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Paeds > Immunology > Flashcards

Immunology Flashcards

1
Q

What is atopy

A

Predisposition to having a hypersensitivity reaction to an allergen

Eczema, asthma, hay fever, allergic rhinitis, food allergies

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2
Q

What is a type 1 allergic reaction

A

IgE antibody mediated

Triggers mast cells and basophils to release histamine and cytokines

Immediate reaction

Itching, facial swelling, urticaria, anaphylaxis

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3
Q

What is a type 2 allergic reaction

A

IgG and IgM mediated

Activation of complement system

Direct damage to local cells

Haemolytic disease of the newborn, transfusion reactions

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4
Q

What is a type 3 allergic reaction

A

Immune complex mediated

Damage to local tissue

SLE, rheumatoid arthritis

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5
Q

What is a type 4 allergic reaction

A

Cell mediated

T cells inappropriately activated

Inflammation and damage to local tissue

Organ transplant rejection, contact dermatitis

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6
Q

What are the investigations for allergies

A

Detailed history

Skin prick test

RAST test (blood test for total and specific IgE, assesses for sensitisation)

Food challenge test (gold standard, in specialised unit, gradually increase quantity of food)

Patch testing (for allergic contact dermatitis)

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7
Q

What is the management for allergic reactions

A

Identify correct allergen

Avoidance

Regular hoovering and changing sheets

Stay indoors when pollen count high

Prophylactic antihistamines

Adrenaline auto-injector

Antihistamines, steroids (oral prednisolone, IV hydrocortisone), IM adrenaline

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8
Q

What is anaphylaxis

A

Life threatening medical emergency

Severe type 1 hypersensitivity reaction

IgE stimulates mast cells to release histamine and other cytokines

Rapid onset

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9
Q

How might a patient with anaphylaxis present

A

Urticaria

Itching

Angio-oedema

Abdominal pain

Shortness of breath

Wheezing

Stridor

Tachycardia

Lightheadedness

Collapse

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10
Q

What is the management for anaphylaxis

A

Call for help early

ABCDE

IM adrenaline (repeat after 5 minutes)

Antihistamines (oral chlorpheniramine or cetirizine)

Steroids (IV hydrocortisone)

Assessment after episode

Confirm with serum tryptase (within 6 hours)

Education

Give parents BLS training

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11
Q

What are the indications for having an adrenaline auto-injector

A

Anaphylactic reaction

Generalised allergic reactions with risk factors (asthma needing steroids, poor access to medical treatment, adolescents, insect sting allergies, significant comorbidities)

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12
Q

What is allergic rhinitis

A

IgE mediated type 1 hypersensitivity reaction

Triggers: tree pollen, grass, house dust mite, pets

Can be: seasonal, year round, occupational

Associated with personal or family history of atopy

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13
Q

How might a patient with allergic rhinitis present

A

Runny, blocked, itchy nose

Sneezing

Itchy, red, swollen eyes

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14
Q

What is the management for allergic rhinitis

A

Avoid triggers

Hoover and change pillows regularly

Good ventilation in home

Stay indoors when pollen count high

Oral antihistamines

Nasal corticosteroid spray

Nasal antihistamines

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15
Q

What are some non-sedating antihistamines

A

Cetirizine

Loratadine

Fexofenadine

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16
Q

What are some sedating antihistamines

A

Chlorphenamine (piriton)

Promethazine

17
Q

What is Cow’s milk protein allergy

A

In infants and children under 3

IgE mediated (within 2 hours)

Non-IgE mediated (over several days)

More common in formula-fed babies

18
Q

How might a baby with Cow’s milk protein allergy present

A

Bloating

Wind

Abdominal pain

Diarrhoea

Vomiting

Urticarial rash

Angioedema

Cough

Wheeze

Sneezing

Watery eyes

Eczema

Possible anaphylaxis

19
Q

What is the management for cow’s milk protein allergy

A

Skin prick test (not always needed)

Avoid cow’s milk (breastfeeding mothers avoid dairy, switch formula)

Every 6 months, try stepping up milk ladder (gradually build up to a normal diet)

20
Q

When would you refer a child to a specialist for recurrent infections

A

Chronic diarrhoea since infancy

Failure to thrive

Unusually unwell

Significantly more infections than expected

Unusual or persistent infections (cytomegalovirus, candida)

21
Q

What are the investigations for recurrent infections

A

FBC

Immunoglobulins

Complement protein

Antibody response

HIV test

Chest X-ray

Sweat test

CT chest

22
Q

What is severe combined immunodeficiency

A

Children have almost no immunity to infection

Absence or dysfunction of T and B cells

X-linked recessive

23
Q

How might a patient with severe combined immunodeficiency present

A

Within first few months of life

Persistent severe diarrhoea

Failure to thrive

Frequent opportunistic infections

Unwell after live vaccines

Ommen syndrome

24
Q

What is Ommen syndrome

A

Rare cause of SCID

Abnormally functioning and downregulated T cells

Presentation: red scaly dry skin, hair loss, diarrhoea, failure to thrive, lymphadenopathy, hepatosplenomegaly

25
Q

What is the management for severe combined immunodeficiency

A

Fatal unless successfully treated

Treat underlying infections

Immunoglobulin therapy

Sterile environment

Avoid live vaccines

Haematopoietic stem cell transplant

26
Q

What is selective immunoglobulin A deficiency

A

Most common immunoglobulin deficiency

Low IgA (normal IgG and IgM)

Asymptomatic if mild

If severe, recurrent mucous membrane infections

27
Q

What is common variable immunodeficiency

A

Genetic mutation in the genes coding for components of B cells

Deficiency in IgA and IgG

Recurrent respiratory tract infections

Unable to develop immunity (to infections or vaccines)

Prone to rheumatoid arthritis and non-Hodgkin’s lymphoma

Management: regular immunoglobulin infusion, treat infections as they occur

28
Q

What is X-linked agammaglobulinemia

A

Abnormal B cell development

29
Q

What is DiGeorge syndrome

A

A T cell deficiency

Developmental defect in 3rd pharyngeal pouch and 3rd branchial cleft

Incomplete development of thymus gland

Inability to create functional T cells

Clinical features: congenital heart disease, abnormal facial features, thymus incomplete, cleft palate, hypoparathyroidism, 22nd chromosome affected

30
Q

What is purine nucleoside phosphorylase deficiency

A

A T cell deficiency

Autosomal recessive

Immunity gradually gets worse (very susceptible to infection)

31
Q

What is Wiskott-Aldrich syndrome

A

X-linked recessive

Abnormally functioning T cells

Get: thrombocytopenia, immunodeficiency, neutropenia, eczema, recurrent infections, chronic bloody diarrhoea

32
Q

What are complement disorders

A

Recurrent infections with encapsulated bacteria (Haemophilus influenza B, streptococcus pneumoniae, neisseria meningitidis

Paeds (17 decks)

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