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Paediatrics > Immunity and Infections > Flashcards

Immunity and Infections Flashcards

1
Q

What immunoglobulin is associated with first response adaptive immunity?

A

IgM

IgG for second response

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2
Q

What is included in the ‘5 in 1’ and when is it given?

A

DTaP (diptheria, tetenuss and pertussis), IPV and HiB
2 months, 3 months and 4 months

HiB also given at 12-13 months
DTaP and IPV also given at 2-3yrs (‘4 in 1’)
DT and IPV also given in teen years

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3
Q

When are Men C and Men B vaccines given?

A

Men B - 2 months, 4 months and 12-13 months

Men C - 2 months, 12-13 months

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4
Q

When is PCV (pneumococcal conjugate vaccine) given?

A

2 months, 4 months, 12-13 months

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5
Q

When is the MMR vaccine given?

A

12-13months, 2-3yrs

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6
Q

What is the Gardisil vaccine?

A

Vaccine against HPV 11 + 16 give to girl in their teen years

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7
Q

Why are some vaccines given several times and others not?

A

Live attenuated vaccines give good, long-term immuntiy e.g. MMR
Inactivated/sub-unit need ‘boosters/top-ups’

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8
Q

What are the bacterial causes on meningitis?

A 
Streptococci Pneumoniae (gram +ve diplococci)
Haemophilus Influenzae (gram -ve rods)
Neisseria Meningitis (gram -ve diplococci)
TB
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9
Q

What are the prodromes for viral/bacterial meningitis and what is meningism?

A

Viral - gi upset, pharyngitis
Bacterial - drowsiness
Meningism = stiff neck, photophobia, headache

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10
Q

Signs of raised ICP?

A

Irritability, drowsy/lethargic, high-pitched cry

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11
Q

What sign would indicate that meningitis has progressed to meningococcal septicaemia?

A

Non-blanching rash

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12
Q

What signs can you elicit from an infant with meningitis?

A

Kernings sign - resistance to knee extension with hip flexed (children>infants)
Brudninski’s sign - head flexion –> hip flexion
Tense fontanelle

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13
Q

What would you find when analysing the CSF in bacterial meningitis?

A 
Cloudy appearance
Opening pressure increased
Low glucose
Very high protein
Some RBCs
>WBCs (c/mm3)
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14
Q

When should you not do a LP in suspected meningitis?

A

Raised ICP is a contraindication

Can lead to coning - herniation of the brain stem through the foramen magnum –> paralysis and respiratory inhibition

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15
Q

Management of bacterial meningitis?

A

In GP - gie benzylpenecillin IM (<1yr = 300mg, 1-9yrs = 600mg, 10+ = 1.2g)
In hospital - ceftriaxome (80mg/kg/day) then indicated Abx after culture
Can give steroids (dexamethasone) to reduce inflammation

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16
Q

Complications associated with meningitis?

A

Hydrocephalus
subdural effusion\acute adrenal failure
deafness
cerebral palsy +/- learning difficulties (10%)

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17
Q

What are pupura?

A

Bleeding in the dermis –> purple spots/nodules that do not blanch

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18
Q

Non-thombocytopenic causes of purpura?

A

Meningococcal septicaemia
HSP
Hypertensive states
Trauma

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19
Q

Thrombocytopenic causes of pupura?

A

Immune thombocytopenic pupura (ITP) - often preceded by vrial infection e.g. CMV in <1yr
Coagulation disorders - disseminated intra-vascular coagulation (DIC) and scurvy (vit C difficiency)
Leukaemia

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20
Q

Management of ITP?

A

Steroids and immunoglobulins

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21
Q

What gram +ve cause of septicaemia are babies at risk of when they are <48hrs and >48hrs old?

A

> 48hrs = Staphylococcus - aureus, coagulase -ve

<48hrs = group B streptococci (pneumoniae)

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22
Q

What are the symptom of septicaemia?

A 
Fevers, rigors, sweating
SOB
Poor feeding
Non-blanching rash 
lethargy
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23
Q

Investigations for septicaemia?

A 
Septic screen:
Bloods - FBC, U+E's, culture
LP - culture, glucose, cell count
Urine - MSU, culture
Stool - culture, virology
CXR
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24
Q

Broad spectrum management of specticameia in <3months and >3months?

A

<3 months - cefotaxime +/- amoxacillin

>3months - ceftriaxone

25
Q

What causes chicken pox?

A

Varicella zoster virus (VZV) - typically affects 4-10yrs old

26
Q

When is chicken pox infectious?

A

4 days before rash until it has all scabbed over (~1 week)

27
Q

Symptoms of VZV?

A

Prodrome - fever, coryza, cough

2 days later –> Characteristic vesicular rash (macule–>papule–>vesicle) on face and trunk

28
Q

Management of chicken pox?

A

Supportive - fluids, calpol/paracetamol
Advise to not scratch / cut child’s nails
Use cold baths and calamine ointment to relive itching
If immunocompromised give aciclovir and anti VZV immunoglobulin
If they have superimposed infection give flucloxacillin

29
Q

What is conjunctivitis?

A

Inflammation of the conjuctiva - viral, bacterial and allergic
Red eyes + discharge:
Viral - watery/sticky +/- lymphoid aggregates
bacterial - thick yellow/green
Allergic - watery/clear, itchy/gritty eyes

30
Q

What specific causes are there for neonates?

A

Gonoccocal conjunctivitis +/- chlamydia infection
= red eyes +/- lid swelling + purulent discharge
Complications = corneal rupture/hazing

Sticky eyes (staph/pseudomonas/strep) - treat with topical neomycin

31
Q

Management of bacterial conjunctivitis?

A

Chloramphenicol in most cases (+cefotaxime IM stat in neonatal gonococcal)

32
Q

What is infectious mononucleosis?

A

Aka glandular fever - caused by Epstein-Barr virus

33
Q

What are the symptoms of glandular fever?

A 
Fever, malaise, lethargy
Sore throat --> tonsillitis 
Weight loss/anorexia
Cough
Nausea
Photophobia
34
Q

What are the signs for glandular fever?

A 
Cervical lymphadenopathy
Petechiae on the soft palate
maculopapular rash 
Spleno/hepatomegaly
Jaundice
35
Q

What investigations can be done in suspected infectious mononucleosis?

A

Bloods: FBC (atypical lymphocytes)
Monospot test (checks for heterophile Abs) is positive in 60% cases (often -ve in infants)
Virology - will show IgM early –> IgG

36
Q

Complications of infectious mononucleosis?

A

Concomitant group A streptococcus tonsillitis - treat with amox/ampicillin
Burkitt’s lymphoma (if immunocompromised)

37
Q

What age group are usually affected by egg/milk allergy?

A

Infants - they are likely to grow out of this

38
Q

What are the majority of allergies mediated by?

A

IgE mediated e.g. peanut allergy
Primary = from birth
Secondary = acquired (usually milder)

39
Q

What type of allergy is coeliac’s?

A

Non-IgE mediated - delayed presentation, insidious onset

40
Q

Symptoms of mild and severe allergic reactions?

A

Mild - urticaria, itching, facial swelling

Severe - angioedema, wheeze/stridor, abdo pain/vomiting, collapse

41
Q

Investigations for allergies?

A

IgE - skin prick test, RAST (blood test for specific IgE groups)
Non-IgE - avoidance of food types

42
Q

What are the symptoms of measles?

A

Prodrome - irritable, conjunctivitis, fever
Sign before rash = koplik’s spots - white spots on buccal mucosa

3 C’s - cough, coryza, conjunctivitis
Fever (often >40)
Rash - maculopapular (appears behind ear–> rest of body)

43
Q

Management of measles?

A

A NOTIFIABLE DISEASE
Anti-viral = ribavarin
MMR vaccine should have been given - to all contacts <72hrs

44
Q

What complications can occur due to measles?

A

Immediate - Diarrhoea, bronchopneumonia, acute otitis media, febrile convulsion

Corneal ulceration, increased incidence of appendicitis, myocarditis

Encephalitis ~1 week later (1/5000) - headache, irritability, drowsy - 15% mortality

Sub-acute Sclerosing Panencephalitis (SSPE) - 1/100,000 - 4-10yrs after infection - progressive neurological dysfunction

45
Q

What is Kawasaki’s disease?

A

A systemic vasculitis - more common in Japanese/Caribbean

46
Q

Symptoms of Kawasaki’s?

A

Prolonged fever >5 days (characteristically resistant
+/- >1 of the following:
Non-purulent conjunctivitis
Red mucus membranes (can have red swollen tongue = strawberry tongue)
Cervical lymphadenopathy
Rash
Red swollen palms/soles and finger/toe peeling

Can also have GI upset - diarrhoea and reduced appetite

47
Q

Investigations in kawasaki’s?

A

Bloods - ESR, CRP
Echocardiogram - check for coronary artery aneurysm (complication of kawasaki’s)
ECG - look for any conduction abnormalities

48
Q

Management of Kawasaki’s

A

High dose aspirin + immunoglobulins:

  • High dose immunoglobulin stat - 2g/kg (only given within 10 days of onset of symptoms)
  • Aspirin - high dose until fever subsides, lower anti-platelet dose for 6 weeks

Severe = infliximab/ciclosporin

49
Q

Symptoms of peri-orbital cellulitis?

A

Peri-orbital oedema and erythema

Fever

50
Q

Investigations for peri-orbital cellulitis?

A

CT head - check infection spread and brain involvement

LP - exclude meningitis

51
Q

Complications of peri-orbital cellulitis?

A

Orbital cellulitis - proptosis, painful eye movements, reduced visual acuity
Meningitis
Abscess formation
Cavernous sinus thrombosis

52
Q

At what age will Abs to HIV appear in the blood of a baby who has been exposed to HIV at birth?

A

18 months

Maternal Abs detected prior to 18 months only incurs exposure to the virus

53
Q

What is rubella syndrome?

A

Congenital infection –> deafness, microcephaly, cataracts and PDA (= reason for vaccination given)

54
Q

Symptoms of rubella -diagnostic?

A

Child generally well/low-grade fever
Maculopapular rash - starts on face then spreads centrofugally (fades 3-5 days) - not itchy in children

Not clinically diagnostic - need seroloy

55
Q

Hand, foot and mouth disease

A

Self-limiting disease common in <10yrs:

  • Mild systemic upset
  • oral ulcers
  • vesicles on palms and soles of feet

Management:

  • Reassurance - no link to cow disease
  • Hydration and analgesia
  • Can go to nursery/school if feeling well enough to do so
56
Q

Impetigo management

A

Localised disease:

  • Topical fusidic acid - first line
  • Topical retapamulin - 2nd line
  • Topical mupirocin - MRSA

Systemic disease

  • Flucloxacillin
  • Clarithromycin if penicillin allergic
57
Q

Complications of impetigo

A 
Cellulitis
Lymphadenitis
SSSS
scarlet fever
post-streptococcal glomerulonephritis
58
Q

HSP

A

Florid, non-blanching purpura
IgA mediated hypersensitivity vasculitis
50-90% have preceding URTI

Rash starts as erythematous macules –> raised and purpuric in 24 hrs

Other symptoms:
arthralgia/arthritis
Abdominal pain - colicky
Testicular pain

Self-limiting but give NSAIDS +/- steroids

59
Q

Complications of HSP

A

Renal involvement
Intussusception
GI bleeding
Pulmonary haemorrhage

25% have recurrent symptoms

Paediatrics (14 decks)

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