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FOP/TAS > Infection > Flashcards

Infection Flashcards

1
Q

List common antibody deficiency disorders

A
  1. X linked agammaglobulinaemia (brutons disease).- lack of B cells
  2. combined variable immunodeficiency - lack of IgG production
  3. IgA deficiency increased resp infections and allergies
  4. ataxia telangiectasia
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2
Q

features of ataxia telangiectasia

A
  1. recurrent resp infections
  2. ocular and facial telangiectasia
  3. progressive cerebellar ataxia
  4. increased leukaemia and lymphoma risk
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3
Q

describe omenn SCID

A

= exaggreated inflammatory response cause of oligclonal T CELLS

severe inflammation of skin - generalised erythroderma, alopecia, no eyelashes
lymphadenopathy
hepatosplenomegaly
chronic diarrhoea
present in 1st few weeks of life

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4
Q

describe wiskott aldrich syndrome

A
  1. eczema
  2. thrombocytopenia - bleeding, bruising
  3. recurrent infections - HSV, EBV
  4. malignancy

X linked disease , affects males

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5
Q

features of IgA deficiency

A

most common immunodeficiency
recurrent upper resp tract infections age >4 y/o
increased allergies
otitis media common

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6
Q

features of measles infection

A

infectious 7 days after exposure
prodrome: low grade fever, cough, coryzal, KOPLIK SPOTS (in buccal mucosa) , conjunctivitis
eruptive: macular rash starts behind ears and hairline and spreads, fever

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7
Q

diagnosis of measles

A

salivary sample for IgM measles

notify public health within 24 hours and they will contact trace

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8
Q

complications of measles

A

otitis media
interstitial pneumonitis
acute demyelinating encephalitis
sub sclerosing pan=encephalitis
deafness
myocarditis

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9
Q

presentation of mumps

A

fever
malaisea
parotitis - swelling and pain in both parotids

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10
Q

complications of mumps

A

orchitis
meningitis
encephalitis

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11
Q

diagnosis of mumps

A

salivary IgM
PCR
mumps specific antibodies

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12
Q

treatment consideration in severe mumps

A

ribavirin (anti viral)

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13
Q

varicella zoster type of virus

A

double stranded DNA virus

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14
Q

features of chicken pox

A

infectious 24 hours before rash
prodrome fever and malaise
erythematous itchy, widespread rash (macular -> papular -> vesicles -> crust)

moct common neurological complication = acute cerebellitis

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15
Q

describe the secondary infection of varicella zoster

A

SHINGLES!!
pain and tenderness in dermatome
vesicular rash in dermatomal distribution
ramsay hunt = vesicles in external ear (facial nerve)

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16
Q

management of immunocompromsied pts or babies exposed to varicella zoster

A

IV zoster immunoglobulin
following varicella exposure in immunocompromised OR babies born to mothers to have had chicken pox 5 days before delivery - 2 days after

or oral aciclovir for 7-14 days

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17
Q

management of unwell/ immunocompromised pts with varicella

A

IV aciclovir
and to neonates with delivery exposure

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18
Q

type of virus in slapped cheek syndrome

A

PARVOVIRUS B19
‘5th disease’
single stranded DNA virus

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19
Q

presentation of parvovirus/ slapped cheek

A

2-5 days of prodromal illness
erythematous cheeks with peri oral sparing
erythematous maculopapular rash on trunk and extremities (fades with lacy reticular rash)
can go back to school 1 day after rash appeared

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20
Q

complications of parvovirus

A

aplastic crisis in chronic haemolytic disease
aplastic anaemia -> bone marrow suppression
arthritis
congenital infection

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21
Q

presentation of EBV

A

fever
pharyngitis
cervical lymphadenopathy
malaise
maculopapular rash (worsens with penicillin)
hepatitis
splenomegaly(50%) and hepatomegaly (30%)
Increased risk of burkitt lymphoma

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22
Q

type of cell EBV infects

A

B lymphocytes
human herpes virus 4

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23
Q

diagnosis of EBV

A

monospot test - heterophile antibodies
blood film - atypical lymphocytosis
EBV antibodies - raised IgM and IgG
raised AST and ALT

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24
Q

type of virus cytomegalovirus

A

herpes virus 5
double stranded DNA virus

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25
Q

cytomegalovirus congenital presentation

A

blueberry muffin rash
symmetrical IUGR
hearing loss ***
microcephaly
congenital cataracts

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26
Q

diagnosis of CMV

A

PCR
serology

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27
Q

types of malaria

A
  1. P.falciparum ** - 75% cases, 10-28 days after bite
  2. P.vivax - asia, south ameria, africa (west africans resistent)
  3. P.ovale - west africa, west pacific
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28
Q

pathophysiology of malaria

A
  1. parasite carried by mosquito and transmission via bite from female anopheles mosquito
  2. sporozoites travel in blood stream to liver
  3. develop into schizonts (hypnozoites = dormant p.vivax and p.ovale) and rupture and release merozoites
  4. merozoites infect red blood cells (use duffy blood group antigens) where they mature and replicate
  5. RBC rupture and release more merozoites so parasite level increases
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29
Q

presentation of malaria

A

fever
malaise, sweats
pallor - anaemia
abdo pain, diarrhoea and vomiting
jaundice
hepatosplenomegaly

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30
Q

complications of malaria

A
  1. anaemia
  2. hypoglycaemia
  3. metabolic acidosis
  4. acute tubular necrosis
  5. DIC
  6. nephrotic syndrome
  7. resp distress from ARDS
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31
Q

diagnosis of malaria

A
  1. thick and thin blood films
    thick = parasite detection, large volume of blood
    thin = species detection
    parasitaemia >2% = severe
  2. malaria antigen testing = rapid, first test
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32
Q

prophylaxis for malaria

A

atovaquone and proguinail
mefloquine *

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33
Q

treatment of malaria

A

malarone * - proguanil and atovaquone

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34
Q

treatment of severe malaria

A

IV quinine + IV clarithromycine
exchange transfusion if >10% parasitaemia

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35
Q

type of bacteria Listeria

A

gram positive anaerobic bacteria
transmission from contaminated food (deli meats, cold cut)
can cross blood brain barrier

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36
Q

treatment of listeria

A

ampicillin or amoxicillin +/- gentamicin

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37
Q

cause of lyme disease

A

Borrelia burgdorferi (spirochere) spread by Ixodes tick

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38
Q

presentation of lyme disease

A
  1. erythema migrans ‘bulls eye’ rash
  2. disseminated disease - flu, neurological disease (facial palsy 15%, meningism), myopericarditis (cardiac disease RARE), lymphocytomas, AV or 1st degree heart block
  3. late stage - arthritis, acrodermatitis chronica atrophicans
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39
Q

Diagnosis of lyme disease

A
  1. ELISA test -> if positive, immunoblot test *
  2. IgM and IgG
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40
Q

management of lyme disease

A

doxycycline for 21 days
(if <12 y/o, amox or azithromycin)

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41
Q

cause of impetigo

A

streptococcus pyogenes (group a strep) and staph aureus

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42
Q

presentation of impetigo

A

honey coloured crusting and vesicles
pruritis
around face and mouth

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43
Q

presentation of toxic shock syndrome

A

high fever
hypotension, multi organ dysfunction
generalised erythematous rash ‘sunburn’
desquamation over 1-2 weeks
altered mental state

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44
Q

investigations of toxic shock

A
  1. blood cultures
    2, FBC - thrombocytopenia
  2. U&E - creatinine 2 x normal
  3. LFT - bilirubin 2 x normal
  4. CK - 2 x normal
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45
Q

management of toxic shock syndrome

A

1st line = clindamycin
Intestive care support
IV IG

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46
Q

cause of scabies

A

parasitic mite sacroptes scabei
transmitted by 10-15 mins skin contact

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47
Q

presentation of scabies

A

itching
rash 4-6 weeks after infestation - vesicular, around groin etc

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48
Q

diagnosis of scabies

A

skin scraping and dermatoscope

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49
Q

management of scabies

A

permethrin 5% cream and treat all members of household and sexual partners in last month

wash all bedding/ clothing/ towels at 60 degrees

50
Q

presentation of congenital toxoplasmosis

A

microcephaly
hydrocephalus, intracranial calcifcations - need MRI HEAD
chorioretinitis
developmental delay and epilepsy

51
Q

management of immunocompromised patients for toxoplasmosis

A

pyrimethamine + sulfadiazine + folic acid for 4-6 weeks

52
Q

list the diseases protected against in the 6 in 1 vaccine

A

diptheria
tetanus
polio
pertussis
hep B
h.influzena type B

53
Q

prophylaxis management if non immunised/ partially immunised close contact of pertussis

A

clarithromycin

54
Q

vaccines at 2 months old

A

6 in 1 vaccine
Men B
rotavirus oral

55
Q

vaccines at 3 months old

A

6 in 1 vaccine
penumococcal 13
rotavirus oral

56
Q

vaccines at 4 months old

A

6 in 1 vaccine
Men B

57
Q

vaccines at 12 months old

A

Men C
pneumococcal vaccine
MMR - measles, mumps , rubella
h. influenza B

58
Q

vaccine at 3 years 4 months

A

DTap, / IPV
MMR

59
Q

vaccine at 12-13 y/o

A

Human papillomavirus - types 16 and 18 cancers
genital warts HPV type 6 and 11

side effect: bronchospasm

60
Q

vaccine at 14 y/o

A

tetanus, diptheria and polio

meningococcal group A,C,W,Y

61
Q

list live vaccines

A

BCG
MMR
rotavirus
yellow fever
influenza
oral polio
varicella

62
Q

common causes of c.diff

A

cephalosporins
lincomycin, clindamycin
ampicillin, amoxicillin

3-4 weeks after abx course

63
Q

screening test for c.diff

A

glutamate dehydrogenase

64
Q

treatment of c.diff

A

1st line = vanocmycin
2nd line = fidoxamicin
3rd line = IV metronidazole

65
Q

cause of scarlet fever

A

group A streptococcus

66
Q

presentation of scarlet fever

A

symptoms 1-7 days after being infected
sandpaper rash
red tongue ‘strawberry tongue’
fever
sore throat

67
Q

presentation of leptospirosis

A

contact with contaminated water
jaundice
influenza like illness
renal disease -> weils disease

68
Q

defintiion of periodic fever syndrome

A

unexplained fever in >3 episodes in 6 months at least 7 days apart

rise in IgD

69
Q

describe giardia infection

A

acute diarrhoea
vomiting
very dehydrated

70
Q

management of giardia

A
  1. hydration
  2. metronidazole

can lead to malabsorption from partial villous atrophy

71
Q

features of cholera

A

‘rice water ‘ diarrhoea -> extremely dehydrated
50% die if untreated

72
Q

desribe dengue

A

fever + rash +arhralgia
at risk of haemorrhagic fever
transmitetd by aedes mosquito

73
Q

describe presentation of visceral leischmaniasis

A

ulcers with hyperpigmented scars
splenomegaly
hepatomegaly
anaemia

74
Q

management of visceral leischmaniasis

A

sodium stibogluconate + amphotericin

75
Q

describe brucellosis infection

A

unpasterised dairy products in Mediterranean, middle east

fever, headache, sweating, anorexia, papular rash

76
Q

describe schistosomiasis infection

A

presents 4 weeks after swimming in affected water - asia, lake malawi, south america
painless haematuriea
itchy rash

77
Q

management of schistosomiasis

A

detect by urine under microscope
praziquantel

78
Q

describe gell + coombs classification type 1

A

IgE mediated

e.g. anaphyalxis, asthma, hayfever, eczema

79
Q

describe gell + coombs classification type 2

A

cyctoxic antibody

e.g. goodpastures, rheumatic heart disease

80
Q

describe gell + coombs classification type 3

A

immune complexes

e.g. post strep glomerulonephritis, lupis

81
Q

describe gell + coombs classification type 4

A

T cell mediated

e.g. mantoux, contact dermatitis, chronic or acute transplant rejection

82
Q

describe gell + coombs classification type 5

A

receptor mediated autoimmune e.g. graves, myasthenia gravis

83
Q

inheritance of severe combined immunodeficiency syndrome

A

usually autosomal recessive *

ADA deficiency (10-15%) - X linked causes deficiency purine salvage

84
Q

presentation of SCIDS

A

present early (6 months old) with severe recurrent life threatning infections
e.g. bacterial pneumonias, RSV, CMV, adenovirus
diarrhoea and faltering growth
BCG related complications e.g. abscess
skin rashes
candidiasis infections

85
Q

diagnsosis of SCIDS

A
  1. lymphopenia
  2. CXR - absent thymus shadow
  3. low igG, igA, igM (all antibody subsets low)
86
Q

management of SCIDS

A
  1. antimicrobial prophylaxis e.g. co-trimoxazole, acicvlovir, itraconazole
    IgG replacement
    haematopoietic stem cell transplant - only cure ! otherwise likely die by age of 2
87
Q

cause of hypogammaglobunlinaemia

A

most common immune deficiency
X linked
mutation in BTK gene (Xq21.33-q22) - Involved in B lymphocyte differentiation and maturation -> failrue to produce B cells and Ig heavy chain rearrangement

88
Q

presentation of hypogammaglobinaemia

A

severe, recurrent resp (bacterial) infections in infant BOYS
e.g. s.pnuemoniea, staphylococcus, moraxella, h.influenza
persistent diarrhoea
faltering growth

88
Q

management of hypogammaglobulinaemia

A
  1. low or absent CD19 lymphocytes (normal T cells)
  2. annual LFTS
  3. IV immunoglobulin and antibiotics
88
Q

cause of chronic granulomatous disease

A

X linked form (gp96phox deficiency) = 2/3 cases

other forms autosomal recessive
increase with consanguinity

phagocytes lack abaility to kill bacteria which causes granulomas formed by dysregulated inflammatory response

89
Q

presentation of chronic granulomatous disease

A

presents under 5 y/o
recurrent pneumonia (burkholderia, aspergillus, pseudomonas)
deep seated infections and abscesses
osteomyelitis at multiple sites
poor growth
skin abscesses

90
Q

investigations for chronic granulomatous disease

A
  1. dihydrorhodamine neutrophul burst assay - absent
  2. nitroblue tetrazolium test - negative
91
Q

inheritance of hereditary angioedema

A

autosomal dominant

92
Q

presentation of hereditary angioedema

A

episodic attacks starting in 1st decade of life precipitated by trauma, stress, menstruation, COCP and ACE-I

abdominal pain
rash - erythema marginatum
swelling of lips and mucosa
non pitting oedema of hands and feets
symptoms nOT relieved by adrenaline / anti histmine

93
Q

diagnosis of hereditary angioedema

A

reduced C4 level
C1INH level reduced (C1 esterase inhibitor)

94
Q

to prevent attacks in hereditary angioedema

A

anti fibrinolytics e.g. transexamic acid
purified C1INH from human plasma
monoclonal antibody

95
Q

how does mantous test work

A

intradermal tuberculin
measure induration at injection site 72 hour after

96
Q

most common form of shigella

A

shigella sonnei most common in developed world, milder disease

97
Q

deficiency in which complement in meningitis

A

C5- C9 deficits
(terminal complement deficiecny suspceptible to meningitis)

98
Q

commonest cause of nec fasc

A

group a strep

99
Q

presentation of yellow fever

A

south and central america
severe flu like illness, fevers -> recovery and feel better -> severe fever again, jaundice =, hepatomegaly, bleeding gums, malaena

100
Q

common causes of myocarditis

A

coxsackie B in england
trypanosoma cruzi - worldwide, ‘chagas disease’

101
Q

dose of adrenaline in anaphylaxis

A

1:1000
>12 y/o - 500 micrograms
6-12 y/o - 300 micrograms
6 yo - 150 micrograms

102
Q

how can tinea present

A
  1. kerion - boggy swelling on head, red, alopecia surrounding
  2. extensive scaling with hair loss
  3. black dots where hair follicles fallen off
  4. widespread pustules with lymphadenopathy
  5. patchy hair loss
103
Q

diagnosis of wiskott aldrich syndrome

A

low IgG and IgM
high total IgE and IgA

decreased number and function of T cells

104
Q

chemical mediators in anaphylaxis

A
  1. surface bound IgE on mast cells and basophils interact with specific allergen
  2. mast cell degranulation and mediator release inc:
    - histamine - produces symptoms of anaphylaxis (causes coronary artery vasoconstriction and increased vascular permeaility)
    - tryptase - released in inoculation anaphyalxis e.g. contrast, insect stings
105
Q

incubation period for chicken pox

A

10-20 days

106
Q

features of congenital varicella syndrome

A

skin scarring
limb hypoplasia
microcephaly, seizures, developmental delay
chorioretinitis, cataracts
hydronephrosis
neurogenic bladder
swallowing difficulties

107
Q

90% of food allergens include…

A

peanut - 80% persist to adulthood
cows milk
egg
tree nut and seeds
fish
shellfish
soya
wheat

108
Q

how does IgE allergy present

A

immediate after consumption of allergen
angioedema - lips, tongue, eyes
acute urticaria
vomiting, diarrhoea
wheeze, cough, congestion

109
Q

how is IgE allergy diagnosed

A
  1. food specific igE
  2. ‘skin prick’ testing - increased size of wheal = increased incidence of allergy
110
Q

how does non IgE allergy present

A

2-72 hours after encountering allergen
pruritus
erythema
GORD
blood/ mucus in stool
abdo pain
faltering growth

111
Q

how is non igE allergy diagnosed

A

trial elimination of food

112
Q

which vaccine to avoid in hIV

A

BCG

113
Q

how does adrenaline work in anaphyalxis

A
  1. alpha adrenergic - vasoconstriction to increase blood pressure and reduce plasma extravasation
  2. beta adrenegric - cause bronchoconstriction in the airways
  3. mast cell stabilisation - prevents further degranulisation and release of vasoactive materials
114
Q

common cause of encephalitis

A

herpes simplex virus

115
Q

treatment for whooping cough

A

azithromycin (or clarithromycin < 6 months old)

116
Q

cholera vaccination

A

3 doses orally to children 2-5 y/o
2 doses if 6-16 y/o

oral inactivated cholera vaccine (Dukoral)

117
Q

how is the complement cascade activated

A

IgA activates alternative pathway
IgG and IGM activate classical pathway

118
Q

diagnosis of anaphylaxis

A

mast cell tryptase levels 1.5 hours after anaphylaxis
IgE levels if in clinic

FOP/TAS (12 decks)

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