Pedia Topnotch Flashcards
Immediate goal of immunization
Prevention of disease
Ultimate goal of immunization
Eradication of disease
Two types of immunization
Active and passive
Types of antigen for active immunization
- Live attenuated
2. Inactivated
What are the live vaccines? List 7.
BCG Measles MMR Varicella Rotavirus Influenza intranasal Typhoid fever
Peak of passive immunization for IM injections
48-72 hrs
System for ensuring the potency of a vaccine from the time of manufacture to the time it is given to a child
Cold chain
When can combination vaccines be given simultaneously?
- Equal or >2 inactivated vaccines
2. Inactivated and live vaccines
What is the rule in giving live vaccines in combination?
28-day minimum interval if not given simultaneously
What is the principle in lapsed immunization?
does not require reinstitution of the entire series. subsequent immunizations should be given at the next visit as if the usual interval has elapsed.
Only vaccine given intradermally
BCG
When is BCG usually given?
earliest possible age after birth preferrably within the first 2 months
If BCG is not given in the first 2 months what do we do?
PPD vaccination is NOT recommended prior to vaccination.
PPD is however required if the following conditions are present:
- suspected congenital TB
- history of close contact to know TB case
- clinical findings suggestive of TB or xray suggestive of TB
What is a positive PPD test in those requiring PPD before vaccination?
> 5mm induration
What is the dose of BCG?
12 mos - 0.1 ml
Measles vaccine is given through what route
SQ
Measles vaccine is given at
9 months
Measles vaccine can be given as early as ___ in cases of outbreaks as declared by PH officials
6 months
Common adverse effects of BCG vaccine
Abscess or ulcers at site
Axillary Lymphadenopathy
Dose of measles vaccine
0.5ml
Common adverse effect of measles vaccine
fever 5-12 days after vaccination
rash
A 14 year old male presents with joint pains and morning stiffness for the past 3 months. The joint pain is present in both hands and feet bilaterally. On PE, joints are tender to palpation, warm, and swollen. What is the most likely diagnosis?
Juvenile Rheumatoid Arthritis
3 prinicipal types of onset of JRA
- Oligoarthritis (pauciarticular)
- Polyarthritis
- Systemic-onset disease
HLA subtypes in JRA
HLA DR4 (Polyarticular) HLA DR8 and DR5 (Pauciarticular)
Criteria of classification of JRA
Age <16years
Arthritis (2 or more of the following) limitation of ROM, tenderness or pain on motion, increased heat in one or more joints
Onset type of JRA is defined by disease characteristic in the first _months
6 mos
JRA classifications, differentiate each:
- Polyarthritis - 5 or more inflamed joints
- Oligoarthritis: <5 inflamed joints
- Systemic arthritis: with characteristic fever
Characteristic of fever in systemic onset JRA
quotidian fever with daily high spikes and rapid return to baseline usually associated with a faint red macular rash (salmon pink rash)
Treatment of JRA
NSAIDs
Methotrexate and immunosuppresive agents
Steroids for overwhelming systemic illness
Physical and occupational therapy
Inflammation if the joints of the axial skeleton and limbs, presence of enthesitis (inflammation of the sites of attachments of ligaments, tendons, fascia, and capsule to bone), absence of Rheumatoid factor
Ankylosing spondylitis
Demographic of people with ankylosing spondylitis
older boys, adolescents, young adults
HLA type found in >90% of people with ankylosing spondylitis
HLA-B27
Forms of ankylosing spondylitis (3)
- Juvenile (oligoarthritis legs>arms, enthesitis, hip joint arthritis, back pain, loss of spinal flexibility
- Psoriatic (oligoarthritis, asymmetric, nail pitting, dactylitis, FH of psoriasis)
- Reactive (Reiter syndrome: arthritis, conjunctivitis, urethritis), lower limb arthritis
Eye complication of ankylosing spondylosis
Anterior uveitis (Iridocyclitis) 25%
Treatment for ankylosing spondylosis
NSAID and may add sulfasalazine
Intraacrticular triamcinolone
Criteria for diagnosis of SLE
4 out of 11
SOAP BRAIN MD
Serositis (Pleuritis, Carditis)
Oral Ulcers (painless)
Arthritis (2 or more joints)
Photosensitivity
Blood Changes (anemia, leukopenia, thrombocytopenia) Renal Disorder (persistent proteinuria,cellular casts) ANA abnormal titer Immunological Changes (anti dna, Ab, Anti Sm) Neurologic signs (seizures, frank psychosis)
Malar rash
Discoid rash
screening for SLE
ANA
more specific marker for lupus and reflects degree of disease activity
anti dsdna
Complement low in lupus
low C3, C4
marker only found in SLE
anti Smith Ab
Route of rotavirus vaccine
oral
RV1 and RV5 number of doses, schedule, interval between doses and brands
RV1 (monovalent) Rotarix 2 doses
RV5 (pentavalent) RotaTeq 3 doses
between 6 weeks and 32 weeks (8mos)
interval between doses: 4 weeks
MMRV:
Route?
How many doses?
Schedule between ?
Minimum interval between doses?
Route? SQ
How many doses? 2 doses
Schedule between ? 12 mos-12 years
Minimum interval between doses? 3 mos
Definition of hematuria
More than 5 rbcs/hpf
Dipstick test for hematuria is based on what chemical reaction?
Peroxidase reaction with hemoglobin
Is cloudy urine always abnormal?
No. It can be due to crystal formation at room temp.
Tea colored urine usually points out to a ___ problem
Glomerular
Normal specific gravity
1.015-1.025
What crytals form in acidic urine?
Uric acid
What crystals form in basic urine?
Phosphate crystals
Positive dipstick but absent rbcs in urine. What is the usual cause?
Myoglobinuria from rhabdomyolysis
Primary treatment in SLE
Prednisone 1-2mg/kg/day
Severely ill: Pulse IV steroids (30 mg/kg/dose max 1 gm over 60mins OD for 3 days)
Severely ill: pulse IV cyclophosphamide to maintain renal function and prevent progression
Most common of the pediatric inflammatory myopathies
Dermatomyositis
HLA subtype association in Dermatomyositis in >80%
HLA Ag DQA1*0501
Systemic vasculopathy with cutaneous findings and focal areas of myositis resulting in progressive muscular weakness that is responsive to immunosuppressive therapy
Dermatomyositis
Usual risk factor and infection triggers of Dermatomyositis
Sun exposure
Enterovirus (Coxsackievirus B) and GABHS
Periorbital violaceous erythema common in Dermatomyositis
Heliotrope rash
Skin finding over the metacarpal and proximal interphalangeal joints that is hypertrophic and pale red with a papular, alligator-skin like appearance seen in dermatomyositis
Gottron papules
Severe prognostic sign in dermatomyositis
Dysphagia
A chronic disease characterized by fibrosis affecting the dermis and arteries of the lungs, kidney, and GIT
Scleroderma
Pathophysio of Scleroderma
Injury of vascular endothelium leading to fibrosis
Earliest manifestation of scleroderma and may precede skin and internal organ involvement by months or years.
this is not however limited to scleroderma but can also herald other diseases such as connective tissue disorders, rheumatic disorders and other immunologic conditions
Raynaud phenomenon
excessively reduced blood flow in response to cold or emotional stress, causing discoloration of the fingers, toes, and occasionally other areas
Components of CREST Syndrome
Calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia.
Is a systemic connective tissue disease.
Characteristics include essential vasomotor disturbances; fibrosis; subsequent atrophy of the skin, subcutaneous tissue, muscles, and internal organs (eg, alimentary tract, lungs, heart, kidney, CNS); and immunologic disturbances accompany these findings.
Systemic sclerosis (SSc)
Diagnostic Criteria of Systemic Sclerosis
Major criterion or 2 of the 3 Minor criteria
Major Criteria:
1. Proximal scleroderma: typical skin changes (tightness, thickening, non-pitting induration excluding localized forms) involving areas proximal to the MCP or MTP joints
Minor Criteria
- Sclerodactyly
- Digital pitting scars from digital ischemia
- Bibasilar pulmonary fibrosis not attributable to primary lung disease
Antibody finding mostly suggestive for scleroderma
Anti-SCL70 specific for topoisomerase 1 and anticentromere autoantibodies
Drug used that may prevent ulcerations in scleroderma
ACE inhibitors
Imunosuppresive agents used in scleroderma
Methotrexate and steroids
How many percent of coronary aneurysms in Kawasaki disease resolve after 1-2 years?
50%
IgA mediated vasculitis of the small vessels
HSP
Typical Prodrome of HSP
typically follows after an URTI
Pathophysio of HSP
IgA deposition in blood vessels that cause leaking –> purpura and petechiae
HLA subtype common in HSP
HLA-DRB1*07
Organ systems primarily affected in HSP
Skin, GI, Kidney