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Paediatrics for Finals > Infection and Immunity > Flashcards

Infection and Immunity Flashcards

1
Q

What is an allergy?

A

Umbrella term for immune mediated hypersensitivity reaction to an allergen

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2
Q

What is an allergen?

A

Proteins that the immune system sees as foreign and harmful

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3
Q

What is a type 1 hypersensitivity reaction?

A
  • IgE mediated to a specific allergen
  • Immediate
  • There is mast cell degranulation and histamine release
    E.g. food allergy
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4
Q

What is a type 2 hypersensitivity reaction?

A
  • IgG or IgM mediated
  • Activation of the compliment system leading to localised damage
    E.g. haemolytic disease of the new-born
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5
Q

What is a type 3 hypersensitivity reaction?

A
  • Due to deposition of immune complexes causing local tissue damage
    E.g. RA, SLE, HSP
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6
Q

What is a type 4 hypersensitivity reaction?

A
  • Cell mediated
  • T lymphocytes inappropriately activated leading to local tissue damage
    E.g. contact dermatitis
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7
Q

How can allergies/ sensitivities be tested for? Describe these methods

A

Skin prick: drops onto skin and then prick. See if a wheal develops. This is used for allergies

Skin patch: Sticker patches are put on to the skin. This is used for contact dermatitis

R: Looks for IgE in the blood

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8
Q

What is allergic rhinitis and what are the signs and symptoms?

A

Type 1 hypersensitivity reaction

  • Sneezing
  • Nasal congestion, discharge
  • Eye watering and redness
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9
Q

How is allergic rhinitis managed?

A

Cetirizine

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10
Q

When and how does cows milk protein allergy present?

A

Often from 3 months, can be at point of weaning.

  • Regurgitation and vomiting
  • Diarrhoea
  • Urticaria, rash, angioedema
  • colic type pain and distress
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11
Q

How should cows milk protein allergy be managed?

A
  1. hydrolysed formulae
  2. amino acid based formulae

If breastfeeding then a maternal cow milk free diet

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12
Q

What are the features of DiGeorge syndrome?

A 
C - congenital heart defect
A - abnormal face 
T - thymus underdevelopment (= T cell non-functional)
C - cleft lip and palate 
H - hypoparathyroidism = hypocalcaemia 
22 - deletion of chromosome 22
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13
Q

How is Wiskott-Aldrich inherited? What are the features?

A

X-linked recessive

  • Abnormal T cells
  • Thrombocytopenia, neutropenia
  • Eczema, recurrent infection
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14
Q

What is SCID and how does it present?

A

Absent/ dysfunctional T and B cells

  • recurrent opportunistic LRTIs
  • persistent diarrhoea
  • reaction to live vaccines (MMR)
  • FTT
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15
Q

How is SCID managed?

A

sterile environment

haematopoietic stem cell transplant

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16
Q

What is selective IgA deficiency and how does it present?

A

maturation defect in B cells

  • very mild and sometimes not picked up
  • frequent respiratory and sinus infections
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17
Q

What is common variable immunodeficiency? How does it present? What are patients more at risk of?

A

Deficiency in IgA, IgG +/- IgM

  • recurrent respiratory infections
  • risk: RA and NH lymphoma
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18
Q

What are the signs and symptoms of Kawasaki disease?

A 
Very high fever
Strawberry tongue 
Red and cracked lips 
Conjunctival redness 
Red palms and soles
Rash over torso - can be desquamating 
Cervical lymphadenopathy
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19
Q

How is Kawasaki disease managed?

A

IvIG and aspirin

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20
Q

What is a complication of Kawasaki disease?

A

Coronary artery aneurysm

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21
Q

Define neonatal conjunctivitis. What organisms most commonly cause it?

A

Conjunctivitis within the first 28 days

- Neisseria gonorrhoea and chlamydia trachomatis

22
Q

What are the signs of neonatal conjunctivitis?

A 
Lid swelling
Mucopurulent discharge 
Conjunctival oedema (chemosis)
23
Q

What causes glandular fever? What are the signs and symptoms?

A 
EBV
Sore throat + fever + cervical lymphadenopathy 
\+/- splenomegaly 
\+/- palatal petechiae 
\+/- hepatitis
24
Q

How is glandular fever diagnosed?

A

Monospot test in the 2nd week of illness

25
Q

How does threadworm present and how is it managed?

A

Itchy bottom and vulva - itching worse at night

Mebendazole for the whole family

26
Q

How is impetigo managed?

A
  1. topical hydrogen peroxide
  2. topical fusidic acid

Oral flucloxacillin if widespread

27
Q

What organism causes chicken pox? How does it present?

A

varicella zoster

Prodromal fever then rash beginning on the torso and progressing in “crops” as follows:
macular to papular to vesicular to crust

28
Q

How is chicken pox managed?

A

topical calamine lotion
trimming the nails
VZIg and aciclovir if immunocompromised

29
Q

What are the complications of chicken pox?

A
  • varicella pneumonia - miliary opacities seen on CXR
  • encephalitis
  • superimposed infection
30
Q

Describe the rash seen in Measles

State if there are any associated features of prodromes

A

Beginning behind the ears it then spreads down the torso becoming blotchy and confluent
+ fever, conjunctivitis prodrome
+ Koplick spots (white) on buccal mucosa

31
Q

Describe the rash seen in Rubella

State if there are any associated features of prodromes

A

Pink, maculopapular starts on the face

  • occipital lymphadenopathy
  • low grade fever
32
Q

Describe the rash seen in Fifth disease

State if there are any associated features of prodromes

A

Slapped cheek rash on the face

  • rash spreads to arms
  • can have lethargy, fever prodrome
33
Q

Describe the rash seen in Roseola infantum

State if there are any associated features of prodromes

A
  • Extremely high fever +/- febrile convulsions
  • Sore throat
  • Rash spares the face
34
Q

Describe the rash seen in Scarlet fever

State if there are any associated features of prodromes

A
  • Sandpaper rash on the torso that spares the palms and soles
  • Strawberry tongue
  • Fever, tonsillitis, otitis media
35
Q

Describe the rash seen in Hand, foot and mouth disease

State if there are any associated features of prodromes

A
  • Yellow ulcers with a red halo in the mouth

- Then erythematous macules on palms and soles

36
Q

What virus causes:

a) rubella
b) 5th disease
c) Roseola infantum
d) Scarlet fever
e) Hand, foot and mouth

A

rubella: Togovirus
5th: parvovirus B19
Roseola: Herpes virus 6
Scarlet: group A haemolytic strep
HFM: Coxsackie A16

37
Q

How is scarlet fever managed?

A

Penicillin

38
Q

Which childhood rashes/ infections require school exclusion?

A

Measles
Rubella
Scarlet fever

39
Q

What is ITP?

A

type 2 hypersensitivity reaction i.e. autoimmune disorder resulting in reduced platelets

40
Q

What are the signs and symptoms of ITP?

A

Bleeding and bruising

  • nose bleeds
  • menorrhagia
  • gum bleeds

Can get intracranial and GI bleeds

41
Q

When and how is ITP pharmacologically managed?

A

It is dependant on symptom severity

  1. prednisolone
  2. IV Ig
  3. other immunosuppressing agents
42
Q

What advice should be given to parents whose child has ITP?

A
  • No contact sports
  • Alert medics if involved in trauma eg crash
  • Avoid IM injections
  • Avoid NSAIDs and aspirin
43
Q

Which complication of DKA are children particularly at risk of?

A

cerebral oedema

44
Q

What can cause congenital hypothyroidism?

A

Most of the time it is a problem with the thyroid gland.

Can also be thyroid hormone or pituitary or hypothalamus

45
Q

How may congenital hypothyroidism present?

A
  • Prolonged jaundice
  • Poor feeding
  • Constipation
  • Hypotonia
  • Macroglossia
46
Q

If not treated, what characteristic appearance do children with hypothyroidism develop?

A
  • Wide spaced eyes
  • Eyelid oedema
  • Narrow palpebral fissure
  • Depressed nasal bridge
47
Q

What is the most common cause of childhood hypothyroidism and how is it diagnosed?

A

Hashimotos

Anti-TPO antibodies

48
Q

What are the signs and symptoms of childhood hypothyroidism?

A

Poor growth

+ same as adults (fatigue, weight gain, brittle hair, constipation)

49
Q

What are the hormone abnormalities of congenital adrenal hyperplasia? Therefore how is it managed?

A

Low cortisol
Low aldosterone
High testosterone

Managed with hydrocortisone and fludrocortisone

50
Q

How does congenital adrenal hyperplasia present in

a) both sexes
b) females
c) males

A

a) hyponatraemia, low glucose, hyperkalaemia and pigmented skin
b) Ambiguous genitalia if severe. Amenorrhoea, tall, deep voice, facial hair
c) Tall, deep voice, large penis, small testis

Paediatrics for Finals (11 decks)

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