Immunisation And Immunology

Question 1

What immunisations are given at 2,4,6 months?

Answer 1

Diphtheria, pertussis, tetanus, Hib, hep B, polio, pneumococcus, rotavirus

Question 2

What immunisations are given at 12 months?

Answer 2

MMR, meningococcal C and Hib

Question 3

What immunisations are given at 18 months?

Answer 3

MMRV (+ pneumococcus for aboriginal/ Torres Strait)

Question 4

What immunisations are given at 4?

Answer 4

DTP, polio

Question 5

What immunisations are given at 10-15?

Answer 5

HPV, ADT

Question 6

What immunisations should adults have?

Answer 6

Adult diphtheria and tetanus every 10 years
Rubella if not immune in women during childbearing years
Influenza for all people with chronic debilitating diseases, especially chronic cardiac, pulmonary, kidney and metabolic diseases, people over 65, indigenous over 50, people on immunosuppressant therapy, health care workers
Pneumococcal for same risk groups as influenza
Hep a for occupation groups at risk, non immune homosexual men, those with chronic liver disease, recipients of blood products, travellers to hep a endemic areas
Hep b for occupational exposure, high risk sex
Q Fever for at risk occupations especially abattoir workers

Question 7

True or false. An allergy to tree nuts such as almonds may occur in up to 50% of people with peanut allergy

Answer 7

True

Question 8

What are common allergens?

Answer 8

Inhalants: pollens, domestic animals, house dust mites, mould spores, cockroaches
Foods: peanuts, fish, shellfish, milk, eggs, wheat
Other: latex, drugs, insect venoms, occupational

Question 9

What are the symptoms on an IgE mediated food reaction?

Answer 9

Itchy oropharynx
Itchy, runny nose and eyes
Wheeze
Urticaria
Vomiting, diarrhoea abdominal colic
Angioedema of face and airway
Frequently occurs in infants and toddlers and resolves around 3-5 years

Question 10

What are the symptoms of a non IgE mediated food reaction?

Answer 10

Usually delayed (24-48 hours after food ingestion)
Gastrointestinal symptoms
May be malabsorption, weight loss, failure to thrive (rare)
Aggravation of atopic dermatitis
Main foods: cow’s milk, soy

Question 11

What are clinical features of SLE?

Answer 11

Prevalence about 1 in 1000
Mainly affects women in "high oestrogen" period
Fever, malaise, tiredness common
Multiple drug allergies
Problems with OCP and pregnancy
Malar rash
Discoid rash
Photo sensitivity
Arthritis
Painless oral ulcers
Serositis (pleurisy or pericarditis)
Kidney features
Neurological features
Haematological features
Immunological features
Positive ANA

Question 12

What immunisations are given at birth?

Answer 12

Vit k and hep b

Question 13

What are the two clinical syndromes of giant cell arteritis?

Answer 13

Polymyalgia rheumatica

Temporal arteritis

Question 14

What are the clinical features of polymyalgia rheumatica?

Answer 14

Pain and stiffness in the proximal muscles of shoulder and pelvic girdle, cervical spine
Symmetrical distribution
Typical age: 60-70
More common in women
Early morning stiffness
May be systemic symptoms: weight loss, malaise, anorexia

Question 15

What are the clinical features of temporal arteritis?

Answer 15

Unilateral, throbbing headache
Temporal tenderness
Loss of pulsation of temporal artery
Jaw claudication

Question 16

What are the clinical features of scleroderma?

Answer 16

Female to male 3:1
Progressive disease of multiple organs
Raynaud phenomenon
Stiffness of fingers
Puckered mouth "bird like facies"
Dysphagia and diarrhoea (malabsorption)
Respiratory symptoms
Cardiac symptoms

Question 17

What is the treatment for scleroderma?

Answer 17

Analgesics for pains
Avoid vasospasm (no betablockers, no smoking, no ergotamine)
Treat malabsorption if present
Skin emollients
D- penicillamine can help if significant systemic or cutaneous involvement

Question 18

What are the three clinical variants of scleroderma?

Answer 18

1. Limited cutaneous disease
   - morphea: plaques of erythema with violaceous periphery, feels hard, mainly on trunk
   - linear
2. Cutaneous with limited skin involvement
   - CREST: calcinosis, raynaud phenomenon, oesophageal dysmotility, sclerodactyly, telangiectasia, anticentromere antibody
3. Diffuse systemic disease