Allergy/Immune/Oncology/ID Flashcards
what are the four types of hypersensitivity reactions?
type I - anaphylactic
type II - cell bound
Type III - immune complex
Type IV - delayed hypersensitivity
what is the mechanism of type I hypersensitivity reactions?
IgE mediated reaction - IgE reacts with the antigen
what are examples of type I hypersensitivity reactions?
anaphylaxis
atopy - asthma, eczema, hayfever
what is the mechanism of action in type II hypersensitivity reactions?
IgG or IgM binds to antigens on the cell surface
what are examples of type II hypersensitive reactions?
goodpastures syndrome
pernicious anaemia
rheumatic fever
autoimmune haemolytic anaemia
ITP
what immunoglobulins are involved in type III hypersensitivity reactions?
sle
post strep glomerulonephritis
EAA
what mediates type IV reactions?
T cell mediated
what are examples of type IV reactions?
TB
graft versus host disease
Alergic contact dermatitis
scabies
EAA
MS
GBS
what is oral allergy syndrome?
IgE mediated hypersensitivity reaction to specific raw, plant based foods including fruits, vegetables, nuts and certain spices
the allergy is due to cross-sensitisation to a structurally similar allergen present in pollen - not o the actual protein in the food itself
what are the symptoms of oral allergy syndrome?
tingling or pruritis of the lips, tongue and mouth
what is the most common allergen involved in oral allergy syndrome?
birch pollen
are the symptoms of oral allergy syndrome the same throughout the year or do they vary?
they are worse during summer months - as they are so strongly linekd to birch pollen allergies
are the symptoms of oral allergy syndrome worse with raw or cooked foods?
worse with raw foods - cooking them denatures the proteins, preventing symptoms from occuring
what dose of adrenaline is given in 6 months to 6 years of age?
150 micrograms (0.15ml 1 in 1000)
what dose of adrenaline is given from 6-12 years?
300 micrograms (0.3ml, 1 in 1000)
what dose of adrenaline is given in adults and children > 12 years?
500 micrograms (0.5 mls of 1 in 1000)
when should IM adrenaline injection be repeated?
if symptoms not improved in 5 mins
where should the IM adrenaline injection be given?
anterolateral aspect of the middle third of the thigh
how many adrenaline auto-injectors should patients be prescribed?
2
what are the 3 most common cancers in men and the 3 most common in women?
Prostate / breast
lung
colorectal
which type of chemotherapy agent causes pulmonary fibrosis?
bleomycin
which type of chemotherapy agent causes haemorrhagic cystitis ?
cyclophosphamide
which antiemetic is the best for chemotherapy induced nausea and vomiting?
metoclopramide first line
ondansetron second line - 5HT 3 antagonist
which chemotherapy agent causes peripheral neuropathy?
vincristine
what are the contraindications for the influenza vaccine?
food allergy to egg
aged < 2 years
current febrile illness or blocked nose (as intranasal vaccine)
current wheeze
hx of severe asthma
pregnancy/breastfeeding
if the child is taking aspirin (i.e. kawasaki) - due to rise of reyes syndrome
which are the different types of malaria species?
plasmodium sp -
p falciparum - most severe, causes cerebral malaria
p vivax + p ovale - can relaps3
p malariae - less severe, chronic infection
p knowlesi - zoonotic
what are the symptoms of malaria/
fever- often cyclical or irregular
rigors
headache
malaise
myalgia
nausea/vomiting/diarrhoea
jaundice
hepatosplenomegaly
neuro signs - indicator of more severe cerebral disease
what are the red flag signs of more severe malarial disease?
altered consciousness
severe anaemia
hypoglycaemia
acidosis
resp failure
shock + multi organ failure
what is the gold standard investigation for malaria?
blood films - thick and thin to detect the parasite + species
which strains of malaria can lead to relapse?
p vivax and p ovale
how do you prevent malarial relapse in certain strains?
primaquine - taken to prevent relapse
which malarial prophylacitic agent causes headache as a SE?
chloroquine
which malarial prophylactic most commonly causes GI upset?
atovaquone + proguanil - (malarone)
which antimalarial commonly causes photosensitivty and oesophagitis?
doxycycline
which antimalarial commonly causes dizziness + neurophsychiatric distubrance?
mefloquine (Lariam)
which antimalarials are contraindicated in epilepsy?
chloroquine
mefloquine (lariam)
which antimalarial can be taken by a pregnant woman safely?
chloroquine
what is the first line treatment of gonorrhea?
IM ceftriaxone
what is the second line treatment of gonorrhoea or given as alternative if IM not tolerated?
oral cefixime 400mg single dose + axithromycin 2g single dose
what causes lyme disease?
borrelia burdorferi
what are the symptoms of lyme disease?
erythema migrans - “bulls eye” rash at the site of the tick bite
typically develops 1-4 weeks after the initial bite
usually painless
then systemic features - headahe, lethargy, fever, arthalgia
what re some late features of lyme disease?
can cause CVS symptoms - heart block + peri/myocarditis
neurological symptoms - facial nerve palsy, radicular pain, meningitis
management of suspected early lyme disease?
doxycycline - if early disease
what should be given for late disseminated lyme disease?
ceftriaxone
what is the first line test for lyme disease?
ELISA antibodies - first line test
if negative and still suspected in 4-6 weeks - then repeat ELISA test
if symptoms still present in 12 weeks but initial tests negative, then can do immunoblot test
what is the treatment for BV?
5-7 day course of metronidazole if symptomatic
no treatment needed if incidental finding and asymptomatic
single 2g dose of metronidazole can be used if adherence is an issue
what causes BV?
gardnerella vaginalis infection
what antibiotics are used to treat TB?
initial phase - RIPE - 2 months
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
continuation phase - 4 months
Rifampicin
Isoniazid
what are SE of rifampicin?
hepatitis
orange secretions
flu like symptoms
what are the SE of isoniazid?
peripheral neuropathy
hepatitis
agranulocytosis
what are the SE of pyrazinamide?
hyperuricaemia - may cause gout
arthalgia
myalgia
hepatitis
what is the SE of ethambutol?
optic neuritis - check visual actuity before starting treatment
what is the first line treatment for chlamydia?
doxycycline 7 days
axithro if allergic
what causes trichomonas?
trichomonas vaginalis
what are the symptoms of trichomonas?
vaginal discharge - offensive, yellow/green and frothy
vulvovaginitis
strawberry cervix
men usually asymptomatic
what is the invetigation for trichomonas?
wet mount - shows motile trophozites
name the inducers of the p450 system?
CArbamazepine, Rifampicin, Phenytoin/Phenobarbitone, Excess alcohol intake (chronic), Topiramate, Smoking/St. John’s Wort
CARPETS
what effect do p450 inducers have on the INR?
inDUCers reDUCE the INR
what effect do p450 inhibitors have on the INR?
INhibitors INCREASE the INR
why do betablockers cause a disruption in sleep?
This occurs due to their ability to block β-adrenergic receptors in the brain, which reduces melatonin secretion. Melatonin is a hormone that regulates sleep-wake cycles, so its suppression can disrupt sleep. Additionally, beta-blockers may increase vivid dreams or nightmares.
what are alpha blockers used for?
treat hypertension + BPH
Alpha blockers are a group of drugs that block the effect of adrenaline on specific receptors (alpha receptors) found in the smooth muscle lining blood vessels and the urinary tract. The main indications for their use are hypertension, where they cause vasodilation and reduce systemic vascular resistance, and benign prostatic hyperplasia (BPH), where they relax smooth muscle in the prostate and bladder neck to improve urinary flow.
give two examples of alpha blockers?
tamsulosin
doxasozin
