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70 Cards in this Set
- Front
- Back
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Toxoid
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- inactivated bacterial toxin that stimulate a response (Ab's) from the immune system
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Ig
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- sterile solution containing pooled Ab's from HUMAN blood
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Antitoxin
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- Ab's from the serum of ANIMALS immunized with specific antigens (like antivenom for snake bites)
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Active Immunization
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- give someone vaccine/toxoid, and have them develop Ab/AT themselves
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Passive Immunization
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- temporary immunity from antitoxin or Ab's (like maternal ab's)
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Live vs Inactive vaccine risks?
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- Live = single dose enough (no need of boosters), more COMPLETE/thorough, long lasting immunity, can be given not just through parenteral route
- Risk of live = produce true infection with variable risk of morbidity and mortality, needs special handling, risk of transmission, CI in preg, imm.compr. pt or family member |
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Name the 3 recommended conjugate vaccines (WHY do we need to conjugate these 3?)
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- Haemophilus Influenzae
- Pneumococcus - Meningococcus - why: we make immune responses to polysacchrides, but our mac's aren't mature enough to do so until we're 2 years old... if we conjugate polysaccharide to protein carrier, mac's can process immune complex (protein AND polysaccharide), and present both to t-cells => t-cells can now recognize both and it leads to MEMORY |
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There are more childhood vaccines these days, but are there are more antigens?
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- No!
- advances in technology |
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What is a conjugate vaccine?
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- covalently attach a (good antigenic) carrier protein to an otherwise poor bacterial antigen
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If you combine vaccines, the coverage rates are higher?
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- Yes!
- more coverage since people have to do more work to get all vaccines |
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The 5 classic exanthems? (with alternate name)
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- Measles (Rubeola)
- Rubella (German Measles) - Scarlet Fever - Exanthem Subitum (Roseola) - Erythema Infectiosum (Fifth Disease) |
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"other" 6 childhood diseases? which one causes exanthems?
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- Enteroviral Disease
- Varicella - HSV - EBV (Infectious Mononucleosis) - CMV - Mumps - all but mumps has exanthem, and CMV rarely |
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Rubeola (Measles)
cause? |
- paramyxovirus (RNA), one antigenic type
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Rubeola (Measles)
epidemiology? |
- highly infectious, especially respiratory
- still seen in young adult and infant outbreaks - transplacental immunity (blocks vaccine for 15 months) - incubation period = 10 days |
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Rubeola (Measles)
clinical manifestations? |
- prodrome of fever, Cough, Coryza, Conjunctivitis (CCC)
- Koplik's spots (pathomnemonic) - maculopapular/morbilliform heterogeneous rash; spreads from face downward - complications: pneumonia & encephalitis (SSPE - subacute sclerosing periencephalitis) |
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Rubeola (Measles)
atypical? |
- atypical = immune complex disease
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Rubeola (Measles)
dx by? |
- serology
- viral culture - detection (of Measles RNA) by RT PCR |
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Rubella (German Measles)
cause? |
- togavirus (RNA), one antigenic type
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Rubella (German Measles)
epidemiology? |
- less infectious than Rubeola, but still respiratory
- responsible for congenital infection and affliction (=> birth defects in baby if mother is not vaccinated and gets) - incubation period = 7 days |
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Rubella (German Measles)
clinical manifestations? |
- mild URI, malaise
- lymphadenopathy (posterior auricular => ALMOST pathemnemonic) - maculopapular homogeneous pink/rust colored rash, 3 day duration - more mild than rubeola - complications: arthritis, meningeoencephalitis, thromocytopenia |
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Rubella (German Measles)
dx by? |
- serology (IgG & IgM)
- viral culture - detection (of RNA) by RT PCR - ddx = enterovirus disease, drug rx, measles |
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Scarlet Fever
- cause |
- Strep Pyogenes (Grp.A), gram+ cocci in chains ("strip of strep")
- 3 erythrogenic eXotoxins: A, B, C |
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What do the following look like on a gram stain?
- Strep Pyogenes - Staph A - Pneumococcus |
- gram+ cocci in chains
- gram+ cocci clusters - gram+ diplococci bullet-shaped |
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Scarlet Fever
epidemiology? |
- respiratory spread
- can occur 3 times |
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Scarlet Fever
clinical manifestations? |
- fine red, punctate rash
- circumoral pallor - Pastia's lines (pathomnemonic) - strawberry tongue, erythematous oral enanthema |
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Scarlet Fever
dx? tx? |
- clinical
- serology/rapid testing - culture - tx = penicillin & other antibiotics (like cephalosporins); supportive |
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Roseola (Exanthem Subitum)
cause? |
- HHV6/HSV-1 (DNA), 2 antigenic types (infects CD4TCells, other TCells, BCells, NKCells, Astrocytes, Mac's)
- HHV7 (less common) |
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Roseola (Exanthem Subitum)
epidemiology? |
- transmitted via respiratory secretions
- incubation: 5-15 days - 80% contracted in childhood |
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Roseola (Exanthem Subitum)
clinical manifestations? |
- sudden onset of high fever (105deg)
- irritable, mild URI but no significant focal signs; may have diarrhea and vomitting - seizures can complicate fever - after 2-5 days, abrupt onset of rash and defervescence w/in 24 hours - rash: rose, pink, subtle, on trunk then face and extremities |
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Roseola (Exanthem Subitum)
dx? tx? |
- clinical
- serologic - isolation of virus (difficult - detection of DNA by PCR - tx = GANCICLOVIR |
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Fifth Disease (Erythema Infectiosum)
cause? |
- Human Parovirus B19 (DNA), one antigenic type
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Fifth Disease (Erythema Infectiosum)
epidemiology? |
- transmission by respiratory secretion, PRIOR to onset of rash (so if you see a kid with rash here, he's safe)
- incubation: 4-14 days |
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Fifth Disease (Erythema Infectiosum)
clinical manifestations? |
- "not very sick" (like rubella), fever, malaise, mild URI symptoms
- lacy pink rash on cheeks (slapped cheeks!), chest, extremities - special receptor on eythroblast => hemolytic anemia => intrauterine hydrops and Sickle Cell crisis - may be associated arthritis |
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Enteroviral Diseases
causes? |
- Picornaviruses (ssRNA)
- Coxsackie A (23 types) - Coxsackie B (6 types) - Echo (32 types) - Enterovirus (2 types) - Polio (3 types) |
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Enteroviral Diseases
epidemiology? |
- ubiquitous (everywhere), epidemic, and sporadic
- spread by respiratory and GI - spring, summer, and fall - type-specific immunity (way too many types to vaccinate effectively against) - shortest incubation period (of all diseases talked about) |
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Enteroviral Diseases
clinical manifestations? |
- non-specific febrile disease
- common cold - pneumonia - neonatal fulminate virmia - conjunctivitis - pharyngitis, croup, parotitis - hepatitis, pancreatitis, enteritis, mesenteric adenitis - aseptic (viral) meningitis, encephalitis - orchitis - arthritis - macular, papular, vesciular, petechial exantem (rashes), lasting 2-10 days |
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3 Pathogens that cause the common cold?
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- Enteroviruses
- Rhinovirus - Corynevirus |
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3 Bacteria that cause antibiotic treatable pharyngitis?
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- Grp.A Strep
- Diptheria - Gonorrhea |
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Enteroviral Diseases
UNIQUE clinical manifestations? |
- Coxsackie A: Herpangina, "Hand, Foot, Mouth" Disease (most common cause is CoxA)
- Coxsackie B: Pleurodynia, incr. Myocarditis&Pericarditis - Polio: Anterior root neuronal paralysis |
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What is the dromedary phenomenon?
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- initial symptoms are mild, then second set are much worse
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Enteroviral Diseases
dx? prophylaxis? tx? |
- serology
- viral culture - detection (of RNA) by RT-PCR (accurate, rapid, available in fef labs) - prevent w/ polio vaccine - tx (experimental): IVIG, pliconaril |
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Varicella (Chicken Pox)
cause? |
- Herpes varicella zoster virus (DNA), one antigenic type
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Varicella (Chicken Pox)
epidemiology? |
- extremely contagious
- respiratory and foamite (sheets, plastic, etc.) spread - incubation: 11-21 days - seasonal (spring) - mostly in children |
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Varicella (Chicken Pox)
clinical manifestation? |
- variable (from subclinical to dissemintated disease and death)
- vesicles rash which matures to crusted necrotic ulcers and occur in crops - 4 major causes of death: 3 from primary dissemination to liver, lung, and brain - 4th cause from super-infection w/ Grp.A Beta-Hemolytic Streptococcus Pyogenes - thromocytopenia, cerebelllar ataxia - congenital/perinatal disease - more severe disease in adults - zoster (dermatomal) |
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Varicella (Chicken Pox)
dx? prophylaxis? tx? |
- clinical
- serology - viral culture (zank prep) - detection of DNA by PCR - prevent w/ vaccine or VZIG - tx: Acyclovir, symptomatic, VZIG |
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Cytomegalovirus Disease
cause? |
- cytomegalovirus (DNA), 2 antigenic types
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Cytomegalovirus Disease
epidemiology? |
- transmission by salivary secretions, breast milk, genital secretions, and transfusions
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Cytomegalovirus Disease
clinical manifestations? |
- largely subclinical, and underdiagnosed
- mild heterophile-negative mononucleolisis (heterophile-positive by EBV) - congenital infection and affection - heptatitis, enteritis - pneumonia - myocarditis - encephalitis - cervicitis |
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Cytomegalovirus Disease
dx? prophylaxis? tx? |
- serology
- viral culture - PCR - prevent w/ vaccine (unlicensed) - tx: Ganciclovir, Foscarnet |
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Mumps
cause? |
- paramyxovirus (RNA), one serotype
- respiratory transmission - incubation: 18-21 days |
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Mumps
clinical manifestations? |
- generally mild
- parotitis, mastitis - myocarditis - pancreatitis - meningoencephalitis/deafness - orchitis/oophoritis |
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Mumps
dx? prophylaxis? |
- serology
- viral culture - detection of Mumps RNA by RT-PCR - prevent w/ vaccine |
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Differential diagnosis of parotitis?
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- anatomic (Stenson's duct) or traumatic abnormality
- bacterial infections - enterovirus, mumps, influenza, parainfluenza |
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Primary (Innate, Non-Specific)
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- granulocytes
- APCs: mononuclear phagocytes, tissue macrophages, dendritic cells - NK Cells - Inflammatory mediators - Complement System - Skin and mucous membrane barriers |
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Secondary (Specific)
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- T Lymphocytes (CD4 THelper, CD8 TCytotoxic); TCell Receptor = CD2
- B Lymphocytes (surface Ig's; CD10, 19, 34 cell surface markers) |
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Tertiary (Immunologically mediated diseases)
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- Hypersensitivities (Type I, II, III, IV)
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Name the disorders of phagocytic function pertaining to the following:
- Adhesion - Chemotaxis - Phagocytosis - Killing |
- Leukocyte Adhesion Defects
- Buckley-Job's Syndrome (Hyper IgE Syndrome) - Chediak-Higashi Syndrome - Chronic Granulomatous Disease |
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Hyper IgE Syndrome
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- chemotactic deficiency
- recurrent "cold" abscesses - allergic diathasis - "leonine" appearance - variable T-Cell deficiency |
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Chronic Granulamatous Disease
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- NADPH functional deficiency => decr. production of H2O2 and decr. bacterial killing
- recurrent and persistent chronic staph and candida infections (cat+) - pneumonia, lymphadenitis, liver abscess, gastric fibrosis - prognosis = poor (bone marrow transplant helps) - dx = bacteriocidal assays |
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How to diagnose CGD?
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- Nitroblue Tetrazolium (NBT) Test => poly's turn blue = good
- Bacterial Assay (long and expensive) |
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Most common cause of acquired heart disease in the US and Asia?
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Kawasaki Disease
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Kawasaki Disease
etiology |
- true etiology UNKNOWN
- ubiquitous infecious agent - develops in small subset of genetically predisposed individuals - CD8 cytotoxic suppressor cells & oligoclonal IgA plasma cells predominate in the arterial walls of patients - collections of plasma cells in resp. tract (portal of entry) - viral particles seen on EM studies of these tissues |
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Kawasaki Disease
pathogenesis? |
- immune disregulation = cytokine release from hyper stimulated B and T cells with autoantibody production and enhanced adhesion molecule expression resulting in endothelial cell damage
- infectious! = acute onset in younger patients, geographic clustering, seasonal predominance - super antigens most likely responsible = bacterial exotoxins and some viral antigens which bind to and stimulate lymphocytes and APCs, triggering a MASSIVE, NONSPECIFIC IMMUNE RESPONSE - genetic polymorphisms = HLA Bw22, history of atopic disease |
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Kawasaki Disease
clinical manifestation? |
- acute, febrile
- multi-system, vasculitis syndrome - afflicting infants and children motorbike analogy... - spiking fever greater than 5 days duration - conjunctivitis: bilateral - cracked and reddened lips - red palms and soles, edema of hands and feet, desquamation of skin of tips and fingers and toes - polymorphous, macular, erythematous rash (DIAPER AREA) - cervical lymphadenoapthy - exclusion of other etiologies |
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What is Kawasaki disease similar to?
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Infantile Periarteritis Nodosum
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When is Kawasaki disease seen most often? How does this compare with Acute Rheumatic Fever? What population is Kawasaki's seen more often in?
EXTREME HIGH YIELD! |
- Kawasaki: 80% seen b/w 6mo. and 5 years, ASIAN BOYS > girls
- ARF: primarily seen in children 6-15 yrs old - BOTH are seen much more in children under 15 than not |
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Laboratory findings in Kawasaki Disease? (thrombocytosis, ESR, IgE?)
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(HIGH FOR ALL)
- profound thromobcytosis - elevated sedimentation rate - elevated IgE |
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Kawasaki Disease
tx? |
- IVIG!!! (most effective)
- antibiotic treatment - steroid treatment (harmful) - salicylate treatment |
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Acute Rheumatic Fever
cause? |
- nonsuppurative (no pus) sequela (addition) of S.pyogenes infection (Grp.A Beta-Hemolytic Strep (GAS))
- acute, febrile, inflammatory conditions... ALL OVER DA PLACE |
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What is significant about the M5 serotype of GAS?
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- Rheumatogenic strain type that may elaborate a super-antigen
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