Immunology

Question 1

Exogenous pyrogens e.g. LPS are initially encountered by what?

Answer 1

Macrophages - causing cytokine release

Question 2

Cancer causes fever how?

Answer 2

Tumour releasing pyrogens

or

Host macrophages releasing pyrogens in resposne to tumour

Question 3

How does the acute phase reaction start, what are its products and their effects?

Answer 3

Macrophage/monocytes encounter exogenous pyrogen and release cytokines (endogenous pyrogens) which reach liver and cause upregulation of acute phase protein production.

CRP = opsonin
Serum amyloid A = leukocyte migration
Fibrinogen = pro-clotting = traps microbes
Complement factors = actives compliment

Question 4

Ill-looking child with rash, dehydrated, neck stiffness, bulging fontanelle

Answer 4

?Meningitis

• IV benpen if rash, before hospital, otherwise urgent transfer

If >3/12, IV ceftriaxone

If

Question 5

Seizures, focal neurological signs and decreased GCS

Answer 5

Herpes simplex encephalitis -> antivirals

Question 6

UTI

Answer 6

Fever
N&V
Lethargy
Irritable
Pain/tenderness
Dysuria
Rigors

Lower UTI = 3 days trim/nitro
Upper UTI = 7-10 days PO co-amoxiclav / broad spec cef

Question 7

Kawasaki disease

Answer 7

Fever lasting above 5 days

Rash
Oedema or erythema of extremities e.g. hand / feet swelling
Lymphadenopathy
Bilateral conjuctival infection
Mouth crusting (mucous membrane problem with URT)

Question 8

Campylobacter

Answer 8

Clarithromycin if severe/ic

Hx of inadequately cooked food or untreated water

Can cause dysentry

Question 9

Giardia

Answer 9

Protozoa

Travellers diarrhoea - prolonged

Fever,diarrhoea,rapidweight loss, steatthorea