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Nicu Brodsky+Pediatrix+NeoReview Questions > ID + Immunology > Flashcards

ID + Immunology Flashcards

1
Q

CMV is a ____ stranded _____ virus

A

DS herpes DNA virus

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2
Q

In VLBW infants, ____ is the most common bacteria

A

E coli

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3
Q

Which TORCH-like infections increase risk of stillbirth or fetal loss?

A

Listeria, parvovirus, syphillis. Varicella and toxo do not

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4
Q

At birth, most infants with CMV are symptomatic or asymptomatic? What are routes of transmission?

A

Most are asymptomatic regardless of route of transmission. Transplacentally (all trimesters), intrapartum, BM, blood transfusions

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5
Q

Progression of maternal IgG, IgA, IgM

A

During fetal period, IgG from mother following placental transport but endocytosis, maternal IgG disappears by 9 mo

IgM: 75% of adult levels are reached by 1 year of age, some fetal IgM production

IgA: NO fetal IgA production, levels at 1 year are 20% of adult levels

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6
Q

Both term and preterm toxo are symptomatic or asymptomatic at birth?

A

ASYMPTOMATIC. 80% of infants will have both learning AND visual disabilities

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7
Q

Risk of transmission of HIV through breastmilk is ____%

A

9-15%. Viral load in human milk may not be same as that in plasma. Different antiretroviral drugs have different penetration in milk vs plasma.

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8
Q

Betamethasone is NOT recommended for gestational age ____ weeks

A

> 34 weeks

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9
Q

Kostmann Syndrome

A

congenital neutropenia that results from mutations in neutrophil elastase gene

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10
Q

What % of CONS is resistant to methicillin?

A

90%

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11
Q

Most common complication of omphalitis is ____? Risk factors for omphalitis?

A

sepsis (not nec fasc). Risk factors for omphalitis? RF: low BW, prolonged labor, PROM, maternal infection, non-sterile delivery

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12
Q

when does IgA and IgM get produced? Levels at 1 year?

A

NO fetal IgA production. Increase after birth, 20% of adult levels at 1 year.
Some fetal IgM production, levels are 75% of adult levels at 1 year

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13
Q
A
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14
Q

B cell production in fetus

A

Pre-b cells in liver at 7 weeks GA
“” “” bone marrow by 12 weeks
at 30 weeks, no detectable pre-B cells in fetal liver, and bone marrow becomes exclusive site for B-cell maturation
Birth: proportion of B cells is similar to that of adults, but absolute # of B cells I significantly higher
3-4 months: # of B cells peaks
6-7 years: declines to adult levels

Preterm infants have B-cell #’s that are comparable to those in term infants

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15
Q

Compared to neutrophils of adults, those of neonates ____

A

adhere poorly to endothelium and have poor chemotactic response

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16
Q

Neutrophils from preterm neonates vs adult neutrophils?

A

defects in phagocytosis that corrects by late 3rd trimester / term

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17
Q

What is function of complement system?

A

Principal component of natural immune system. Neutralize foreign substances in circulation or mucous membranes. Needs antibodies against particular antigen –> formation of immune complexes

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18
Q

What is early vs late complement?

A

Early (C1-C4); deficiency = increased risk of pneumococcal infections and collagen vascular dz. C2 is MC deficiency
Late complement C5-C9 leads to increased risk of Neisseria

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19
Q

septic arthritis - mobilize or no? Need bone biopsy?

A

YES to immobilize. Bone biopsy not indicated

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20
Q

what type of bacteria is clostridium botulinum

A

gram positive bacillus

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21
Q

What type of bacteria is GBS

A

gram positive diplococcus in chains

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22
Q

How has maternal GBS swabbing affected sepsis rates

A

early onset GBS has gone down, but late onset sepsis has not been affected

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23
Q

Function of neutrophils?

A

chemotaxis, phagocytosis, bacterial killing

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24
Q

Compared to adults, neonates neutrophils have _____

A

decreased migration, NORMAL killing, majority of neutrophils in BM instead of plasma. HIGHER baseline proliferation rate

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25
Q

Placental pathologies of syphillis vs CMV

A

Syphillis: hydrops, marked round cell infiltration caused by maternal immunocytes
CMV: villous damage with thrombosis and villitis with some villi containing inclusion body cells and hemosiderin deposits

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26
Q

osteomyelitis incidence in neonates vs older children

A

more common in neonates

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27
Q

Which bones are commonly affected in neonatal osteo

A

Long bones of lower limb, followed by long bones in upper limb. Bone marrow involvement is rare

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28
Q

Which type of HSV infection (recurrent vs primary) has higher rate of transmission?

A

primary infection - 57%. If mother had previous infection with different serotype, 25% risk. If recurrent infection with same serotype, 2%.

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29
Q

Suppressive acyclovir therapy decreases need for CS in women with hx of genital herpes. When to start?

A

36 weeks. However does NOT completely prevent viral shedding

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30
Q

If mom has primary HSV-1, but baby workup is negative, how to treat baby?

A

IV acyclovir x 10 days (transmission risk 57%~!)

31
Q

What is the molecular basis for newborn screening of SCID?

A

detection of PCR of DNA fragments that are excised during T cell receptor rearrangement / T cell receptor excision circles

32
Q

Partial diGeorge syndrome symptoms

A

Eczematous rash + lymphadenopathy –> oligoclonal expansion of peripheral T-cells. Need steroids to suppress oligoclonal T-cells and thymus transplant

33
Q

DiGeorge syndrome IgG levels and T cells

A

Can have low Ig levels bc dependent on CD4% cell signals. precursor T-cells can form in bone marrow but cannot undergo maturation process in thymus

34
Q

Mutation in leukocyte adhesion deficiency?

A

mutation in beta-2 integral gene leading to neutrophil dysfunction

35
Q

Enterobacter is resistant to cefotaxime due to ______

A

inherited AmpC type beta lactamases (SPACE organisms - Serratia, Pseudomonas, Acinetobacter, Citrobacter, Enterobacteer)

36
Q

Encapsulated bacteria

A

Hflu, neisseria meningitidis, salmonella, strep pneumo

37
Q

Spleen function

A

produces IgM and complement, matures antibodies, supports proliferation of T-cells. Scavenges damaged or senescent RBCs and platelets from circulation and serves as reservoir of extra blood

38
Q

What hematologic histology seen for non-functioning spleen?

A

Howell jollly bodies - small round nuclear remnants

39
Q

What are Heinz bodies?

A

denatured hemoglobin and Pappenheimer bodies are granules of iron

40
Q

Highest risk of CLABSI is in infants with _____

A

low birth weight and premature GA

41
Q

If infant > 37 weeks, membrane rupture < 18 hours, GBS+ with inadequate tx, what is plan?

A

No labs or abx, but monitor for 48 hrs

42
Q

What is order of most common infections in EOS

A

BEESL
GBS, E coli, enterococcus, staph aureus, listeria

43
Q

Blood serums HSV PCR is or is not necessary to dx disseminated dz?

A

is NOT

44
Q

Most common complication of subclinical congenital toxo?

A

chorioretinitis. Symptomatic toxo causes intellectual disability, seizures, spasticity, deafness

45
Q

What do white spots on umbilical cord indicate?

A

candida chorioamnionitis

46
Q

Which ethnicity has highest rates of HIV transmission?

A

African American mothers

47
Q

What is CGD? How to dx?

A

Chronic granulomatous disease - phagocytic cells (neutrophils) cannot generate superoxide that is necessary to kill bacteria. Absent or decreased neutrophil respiratory burst (nitro blue tetrazolium test) - if does not turn blue, neutrophil respiratory burst is impaired

48
Q

Chediak Higashi syndrome

A

Decrease in phagocytosis. pigment dilution of skin, hair, eyes. Abnormally large granules in cells, LYST gene (lysosomal tracking regulator)

49
Q

What are collectins?

A

family of soluble oligomeric proteins that play a part in host defense of neonate –> related in structure to complement protein C1q. Mannose-binding lectin SP-A, SP-D

50
Q

Which of rubella and CMV have cataracts?

A

RUBELLA. both can have blueberry muffin rash. CMV has chorioretinits.

51
Q

Next best step in Asymptomatic infant born to woman with untreated gonorrheal infection

A

tx with both topical ophthalmic erythromycin and IV/IM CTX

52
Q

Which TORCH infections increase risk of stillbirth?

A

Listeria, parvo, syphillis

53
Q

How to tx mom who gets varicella in pregnancy?

A

VZIG only! (Vaccine is live)

54
Q

How to reduce CMV transmission in BM?

A

freezing or pasteurization. CMV more likely to occur among preterm bc term infants receive more passively transferred maternal ab

55
Q

Transmission time for CMV, syphillis, rubella, toxo

A

CMV - transmission can occur anytime, but more severe if earlier
Syphillis - can transmit at any time but more severe if acquired LATER
Rubella - transmission is U-shaped (RU-bella) but more severe if acquired earlier
Toxo - transmission INCREASES with gestation, but more severe if acquired earlier

56
Q

How long do you wait to swab baby’s skin if concerned for HSV and why do we wait?

A

12-24 hrs - make sure not contamination

57
Q

Manifestations of early vs late-onset listeria? Method of transmission?

A

Early-onset listeria = transplacental; late-onset = contact during delivery with vaginal flora.
Early-onset: PNA and sepsis
Late-onset: Meningitis

58
Q

How to definitively tell HIV negative

A

1)Two negative HIV RNA or DNA viral test results, from separate specimens, both of which were drawn at ≥2 weeks of age and one of which was drawn at ≥4 weeks of age
2)One negative HIV RNA or DNA viral test result from a specimen drawn at ≥8 weeks of age
3)One negative HIV antibody test result drawn at ≥6 months of age

59
Q

What is pleconaril

A

antiviral capsid binding drug that inhibits viral attachment to host cells; can be useful for enterovirus

60
Q

IgA and IgM production for neonate

A

IgA is produced after birth. 20% of adult levels at 1 year of age
IgM is 75% of adult levels by 1 year of age

61
Q

B-cell production in neonates

A

At birth, proportion of B cells is similar to adults, but absolute # is significantly higher - # peaks at 3-4 months of age
12 weeks - BM produces B-cells
30 weeks - BM becomes exclusive site for B-cell maturation

62
Q

Neutrophils in babies; term vs preterm

A

***Neutrophils from term/preterm adhere poorly to endothelium and have impaired chemotaxis. NORMAL killing.
Neutrophils from preterm are bad at phagocytosis, correct by late 3rd trimester or term
Neutrophils from term have granule contents + degranulation similar to adults
Baseline Higher proliferation rate; does not increase production as rapidly as adult

63
Q

What is classic complement? where do they converge? What does complement do?

A

Classic complement - C1, C4, C2, C3
Classic and alternative converge at C3
Complement plays role as natural immune system - facilitates neutralization of foreign substances in circulation or in MM
Requires specific ab against particular Ag, leading to formation of immune complexes

64
Q

Electromyography of clostridium

A

Clostridium EMG - Incremental response at high-frequency Abnormal spontaneous activity
Abundant, brief, small-amplitude action potentials

65
Q

Placental path of syphillis

A

hydrops and round cell infiltration caused by maternal immunocytes

66
Q

Osteomyelitis facts; neonates vs children

A

osteomyelitis is more common in neonates than children
Neonates - hematogenous spread; more likely to have new bone formation and bone remodeling.
Children - contiguous spread

Vascular anatomy of neonates = more likely to have septic arthritis. BOny destruction less common in neonates bc thin periostea tissues allows for spontaneous drainage of bony abscess. The thin periostea llayer is good for protecting the BM though.

67
Q

Does recurrent HSV increase risk of infection?

A

no!

68
Q

DiGeorge syndrome and precursor T-cells

A

Patients with DiGeorge syndrome have absent or hyoplastic thymuses. Therefore, the precursor T-cells formed in the bone marrow cannot undergo their maturation process in the thymus

69
Q

Spleen function

A

Spleen does NOT excrete extra iron
It saves as site of IgM and complement production
Maturation of ab
Supports proliferation of T-cells
Scavenges damaged RBC and platelets; recycles iron from hemoglobin for use in hematopoiesis

70
Q

Greatest risk for CLABSI?

A

infant’s GA and BW

71
Q

MC complication of untreated toxo?

A

chorioretinits

72
Q

Transmission of HBV to infant is associated with

A

maternal HBV load
If HB e+, then risk of transmission higher than if negative

73
Q

characteristic rash of congenital syphillis

A

vesicular or bullous skin lesions; usually rupture to form spuperficial crusted erosions or ulcerations. Generalized, involves palms + soles

Nicu Brodsky+Pediatrix+NeoReview Questions (14 decks)

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