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ID Flashcards

1
Q

Which immunoglobulin is low in babies? And why?

A

Low IgA, IgM and IgE – NORMAL IgG and IgGoes across the placenta

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2
Q

What bugs can be transferred via placenta to baby?

A

syphilis, CMV, toxoplasmosis, rubella, malaria, parvovirus and HIV

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3
Q

What are the 4 classic symptoms of congenital CMV?

A

Microcephaly, congenital deafness, intracranial periventricular calcifications, jaundice
Can also get seizures

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4
Q

What proportion of babies are symptomatic with CMV?

A

15% symptomatic of which 50% have SSNL
85% asymptomatic, of which 7-15% have SSNL

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5
Q

What’s the first line test for CMV?

A

Urine PCR

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6
Q

What is the leading non-genetic cause of SSNL in childhood?

A

CMV

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7
Q

How many babies have primary CMV?

A

6/1000

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8
Q

What is the overall rate of hearing loss secondary to CMV?

A

0.5/1000

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9
Q

What is the treatment for CMV?

A

Galciclovir, Valganciclovir

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10
Q

How is HIV transmitted to the baby?

A

though all forms! Direct transfer, contact, placenta, vertical transmission (also via breast milk in 10-20% during first few months)

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11
Q

What is the classic presentation for babies with HIV?

A

IUGR, low birth weight, FTT and then later go onto to get opportunistic infections etc

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12
Q

What is contraindicated in babies whose mums have HIV?

A

Breastfeeding

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13
Q

What is the testing pathway for babies of mums with HIV?

A

Antibody tests not done in infants <18months because tranplacental Ab
So, diagnosis via HIV DNA PCR assay (at birth, 1-2 months, 4 months and 12 months)
Negative test at 4 months or older after which 100% assurance that NOT infected

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14
Q

What is the treatment for HIV?

A

ZIDOVIDINE

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15
Q

What is the most effective treatment for reducing congenital HIV?

A

Antiretroviral treatment in pregnancy is most effective at reducing vertical transmission.

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16
Q

What is the presentation for congenital syphillis?

A

Snuffles, IUGR, hepatosplenomegaly, choreoretinitis, periostitis

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17
Q

When is the highest risk of damage to babies from Syphillis?

A

In first trimester

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18
Q

Treatment for congenital Syphillis?

A

10 days of IV Benpen. If med risk, can give one off IM Benpen before results

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19
Q

What is the presentation of babies with Rubella?

A

deafness, heart defects, intellectual disability and cataracts
Main risk in first trimester

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20
Q

What is the presentation of babies with Toxo??

A

Chorioretinitis, hydrocephalus/, blueberry muffin rash, pericardial effusion.
also hypotonia, seizures, CSF abnormalities
and intracranial calcification

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21
Q

When is damage to foetus highest in Toxo?

A

First trimester

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22
Q

When is the highest risk of damage to babies with mums who have Parvovirus?

A

SECOND trimester

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23
Q

What is the main risk with parvovirus for the child?

A

Hydrops.

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24
Q

What is the leading infective cause of foetal death

A

Parvovirus

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25
Q

What is the relationship between age of diagnosis and damage for Hep B?

A

Risk of chronic infection and liver damage inversely proportional to age
90-95% of Hep B infections in < 1 yo= chronic disease

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26
Q

What is the risk of transmission for Hep B when mum is HbSAg positive vs HbeAg?

A

5-20% transmission, e antigen positive = 80-90% transmission

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27
Q

If mum is Hep B surface antigen positive, how should baby be treated?

A

Wash baby, Hep B vaccine and immunoglobulin

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28
Q

What are the two presentations of babies infected with GBS?

A

EOS: < 7 days, 30% of prems. Bacteremia and pneumonia. Fulminant
LOS: 7 days – 2 months. Term babies. Bacteremia and meningitis. Mortality 2-6%

Intrapartum Abx ONLY protect against EOS

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29
Q

What is the preventative treatment for mums with HSV?

A

Treat from 36 weeks. LUSCs if active lesion.

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30
Q

When is the risk of congenital varicella the highest?

A

Risk of congenital varicella 2% if maternal infection between 13-40
0.4% if less than 13 weeks
HIGH risk if perinatal exposure ie 5 days before and 2 days post delivery

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31
Q

What does congenital varicella present with?

A

affects eyes, hypoplastic limbs, CNS

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32
Q

What is the treatment for HIGH risk VZV in babies?

A

ZIG to baby otherwise no treatment for babies.

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33
Q

What drugs are involved in the FIRST LINE defence for antimicrobial?

A

CELL WALL SYNTHESIS- castle wall made of PVC.
Penicillin, Vancomycin, Cephalosporin and Carbepenams

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34
Q

What is the SECOND line defence for antimicrobial?

A

SAT on BOMB. Bind to ribosome to stop protein synthesis
30S - AT.

Aminoglycosides ie Gent
Tetracyclines

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35
Q

What is the THIRD line of defence for antimicrobial?

A

50S- bringing the big guns ie TEENAGERS from MLC
Macrolides
Linezolid
Chloramphenicol

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36
Q

What are the 4 types of antigens in vaccine?

A

Toxoid (deactivated toxin ie diptheria), killed/inactivated bacteria (hep A), live attenuated (MMR, chicken pox) and subunit (Hep B)

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37
Q

What are some additional vaccines on the schedule for at risk ppn?

A

Pneumococcal: for medically at risk patients
Meningococcal: For indigenous. Get Men B at 2,4 months prior to Men ACWY at 12 months
Hep A: For indigenous

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38
Q

What is the rate of penicillin resistant Strep pneumo in Australia?

A

1% (treat with Benpen, treat resistance with higher doses of Benpen)

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39
Q

What is the stain and type for Penumococcal disease?

A

Gram POSITIVE diplococci. ALPHA HAEMOLYTIC

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40
Q

Where is the reservoir for pneumococcal and when is the peak carraige?

A

Upper resp tract, peak at 2-3yo. Most mums carry it

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41
Q

What sorts of disease can Strep pneumo cause?

A

From OM to pneumonia to meningitis

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42
Q

What is the most common serotype for pneumococcal disease?

A

Serotype 3

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43
Q

What is the current vaccination schedule for pneumococcal? ie 3+0, 1+2, 2+0, 2_1

A

2+1

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44
Q

What are some risk factors for strep pneumo?

A

Immunosuppression, asplenia, indigenous (own risk factor independant), cardiac/renal/liver disease, prev invasive strep disease, prematurity.
All of these patients get extra dose of Prevenar (13) and Pneumovax (23)

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45
Q

What is the difference between Prevenar and Pneumovax? how many valent are they/

A

Prevenar -13, normal schedule
Pneumovax- 23, extra. Not given before 4 yo as no immune potential

46
Q

What is the gram stain for Meningococcal?

A

Gram NEGATIVE diplococci

47
Q

What is the mortality and morbidity from Meningococcal?

A

10-15% mortality
20-30% morbidity (limb deformities, scarring, deafness, neurological deficit)

48
Q

What is the carriage of meningococcal in teens and young adults?

A

23%

49
Q

What are some high risk patients that should get additional meningococcal vaccines?
Think: which patients are at high risk of this infection

A

Immunodef (SPECIFICALLY COMPLEMENT), functional aplenia, ECULUZIMAB

Eculizimab is anti-C5used to treat paroxysmal noctural haemoglobinuria

50
Q

Who is Men B given to?

A

Not on schedule but given to those at risk.
Definitely given to Aborginal australians

51
Q

Which vaccine causes fever and a prophylactic paracetamol is advised for?

A

Men B

52
Q

What is the most common strain of meningococcal in Aus?

A

Men B

53
Q

What is the current meningococcal vaccine in Australia?

A

MenACWY

54
Q

Is Infliximab associated with increased risk of meningococcal?

A

No.

55
Q

When is the varicella vaccine administered?

A

18 months

56
Q

When is the infectivity of chicken pox?

A

2 days before onset of rash.

Remember different in pregnancy, which has 5 days before delivery or 2 days post.

57
Q

What is the risk of complications from chicken pox?

A

1% ie cerebellar ataxia, transvrese myelitis, secondary bacterial infection

58
Q

What is shingles transmitted through?

A

The vesicles.

59
Q

Is the vaccine for shingles live or inactivated?

A

LIVE. Lasts 5 years

60
Q

What is Ramsay Hunt Syndrome?

A

Shingles- reactivation affecting ear and facial nerve. Presents with facial paralysis and vesicular lesion.

61
Q

Would you give IV or oral aciclovir in an immunosuppresed patients with signs of shingles?

A

IV!! Even if they are well because they have a risk of invasive disease

62
Q

Who should get post-exposure prophylaxis for chicken pox?

A

House hold contact, F2F 5 mins or in room for 1 hour.

63
Q

When should zoster immunoglobulin be administered post exposure?

A

Within 96 hours

64
Q

What has the highest risk of transmission post needle stick injury

A

Hep B
Hep C less risk but more prevalent so overall risk is higher

65
Q

When would you give Tetanus vaccine?

A

If not fully vaccinated or hasnt received 3 doses OR no booster in last 5 years

66
Q

When would you give Hep B prophylaxis post exposure and in what form?

A

Hep B vaccine on the day, then at day 7 and 21. If minimal antibodies in patient, given imunoglobulin within 72 hours

67
Q

What is the nPEP given post CSA?
Think Tru Rape

A

Truvuda+ Raltegravir
(Rape = raltegravir). Start within 72 hours and continue for 28 days

68
Q

What is a hypotonic hyporesponsive episode?

A

Self-resolving episode usually post first set of vaccines.

69
Q

What is the first line of defence against TB?

A

TNFa. Innate immune system.

70
Q

What are the common symptoms of active TB?

A

Fever/cough/night sweats/weight loss.
Clinical presentation weeks-months

71
Q

What is the time frame between primary exposure and active disease in paeds for HIV?

A

2 years

72
Q

What is the purpose of screening for TB? Ie what is it physiologically testing?
Timing between exposure and positive test?

A

If immune system has had prior exposure to TB antigen. Usually takes 8 weeks from primary exposure to test +

73
Q

How does the tuberculin skin test work?

A

Intradermal virus, look at response. Type IV hypersensitivity reaction.

74
Q

What do results of 5mm, 10mm and 15mm mean for Tuberculin skin test?
Which one is diagnostic for paediatrics?

A

5mm= considered positive if KNOWN HIV infection, close contact, organ recipient or CXR consistent with prev TB
10mm= consistent with TB if lab staff, PAEDIATRIC, prisoner etc
>15mm = positive, if no other risk factors are present.

75
Q

What can cause false positive in Tuberculin skin test?

A

BCG baccine, stie trauma, infection with non-TB mycobacteria

76
Q

What is IGRA?

A

Blood test for TB. Not for <5yo

77
Q

What is the gold standard test for TB/

A

Culture- 3x induced sputum or 3x early morning gastric aspirate

78
Q

What is the benefit of geneexpert (PCR) over culture in TB?

A

Quicker AND tells you about rifampicin resistance

79
Q

What is the treatment for TB?

A

RIZE
RIfampicin
Isoniazid
Z: Pyrazinamide
E: ethambutol

80
Q

Which TB drug is most and least likely to cause hepatits?
RIZE
RIfampicin
Isoniazid
Z: Pyrazinamide
E: ethambutol

A

Most= Pyrazinamide
Least= Ethambutol

81
Q

Which TB drug is mostly likely to cause a rash?
RIZE
RIfampicin
Isoniazid
Z: Pyrazinamide
E: ethambutol

A

Rifampicin

82
Q

Which TB drug causes peripheral neuropathy?
*** dont want this pain

A

Isoniazid
I sooo dont want this pain

83
Q

Which TB drug causes optic neuropathy?
RIZE
RIfampicin
Isoniazid
Z: Pyrazinamide
E: ethambutol

A

Ethambutol
E= EYES

84
Q

Which TB drug causes gout?
RIZE
RIfampicin
Isoniazid
Z: Pyrazinamide
E: ethambutol

A

Pyrazinamide
You pee out gout?

85
Q

What is the risk of active TB in patients with latent TB?

A

5-10%. REMEMBER MOST IN FIRST 2 YEARS

86
Q

What is the treatment for latent TB?

A

Rifapicin and Isoniazid (RI)

87
Q

How can you test for latent TB?

A

Essentially, positive tuberculin skin test with NO clinical symptoms.
Wouldnt do a CXR to check if under 12. Go by clinical

88
Q

What vaccine is Guillian Barre related to

A

Influenza

89
Q

Name all the live vaccines? On and off the schedule

A

Schedule:
Rota
Varicella
MMR

Off-schedule
Yellow fever
Typhoid
BCG
Cholera
Polio

90
Q

Which vaccines cannot be frozen?
Think liver and rust

A

Hep A, Hep B and DTPa

91
Q

What is a beta-haemolytic strep

A

Strep pyogenes

92
Q

What additional vaccinations are recommended for patients with functional/asplenia?

A

Pneumococcal, meningococcal and haemophilus influenzae

93
Q

What is HHV 4?

A

EBV
4 EBV infections

94
Q

What is HHV 3?

A

VZV. Commonest cause of cerebellar ataxia.
You have 3 chicken pox on your forehead

95
Q

What is HHV 6?

A

causes roseola infantum. Red maculopapular rash in otherwise well child.
6 rosy cheeks

96
Q

What is the bug in scarlet fever?

A

Strep pyogenes, starts post sore throat and fever.

97
Q

What bug can cause glomerular disease from prolonged exposure?

A

Schistosomiasis. Presents as nephrotic syndrome

98
Q

Which bacteria is inherantly resistant to cephalosporins?

A

Entero faecalis. Gram POSITIVE cocci, commonly causes UTIs in patients with VUR or indwelling catheters.

99
Q

What causes Blue-green pus?

A

Psuedomonas aeruoginosa
Causes infections in immunocomprimised and skin infections in immunocompetant (nail through shoe)

100
Q

What should be used to treat strep pneumo if intermediately resistant to penicllin? What if its meningitis

A

Vancomycin if meningitis
If chest, go for higher dose of ben pen

101
Q

What is Melanosis coli in relation to diarrhoea (chronic)

A

Indication of laxative abuse

Found on gastroscopy/colonoscopy- death of cells in large intestine

102
Q

What causes hydatidid cyst disease in the liver and what is the treatment?

A

Tapeworm –> causes echinococcosis
Treat with Albendazole

103
Q

What causes bacterial trachietitis? Most commonly/

A

Staph aureus

104
Q

What is hyper IgE syndrome? What bug is most commonly involved in infections.

A

Hyper IgE Syndrome (HIES) is a rare primary immunodeficiency disease characterized by eczema, recurrent staphylococcal skin abscesses, recurrent lung infections, eosinophilia (a high number of eosinophils in the blood) and high serum levels of IgE

105
Q

What is the efficacy of the rotavirus vaccine in preventing any disease severity?

A

70%

106
Q

What is epidermolysis bulluosa?

A

Rare blistering skin condition where skin peels from even simple touch

The EB conditions result from genetic defects of molecules in the skin concerned with adhesion. AUT DOMINANT. 4 diff types

107
Q

Which bacteria has the quickest onset of diarrhoea and vomiting in the setting of food poisoning?

A

Staph aureus

108
Q

Which species of malaria can exclusively cause cerebral malaria?

A

P. Falciparum

109
Q

Age until which kids have to sit at the back of a car?

A

7yo

110
Q

Post varicella, which organism causes joint infections? (Hint, its a strep)

A

Strep A

V A (Varicella upside down?)

RACP Written (18 decks)

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