Chapter 42: The Child with an Immunologic Alteration

Question 1

Why does HIV have a more rapid disease progression in infants than teenagers?

Answer 1

Infants have naturally decreased or immature immune systems to begin with.

Question 2

Diagnosis of HIV in children uses the tests __________ and ___________.

Answer 2

HIV DNA PCR
HIV RNA Assay

Question 3

_____________________ disorders occur when the body’s immune system can no longer differentiate its own cells from antigens.

Answer 3

Autoimmune

Question 4

Treatment goal of Systemic Lupus Erythematosus (SLE)

Answer 4

prevent organ damage

Question 5

____________ infants have longer immunity

Answer 5

Breastfed

Question 6

Sneezing; tightness, tingling of mouth or face with subsequent swelling of lips and tongue; severe flushing, urticaria, and itching (especially head and upper trunk); rapid development of erythema; and a sense of impending doom are manifestations of _____________.

Answer 6

initial anaphylaxis

Question 7

The newborn receives __________ by placental transfer, which disappears by _____________

Answer 7

IgG, 6-8 weeks

Question 8

Classic sign of SLE

Answer 8

butterfly rash

Question 9

The spleen reaches its full size at _________________

Answer 9

adulthood

Question 10

___________ help build the immune system

Answer 10

Vaccines

Question 11

When is oral ZDV given to infants

Answer 11

within first 6-12 hours after birth until 6 weeks old or positive HIV diagnosis

Question 12

What is required for HIV to be considered negative in children?

Answer 12

2 negatives on 2 different occasions at 1 month and 4 months

Question 13

Lymphoid tissue (increases, decreases) in males during __________ and ____________

Answer 13

increases, infancy, childhood

Question 14

Treatment given to the mother during labor for HIV-exposed infants

Answer 14

IV ARV

Question 15

Diagnosis for SLE involves this test

Answer 15

positive ANA assay

Question 16

Type II hypersensitivity also known as

Answer 16

cytotoxic hypersensitivity

Question 17

An acquired cell-mediated immunodeficiency disorder that is chronic and causes a widespread spectrum of illnesses in children

Answer 17

HIV

Question 18

Why is CD4 direct count not monitored in children?

Answer 18

CD4 count can vary greatly based on age

Question 19

Allergic rhinitis, acute anaphylaxis, hives, eczema, and asthma are examples of __________ hypersensitivity

Answer 19

Type I (immediate, anaphylactic)

Question 20

Most likely method of HIV transmission in adolescents

Answer 20

sexual transmission or illegal drug use (due to high risk behaviors)

Question 21

Type III hypersensitivity also known as

Answer 21

arthrus hypersensitivity (immune complex)

Question 22

Other causes of anaphylaxis in children

Answer 22

medication, insect stings

Question 23

What therapy is initiated after an infant receives a positive HIV diagnosis

Answer 23

antiretroviral (ARV) therapy

Question 24

Children have ____________ capacity to mount an antibody response

Answer 24

limited

Question 25

Recurrent upper respiratory infections and ear infections are common with this disorder

Answer 25

HIV

Question 26

Immunologic alterations are usually ________________ with intervals of ___________ and ____________

Answer 26

chronic, wellness, relapses

Question 27

This type of therapy acts as natural products of the adrenal glands and reduces systemic inflammatory symptoms

Answer 27

corticosteroid therapy

Question 28

Preferred method of birth for HIV positive mothers

Answer 28

Cesarean section

Question 29

Chemotherapy drug that decreases immune response and is also used for SLE

Answer 29

cyclophosphamide

Question 30

The number of Peyer patches (increases, decreases) until __________________

Answer 30

increases, adolescence

Question 31

Type I hypersensitivity also known as

Answer 31

immediate (anaphylactic) hypersensitivity

Question 32

Diagnosis of SLE requires _______ or more of the manifestations to be present.

Answer 32

4

Question 33

For treatment of anaphylactic shock, ensure an adequate ___________ and __________ if necessary. Administer _________________, _____________, ______________, and/or _____________ as ordered. Keep the child (warm, cold) and lying ______ or with feet ________________. Start an ____________.

Answer 33

airway, intubate epinephrine, oxygen, corticosteroids, antihistamines warm, flat, slightly elevated IV line

Question 34

The thymus gland is fully functional until ____________, when it begins to __________ and is ultimately replaced by _________________________

Answer 34

puberty, shrink, fatty tissue

Question 35

Encourage to have low ________ and low ___________ diet to preserve renal function (in SLE that affects kidneys)

Answer 35

sodium, protein

Question 36

Serum sickness and glomerulonephritis are examples of _________ hypersensitivity

Answer 36

Type III (arthrus, immune complex)

Question 37

Long-term use of ___________________ results in adrenal suppression

Answer 37

corticosteroids

Question 38

Treatment given to HIV-exposed infants after birth

Answer 38

oral ZDV

Question 39

Transfusion reaction after receiving incompatible blood is an example of _________ hypersensitivity

Answer 39

Type II (cytotoxic)

Question 40

Contact dermatitis (such as from poison ivy) is an example of ________ hypersensitivity

Answer 40

Type IV (delayed cell-mediated)

Question 41

Why is the western blot assay inaccurate under 18 months?

Answer 41

Mother's antibodies are still present

Question 42

A common autoimmune disorder that results in connective tissue inflammation

Answer 42

Systemic Lupus Erythematosus (SLE)

Question 43

What is required for a positive diagnosis of HIV in children?

Answer 43

2 positive tests on 2 different occasions

Question 44

(Increased/Diminished) immune response allows for spread of ___________

Answer 44

Diminished, infection

Question 45

Most common cause of anaphylaxis in children

Answer 45

food allergies

Question 46

To be diagnosed with adrenal suppression, the patient is administered _______, and the _______________ level does not elevate as it should.

Answer 46

ACTH, serum cortisol

Question 47

Type IV hypersensitivity also known as

Answer 47

delayed cell-mediated hypersensitivity

Question 48

Amount of HIV virus detected in bloodstream

Answer 48

viral load/burden

Question 49

Most likely method of HIV transmission in infants

Answer 49

mother to infant across placenta or during childbirth

Question 50

More severe complications include osteoporosis, amenorrhea, cataracts, and pancreatitis

Answer 50

corticosteroid therapy

Question 51

Short-term use of _____________________ can shorten the span of illness and improve patient wellbeing

Answer 51

corticosteroids

Question 52

Instead of CD4 direct count, what levels should be monitored in children with HIV?

Answer 52

CD4 percentage

Question 53

Manifestations include edema, GI upset, bruising, increased infection, increased appetite and weight, muscle atrophy, hypertension, and growth limitations.

Answer 53

corticosteroid therapy