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Child Health > Paediatric Infection and Immunity - Allergies, Conjunctivitis, Impetigo and Chickenpox > Flashcards

Paediatric Infection and Immunity - Allergies, Conjunctivitis, Impetigo and Chickenpox Flashcards

1
Q

What is an allergy?

A

Immunological hypersensitivity leading to a variety of disease

May or may not be IgE mediated

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2
Q

What is an allergen?

A

Substance that stimulates the production of IgE or cellular immune response

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3
Q

What is sensitisation?

A

Production of IgE antibodies after repeated allergen exposure

Asymptomatic

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4
Q

What is required for something to be an allergy?

A

Symptoms + specific IgE rise

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5
Q

Give examples of atopic disease

A 
Allergic rhinitis
Allergic conjunctivitis
Asthma
Atopic dermatitis (Eczema)
Urticaria
Insect, food and drug allergy
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6
Q

How does urticaria present and when is it not allergic?

A

Maculo-papular pruritic rash

If chronic >6weeks, not allergic

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7
Q

What are the hypotheses for increasing allergies?

A

Hygiene hypothesis
Dual allergen hypothesis
Vitamin D hypothesis

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8
Q

What is the hygiene hypothesis?

A

Microbiological exposure low in developed environment so immune system development is suppressed

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9
Q

What is the dual allergen hypothesis?

A

Exposure through skin may lead to allergy

However, consumption will lead to tolerance

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10
Q

What is the vitamin D hypothesis?

A

Need high levels of Vit D to regulate the immune system

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11
Q

What can you do to reduce risk of allergy onset?

A

Good skin hygiene
Microbial exposure - pets
Vitamin D
Early weaning - varied diet

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12
Q

What are the types of allergic rhinitis?

A

Seasonal - hayfever
Persistent - dust mites, pets
Occupational - flour, wood dust

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13
Q

What is the pathophysiology of allergic rhinitis?

A

IgE mediated inflammation of the nasal mucosa

Mast cells release histamines - increase epithelial permeability

Inflammatory cell migration

Acute and late phase response

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14
Q

What happens in the acute phase response?

A

Sneezing followed by secretions

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15
Q

What happens in the late phase response?

A

6-12 hours after –> nasal congestion

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16
Q

What symptoms does allergic rhinitis present with?

A 
Bilateral nasal congestion
Itching
Sneezing
Discharge
Watery, red eyes
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17
Q

How is allergic rhinitis assessed?

A

Diagnosis from history

Can do skin prick or IgE testing via ELISA

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18
Q

How is allergic rhinitis managed?

A

Avoid allergen
Cetirizine
>5yo - try topical nasal antihistamines PRN

Nasal steroids if nasal blockage predominant symptom

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19
Q

How can food allergies be split up?

A

Immunological - IgE mediated and Non-IgE mediated

Non-immunological

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20
Q

What symptoms would all immunological food allergies present with?

A

Pruritis
Diarrhoea
Abdo pain

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21
Q

What symptoms of food allergy would be indicative it is IgE mediated?

A 
Urticaria
Angio-oedema
Oral itching
Sneezing
SOB and wheeze
Signs of anaphylaxis
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22
Q

What symptoms of a food allergy would indicate it is a non IgE mediated immunological allergy?

A

Eczema
GORD and colic
Bowel changes
Poor growth

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23
Q

What symptoms would indicate a food allergy is non immunological?

A 
Take hours - days to occur
Headache
Fatigue
Bowel changes
Urticaria
24
Q

How are IgE mediated food allergies investigated?

A

Food diary
Physician supervised oral food challenge
Skin prick
Allergen specific IgE measurements via ELISA

25
Q

How is a non IgE mediated food allergy investigated?

A

Trial elimination diet

26
Q

How are immunological food allergies managed?

A

Food avoid
Dietician referral
Antihistamines
Adrenaline

27
Q

How are non-immunological food allergies managed?

A

Food avoidance

Dietician referral

28
Q

What commonly causes lactose intolerance?

A

Post-viral gastroenteritis lactase deficiency

29
Q

What is the pathophysiology of lactose intolerance?

A

Lactase normally decrease with age

If accelerated - lactose intolerance

Lactose pass into colon and fermented - diarrhoea and bloating

30
Q

How can cows milk protein allergy present?

A 
With other food allergies
Colic
Oesophagitis
Constipation
Acute colitis
31
Q

How are infants with cows milk protein allergy fed?

A

Hydrolysed formula first

Then wean onto cows milk protein free diet

32
Q

What organisms commonly cause conjunctivitis?

A

Adenovirus
Staph
Strep pneumoniae
H Influenzae

33
Q

How does conjunctivitis present?

A

Generalised red eye
Irritated gritty feeling
Vary depending on bacterial or viral
History of close contact

34
Q

What symptoms are indicative of bacterial conjunctivitis?

A

Purulent discharge

Eyes stick together

35
Q

What symptoms are indicative of viral conjunctivitis?

A

Serous discharge
Recent URTI
Periauricular lymphadenopathy

36
Q

How is viral conjunctivitis managed?

A

Self limiting - resolve in 2 weeks

Lubricant eye drops, warm water

No school exclusion but don’t share towels etc.

37
Q

How is bacterial conjunctivitis treated?

A

Antibiotics if severe - Chloramphenicol

Prescribing can be delated - 3 days with no improvement

38
Q

What is impetigo?

A

Superficial skin infection by staph aureus or strep pyogenes

39
Q

What are risk factors for impetigo?

A

Poor hygiene

Break in skin - eczema, bites

40
Q

How does impetigo present?

A 
Usually around a month 
Tiny vesicles which crust into honey coloured plaques
Rapidly spreading
Some itching
No erythema or oedema
Regional lymphadenopathy
41
Q

How is impetigo investigated?

A

Swab for culture if lesion widespread or MRSA suspected

42
Q

How is impetigo managed?

A 
Keep area clean - soap and water
Avoid sharing towels, dummies etc
No school until lesions crusted or antibiotics for 48hrs
Fusidic acid - topical
Oral fluclox if widespread or bullous
43
Q

What are the complications associated with impetigo?

A

Cellulitis

Staph scaled skin syndrome

44
Q

What is bullous impetigo?

A

Thin roofed lesions which rupture seen on top of other lesions

45
Q

Where is bullous impetigo most commonly seen?

A

Face, trunk and buttocks

46
Q

Who is bullous impetigo most commonly seen in?

A

Neonates

47
Q

What organism causes chicken pox?

A

Varicella zoster

48
Q

What is a key property of chicken pox?

A

Infectious!

49
Q

How and when does chicken pox spread?

A

Via respiratory route from someone who has chicken pox or shingles

4 days before rash –> 5 days after rash appear

50
Q

How long is the incubation period for varicella zoster?

A

10-21 days

51
Q

How do children with chicken pox present?

A

38-39 degrees for up to 4 days

Itchy rash on head and trunk

52
Q

What is the progression of the chicken pox rash?

A

Macular –> papular –> vesicular –> crust

53
Q

What complications are associated with chicken pox?

A

Bacterial infections of lesion
Pneumonia
Encephalitis

54
Q

How is chicken pox managed non pharmacologically?

A

Calamine lotion
Trim nails
Exclude from school - 5 days after rash onset

55
Q

How is chicken pox managed pharmacologically?

A

Varicella zoster immunoglobulin for immunocompromised and newborns exposed to it

Aciclovir if contract chicken pox

56
Q

What can be seen on chest X-ray with varicella pneumonia?

A

Miliary opacities

57
Q

What are each of the HHV’s and what disease do they cause?

A

HHV1 - herpes simplex 1 - oral infection and encephalitis
HHV2 - herpes simplex 2 - neonatal and genital infection
HHV3 - varicella zoster - chickenpox and shingles
HHV4 - Epstein Barr virus - glandular fever
HHV5 - Cytomegalovirus - congenital & immunocompromised
HHV6/7 - Roseola

Child Health (30 decks)

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