Radiation

A

Wilms’ Tumor/Nephroblastoma

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18
Q

Signs and symptoms include: 1. Asymptomatic if not disseminated 2. Difficulty swallowing, breathing, or cough 3. Swelling in neck, face, upper extremities 4. Lymphadenopathy 5. Abdominal pain

A

Non-Hodgkin’s

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19
Q

Management/treatment determined by stage and extent of disease: 1. Surgery - reduction or enucleation 2. Radiation 3. Laser therapy 4. Cryotherapy 5. Chemotherapy - advanced/recurrent disease

A

Retinoblastoma

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20
Q

Signs and symptoms include: 1. Fatigue, headache 2. Bruising 3. Fever 4. Nosebleeds 5. Bone pain, limp

A

Leukemia

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21
Q

Management includes: 1. Treatment of emergent symptoms 2. Surgery 3. Radiation (for resistant/relapse disease) 4. Combination chemotherapy 5. Bone marrow transplant for high-risk disease 6. Immune-mediated therapy - monoclonal antibody

A

Neuroblastoma

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22
Q

A solid tumor of he bone in which malignant spindle cell stroma produce osteoid; most common form of bone cancer in children; peak incidence during growth spurt between 15-19 years

A

Osteosarcoma

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23
Q

Physical findings are related to site of primary tumor: 1. Lymph node enlargement 2. Hepatomegaly 3. Abdominal or flank mass 4. Proptosis and periorbital ecchymoses 5. Scalp or skin nodules (often bluish)

A

Neuroblastoma

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24
Q

CD4 15-24%

A

Moderate Suppression

25
Q

Physical findings include: 1. Pallor 2. Purpura, ecchymosis 3. Organomegaly (liver/spleen) 4. Lymphadenopathy 5. Testiculomegaly 6. Cranial nerve palsy

A

Leukemia

26
Q

Signs and symptoms include: 1. Painless, firm swelling of lymph nodes 2. Fatigue 3. Decreased appetite and unintentional weight loss 4. Unexplained fever 5. Drenching night sweats

A

Hodgkin’s

27
Q

Monitored in HIV + children every 3-6 months to determine need for antivirals

A

Immunologic Markers

28
Q

Signs and symptoms include: 1. Local pain 2. Local swelling 3. Mass at end of long bone 4. Decreased range of motion

A

Osteosarcoma

29
Q

Most common solid childhood tumor

A

Brain Tumors

30
Q

Monitored in HIV + children every 3-6 months

A

Blood pressure

31
Q

Physical findings include: 1. Leukocoria - yellow-white pupillary reflex (most common presentation) 2. Strabismus 3. Hyphema may be present

A

Retinoblastoma

32
Q

VZIG should be administered within 72 hours of exposure to this condition if IVIG has not been administered within 3 weeks

A

Varicella

33
Q

Physical findings include: 1. Pain over involved site 2. Palpable mass 3. Swelling 4. Decreased range of motion of affected extremity Diagnostic tests/findings: 1. X-ray of affected bone 2. MRI of affected bone 3. Biopsy of area 4. CT of the chest and bone scan or PET scan to evaluate for metastatic disease

A

Osteosarcoma

34
Q

Treatment/management includes: Combination antiretroviral therapy of a protease inhibitor or nonnucleoside reverse transcriptase inhibitor in addition to 2 or more nucleoside reverse transcriptase inhibitors

A

HIV

35
Q

Should be administered to HIV-exposed infants beginning at 6 weeks of age even if HIV infection is not confirmed; continue until 12 months of age or until HIV diagnosis is excluded. For children 1-5 years of age if CD4 is <500cells For children 6-12 years of age if CD4 is <200 cells Lifelong requirement for children who have a history of PCP, despite immune reconstitution; co-trimoxazole

A

Antimicrobial prophylaxis

36
Q

Signs and symptoms include: 1. Squinting 2. Eyes turning inward or outward 3. Painful red eye

A

Retinoblastoma

37
Q

CD4 > 25%; live vaccines may be administered. If IVIG or blood products administered within 3 months, do not give live virus.

A

Normal Immune Category

38
Q

Monitored in HIV + children yearly

A

Tuberculosis

39
Q

Diagnostic tests/findings include: 1. Fundoscopic findings include creamy-pink mass or white avascular tumor mass 2. CT of the orbits to evaluate extent of tumor and to determine optic nerve or bony structure involvement 3. MRI to assess for optic nerve invasion 4. Ultrasound to detect calcification and the proximity of the tumor

A

Retinoblastoma

40
Q

Management/treatment includes: 1. Multiagent chemotherapy 2. Surgery - amputation/limb-sparing surgery

A

Osteosarcoma

41
Q

AZT administered 2mg/kg and then 1mg/kg/hour until delivery; Infant is administered dose within 12 hours and given for 3-6 weeks.

A

Intrapartum

42
Q

Diagnostic tests/findings include: 1. CBC and UA for anemia, hematuria 2. CT of abdomen 3. Abdominal and pelvic ultrasound to indicate if tumor is intrarenal 4. Chest x-ray and chest CT to evaluate for metastasis to lung

A

Wilms’ Tumor/Nephroblastoma

43
Q

Signs and symptoms are dependent on primary site and presence of metastases: 1. Listlessness 2. Poor feeding 3. Pale 4. Weight loss 5. Abdominal pain 6. Weakness 7. Irritability

A

Neuroblastoma

44
Q

A primary malignant renal tumor that is the most common form of renal tumors is children. Signs and symptoms include: 1. May be asymptomatic 2. Abdominal mass - usually nonpainful 3. Occasionally abdominal pain 4. Malaise, fever, loss of appetite 5. Vomiting 6. Blood in urine

A

Wilms’ Tumor/Nephroblastoma

45
Q

Immunizations held while on therapy and resume 6-12 months after therapy completed; fever on therapy requires CBC/blood cultures and hospitalization for neutropenia with fever or if patient has a CVL

A

Leukemia

46
Q

Physical findings include: 1. Similar to other form of lymphoma 2. May vary depending on degree of involvement 3. Distended neck veins and respiratory distress due to superior vena cava syndrome

A

Non-Hodgkin’s

47
Q

Physical findings include: 1. Abdominal mass - usually asymptomatic 2. Hypertension 3. Associated congenital anomalies - aniridia, hemihypertrophy, genitourinary anomalies

A

Wilms’ Tumor/Nephroblastoma

48
Q

Intensive chemotherapy to eliminate residual malignant stem-cells

A

Consolidation

49
Q

Diagnostic tests/findings include: 1. Tissue diagnosis necessary before treatment is started 2. Excision or fine needle biopsy of isolated peripheral nodes 3. Thoracotomy of mediastinal mass 4. Open biopsy of abdominal mass 5. Increased lactic dehydrogenase Treated with chemotherapy and radiation

A

Non-Hodgkin’s

50
Q

Physical findings include: 1. Affected nodes - often fixed, firm, nontender, discrete; cervical and supraclavicular areas most common 2. Splenomegaly

A

Hodgkin’s

51
Q

Diagnostic tests/findings include: 1. CBC - presence of blast cels on peripheral blood smear highly suggestive; requires confirmatory bone marrow examination 2. Bone marrow aspiration/biopsy (required for diagnosis) - bone marrow replaced by >25% blasts

A

Leukemia

52
Q

Before HIV drug therapy is initiated baseline labs include: CBC, LFT, CD4 T lymphocyte count, plasma HIV RNA level Plasma HIV RNA level should be measured every _____

A

4 weeks

53
Q

CD4 <15%

A

Severe Suppression

54
Q
  1. Lopinavir/ritonavir (preferred) 2. Nelfinavir 3. Ritonavir (alone) 4. Amprenavir and indinavir Used in HIV management; combination antiretroviral therapy (HAART) is recommended for all HIV + infants for first year of life AZT is initiated in infancy
A

Protease inhibitors

55
Q

Primitive neuroectodermal tumor of bone that arises in bone marrow spaces, commonly in shaft of long and trunk bones. This cancer almost exclusively arises in individuals under 30. Treatment includes radiation and chemotherapy.

A

Ewing’s Sarcoma

56
Q

HIV protocol began at 14 weeks with AZT treatment; given 5x/daily

A

Antepartum

57
Q

Pandemic caused by a retrovirus that erodes the integrity of the human immune system over time, resulting in immune incompetence and a susceptibility to opportunistic infections and malignancies.

A

HIV

58
Q

Malignant disorders characterized by proliferation of cells, usually restricted to lymphoid cells but may be found in bone marrow; includes Hodgkins and non-Hodgkins; it is the 3rd most common childhood cancer.

A

Lymphomas

59
Q

Physical findings include: 1. Fever 2. Night sweats 3. Weight loss 4. Skin rashes 5. Oral ulcers 6. Diarrhea 7. Generalized lymphadenopathy 8. Genital STDs

A

HIV

Nurs 648 (6 decks)

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