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CP2 PAEDS > Infection + Immunology > Flashcards

Infection + Immunology Flashcards

1
Q

Febrile infant <3 months PS

A 
Poor feeding 
Vomiting 
Apnoea + Decr HR 
Resp distress 
Abdo distention 
Jaundice 
Neutropenia 
Incr/Decr glucose 
Shock 
irritable 
Seizures 
Meningitis - bulging fontanelle/head retraction
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2
Q

If Sx of bacterial febrile child, what should you do?

A 
Septic screen 
Bloods - culture, FBC, CRP
Urine sample 
CXR
LP
Antigen screen 
Meningococcal/pneumococcal PCR
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3
Q

When is LP contraindicated? (4)

A

Platelets <50
CV compromise
Incr ICP
Seizures/neuro signs

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4
Q

Red flags febrile child (6)

A 
Fever >38' (<3 months) or .39' (>3 months) 
Pale, mottled, blue 
Meningitis signs 
Resp distress 
Bile-stained vomit 
Severe dehydration/shocked
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5
Q

Appearance meningitic rash

A

Non-blanching purpuric rash
Anywhere on body
Irregular size + outline
Necrotic core

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6
Q

Purpura DDx (6)

A 
Meningitis 
Sepsis 
Febrile seizures
Mumps/measles 
HSP
ITP
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7
Q

what % of meningococcemia are left with lifelong neurological impact?

A

10%

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8
Q

When do you have your meningitis C vaccines?

A

3 months, 4 months, 1 year

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9
Q

PS meningococcal septicaemia (7)

A 
CRT >2s
Mottle skin 
Decr BP
Leg pain 
Cold extremities 
Diarrhoea 
Resp distress
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10
Q

PS Bacterial meningitis (7)

A 
Fever, headache 
Neck stiffness, bulging fontanelle, photophobia
Altered mental state 
Non-blanching purpuric rash
Shock 
Kernigs 
Brudzinskis
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11
Q

Kernigs

A

Pain on knee extension when hips flexed

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12
Q

Brudzinskis

A

Hip flex on bending head foreward

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13
Q

Ix meningococcal sepsis + meningitis (6)

A 
Bloods - culture, FBC, CRP, U+E, LFT
PCR
LP
Incr PT, decr platelets, decr fibrinogen --> DIC
CXR
CT/MRI, EEG
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14
Q

Mx meningitis (2)

A

IV ceftriaxone/cefotaxime

Dexamethasone - decr complications

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15
Q

Mx meningococcal sepsis (6)

A 
IV ceftriaxone 
Dexamethasone 
IV fl 
Mechanical ventilation 
Inotropic support 
FFP + platelets - prevent DIC
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16
Q

Meningitis prophylaxis (3)

A

Give household contacts
Ciprofloxacine
ACWY

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17
Q

Early complications meningitis (6)

A 
Seizures 
Incr ICP 
Sinus thrombosis 
Hydrocephalus 
DIC
Decr platelets
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18
Q

Late complications meningitis (8)

A 
Hearing loss 
Amputation 
Skin scarring 
CKD
Neurodevelopment 
Cerebral abscess 
Septic arthritis 
Pericarditis
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19
Q

What is sepsis?

A

Bacterial proliferation in the bloodstream

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20
Q

Sepsis causative organisms - early onset neonatal (3)

A

Group B strep
E.coli
Listeria

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21
Q

Sepsis causative organisms - late onset neonatal (5)

A 
Staph epidermis 
Staph aureus 
E.coli 
H. influenza 
Listeria
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22
Q

Sepsis causative agents - children (4)

A

N,meningitides
Strep Pn
E.coli
Proteus

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23
Q

Sepsis causative agents - immunocompromised (5)

A 
Strep/Kleb Pn 
Staph aureus 
Legionella 
CMV, influenza
Pseudomonas
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24
Q

Hx sepsis (5)

A 
Fever 
Poor feeding 
Lethargy, irritability 
Hx of focal infection 
Predisposing condition
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25
Q

O/E Sepsis (6)

A 
Fever 
Incr RR
Incr HR 
Decr BP 
Shock 
Multi=organ failure
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26
Q

What is shock?

A

Inadequate delivery of substrates/O2 to tissues

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27
Q

Pathophysiology of sepsis

A

Vasodilation + leaky capillaries –> hypovolaemia

  • -> Decr CO
  • -> Decr BP
  • -> Hypoxia
  • -> Cell death
  • -> Multiple organ failure
  • -> Death

+ Incr Coagulation
–> thrombosis –.> hypoxia –> organ failure –> death

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28
Q

Pathophysiology of shock

A 
Cells starved of O2
--> anaerobic resp 
Hence prod < ATP + incr lactic acid 
Cellular homeostasis breaks down 
Cell death --> organ failure --> death
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29
Q

Early/compenstated shock signs (7)

A 
Incr RR + HR
Decr turgor 
Sunken eyes 
CRT >2 
Mottled, pale, cold skin 
Core-peripheral temp gap >4 
Decr urine output
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30
Q

Late/decompensated shock signs (6)

A 
Acidotic breathing (Kusmmal) 
Decr HR
Decr BP 
Decr consciousness 
Blue peripheries 
Absent urine output
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31
Q

Abx for sepsis - newborns/young infants

A

IV amox

Genatmicin

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32
Q

ABX for sepsis - older infants

A

Cefotaxime

or Cefrtiaxone

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33
Q

Tx shock

A 
IV ABX
Fl - hypovolaemia (20ml/kg) 
Assess fl balance 
Mechanical vent 
Inotropes 
FFP  + platelets 
O2 15L high flow 
May req ICU
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34
Q

What is an allergy

A

Abnormal immune response to harmless environmental stimuli (proteins)

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35
Q

What is hypersensitivity

A

Reproducible symptoms following exposure to defined stimulus

36
Q

IgE HS - early phase (mins) (2)

A

Release of histamine from mast cells

Urticaria, angiodema, bronchospasm

37
Q

IgE HS - late phase

A

Nasal congestion
Cough
Lower airway spasm

38
Q

Ix allergy (4)

A

Detailed Hx
Blood tests - HS markers
Controlled stimulant testing
Patch testing

39
Q

Mx allergy (3)

A

Anti-H
Steroids
Epipen if severe

40
Q

Short term risks HIV

A

Opportunistic infections

Blood problems - thrombocytopaenia, anaemia, neutropenia

41
Q

L term risks HIV (6)

A 
Compliance to Dx 
FTT 
Transmission risk 
HIV encephalopathy 
myelopathy 
Kaposi sarcoma/Non-Hodgkin's lymphoma
42
Q

Prevention HIV (if mother has high vital load) (5)

A 
Avoid breast feeding 
ART antenatally, perinatally + postnatally 
Avoid PROM 
Avoid unnecessary instrumentation 
Pre-labour CSC if detectable VL
43
Q

mx HIV (4)

A

ART - combo of 3/4 Dx
Prophylactic co-trimoxazole
Imms - routine
Follow up - focus on W + neurodevelopment

44
Q

Which vaccines should + shouldn’t be given to someone w/ HIV

A

DONT GIVE BCG - LIVE

Give influenza, Hep A/B + VZV

45
Q

Clinical features glandular fever (8)

A 
Low grade fever 
Fatigue 
Prolonged malaise 
Odynophagia/tonsilar enlargement 
Fine macular rash 
Lymphadenopathy 
N + anorexia 
Arthralgia
46
Q

What should you test for if you suspect glandular fever? (3)

A

Atypical lymphocytes blood film
PAUL-Bunuel test
Monospot test

47
Q

Complications of glandular fever (8)

A 
Upper airway obstruction 
Hepaitits 
Splenic rupture 
Jaundice 
Myocarditis 
Blood - anaemia, thrombocytopaenia 
Kidneys - nephritis 
Chronic fatigue + depression
48
Q

Tx glandular fever (5)

A 
Self resolving 
avoidcontact sport 
No alcohol 
Paracetamol for fever + analgesia 
Resolves 1-3 months
49
Q

What is Kawasaki’s

A

Systemic vasculitis that mainly affects children from 6m to 4y

50
Q

Diagnostic criteria Kawasakis (6)

A

Fever >38’ for >5 days + 4 of:

Conjunctival infection both eyes 
Change to mouth/throat 
Changes to skin/arms 
rash 
Swollen neck nodes
51
Q

How many phases are there of Kawasaki’s disease?

A

3

52
Q

Phase 1 - Kawasaki’s

A

Sudden +severe symptoms

Week 1/2

53
Q

Phase 2 - Kawasaki’s

A 
Weeks 3/4 
Fever should subside 
Abdo pain, vom, diarrhoea, urine +puss
Lethargy, headache
Complications begin to develop
54
Q

Phase 3 - Kawasaki’s

A

Recovery
Can lack energy
Complications can occur

55
Q

Who should you suspect Kawasaki’s in?

A

Any child w/ prolonged fever

56
Q

Ix Kawasakis

A

Bloods - Incr CRP, ESR, WCC
+ high platelet count
Echo

57
Q

Tx Kawasakis (3)

A

IV immunoglobulin within 10 days
Aspirin
L.term Warfarin if aneurysm

58
Q

LT complications Kawasakis

A

Aneurysm in heart

Mort - 1-2%

59
Q

Deliberate causes and reasons of immunosuppresion (5)

A

Prevent organ rejection
To Tx autoimmune disease - Chrons, RA

Dx
Splenectomy
Radiation

60
Q

Non-deliberate causes of immunosuppression (5)

A 
Malnutrition 
Ageing 
Cancer - leukaemia, lymphoma 
AIDS
SE Dx
61
Q

Prevention + Tx infection for immunosuppressed people (5)

A 
Monitor immune levels 
Prophylactic ABx as cover 
Low threshold for IV Tx 
Avoid contact of infected people/pets 
Ensure family have imms
62
Q

Main causes of immunodeficiency (5)

A 
Intrinsic defect of immune system (primary) 
Bacterial/viral infection 
Malignancy 
HIV
Immunosuppressive therapy
63
Q

Who should you consider to have a 1’ immunodeficiency?

A

SPUR

Children w/ Severe, Prolonged, Unusual, or Recurrent infections

64
Q

4 types of immune defects

A

T cell
B cell
Neutrophil
Lymphocyte

65
Q

PS T cell defects (4)

A

FTT
Severe/unusual viral/fungal infections
Bronchiolitis
Diarrhoea

66
Q

E.g.s of T cell defect conditions (4)

A

SCID
HIV
Wiskott-Aldrich
Di-George

67
Q

Ix T cell defect conditions (2)

A

FBC

Lymphocyte subset number

68
Q

PS B cell defect (2)

A

Severe bacterial infections

Ear, sinus, pulmonary + skin infections

69
Q

E.g.s of B cell defect conditions (3)

A

X-linked agammaglobinaemia
Combined variable immune deficiency (CVID)
Hyper IGM

70
Q

Ix B cell defects (2)

A

Ig’s

Specific anti-body response

71
Q

PS neutrophils defect (3)

A

Recurrent bacterial infections
Abscesses
Poor healing

72
Q

E.g. of neutrophil defect disease

A

Chronic granulomatous disease

73
Q

Ix Neutrophil defect

A

FBC for neutropenia

74
Q

PS Lecuocyte defects (3)

A

Delayed separation of umbilical chord
Delayed healing
Chronic ulcers

75
Q

E.g. of leucocyte defect

A

LAD - Leucocyte adhesion deficiency

76
Q

Ix Leucocyte defects

A

Test for chemotaxis

77
Q

Prevention + Tx of infection for immunodefiency pt (6)

A 
Anti-microbial prophylaxis 
Antibiotic Tx 
Screen for end-organ disease e.g. CT
Immunoglobulin replacement therapy 
BM transplant (SCID/ CGD)
Gene therapy  -SCID
78
Q

Where do you get typhoid fever from

A

Contaminated drinking water/food

79
Q

CF typhoid (10)

A 
Worsening fever
Headaches 
Cough 
Abdo pain 
Anorexia + malaise 
Myalgia 
Diarrhoea 
Rose-coloured spots on trunk 
Splenomegaly 
Bradycardia
80
Q

Complications typhoid (4)

A

GI perf
Myocarditis
Hepatitis
Nephritis

81
Q

Tx typhoid

A

3rd gen ceph - ceftriaxone/cefotaxime

Azithromycin

82
Q

CF malaria (6)

A 
Fever
D+V
Flu 
Jaundice 
anaemia 
Thrombocytopaenia
83
Q

When does malaria usually onset?

A

7-10 days post birth

84
Q

In relation to malaria, what are children at an increased risk of?

A

Severe anaemia

Cerebral malaria

85
Q

What is cerebral malaria

A

Most severe
–> encephalopathy
Parasit enters cerebral microvasculature –> blockage –> hypoxia –> ischaemia –> seizures

86
Q

Tx malaria

A

QUinine

CP2 PAEDS (18 decks)

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