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
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
3
Q
When is LP contraindicated? (4)
A
Platelets <50
CV compromise
Incr ICP
Seizures/neuro signs
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
5
Q
Appearance meningitic rash
A
Non-blanching purpuric rash
Anywhere on body
Irregular size + outline
Necrotic core
6
Q
Purpura DDx (6)
A
Meningitis Sepsis Febrile seizures Mumps/measles HSP ITP
7
Q
what % of meningococcemia are left with lifelong neurological impact?
A
10%
8
Q
When do you have your meningitis C vaccines?
A
3 months, 4 months, 1 year
9
Q
PS meningococcal septicaemia (7)
A
CRT >2s Mottle skin Decr BP Leg pain Cold extremities Diarrhoea Resp distress
10
Q
PS Bacterial meningitis (7)
A
Fever, headache Neck stiffness, bulging fontanelle, photophobia Altered mental state Non-blanching purpuric rash Shock Kernigs Brudzinskis
11
Q
Kernigs
A
Pain on knee extension when hips flexed
12
Q
Brudzinskis
A
Hip flex on bending head foreward
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
14
Q
Mx meningitis (2)
A
IV ceftriaxone/cefotaxime
Dexamethasone - decr complications
15
Q
Mx meningococcal sepsis (6)
A
IV ceftriaxone Dexamethasone IV fl Mechanical ventilation Inotropic support FFP + platelets - prevent DIC
16
Q
Meningitis prophylaxis (3)
A
Give household contacts
Ciprofloxacine
ACWY
17
Q
Early complications meningitis (6)
A
Seizures Incr ICP Sinus thrombosis Hydrocephalus DIC Decr platelets
18
Q
Late complications meningitis (8)
A
Hearing loss Amputation Skin scarring CKD Neurodevelopment Cerebral abscess Septic arthritis Pericarditis
19
Q
What is sepsis?
A
Bacterial proliferation in the bloodstream
20
Q
Sepsis causative organisms - early onset neonatal (3)
A
Group B strep
E.coli
Listeria
21
Q
Sepsis causative organisms - late onset neonatal (5)
A
Staph epidermis Staph aureus E.coli H. influenza Listeria
22
Q
Sepsis causative agents - children (4)
A
N,meningitides
Strep Pn
E.coli
Proteus
23
Q
Sepsis causative agents - immunocompromised (5)
A
Strep/Kleb Pn Staph aureus Legionella CMV, influenza Pseudomonas
24
Q
Hx sepsis (5)
A
Fever Poor feeding Lethargy, irritability Hx of focal infection Predisposing condition
25
O/E Sepsis (6)
```
Fever
Incr RR
Incr HR
Decr BP
Shock
Multi=organ failure
```
26
What is shock?
Inadequate delivery of substrates/O2 to tissues
27
Pathophysiology of sepsis
Vasodilation + leaky capillaries --> hypovolaemia
- -> Decr CO
- -> Decr BP
- -> Hypoxia
- -> Cell death
- -> Multiple organ failure
- -> Death
+ Incr Coagulation
--> thrombosis --.> hypoxia --> organ failure --> death
28
Pathophysiology of shock
```
Cells starved of O2
--> anaerobic resp
Hence prod < ATP + incr lactic acid
Cellular homeostasis breaks down
Cell death --> organ failure --> death
```
29
Early/compenstated shock signs (7)
```
Incr RR + HR
Decr turgor
Sunken eyes
CRT >2
Mottled, pale, cold skin
Core-peripheral temp gap >4
Decr urine output
```
30
Late/decompensated shock signs (6)
```
Acidotic breathing (Kusmmal)
Decr HR
Decr BP
Decr consciousness
Blue peripheries
Absent urine output
```
31
Abx for sepsis - newborns/young infants
IV amox
| Genatmicin
32
ABX for sepsis - older infants
Cefotaxime
| or Cefrtiaxone
33
Tx shock
```
IV ABX
Fl - hypovolaemia (20ml/kg)
Assess fl balance
Mechanical vent
Inotropes
FFP + platelets
O2 15L high flow
May req ICU
```
34
What is an allergy
Abnormal immune response to harmless environmental stimuli (proteins)
35
What is hypersensitivity
Reproducible symptoms following exposure to defined stimulus
36
IgE HS - early phase (mins) (2)
Release of histamine from mast cells
| Urticaria, angiodema, bronchospasm
37
IgE HS - late phase
Nasal congestion
Cough
Lower airway spasm
38
Ix allergy (4)
Detailed Hx
Blood tests - HS markers
Controlled stimulant testing
Patch testing
39
Mx allergy (3)
Anti-H
Steroids
Epipen if severe
40
Short term risks HIV
Opportunistic infections
| Blood problems - thrombocytopaenia, anaemia, neutropenia
41
L term risks HIV (6)
```
Compliance to Dx
FTT
Transmission risk
HIV encephalopathy
myelopathy
Kaposi sarcoma/Non-Hodgkin's lymphoma
```
42
Prevention HIV (if mother has high vital load) (5)
```
Avoid breast feeding
ART antenatally, perinatally + postnatally
Avoid PROM
Avoid unnecessary instrumentation
Pre-labour CSC if detectable VL
```
43
mx HIV (4)
ART - combo of 3/4 Dx
Prophylactic co-trimoxazole
Imms - routine
Follow up - focus on W + neurodevelopment
44
Which vaccines should + shouldn't be given to someone w/ HIV
DONT GIVE BCG - LIVE
| Give influenza, Hep A/B + VZV
45
Clinical features glandular fever (8)
```
Low grade fever
Fatigue
Prolonged malaise
Odynophagia/tonsilar enlargement
Fine macular rash
Lymphadenopathy
N + anorexia
Arthralgia
```
46
What should you test for if you suspect glandular fever? (3)
Atypical lymphocytes blood film
PAUL-Bunuel test
Monospot test
47
Complications of glandular fever (8)
```
Upper airway obstruction
Hepaitits
Splenic rupture
Jaundice
Myocarditis
Blood - anaemia, thrombocytopaenia
Kidneys - nephritis
Chronic fatigue + depression
```
48
Tx glandular fever (5)
```
Self resolving
avoidcontact sport
No alcohol
Paracetamol for fever + analgesia
Resolves 1-3 months
```
49
What is Kawasaki's
Systemic vasculitis that mainly affects children from 6m to 4y
50
Diagnostic criteria Kawasakis (6)
Fever >38' for >5 days + 4 of:
```
Conjunctival infection both eyes
Change to mouth/throat
Changes to skin/arms
rash
Swollen neck nodes
```
51
How many phases are there of Kawasaki's disease?
3
52
Phase 1 - Kawasaki's
Sudden +severe symptoms
| Week 1/2
53
Phase 2 - Kawasaki's
```
Weeks 3/4
Fever should subside
Abdo pain, vom, diarrhoea, urine +puss
Lethargy, headache
Complications begin to develop
```
54
Phase 3 - Kawasaki's
Recovery
Can lack energy
Complications can occur
55
Who should you suspect Kawasaki's in?
Any child w/ prolonged fever
56
Ix Kawasakis
Bloods - Incr CRP, ESR, WCC
+ high platelet count
Echo
57
Tx Kawasakis (3)
IV immunoglobulin within 10 days
Aspirin
L.term Warfarin if aneurysm
58
LT complications Kawasakis
Aneurysm in heart
| Mort - 1-2%
59
Deliberate causes and reasons of immunosuppresion (5)
Prevent organ rejection
To Tx autoimmune disease - Chrons, RA
Dx
Splenectomy
Radiation
60
Non-deliberate causes of immunosuppression (5)
```
Malnutrition
Ageing
Cancer - leukaemia, lymphoma
AIDS
SE Dx
```
61
Prevention + Tx infection for immunosuppressed people (5)
```
Monitor immune levels
Prophylactic ABx as cover
Low threshold for IV Tx
Avoid contact of infected people/pets
Ensure family have imms
```
62
Main causes of immunodeficiency (5)
```
Intrinsic defect of immune system (primary)
Bacterial/viral infection
Malignancy
HIV
Immunosuppressive therapy
```
63
Who should you consider to have a 1' immunodeficiency?
SPUR
| Children w/ Severe, Prolonged, Unusual, or Recurrent infections
64
4 types of immune defects
T cell
B cell
Neutrophil
Lymphocyte
65
PS T cell defects (4)
FTT
Severe/unusual viral/fungal infections
Bronchiolitis
Diarrhoea
66
E.g.s of T cell defect conditions (4)
SCID
HIV
Wiskott-Aldrich
Di-George
67
Ix T cell defect conditions (2)
FBC
| Lymphocyte subset number
68
PS B cell defect (2)
Severe bacterial infections
| Ear, sinus, pulmonary + skin infections
69
E.g.s of B cell defect conditions (3)
X-linked agammaglobinaemia
Combined variable immune deficiency (CVID)
Hyper IGM
70
Ix B cell defects (2)
Ig's
| Specific anti-body response
71
PS neutrophils defect (3)
Recurrent bacterial infections
Abscesses
Poor healing
72
E.g. of neutrophil defect disease
Chronic granulomatous disease
73
Ix Neutrophil defect
FBC for neutropenia
74
PS Lecuocyte defects (3)
Delayed separation of umbilical chord
Delayed healing
Chronic ulcers
75
E.g. of leucocyte defect
LAD - Leucocyte adhesion deficiency
76
Ix Leucocyte defects
Test for chemotaxis
77
Prevention + Tx of infection for immunodefiency pt (6)
```
Anti-microbial prophylaxis
Antibiotic Tx
Screen for end-organ disease e.g. CT
Immunoglobulin replacement therapy
BM transplant (SCID/ CGD)
Gene therapy -SCID
```
78
Where do you get typhoid fever from
Contaminated drinking water/food
79
CF typhoid (10)
```
Worsening fever
Headaches
Cough
Abdo pain
Anorexia + malaise
Myalgia
Diarrhoea
Rose-coloured spots on trunk
Splenomegaly
Bradycardia
```
80
Complications typhoid (4)
GI perf
Myocarditis
Hepatitis
Nephritis
81
Tx typhoid
3rd gen ceph - ceftriaxone/cefotaxime
| Azithromycin
82
CF malaria (6)
```
Fever
D+V
Flu
Jaundice
anaemia
Thrombocytopaenia
```
83
When does malaria usually onset?
7-10 days post birth
84
In relation to malaria, what are children at an increased risk of?
Severe anaemia
| Cerebral malaria
85
What is cerebral malaria
Most severe
--> encephalopathy
Parasit enters cerebral microvasculature --> blockage --> hypoxia --> ischaemia --> seizures
86
Tx malaria
QUinine
