IDHO Flashcards
1
Q
Main function of C3 (complement)?
A
opsonization
2
Q
Main function of C5a (complement)?
A
chemotaxis
3
Q
Main function of C1 (complement)?
A
lyse viruses
4
Q
Much of the toxicity attributed to LPS is due to what region of the molecule?
A
lipid A region
5
Q
What membrane-bound receptor is necessary for LPS signaling (in addition to TLR)?
A
CD14
6
Q
Gram-positive organisms activate what TLR?
A
TLR2
7
Q
What cell wall molecule of gram positive organisms activates TLR2?
A
lipoteichoic acid
8
Q
An exaggerated SPV (>10) in hypovolemia is due to greater delta up or delta down?
A
delta down component
9
Q
Toxic shock syndrome can be associated as a post-viral infection of what virus?
A
VZV
10
Q
What antigens of Staph aureus cause toxic shock syndrome?
A
PVL, fnbA
11
Q
What antigens of Strep pyogenes cause toxic shock syndrome?
A
SPE-A, SPE-B, SPE-C
12
Q
Clindamycin mechanism?
A
Inhibits bacterial ribosomes (essential for exotoxin production)
13
Q
What medication can be used against exotoxin production if Clindamycin is unavailable?
A
Linezolid
14
Q
Fusobacterium endotoxin?
A
LPS (gram-negative oral anaerobe)
15
Q
“Wooden” induration and pain out-of-proportion is indicative of what diagnosis?
A
necrotizing fasciitis
16
Q
If someone with necrotizing fasciitis has contaminated water exposure, add what antibiotic?
A
doxycycline (Vibrio, Aeromonas)
17
Q
CSF profile: WBC 5-500, lymphocytes, protein >200?
A
TB
18
Q
Data support the use of dexamethasone in which etiology of meningitis?
A
HiB (less hearing loss; administered before or at same time as first antibiotic)
19
Q
Children with which type of congenital heart disease are at increased risk of brain abscesses?
A
right-to-left shunts (bypass reticuloendothelial cells of lung)
20
Q
Chronic granulomatous disease - immune deficiency type?
A
neutrophil defect (phagocyte NADPH oxidase complex/ROS)
21
Q
Chediak-Higashi syndrome - immune deficiency type?
A
neutrophil defect (LYST gene, trafficks lysosomes, impaired phagocytosis)
22
Q
What type of immune defect causes recurrent skin infections and abscesses?
A
neutrophil defect
23
Q
What type of immune defect causes recurrent sinopulmonary infections, meningitis, and bone infections?
A
B-cell defects
23
Q
What type of immune defect causes recurrent pneumonias, FTT, and mucocutaneous candidiasis?
A
T-cell defects
24
What type of immune defect causes recurrent meningitis or sepsis?
complement defects
25
CVID - immune deficiency type?
B-cell defect
26
SCID - immune deficiency type?
T-cell and B-cell defect
27
DiGeorge syndrome is associated with what type of immune deficiency?
T cell defects
28
Empiric antifungal coverage choices?
liposomal amphotericin B or caspfungin/micafungin
29
CMV treatment?
ganciclovir, CMV Ig
30
Induction with ATG (solid organ transplant) will delay the function of what part of the immune system?
T cells
31
Solid organ transplant: high risk CMV donor/recipient status?
donor +, recipient -
32
HCT: high risk CMV donor/recipient status?
donor -, recipient +
33
CMV prophylaxis?
valganciclovir
34
EBV treatment?
no antiviral (may try INFalpha)
35
TAMOF is characterized by what lab finding?
moderately reduced ADAMTS13 (<57%)
36
IPMOF is characterized by what 3 lab findings?
lymphopenia, reduced TNFa response to exotoxin (whole blood), reduced monocyte HLA-DR expression
37
SMOF is characterized by release of what?
soluble Fas ligand (sFasL)
38
What are the 3 main phenotypes of MODS?
TAMOF, IPMOF (immune paralysis), SMOF (sequential)
39
SMOF is characterized by dysfunction of what cells?
NK cells and cytotoxic T lymphocytes
40
Critical pertussis-associated MOF (MODS phenotype) is characterized by cellular plugging where?
pulmonary arterioles (pulmonary hypertension)
41
MAS is characterized by what lab finding?
hyperferritinemia
42
TAMOF treatment?
plasmaphresis, eculizumab
43
IPMOF treatment?
Gm-CSF
44
Pulmonary hypertension-associated MOF treatment?
leukoreduction
45
SMOF treatment?
Stop immunosuppression, rituximab
46
MAS treatment (3)?
IVIG, anakinra, tocilizumab
47
Anakinra mechanism?
anti-IL1R
48
Tocilizumab mechanism?
anti-IL6R
49
Rituximab mechanism?
anti-CD20
50
What is the principal initiator of inflammation-induced thrombin generation?
tissue factor
51
NETs (neutrophil extracellular traps) are what kind of molecule?
DAMPs
52
In DIC: antithrombin levels?
low
53
In DIC: protein C activity?
reduced
54
In DIC: thrombomodulin activity?
reduced
55
What enzyme activates protein C?
thrombomodulin
56
Protein C: procoagulant or anticoagulant?
anticoagulant
57
In DIC: PAI-1 activity?
increased
58
How does trauma-associated DIC differ than inflammation-associated DIC?
trauma: pro-fibrinolysis, inflammation: anti-fibrinolysis
59
Traumatic shock causes release of what, leading to systemic fibrinolysis?
tPA
60
A total score of what meets criteria for DIC? (ISTH algorithm)
>/=5
61
The ISTH algorithm for diagnosing DIC takes into account what 4 lab markers?
platelet count, fbrin-degradation products (D dimer), PT, fibrinogen
62
How to differentiate liver failure from DIC?
DIC has low levels of factor 8 and factor 13 (normal in hepatic disease)
63
When looking at a ROTEM, what is the order of what's being tested?
coagulation factors (time to clot), fibrinogen (early clot), platelets (clot amplitude), fibrinolysis (amplitude reduction)
64
Vascular tumors associated with Kasabach-Merritt phenomenon can be treated with what?
sirolimus
65
What should trauma patients with DIC be treated with?
TXA (antifibrinolytic)
66
TXA mechanism?
inhibits plasminogen (which breaks down fibrin)
67
What is the immune defect in Kostmann syndrome?
congenital neutropenia (ANC <500)
68
What is the immunodeficiency in Shwachman-Diamond syndrome?
neutropenia
69
Clinical constellation: neutropenia, pancreatic insufficiency, skeletal abnormalities?
Shwachman-Diamond syndrome
70
Treatment for Shwachman-Diamond syndrome?
G-CSF
71
Treatment for Kostmann Syndrome?
G-CSF
72
In leukocyte adhesion deficiency, what is the mutation?
CD-18 (adhesion molecule)
73
Clinical diagnosis: coarse facial features, eczema, retained primary teeth, recurrent Staph infections?
Hyper IgE (Job) syndrome
74
What is the mechanism in hyper IgE (Job) syndrome?
abnormal neutrophil chemotaxis (high IgE, low other cytokines)
75
Chediak-Higashi syndrome mechanism?
impaired neutrophil phagocytosis
76
Clinical diagnosis: albinism, recurrent bacterial infections, peripheral neuropathy?
Chediak-Higashi syndrome
77
Chronic granulomatous disease mechanism?
failed oxidative burst (NADPH oxidase mutation)
78
CGD inheritance pattern?
X-linked recessive (males only)
79
Patients with DiGeorge syndrome need what kind of blood products?
irradiated (destroys host T cells)
80
What immunodeficiency is associated with DiGeorge syndrome?
thymic aplasia (no T cells)
81
SCID is caused by what mutation?
ADA (adenosine deaminase)
82
SCID immunodeficiency involves what cells?
failure of B and T cells (both)
83
Ataxia telangiectasia is associated with what immunodeficiency?
low T cells and low antibodies (both)
84
Clincal diagnosis: neurodegenerative disease (motor), telangiectasias, recurrent sinopulmonary infections?
ataxia telangiectasia
85
Bruton's agammaglobulinemia involves what cell type?
no mature B cells
86
Inheritance pattern of Bruton's agammaglobulinemia?
X-linked recessive (males)
87
Hyper IgM syndrome mechanism?
Decreased IgA/IgG (can't class switch), defective T cell signaling
88
Wiskott-Aldrich syndrome is associated with what type of immunodeficiency?
reduced Ab production, T cell signaling
89
Clinical diagnosis: eczema, recurrent infections, low platelets?
Wiskott-Aldrich syndrome
90
X-linked lymphoproliferative disease result in B cell cancer after what infection?
EBV
91
HLH involves dysfunction of what cell type?
NK cells
92
What immune defect is associated with infections caused by: encapsulated bacteria, enteroviruses, giardia?
antibody deficiency
93
What immune defect is associated with infections caused by: catalase-positive bacteria, atypical mycobacterium, or fungus?
phagocytic defects
94
A health-care associated infection is defined as a new infection discovered after how long from admission?
after 48H
95
What 3 infections account for 75% of all HAIs?
CLABSIs, VAC (ventilator-associated complication), CAUTI
96
What is the most common HAI in PICUs?
CAUTIs
97
Which patient age has the highest incidence of HAI in PICU?
infants (2mo to 1 year)
98
TPN exposure before what day of admission is associated with higher rates of HAI in PICUs?
TPN before PICU day 8
99
What central line location has the highest rate of infection in PICU patients?
all equal (trick question; though femoral is most common because it is also most common line site)
100
PICC line vs CVL: which has higher CLABSI rate?
PICC line
101
PICC line vs CVL: which has higher thromboembolic complications?
PICC line
102
HD catheters vs CVL: which has higher CLABSI rate?
HD catheter (4x risk!)
103
A definite CLABSI: central vs peripheral blood culture ratio of CFU/mL?
>5:1 in central line culture vs peripheral culture
104
A definite CLABSI: central vs peripheral blood culture time to positivity?
central line is positive >2h earlier than peripheral
105
An intraluminal biofilm (vs extraluminal) commonly occurs after how many device days?
10 days (<10 days is more likely extraluminal)
106
How does the number of catheter lumens affect CLABSI risk?
does NOT increase risk (in children apparently)
107
CLABSI risk: PVC or polyethylene catheters vs polyurethane or Teflon?
polyurethane or Teflon better (lower risk of CLABSI)
108
What number of catheter days increases CLABSI risk?
>5 days
109
Heparin-bonded catheters: affect on CLABSI risk?
decreased CLABSI risk
110
A cuffed HD catheter is indicated if it will be used for how long?
>3 weeks
111
In adolescent (adult) patients, what site of CVL insertion is lowest rate of CLABSI?
subclavian
112
CVL dressings must be changed how often?
every 7 days
113
For CVL insertion, insertion site should be scrubbed with what?
chlorhexidine gluconate
114
How long should the CVL insertion site be scrubbed for (at time of insertion)?
30s, or 2min for groin
115
Ventilator-associated respiratory infections are classified as early onset if they develop within how long since PICU admission?
within 4 days of PICU admission
116
Early onset ventilator-associated respiratory infections are what organisms?
S pneumo, H flu, Moraxella (normal bacterial pneumonias)
117
A "definite" pneumonia is classified when endotracheal aspiration gets how many CFU/mL?
10^5 (100,000)
118
A "definite" pneumonia is classified when BAL gets how many CFU/mL?
10^4 (10,000)
119
A "definite" pneumonia is classified when BAL with protected specimen brush gets how many CFU/mL?
10^3 (1,000)
120
Gastric acid suppression: increases or decreases risk of VAP?
increases risk of VAP (don't use gastric acid suppression if able)
121
Suspicion of what infection is responsible for the most superfluous antibiotic use in PICU?
suspected VAT/VAP
122
CAUTI is defined when urine culture has how many CFU/mL?
10^5 (100,000)
123
CAUTI is defined when urine culture from a catheter specimen has how many CFU/mL?
50,000 and urinary WBC >10
124
Infection with what organism is NOT considered a CAUTI?
Candida/yeast
125
CAUTI incidence increases exponentially after device exposure for how long?
>48H
126
Most wound infections in pediatric cardiac surgery patients are due to what organism?
S aureus (second place CONS)
127
What 3 biomarkers should you look for when investigating healthcare-associated ventriculitis?
CSF cell count (>15 WBC), CSF lactate (>4), CSF procal (>1)
128
Which is better for CNS penetration: meropenem or zosyn?
meropenem
129
What is the most common infection overall in burn patients?
UTI (second place wound)
130
What is the most common device-related infection in burn patients?
VAP (second place CAUTI)
131
Treatment of mild to moderate C diff?
PO flagyl
132
Treatment of severe C diff?
IV flagyl and PO vanc
133
Alcohol-based solutions are effective when isopropyl alcohol concentration is what?
>60%
134
What procedures require "partial sterility" (sterile gloves, mask, partial sterile drape, disinfectant)?
Foley placement, arterial line
135
MRSA requires what isolation?
Contact
136
VRE requires what isolation?
Contact
137
E coli, HSV, shingles, lice, and scabies require what isolation?
Contact
138
Contact isolation involves?
gloves, gown (always)
139
Pertussis requires what isolation?
droplet
140
Influenza requires what isolation?
droplet
141
Enterovirus requires what isolation?
Contact (unless respiratory symptoms, then add Droplet/mask)
142
RSV requires what isolation?
Contact (unless respiratory symptoms, then add Droplet/mask)
143
Adenovirus requires what isolation?
Contact (unless respiratory symptoms, then add Droplet/mask)
144
N. meningitis (or any other bacterial meningitis) requires what isolation?
Droplet
145
What does droplet isolation entail?
mask (gloves/gown only when touching body fluids)
146
VZV requires what isolation?
airborne
147
Measles requires what isolation?
airborne
148
What does airborne isolation entail?
particular respirator (gown/gloves only when touching body fluids)
149
C diff requires what isolation?
"enteric"
150
What does "enteric" isolation entail?
gown, gloves, soap and water (contact + soap/water)
151
What are the 3 components of the classification for tumor lysis syndrome?
creatinine, cardiac arrhythmia, seizure
152
Why can using allopurinol in tumor lysis syndrome be bad?
increased xanthine crystallization (obstructive uropathy)
153
Why can using urine alkalinization in tumor lysis syndrome be bad?
increased calcium phosphate crystallization (obstructive uropathy)
154
Mechanism of action of allopurinol?
inhibits xanthine oxidase
155
Mechanism of action of rasburicase?
recombinant urate oxidase (catalyzes uric acid to allantoin)
156
Risk of calcium phosphate crystallization when Ca x Phos is what?
Ca x Phos > 60
157
Mechanism of action of sevelamer?
decrease gastric absorption of phosphate (phosphate binder)
158
Heparin use can cause elevation in what electrolyte?
potassium
159
Leukoreduction can be indicated with WBC of what in ALL vs AML?
>300K in ALL, >200K in AML
160
In a mediastinal mass, general anesthesia may be safe if the tracheal cross section area is greater than what %?
>50%
161
Peak expiratory flow rate on a PFT of what can be indicative of high risk of airway obstruction in a mediastinal mass?
PEFR <50%
162
Treatment of TB?
isoniazid and rifampin
163
Treatment of toxoplasma gondii?
pyrimethamine and sulfadiazine + folinic acid (toxicity)
164
Treatment of cryptococcus neoformans?
Ampho B and flucytosine
165
Treatment of Nocardia?
Bactrim
166
What fungus is associated with TPN use?
Candida parapsilosis
167
What chemotherapy agent causes acute lung injury?
bleomycin
168
What chemotherapy agent causes dilated cardiomyopathy?
doxorubicin
169
What chemotherapy agent causes acute tubular kidney injury?
cisplatin
170
What chemotherapy agent causes acute pancreatitis?
peg-asparaginase
171
What chemotherapy agent causes acute liver injury?
decarbazine
172
HLH pathophysiology involves uncontrolled activation of what 2 cell types?
NK cells and macrophages
173
HLH classic lab values?
hyperferritin, hypertriglycerides, hypofibrinogen
174
HLH diagnosis involves high levels of what receptor?
soluble CD25 (IL-2 receptor)
175
Secondary HLH is commonly associated with which viruses?
EBV, HHV-6
176
Treatment of cytokine release syndrome?
tocilizumab (anti-IL6) and steroids
177
Mechanism of MMF?
anti-metabolite (inhibits purine synthesis)
178
Mechanism of cyclophosphamide?
alkylates DNA
179
Mechanism of cisplatin?
alkylates DNA
180
Mechanism of procarbazine?
alkylates DNA
181
Mechanism of azathioprine?
anti-metabolite (purine analog)
182
Mechanism of 5-FU?
anti-metabolite (inhibits pyrimidine synthesis)
183
Mechanism of methotrexate?
anti-metabolite (inhibits folic acid, which inhibits purine/pyrimidine synthesis)
184
Mechanism of vincristine?
inhibits microtubules (inhibits mitosis)
185
Mechanism of etoposide?
inhibits topoisomerase (undwinds DNA)
186
What are the anthracyclines?
doxorubicin, danorubicin
187
Mechanism of anthracyclines?
intercalates between base pairs, inhibiting DNA synthesis
188
Mechanism of cyclosporine?
calcineurin inhibitor (inhibits T cell cytokines)
189
Mechanism of tacrolimus?
calcineurin inhibitor (inhibits T cell cytokines)
190
Mechanism of sirolimus?
mTOR inhibitor (inhibits T cells)
191
What's an example of a polyclonal antibody?
ATG (antithymocyte globulin)
192
Mechanism of ATG?
lymphocyte depletion (at large)
193
Mechanism of Basiliximab?
IL-2 receptor inhibitor (CD25)
194
Mechanism of Rituximab?
CD20 inhibitor (B cells)
195
Major side effect of cyclophosphamide?
hemorrhagic cystitis
196
Rescue for methotrexate toxicity?
leucovorin
197
Tacrolimus can cause what lab abnormality?
hyperglycemia
198
Potential antidote for tacrolimus renal toxicity?
aminophylline (dilates afferent arteriole)
199
What chemotherapy agent can cause interstitial pneumonitis?
mTOR inhibitors (sirolimus, rapamycin)
200
Infliximab mechanism of action?
anti-TNFalpha
201
Adalimumab mechanism of action?
anti-TNFalpha
202
Post-exposure prophylaxis (varicella Ig) can be given up to how many days after exposure to compromised hosts?
up to 10 days
203
Positive India ink stain suggests what infection?
cryptococcus
204
Treatment of mucormycosis (Zygomycetes)?
amphotericin B
205
Rising creatinine/acute renal failure in a post-HSCT patient suggests what viral infection?
BK virus
206
Widespread alveolar injury in a patient 3 weeks after HSCT suggests what diagnosis?
idiopathic pneumonia syndrome (IPS)
207
Treatment of PTLD?
rituximab, reduce immunosuppression
208
Avoid total body irradiation in what age?
<3 years
209
Definition of neutrophil engraftment?
first of 3 consecutive days with ANC >500
210
What time does engraftment usually occur?
2-4 weeks after HCT
211
What part of your immune system may be last to reconstitute after HCT?
humoral immunity
212
What are the 3 main graft sources in HCT?
bone marrow, peripheral blood, umbilical cord blood
213
Which graft source in HCT has the highest risk of GVHD?
peripheral blood
214
Which graft source in HCT has the fastest time to achieve recovery?
peripheral blood
215
Which graft source in HCT has the slowest time to achieve recovery?
umbilical cord blood
216
Which graft source in HCT has the lowest risk of GVHD?
umbilical cord blood
217
"Early post-engraftment" is what time period?
day +30 to +100
218
What viral infections are common in pre-engraftment stage?
HSV, HHV6
219
PCP/PJP is common in what stage of HCT?
late post-engraftment (>100 days)
220
VZV is common in what stage of HCT?
late post-engraftment (>100 days)
221
CMV is common in what stage of HCT?
early or late post-engraftment
222
Infection with encapsulated bacteria is common in what stage of HCT?
late post-engraftment (>100 days)
223
Treatment of diffuse alveolar hemorrhage?
steroids
224
Treatment of TA-TMA?
stop calcineurin inhibitors, eculizumab
225
What chemotherapeutic agent is known to cause heart failure secondary to myocardial necrosis?
Cyclophosphamide
226
SOS/VOD occurs most commonly in what stage of HCT?
pre-engraftment
227
Treatment for SOS/VOD?
defibrotide (local hepatic anticoagulant)
228
Beta-D-glucan is found in the fungal wall of all fungi except which?
Cryptococcus, Zygomycetes (Mucor, Rhizopus), Blastomyces
229
Galactomannan diagnoses what fungal infection?
Aspergillus
230
Aspergillus is NOT susceptible to what common antifungal?
Fluconazole
231
Treatment for CMV?
ganciclovir
232
Which virus is associated with limbic encephalitis?
HHV6
233
Cidofovir is dose-limited due to what type of toxicity?
nephrotoxicity
234
Most effective antiviral for treatment of Adenovirus?
Cidofovir
235
What are the 3 main systems involved in GVHD?
skin, liver, GI tract
236
Mainstay of treatment for GVHD?
corticosteroids
237
PRES is commonly associated with what type of immune medications?
calcineurin inhibitors (cyclosporine, tacrolimus) and sirolimus
238
Prophylaxis with AED is indicated if receiving what chemotherapeutic agent?
busulfan
239
Delayed encephalopathy is associated with what chemotherapeutic agent?
methotrexate
240
SIADH is associated with what chemotherapeutic agent?
cyclophosphamide
241
E faecalis drug of choice?
ampicillin
242
Penicillins, cephalosporins and carbapenams are what type of antibiotic?
cell wall inhibitor (beta lactam)
243
Whole blood is deficient in what?
factor V and factor VIII
244
What is now standard of practice for all blood products?
leukoreduction (decreases WBC)
245
What is cryoprecipitate composed of?
fibrinogen, factor VIII, factor XIII, vWF
246
How much pRBC are transfused to increase Hb of a child by 1?
3 mL/kg
247
What the approximate volume and HCT of 1 unit of pRBC?
350 mL, HCT 55% (Hgb 18)
248
Risk of spontaneous hemorrhage occurs at a platelet level below what?
Plt <5K
249
A platelet transfusion of 10 mL/kg is expected to raise platelet count by how much?
50K
250
Which coagulation factors does FFP include?
factors II, VII, IX, X, Protein C and S (all of them)
251
What is in 3 Factor prothrombin complex concentrate (3PCC)? [available in Europe]
factors II, IX, X
252
What is in 4 Factor prothrombin complex concentrate (4PCC)? [available in Europe]
factors II, IX, X, and VII
253
What's the best medicine to treat vWF deficiency?
DDAVP
254
Consider replacing albumin when the level falls below what?
<2 or 2.5
255
Which patients can have severe reactions to IVIG?
IgA deficiency (have anti-IgA antibodies)
256
Patients with Hemophilia A are deficient in what?
factor VIII
257
What can be given during cardiac surgery or ECMO in cases of life-threatening hemorrhage?
novo7 (recombinant factor VII)
258
Irradiating blood decreases what?
T cells
259
Which patients need irradiated blood cells?
immunocompromised or immunodeficiency (including BMT)
260
Washing blood decreases what?
proteins
261
Which patients need washed blood cells?
history of allergy to a blood product, IgA deficiency (if IgA deficient blood is unavailable), complement-dependent autoimmune hemolytic anemia
262
What causes a febrile nonhemolytic transfusion reaction?
cytokines
263
Which blood product causes the highest rate of allergic reactions?
FFP (has a lot of plasma proteins)
264
Allergic tranfusion reactions are caused by what?
plasma proteins
265
Why is the coadministration of lactated ringers with blood contraindicated?
due to the calcium in LR (can complex with citrate and cause microemboli)
266
What is the anticoagulant used in pRBC?
citrate
267
TRALI is thought to be caused by what?
donor antigens activating host WBCs cause complement activation/hyperimmune response
268
Which blood product has a particularly high risk of bacterial contamination?
Platelets
269
Which patients need CMV negative blood (not universally screened for)?
immunocompromised or immunodeficiency (including BMT), neonates with unknown status of SCID (pre-NBS results)
270
Risk of HIV from a transfusion?
1 in 1.5-2 million
271
Risk of HepB from a transfusion?
1 in 1.1 million
272
Risk of HepC from a transfusion?
1 in 1-2 million
273
Risk of HTLV-1/2 from a transfusion?
1 in 2.7 million
274
Risk of syphilis from a transfusion?
Hasn't been a case since 1968
275
Risk of malaria from a transfusion?
Occurs once every 2 years
276
Suggested Hb threshold for complex CHD?
>9
277
How do you manage bleeding in the uremic patient?
DDAVP to improve platelet dysfunction
278
DDAVP mechanism for bleeding disorders?
stimulates the release of factor VIII and vWF from endothelial cells
279
Patients with Hemophilia B are deficient in what?
factor IX
280
Clinically significant iron overload occurs after receipt of how many pRBC units?
10
281
