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Exam 2019 > Chapter 14, 15, 16: Vaccines, Anaesthesia, Poisoning > Flashcards

Chapter 14, 15, 16: Vaccines, Anaesthesia, Poisoning Flashcards

1
Q

Antibodies of human origin are termed as what?

A

Immunoglobulins

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2
Q

What are the two types of human immunoglobulin?

A

Human

Disease- specific

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3
Q

Normal immunoglobulin is available from regional Public health labs for the control and outbreak of what 3 conditions?

For any other indications, where should the immunoglobulins be purchased from?

A

Hepatitis A
Measles
Rubella

All other indications- purchased from the manufacturer

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4
Q

What disease-specific immunoglobulin would you not be able to get from public health labs?

A

Tetanus - get this from manufacturer, hospital pharmacies

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5
Q

True or false:

Hepatitis B immunoglobulin required by transplant centres should be obtained commercially

A

True

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6
Q

How is normal immunoglobulin administered for protection of conditions?

A

Intramuscular injection

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7
Q

What is normal immunoglobulin?

A

Non-specific

Has antibodies for conditions such as measles, mumps, rubella, Hepatitis A and other viruses that would affect the general population

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8
Q

After how long of an injection of normal immunoglobulin are you protected?

A

Immediately

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9
Q

Normal immunglobulin for protection is administered via IM. For what indication would you give it IV?

A

Replacement therapy

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10
Q

Is immunoglobulin recommended for Hep A protection in travellers?

A

No

Hep A vaccine by itself is recommended for individuals visiting high risk areas

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11
Q

Public Health England recommends normal immunoglobulin in addition to Hep A vaccine in which individuals?

A
  • If in close contact with Hep A positive people
  • > 60 years
  • Chronic liver disease/Hep B or C positive
  • HIV infection
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12
Q

In non-immune patients who have had exposure to measles can be given the MMR vaccine, although this is not suitable for prophylaxis as the effect is too slow.

In what patient groups would this be inappropriate for, and what should be given instead?

A

IM normal immunoglobulin for the following patient groups:

Non-immune pregnant women (if clinically appropriate- it will not prevent infection but may prevent clinical attack)
Infants under 9 months

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13
Q

True or false:

After a pregnant woman is exposed to rubella, it is recommended they have IM immunoglobulin to prevent infection

A

No

It is not recommended and it does not prevent infection in non-immune patients. However, it may reduce the risk of a clinical attack so may reduce the risk to the foetus

It should only be used if termination of pregnancy is not possible, and should be given as soon after the exposure

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14
Q

Risk of rubella transmission in pregnant women to the foetus is greatest in the first how many weeks of gestation?

A

Great risk in the first 11 weeks

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15
Q

Females of childbearing age should avoid getting pregnant until how long after getting the MMR vaccine?

A

At least 4 weeks

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16
Q

True or false:

Pregnant women should have the MMR vaccine

A

False

Live vaccines should not be administered routinely to pregnant women because of the theoretical risk of fetal infection but where there is a significant risk of exposure to disease

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17
Q

If a patient requires rabies prophylaxis after a bite, where should the rabies immunglobulin be administered?

A

Bite should be washed with soapy water

All of the dose should be injected around the site of the wound; if this is difficult or the wound has completely healed it can be given in the thigh (remote from the site used for vaccination).

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18
Q

If a patient is bitten in a high risk rabies area, what should happen?

A

Bite should be washed with soapy water

Specific rabies immunoglobulin should be injected into site of wound when possible (if not, thigh)

Rabies vaccine should also be given IM at a different site

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19
Q

How do you manage tetanus prone wounds?

A

Tetanus immunoglobulin should be used
Wound cleansing
Antibacterial prophylaxis if appropriate (Ben Pen, co-amox, or metronidazole)
Tetanus vaccine

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20
Q

How do you treat established cases of tetanus?

A

Tetanus immunoglobulin
Metronidazole
Wound cleansing

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21
Q

Varicella-zoster immunoglobulin is recommended in what patient groups?

A

Increased risk of severe infection in those who have few/no antibodies to the virus:
Neonates, pregnant women, immunosuppressed

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22
Q

In immunocompromised patients on long term antiviral prophylaxis, if they are exposed to the virus, what is the recommendation regarding their antiviral prophylaxis?

A

Increase the dose temporarily

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23
Q

Immunosuppressed patients receiving regular intravenous immunoglobulin replacement therapy only require varicella-zoster immunoglobulin if the most recent dose was administered more than how many weeks before exposure?

A

3 weeks

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24
Q

What is the anti-D (Rho) immunoglobulin used for?

A

In rhesus-negative pregnant women to prevent sensitisation if e.g. gives birth to a rhesus-positive baby

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25
Q

Is the MMR vaccine live or inactivated?

A

Live

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26
Q

Is the BCG vaccine live or inactivated?

A

Live

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27
Q

Is the influenza vaccine live or inactivated?

A

Inactivated

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28
Q

Are live or inactivated vaccines more likely to require booster injections?

A

Inactivated

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29
Q

Vaccination in HIV depends on their immunity status, however there are 3 vaccines that should always be avoided. What are these?

A

BCG
Typhoid
Yellow fever

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30
Q

What vaccines are recommended in asplenic patients?

A

Influenza
Pneumococcal
Meniningococcal

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31
Q

What vaccines are recommended in asplenic patients?

A

Influenza
Pneumococcal
Haemophilus influenza type B with meningococcal type C
Meniningococcal

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32
Q

From what age is the influenza vaccine recommended in adults?

A

65 years

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33
Q

From what age is the pneumococcal vaccine recommended in adults?

A

65 years

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34
Q

From what age is the varicella-zoster vaccine recommended in adults?

A

70 years

At 80 years, they are no longer eligible

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35
Q

How is the cholera vaccine given?

A

Orally

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36
Q

How long does the diphtheria vaccine last?

A

10 years

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37
Q

A Hep A booster dose is given how long after the initial dose?

A

6-12 months after

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38
Q

Primary immunisation of Hep B requires how many doses?

A

3

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39
Q

HPV vaccination is how many doses if the first dose is given before 15 years of age?

What time frame?

A

2

Second dose to be given 6-24 months after the initial one

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40
Q

HPV vaccination is how many doses if the first dose is given after 15 years of age?

Within what time frame?

A

3

All in the space of a 12 month period

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41
Q

What are the ideal months for influenza vaccination?

A

Between September and early November

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42
Q

True or false:

People with diabetes are recommended to get the flu vaccine

A

True

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43
Q

True or false:

Morbidly obese patients are recommended to get the flu vaccine

A

True

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44
Q

What is the MMR vaccination regimen in children?

A

2 doses

1st dose at 1 year of age

2nd dose at 3 years 4 months (before starting school)

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45
Q

Menningococcal vaccination is not recommended after what age?

A

25 years

46
Q

Pertussis vaccine is prophylaxis against what condition?

A

Whooping cough

47
Q

What book can you refer to if you need advice of immunisation against infectious diseases?

A

Green Book

48
Q

Is the rabies vaccine indicated in pregnancy?

A

Yes if there is substantial risk of exposure to rabies and rapid access to post-exposure prophylaxis is likely to be limited.

49
Q

The rotavirus vaccine is given via what formulation?

A

Oral suspension

50
Q

For tetanus prone wounds, what antibacterial prophylaxis options are there/

A

Ben Pen, co-amox or metronidazole

51
Q

Typhoid vaccine comes in what 2 formulations?

A

Oral capsule

IM injection

52
Q

How long does the typhoid vaccine last for?

However, how often should you have a booster if typhoid risk continues?

A

Lasts for 10 years

Booster every 3 years if risk continues

53
Q

How long does the yellow fever vaccine last?

A

10 years is the accepted time period

However probably lasts for life

54
Q

In areas where sanitation is poor, good food hygiene is important to prevent what 4 conditions?

A

Hepatitis A
Typhoid
Cholera
Other diarrhoea diseases

55
Q

What website can healthcare professionals and travellers go on to find the latest information on immunisation whilst travelling?

A

Nathnac

56
Q

What is the MHRA warning regarding vaccines?

A

Reports of death in neonates receiving live vaccines following exposure to TNF-a

57
Q

IM vaccines should not be given to what group of patients?

What is the alternative route of administration that should be done in these patients?

A

Those with bleeding disorders e.g. thrombocytopenia, haemophilia

Deep subcut is an alternative

58
Q

What is the advice regarding a patient needing MMR and yellow fever vaccine?

A

MMR vaccine should not be administered on the same day as yellow fever vaccine; there should be a 4-week minimum interval between the vaccines

59
Q

What is the advice regarding a patient needing MMR and varicella-zoster vaccine?

A

MMR and varicella-zoster vaccine can be given on the same day or separated by a 4-week minimum interval.

60
Q

What is the green book advice regarding immunisation in children born to mothers receiving immunosuppressant biological therapy?

A

Live vaccines should be delayed until 6 months of age

So not eligible to receive rotavirus then

61
Q

What is the advice regarding pregnant women receiving live vaccines?

A

Should not happen due to risk of foetal infection

Should not travel to high risk areas but if this is not possible, the vaccine must be given as the benefit outweighs the risk

62
Q

What is the risk of patients with adrenal atrophy (resulting from long-term corticosteroids) undergoing surgery?
How is this avoided?

A

Fall in blood pressure unless corticosteroid cover is provided during anaesthesia and in the immediate post-op period

63
Q

What do you need to consider in patients undergoing surgery who are on MAOIs?

A

Interactions with drugs used in surgery e.g. pethidine

64
Q

TCAs don’t need to be stopped for surgery, but what is the risk associated with these during the surgical period?

A

Risk of arrhythmias and hypotension

NB - there may be dangerous interactions with vasodilator drugs

65
Q

When should lithium be stopped before major surgery?

A

24 hours before

66
Q

For minor surgery, how are patients on lithium managed?

A

Continue lithium at normal dose but monitor fluid and electrolytes

67
Q

Why would potassium sparing diuretics need to be stopped before surgery?

A

Hyperkalaemia may develop if renal perfusion is impaired or if there is tissue damage

68
Q

How are patients on potassium sparing diuretics managed for surgery?

A

Stop it the morning of surgery

69
Q

How are patients on ACEi and ARBs managed for surgery?

Why?

A

Discontinue 24 hours before surgery

Severe hypotension can occur after induction of anaesthesia

70
Q

Aspiration of gastric contents can be a complication of anaesthesia, especially in cases like emergency surgery. This can also be the case in patients with GORD / delayed gastric emptying.

What is done to prevent this?

A

Prophylaxis against acid aspiration - H2 antagonist orally 1-2 hours before surgery

71
Q

What do you need to ensure in patients receiving neuromuscular blocking drugs (relaxes diaphragm, abdomen, vocal cords) during surgery?

A

Should always have their respiration assisted/controlled until the drug has been inactivated or antagonised

72
Q

What is used to reverse the effects of non-depolarising neuromuscular blocking drugs?

A

Anticholinesterases - neostigmine

73
Q

When adrenaline is being administered with a local anaesthetic, should a low or high concentration of adrenaline be used?

A

Low concentration (no more than 1 in 200,000) - total dose should not exceed 500 micrograms

74
Q

Do local anaesthetics cause dilation or constriction of blood vessels?

A

Dilation

75
Q

Why is adrenaline added to local anasethetic?

What is the risk?

A

Diminishes local blood flow, slowing the rate of absorption and thereby prolonging the anaesthetic effect.

The risk is ischaemic necrosis so should not be given in digits (toes and fingers) or appendages

76
Q

Local anaesthetic with adrenaline can help prolong the anaesthetic by decreasing blood flow around the area. In what patient groups would you not want to give this with adrenaline?

A

In patients with severe hypertension or unstable cardiac rhythm

77
Q

What is used in lidocaine toxicity?

A

Intralipid

78
Q

What is used for benzodiazepine toxicity?

A

Flumazenil

79
Q

What is used for digoxin toxicity?

A

Digoxin-specific antibody

80
Q

What is used for heparin toxicity?

A

Protamine sulphate

81
Q

What is used for opioid toxicity?

A

Naloxone

82
Q

What is used for paracetamol toxicity?

A

Acetylcysteine

83
Q

What is the MHRA advice surrounding the use of acetylcysteine?

A

Reminder for possible need to continue treatment even after the recommended 3 dose regimen over 21 hours

This is on an individual patient case-by-case basis

84
Q

What two places can you find information on poisoning?

A

Toxbase

UK National Poisons Information Service

85
Q

Within how much time of poisoning should activated charcoal ideally be taken?

A

Within 1 hour

86
Q

Activated charcoal should not be used in the poisoning of what substances?

A

Petroleum distillates, corrosive substances, alcohols, malathion, cyanides and metal salts including iron and lithium salts

87
Q

What is the treatment of choice for severe aspirin poisoning?

A

Haemodialysis

88
Q

In opioid poisoning, are the patient’s pupils pinpoint or dilated?

A

Pinpoint

89
Q

What is the disadvantage of naloxone administration in opioid poisoning?

A

Has a shorter duration of action of many opioids so may require repeated doses

Can however be given via continuous infusion

90
Q

When would you consider the use of activated charcoal in paracetamol overdose?

A

If paracetamol in excess of 150 mg/kg is thought to have been ingested within the previous hour.

91
Q

In what situations would you give acetylcysteine in paracetamol overdose?

A
  • If on the treatment line on the paracetamol overdose graph
  • Who present 8–24 hours after taking an acute overdose of more than 150 mg/kg of paracetamol
  • Staggered overdose if ingested more than 150mg/kg, if patient’s risk of toxicity is uncertain
  • Patients with features of hepatic injury, jaundice
92
Q

When is a paracetamol overdose classed as staggered?

A

If they have taken a toxic dose over more than 1 hour

93
Q

The paracetamol treatment graph is unrelieable in what kind of overdose?

A

Staggered

94
Q

What is the dosing regimen for acetylcysteine in paracetamol overdose?

A

1st infusion for 1 hour 150mg/kg

2nd infusion for 4 hours 50mg/kg

3rd infusion for 16 hours 100mg/kg

95
Q

Does TCA overdose result in dilated or pinpoint pupils?

A

Dilated

96
Q

What is used to treat bradycardia in acute overdose of beta blockers?

A

Atropine

97
Q

Therapeutic lithium concentrations are usually within what range?

A

0.4–1 mmol/litre

98
Q

What lithium level is associated with serious toxicity?

A

> 2

May need treatment with haemodialysis

99
Q

Oxygen should be administered to patients with what types of poisoning?

A

Cyanide

Carbon monoxide

100
Q

What is used for ethylene glycol and methanol poisoning?

A

Fomepizole

Ethanol

101
Q

All these side effects are linked to suxamethonium except:

  • Malignant hyperthermia
  • Hyperkalaemia
  • Myopathies
  • Hypertension
A

Hypertension

It is used as part of general anaesthesia and causes hypotension

102
Q

Sodium thiosulphate is used for what type of poisoning?

A

Cyanide

103
Q

For a child born in the UK, what 4 vaccines should they have at 8 weeks?

A

1st 6 in 1 vaccine
1st Rotavirus
1st Pneumococcal
1st Men B

104
Q

For a child born in the UK, what 2 vaccines should they have at 12 weeks?

A

2nd 6 in 1 vaccine

2nd Rotavirus

105
Q

For a child born in the UK, what 3 vaccines should they have at 16 weeks?

A

3rd 6 in 1 vaccine
2nd Men B
2nd pneumococcal

106
Q

For a child born in the UK, what 2 vaccines and 2 boosters should they have at 12 months?

A

Hib and Men C
1st MMR

Booster pneumococcal and booster Men B

107
Q

Under the NHS child vaccination programme, what age should healthy children get the flu vaccine and how is this given?

A

Flu vaccine given via nasal spray

From the age of 2 to 9 (pre-school to Year 5)

108
Q

For a child born in the UK, what 1 vaccines and 1 booster should they have 13-18 years?

A

3 in 1 booster (diphtheria, tetanus, polio)

Men ACWY

109
Q

What does the 6 in 1 vaccine protect against?

A

Diphtheria, tetanus, pertussis (whooping cough), polio, haemophilus influenzae type b (Hib) and hepatitis B

110
Q

True or false: Some flu vaccines contain egg so you need to be careful if the patient has an egg allergy

A

True

111
Q

Can you continue glaucoma medication during surgery?

A

Yes

Exam 2019 (21 decks)

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