GP and community 2 Flashcards
what are the two ways of inducing immunity ?
active immunity - induced using inactivated or attenuated live organisms or their products, acts by inducing cell-mediated immunity and serum antibodies.
Passive immunity - results from injection of immunoglobulin - immediate protection but only last a few weeks
what is herd immunity?
Describes how a population is protected from a disease after
vaccination by stopping the pathogen responsible for the infection
being transmitted between people - in this way even people who
cannot be vaccinated (immunocompromised) can be protected
By being vaccinated an individual is not only protected from being
infected themselves but then then also cannot pass this infection
onto other people where it may cause severe disease
For herd immunity to be effective in a large proportion (80-95%) of
the population needs to be vaccinated
what are some reasons for vaccination uptake and drivers?
Wakefield MMR controversy seriously impacted uptake
access to healthcare has an impact on uptake
emerging group of affluent parents who are opting out of vaccination programs for various reasons - they don’t believe in them, they think they may harm children, they believe they can protect their children
what system can you use to assess a child with a fever?
traffic light system
green = low risk
amber = intermediate risk
red=high risk
when would you put a child into the green section of the traffic light system and how would you manage?
- they have normal skin colour
- they respond normally to social cues
- they are content/smiles
- stays awake or awakens quickly
- strong normal cry/not crying
- normal skin and eyes
- moist mucus membranes
LOW RISK of serious illness - manage child at home with advice and a safety net
advice such as regular fluids and keep an eye out for signs of dehydration
when would you put a child into the amber section of the traffic light system and how would you manage?
- pallor
- not responding normally to social cues
- no smiles
- wake only with prolonged stimulation
- decreased activity
RESP signs - nasal flaring Tachypnoea (6-12 months >50 RR, >12 months RR> 40) - O2 sats less than 95% on air - crackles in the chest
Circulation and hydration
- tachycardia (<12 months - >160bpm, 12-24 months - >150 bpm, 2-5 years- >140 bpm)
- cap refil > 3 seconds
- dry mucous membranes
- poor feeding in infants
- reduced urine output
3-6 months - temp >39 fever for more than 5 days rigors swelling of a limb or joint non-weight baring limb
*intermediate risk of serious illness - seek further help
treat cause
when would you put a child into the red section of the traffic light system and how would you manage?
- pale/mottles/ashen/blue • No response to social cues • Appears ill to a healthcare professional • Does not wake or if roused does not stay awake • Weak, high-pitched or continuous cry
Resp
- grunting
- tachypnoea - RR>60
- moderate/severe chest indrawing
- reduced skin turgor
- <3 months temp greater than 38
- non-blanching rash
- budging fontanelle
- neck stiffness
- focal neurological signs/seizures/status epilepticus
**high risk of serious illness - urgent assessment within 2 hours
what are some common causes of pyrexia?
childhood infections such as chickenpox, croup, measles, tonsillitis
consider UTI if no localising symptoms/ signs
think of TB and endocarditis - especially in high risk (immunocompromised patients)
think tropical diseases e.g. malaria in those returning from holiday
other causes: malignancy such as lymphoma or leukaemia, immunological cause such as Kawasaki disease
what are the pros and cons of barrier contraception?
benefits: used only during intercourse, reduces STI transmission and rarely any side effects
CONs: can break, split or tear, may interrupt intercourse, require some degree of technique, allergies e.g. latex
how does the combined pill act as a contraceptive?
acts to inhibit ovulation
why should you not prescribe COCP?
if one risk factor present with caution, if greater than one then you should avoid
Smoking > 15/day
Controlled hypertension
mmobility e.g. wheel chair use
Family history of venous thromboembolis
elative < 45yrs
BMI > 30kg/m2 (caution), if >35 avoid
Age ≥ 35yrs (caution), if ≥ 50 yrs avoid
Avoid if prothrombotic coagulation abnor
Leiden, antiphospholipid antibodies
Avoid if valvular/congenital heart disease with history of
complications e.g. pulmonary hypertension or AF
History of CVD including stroke/TIA, migraine, IHD, peripheral
vascular disease
Avoid if current breast cancer or carrier of BRCA1 or BRCA2
Avoid in liver disease e.g. active/flare of viral hepatitis, liver tumour or
severe cirrhosis
what are the benefits of the COCP?
- Does not interrupt intercourse
- Can be stopped at short notice
- May make periods more regular, lighter and less painful
- May reduce risk of ovarian, endometrial & bowel cancer
- May have therapeutic benefit in gynaecological disorders
what are the limitations of the COCP?
- Effectiveness is reduced if pill is forgotten - COMPLIANCE IS
MAJOR ISSUE & responsible for failure - S/E’s include headaches, nausea and breast tenderness
- Increases risk of venous thromboembolism and stroke - should
advise to keep legs moving and drink lots of fluids when
travelling more than 3 hrs to reduce DVT risk - Potentially increased risk of breast cancer
- Does not protect from STIs
what advice should be given on taking the COCP?
- If started within the first 5 days of the cycle then there is no
need for additional contraception - If it is started at any other point in the cycle then alternative
contraception should be used e.g. condoms for the first 7 days - Should be taken at the same time every day
what may reduce the efficacy of the COCP ?
- Vomiting within 2 hours of taking pill
- Taking medication that induce diarrhoea or vomiting e.g.
orlistat - Taking liver enzyme-inducing drugs e.g. rifampicin (antiinfective), ritonavir (anti-viral), St John’s wort, anticonvulsants
e.g. carbamazepine or modafinil
Note: sodium valproate does not affect pill efficacy
what happens if a pill is missed when taking the COCP?
- If 1 pill is missed (at any time in the cycle):
• Take the last pill even if it means taking two pills in one
day and then continue taking pills daily, one each day
• No additional contraceptive protection needed - If ≥ 2 pills are missed (i.e. pills are > 48 hrs late at any 1 time):
• Take the most recent pill missed even if it means taking
two pills in one day, leave any earlier missed pills and
then continue taking pills daily, one each day
• The woman should use condoms or abstain from sex until
she has taken pills for 7 days in a row - If pills are missed in week 1 (Days 1-7): EMERGENCY
CONTRACEPTION should be considered if she had unprotected
sex in the pill-free interval or in week 1 - If pills are missed in week 2 (Days 8-14): After seven
consecutive days of taking the COCP there is NO NEED for
emergency contraception - If pills are missed in week 3 (Days 15-21): She should finish the
pills in her current pack and start a new pack the next day; thus
omitting the pill free interval
how does the progesterone only pill work?
prevents ovulation, fertilisation and implantation
what are the benefits of the POP?
- Suitable for those who cannot take oestrogen
- Do not need to remember to start/stop since taken without
breaks - Does not interrupt intercourse
- Can be stopped at short notice
what are the limitations of the POP?
- Protection reduced if forgotten to take
- May cause irregular bleeding, amenorrhoea or more frequent
bleeding - Vomiting and diarrhoea may affect protection
- No protection from STIs
how does progesterone injection work?
prevents ovulation
benefits and limitations of injected progesterone for contraception?
benefits - do not need to remember to take daily, does not interrupt intercourse, can be stopped at short notice, reduces risk of ectopic pregnancy and endometrial cancer
Limitations - menstrual irregularity, injection, weight gain, unpredictable return of fertility, increased risk of osteoporosis
what are the different forms of long-acting reversible contraceptives?
- implant e.g. Nexplanon (inhibits ovulation)
- hormone intrauterine system - Mirena (prevents fertilisation and implantation)
- intrauterine contraceptive device e.g. copper coil (prevents fertilisation and implantation)
what are the pros and cons of the implant?
Benefits:
- Last for 3 years - thus no compliance issues
- Reversible
- Does not interrupt intercourse
Limitations: - May cause irregular bleeding, amenorrhoea or more frequent bleeding - Can cause or worsen acne - Requires training to insert and remove - Infection risk - No STI protection
what are the pros and cons of the IUS?
Benefits: - Lasts for 3-5 years - Reduces BLEEDING, ectopic pregnancy risk (compared to IUCD), dysmenorrhoea - Provides endometrial protection
Limitations:
- May cause erratic bleeding
- Can cause acne, headaches and breast tenderness
- Risk of infection and or pain during insertion and removal
- Increases infection risk -> pelvic inflammatory disease -
related to existing carriage of STIs (screen for STIs before
insertion)