Immunology

Question 1

There are 3 main types of nappy rash that may occur in isolation or co-exist. Name the 3 types

Answer 1

• contact dermatitis
• candida/thrush
• seborrhoreic dermatitis

Question 2

Contact dermatitis in nappy rash is a red de-____ rash that ____ skin folds, and occurs due to prolonged contact with ____ and waste products. Best treatment is to ____ nappy __. and use barrier cream e.g. ____

Answer 2

• desquamating rash
• spares skin folds
• moisture
• leave nappy off/(frequent changes)
• e.g. sudocrem

Question 3

Candida/thrush nappy rash hallmark is ____ spots beyond the main rash. Always check and treat for concurrent oral _____. Treat with nystatin and ___.

Answer 3

• satellite spots
• oral candidiasis
• clotrimazole

Question 4

seborrhoreic dermatitis nappy rash is a diffuse, red shiny rash that extends into __ __ and often occurs with other seborrhoeic areas e.g. ____, __, ___. Treat as for contact dermatitis nappy rash (___)

Answer 4

• extends into skin folds
• occiput (cradle cap), neck, armpits
• leave nappy off, barrier creams

Question 5

Eczema is dry, red inflamed itchy skin often in ____ or ___ fossae and on ___. Treat with regular ____ with topical ____ if required for flare ups. If infected give ___

Answer 5

• antecubital or popliteal fossae and on hands
• regular emollients
• topical steroids
• abx

Question 6

Anaphylaxis is sudden onset life-threatening problems affecting =A/B/C and 80% is associated with ___ ___

Answer 6

skin changes

Question 7

How to deal with paediatric anaphylaxis?

• call ____ ___ __
• remove the ____
• assess using _____
• if poss, place pt on __ with __ __

Answer 7

• call resus/cardiac arrest team
• remove trigger e.g. bee sting, stop drug infusion
• A–>E
• place pt on back w legs raised

Question 8

what do D and E stand for/what do you look for here, when assessing an anaphylactic child with A–>E

Answer 8

D=Disability: confusion, conscious level (Drowsy/coma)

E=Exposure of skin: erythema, angio-oedema, urticaria

Question 9

In treating an anaphylactic child what is the chief drug priority? strength is ____?

Answer 9

Adrenaline IM

1 in 1000

Question 10

12+/Adult dose for anaphylaxis is 
-0.5ml (500mcg) adrenaline 
-10mg chloramphenicol
-200mg hydrocortisone 
what are the doses for <6months children?
6months-6years and
6years-12yrs

Answer 10

<6mths: 0.15ml (150mcg), 25mcg/kg, 25mg
int: 0.15ml (150mcg), 2.5mg, 50mg
up to 12yrs: 0.3ml (300mcg), 5mg, 100mg

Question 11

After how long should you repeat the adrenaline dose in the treatment of an anaphylactic child

Answer 11

after 5mins

Question 12

In the treatment of an anaphylactic child what should you give as well as the classic adrenaline, chloramphenicol and hydrocortisone?

Answer 12

-o2 high flow and crystalloid (20mL/kg IV)

Question 13

If an anaphylactic child has bronchospasm features, _______ should be given but be careful administering ____ ____ as it can cause ______

Answer 13

• bronchodilators
• magnesium sulfate
• hypotension

Question 14

name 3 ddx in a suspected anaphylactic child

Answer 14

• asthma
• septic shock
• breath-holding
• panic attack

Question 15

Name some steps that should be taken after the emergency of an anaphylaxis episode in a child:
Clues: ?admit ?edu ?course ?offer

Answer 15

• try to identify trigger e.g. admit to paediatric allergist
• provide education and training in recognition, avoidance and biphasic reactions
• consider a 3 day course of antihist/oral steroid
• offer an adren. autoinjector w training

Question 16

Mast cell tryptase can confirm anaphylaxis, mostly of drug/venom/idiopathic origin, you need the 1st sample in an ___ bottle, ask lab to ____ asap post emergency rx, and 2nd sample __hrs after symptoms started. (+/- 3rd sample after 24hrs) Who should interpret results?

Answer 16

• LFT bottle
• ask lab to freeze
• 2nd sample 1-2hrs
• an allergy specialist