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
2
Q
What bugs can be transferred via placenta to baby?
A
syphilis, CMV, toxoplasmosis, rubella, malaria, parvovirus and HIV
3
Q
What are the 4 classic symptoms of congenital CMV?
A
Microcephaly, congenital deafness, intracranial periventricular calcifications, jaundice
Can also get seizures
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
5
Q
What’s the first line test for CMV?
A
Urine PCR
6
Q
What is the leading non-genetic cause of SSNL in childhood?
A
CMV
7
Q
How many babies have primary CMV?
A
6/1000
8
Q
What is the overall rate of hearing loss secondary to CMV?
A
0.5/1000
9
Q
What is the treatment for CMV?
A
Galciclovir, Valganciclovir
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)
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
12
Q
What is contraindicated in babies whose mums have HIV?
A
Breastfeeding
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
14
Q
What is the treatment for HIV?
A
ZIDOVIDINE
15
Q
What is the most effective treatment for reducing congenital HIV?
A
Antiretroviral treatment in pregnancy is most effective at reducing vertical transmission.
16
Q
What is the presentation for congenital syphillis?
A
Snuffles, IUGR, hepatosplenomegaly, choreoretinitis, periostitis
17
Q
When is the highest risk of damage to babies from Syphillis?
A
In first trimester
18
Q
Treatment for congenital Syphillis?
A
10 days of IV Benpen. If med risk, can give one off IM Benpen before results
19
Q
What is the presentation of babies with Rubella?
A
deafness, heart defects, intellectual disability and cataracts
Main risk in first trimester
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
21
Q
When is damage to foetus highest in Toxo?
A
First trimester
22
Q
When is the highest risk of damage to babies with mums who have Parvovirus?
A
SECOND trimester
23
Q
What is the main risk with parvovirus for the child?
A
Hydrops.
24
Q
What is the leading infective cause of foetal death
A
Parvovirus
25
What is the relationship between age of diagnosis and damage for Hep B?
Risk of chronic infection and liver damage inversely proportional to age
90-95% of Hep B infections in < 1 yo= chronic disease
26
What is the risk of transmission for Hep B when mum is HbSAg positive vs HbeAg?
5-20% transmission, e antigen positive = 80-90% transmission
27
If mum is Hep B surface antigen positive, how should baby be treated?
Wash baby, Hep B vaccine and immunoglobulin
28
What are the two presentations of babies infected with GBS?
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
29
What is the preventative treatment for mums with HSV?
Treat from 36 weeks. LUSCs if active lesion.
30
When is the risk of congenital varicella the highest?
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
31
What does congenital varicella present with?
affects eyes, hypoplastic limbs, CNS
32
What is the treatment for HIGH risk VZV in babies?
ZIG to baby otherwise no treatment for babies.
33
What drugs are involved in the FIRST LINE defence for antimicrobial?
CELL WALL SYNTHESIS- castle wall made of PVC.
Penicillin, Vancomycin, Cephalosporin and Carbepenams
34
What is the SECOND line defence for antimicrobial?
SAT on BOMB. Bind to ribosome to stop protein synthesis
30S - AT.
Aminoglycosides ie Gent
Tetracyclines
35
What is the THIRD line of defence for antimicrobial?
50S- bringing the big guns ie TEENAGERS from MLC
Macrolides
Linezolid
Chloramphenicol
36
What are the 4 types of antigens in vaccine?
Toxoid (deactivated toxin ie diptheria), killed/inactivated bacteria (hep A), live attenuated (MMR, chicken pox) and subunit (Hep B)
37
What are some additional vaccines on the schedule for at risk ppn?
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
38
What is the rate of penicillin resistant Strep pneumo in Australia?
1% (treat with Benpen, treat resistance with higher doses of Benpen)
39
What is the stain and type for Penumococcal disease?
Gram POSITIVE diplococci. ALPHA HAEMOLYTIC
40
Where is the reservoir for pneumococcal and when is the peak carraige?
Upper resp tract, peak at 2-3yo. Most mums carry it
41
What sorts of disease can Strep pneumo cause?
From OM to pneumonia to meningitis
42
What is the most common serotype for pneumococcal disease?
Serotype 3
43
What is the current vaccination schedule for pneumococcal? ie 3+0, 1+2, 2+0, 2_1
2+1
44
What are some risk factors for strep pneumo?
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)
45
What is the difference between Prevenar and Pneumovax? how many valent are they/
Prevenar -13, normal schedule
Pneumovax- 23, extra. Not given before 4 yo as no immune potential
46
What is the gram stain for Meningococcal?
Gram NEGATIVE diplococci
47
What is the mortality and morbidity from Meningococcal?
10-15% mortality
20-30% morbidity (limb deformities, scarring, deafness, neurological deficit)
48
What is the carriage of meningococcal in teens and young adults?
23%
49
What are some high risk patients that should get additional meningococcal vaccines?
Think: which patients are at high risk of this infection
Immunodef (SPECIFICALLY COMPLEMENT), functional aplenia, ECULUZIMAB
Eculizimab is anti-C5used to treat paroxysmal noctural haemoglobinuria
50
Who is Men B given to?
Not on schedule but given to those at risk.
Definitely given to Aborginal australians
51
Which vaccine causes fever and a prophylactic paracetamol is advised for?
Men B
52
What is the most common strain of meningococcal in Aus?
Men B
53
What is the current meningococcal vaccine in Australia?
MenACWY
54
Is Infliximab associated with increased risk of meningococcal?
No.
55
When is the varicella vaccine administered?
18 months
56
When is the infectivity of chicken pox?
2 days before onset of rash.
Remember different in pregnancy, which has 5 days before delivery or 2 days post.
57
What is the risk of complications from chicken pox?
1% ie cerebellar ataxia, transvrese myelitis, secondary bacterial infection
58
What is shingles transmitted through?
The vesicles.
59
Is the vaccine for shingles live or inactivated?
LIVE. Lasts 5 years
60
What is Ramsay Hunt Syndrome?
Shingles- reactivation affecting ear and facial nerve. Presents with facial paralysis and vesicular lesion.
61
Would you give IV or oral aciclovir in an immunosuppresed patients with signs of shingles?
IV!! Even if they are well because they have a risk of invasive disease
62
Who should get post-exposure prophylaxis for chicken pox?
House hold contact, F2F 5 mins or in room for 1 hour.
63
When should zoster immunoglobulin be administered post exposure?
Within 96 hours
64
What has the highest risk of transmission post needle stick injury
Hep B
Hep C less risk but more prevalent so overall risk is higher
65
When would you give Tetanus vaccine?
If not fully vaccinated or hasnt received 3 doses OR no booster in last 5 years
66
When would you give Hep B prophylaxis post exposure and in what form?
Hep B vaccine on the day, then at day 7 and 21. If minimal antibodies in patient, given imunoglobulin within 72 hours
67
What is the nPEP given post CSA?
Think Tru Rape
Truvuda+ Raltegravir
(Rape = raltegravir). Start within 72 hours and continue for 28 days
68
What is a hypotonic hyporesponsive episode?
Self-resolving episode usually post first set of vaccines.
69
What is the first line of defence against TB?
TNFa. Innate immune system.
70
What are the common symptoms of active TB?
Fever/cough/night sweats/weight loss.
Clinical presentation weeks-months
71
What is the time frame between primary exposure and active disease in paeds for HIV?
2 years
72
What is the purpose of screening for TB? Ie what is it physiologically testing?
Timing between exposure and positive test?
If immune system has had prior exposure to TB antigen. Usually takes 8 weeks from primary exposure to test +
73
How does the tuberculin skin test work?
Intradermal virus, look at response. Type IV hypersensitivity reaction.
74
What do results of 5mm, 10mm and 15mm mean for Tuberculin skin test?
Which one is diagnostic for paediatrics?
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
What can cause false positive in Tuberculin skin test?
BCG baccine, stie trauma, infection with non-TB mycobacteria
76
What is IGRA?
Blood test for TB. Not for <5yo
77
What is the gold standard test for TB/
Culture- 3x induced sputum or 3x early morning gastric aspirate
78
What is the benefit of geneexpert (PCR) over culture in TB?
Quicker AND tells you about rifampicin resistance
79
What is the treatment for TB?
RIZE
RIfampicin
Isoniazid
Z: Pyrazinamide
E: ethambutol
80
Which TB drug is most and least likely to cause hepatits?
RIZE
RIfampicin
Isoniazid
Z: Pyrazinamide
E: ethambutol
Most= Pyrazinamide
Least= Ethambutol
81
Which TB drug is mostly likely to cause a rash?
RIZE
RIfampicin
Isoniazid
Z: Pyrazinamide
E: ethambutol
Rifampicin
82
Which TB drug causes peripheral neuropathy?
*** dont want this pain
Isoniazid
I sooo dont want this pain
83
Which TB drug causes optic neuropathy?
RIZE
RIfampicin
Isoniazid
Z: Pyrazinamide
E: ethambutol
Ethambutol
E= EYES
84
Which TB drug causes gout?
RIZE
RIfampicin
Isoniazid
Z: Pyrazinamide
E: ethambutol
Pyrazinamide
You pee out gout?
85
What is the risk of active TB in patients with latent TB?
5-10%. REMEMBER MOST IN FIRST 2 YEARS
86
What is the treatment for latent TB?
Rifapicin and Isoniazid (RI)
87
How can you test for latent TB?
Essentially, positive tuberculin skin test with NO clinical symptoms.
Wouldnt do a CXR to check if under 12. Go by clinical
88
What vaccine is Guillian Barre related to
Influenza
89
Name all the live vaccines? On and off the schedule
Schedule:
Rota
Varicella
MMR
Off-schedule
Yellow fever
Typhoid
BCG
Cholera
Polio
90
Which vaccines cannot be frozen?
Think liver and rust
Hep A, Hep B and DTPa
91
What is a beta-haemolytic strep
Strep pyogenes
92
What additional vaccinations are recommended for patients with functional/asplenia?
Pneumococcal, meningococcal and haemophilus influenzae
93
What is HHV 4?
EBV
4 EBV infections
94
What is HHV 3?
VZV. Commonest cause of cerebellar ataxia.
You have 3 chicken pox on your forehead
95
What is HHV 6?
causes roseola infantum. Red maculopapular rash in otherwise well child.
6 rosy cheeks
96
What is the bug in scarlet fever?
Strep pyogenes, starts post sore throat and fever.
97
What bug can cause glomerular disease from prolonged exposure?
Schistosomiasis. Presents as nephrotic syndrome
98
Which bacteria is inherantly resistant to cephalosporins?
Entero faecalis. Gram POSITIVE cocci, commonly causes UTIs in patients with VUR or indwelling catheters.
99
What causes Blue-green pus?
Psuedomonas aeruoginosa
Causes infections in immunocomprimised and skin infections in immunocompetant (nail through shoe)
100
What should be used to treat strep pneumo if intermediately resistant to penicllin? What if its meningitis
Vancomycin if meningitis
If chest, go for higher dose of ben pen
101
What is Melanosis coli in relation to diarrhoea (chronic)
Indication of laxative abuse
Found on gastroscopy/colonoscopy- death of cells in large intestine
102
What causes hydatidid cyst disease in the liver and what is the treatment?
Tapeworm --> causes echinococcosis
Treat with Albendazole
103
What causes bacterial trachietitis? Most commonly/
Staph aureus
104
What is hyper IgE syndrome? What bug is most commonly involved in infections.
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
What is the efficacy of the rotavirus vaccine in preventing any disease severity?
70%
106
What is epidermolysis bulluosa?
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
Which bacteria has the quickest onset of diarrhoea and vomiting in the setting of food poisoning?
Staph aureus
108
Which species of malaria can exclusively cause cerebral malaria?
P. Falciparum
109
Age until which kids have to sit at the back of a car?
7yo
110
Post varicella, which organism causes joint infections? (Hint, its a strep)
Strep A
V A (Varicella upside down?)
