Pediatric Immunology

Front 1

Example of active & passive immunity

Back 1

direct exposure, mother 2 baby

Front 2

Examples of non-specific immunity's first line of defense (4)

Back 2

intact skin, body secretions, mucous membranes, pH

Front 3

What two immune cells are primarily responsible for phagocytosis?

Back 3

neutrophils, monocytes (macrophages)

Front 4

5 Classifications of Antibodies

Back 4

IgA, IgD, IgE, IgG, IgM

Front 5

IgA - name its function, presence/ absence at birth, and its progression

Back 5

viral protection, absent at birth, present in breast milk, produced at 2wks, mature at 6-7yrs

Front 6

IgE - name its function, presence/ absence at birth, and its progression

Back 6

allergic response & parasitic infection, absent at birth, produced at 2wks, mature at 6-7yrs

Front 7

IgG - name its function, presence/ absence at birth, and its progression

Back 7

Secondary bacterial protection, present at birth, disappears 6-8mos, matures 7-8yrs

Front 8

IgM - name its function, presence/ absence at birth, and its progression

Back 8

Primary bacterial protection, low presence at birth, rises markedly at 1wk, mature at 1yr

Front 9

Predominate release of what immunoglobin with primary exposure to antigen?

Back 9

IgM

Front 10

Predominate release of which immunoglobin with secondary (subsequent) exposure to antigen?

Back 10

IgG

Front 11

If titer results for a particular infection display high levels of IgG, what information does this provide?

Back 11

that the individual has been exposed to the infection and has developed antibodies to fight against it

Front 12

What cells are responsible for cell-mediated immunity?

Back 12

CD4 (helper-T), TH1, T-cell (CD8)

Front 13

What cells are responsible for humoral immunity?

Back 13

CD4 (helper-T), TH2, B-cell (AB's)

Front 14

What cell does HIV attack?

Back 14

CD4

Front 15

Example of vertical transmission and horizontal transmission

Back 15

mother to baby vs. unprotected sex

Front 16

What is reverse transcriptase?

Back 16

an enzyme that allows RNA to be converted into DNA

Front 17

What is the most critical part of HIV entry into the CD4 cell?

Back 17

Cell lysis, cell death

Front 18

Name the clinical manifestations often seen in children with HIV

Back 18

lymphadenopathy, hepataspleenomegaly, oral candidasis, chronic or recurrent diarrhea, failure to thrive, developmental delays, parotitis

Front 19

What is parotitis?

Back 19

inflammation of the parotid gland, salivary gland in the cheek

Front 20

4 differences between children and adults infected with HIV

Back 20

1-AIDS < 1yr
2-physical&developmental delays
3-more childhood illnesses
4-prenatally acquired

Front 21

If mother is HIV+ what antibiotic are children put on prophylactically? What for? What age?

Back 21

Bactrim for PCP, as early as 2mos

Front 22

What HIV test is used for infants of mother's who are HIV+

Back 22

HIV DNA-PCR Test

Front 23

Explain the HIV testing procedure for infants (r/t time)

Back 23

2 + results on 2 separate blood specimens; if negative, repeated at 3mos and at 6mos; may re-check at 12mos

Front 24

How long will they keep baby on prophylactic meds if mother is HIV+

Back 24

HIV negative x 3

Front 25

What defines each clinical stage, N, A, B & C?

Back 25

N-infected, asymptomatic
A-mild symptoms
B-moderate symptoms
C-severe symtoms, AIDS

Front 26

Can individuals be re-staged?

Back 26

Once staged you cannot regress, only progress

Front 27

Explain immunological staging

Back 27

Stage 1-no suppression
Stage 2-moderate suppression
Stage 3-severe suppression, AIDS

Front 28

Name some indicators seen in children < 13yrs

Back 28

LIP, PCP, CMV,MAC, wasting syndrome, candidal esophagitis, pulmonary candidiasis, cryptosporidiosis, encephalopathy, serious bacterial infections, herpex simplex disease

Front 29

What are the characteristics of MAC?

Back 29

bad respiratory infection (similar to TB), lymphadenopathy, nodules on skin; these kids are very sick

Front 30

What is something you have to consider to initiate therapy? Why?

Back 30

Adherence; drug resistance

Front 31

What indicators determine a need to change medications?

Back 31

worsening immune system, mild intolerance, toxicity, development of a better regime

Front 32

What is the goal of antiretroviral therapy?

Back 32

maximum suppression of viral replication in order to preserve immune function and delay disease progression

Front 33

Generic regimen for antiretroviral therapy

Back 33

2 NRTIs + 1 PI/NNRTI

Front 34

What is an NRTI? 2 examples?

Back 34

Nucleotide reverse transcriptase inhibitor; ZDV & DDL

Front 35

What is a PI? 2 examples?

Back 35

Protease inhibitor; retonavir, nelfinavir

Front 36

What is an NNRTI? 2 examples?

Back 36

Non-nucleoside transcriptase inhibitors; nivirapine, efavirenz

Front 37

Side effects of medication

Back 37

nausea, vomiting, diarrhea, anorexia, fever, rash, abdominal pain, anemia

Front 38

If a child is <1yrs, when should you start combination therapy?

Back 38

Upon diagnosis

Front 39

If a child is >1yrs, when should you start combination therapy?

Back 39

defer tx for normal immune function, low viral load, medical compliance risk; frequent monitoring

Front 40

Prophylaxis Bactrim

Back 40

PCP

Front 41

Prophylaxis IVIG

Back 41

Cadidiasis, herpes simplex, MAC

Front 42

Prophylaxis corticosteroids

Back 42

LIP

Front 43

Prophylaxis immunizations

Back 43

Caution with low CDC; keep child home if outbreak at school

Front 44

What is something you can do to encourage a child with oral candidiasis or parotitis to eat?

Back 44

Ice pops!