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Year 3 Human Disease > Immunocompromised pt > Flashcards

Immunocompromised pt Flashcards

1
Q

what are Abs produced by

A

plasma cells

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2
Q

structure and subtypes of antibodies

A

immunoglobulins (proteins)

5: GAMDE

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3
Q

where is IgA secreted

A

exocrine glands

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4
Q

where are t lymphocytes produced

A

thymus

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5
Q

cycle of activity of t cells

A

T lymphocytes –> activated –> lymphokines –> modulate activity of macrophages, mop up invasive cells (funghi, bacteria, viruses)

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6
Q

examples of these causes of immune deficiency; which is more common

a. congenital 2
b. acquired 4

A

a. congenital 2 RARE:-cyclic neuropenia
- wiskott-aldrich syndrome
b. acquired 4: corticosteroid therapy
- malignancy (leukaemia/ myeloma)
- chemotherapy/ bone marrow/ organ transplantation
- viral eg HIV

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7
Q

7 side effects of long term steroids

A
  • predisposition to diabetes mellitus
  • cushingoid appearance (moon face)
  • inc risk of fungal infections
  • hypertension
  • osteoporosis
  • adrenal suppression
  • gastric ulceration
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8
Q

6 orodental problems associated with steroids

A
  • hypotensive crisis
  • underlying disease process
  • candidal infection
  • delayed healing
  • osteoporosis
  • avoid aspirin and NSAIDs (cause gastric ulceration)
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9
Q

what axis does steroid crisis affect

A

hypothalamic-pituitary-adrenocortical axis

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10
Q

what causes suppression of HPA axis and outcome of this

A

oral corticosteroids

–> hypoadrenal crisis –> shock, circulatory collapse

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11
Q

BDH recommendations for pts currently taking steroids or who have had steroids in the last 3 months

A
  • under 10 mgs prednisolone daily –> fine
  • > 10mgs predisolone daily –> consider inc steroid dose pre-op. for immediate tx, give 100mg hydrocortisone hemisuccinate iv prior to procedure
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12
Q

4 reasons people have chemo

A
  • have had surgery to remove malignancy
  • may have received radiotherapy too
  • malignancy of haemopoeitic tissue (eg leukemia)
  • prior to bone marrow transplant
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13
Q

3 side effects of chemo on bone marrow

A
  • dec WBC (leukopenia, neutropenia
  • dec platelets (thrombocytopenia)
  • dec RBCs (anaemia)
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14
Q

which of these causes coagulation defect

A

thrombocytopenia

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15
Q

value of

a. normal platelet count
b. normal bleeding time
c. inc bleeding time that needs transfusion
d. platelet count that risks spontaneous bleeding

A

value of

a. normal platelet count:150-400x10^9
b. normal bleeding time: 100-150
c. inc bleeding time that needs transfusion: 20-100
d. platelet count that risks spontaneous bleeding:

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16
Q

6 oral side effects of chemo

A
  • mucositis
  • oral ulceration superimposed with opportunistic infections
  • pseudomonas
  • candida inc pseudomembranous (white plaques that rub off)
  • herpes simplex (both sides)
  • herpes zoster (travels down dermatome, stops at midline)
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17
Q

what to prescribe chemo pt who is pyrexic and neutropenic

A

1st line ABs: fluconazole/ itraconazole

anti virals: acyclovir

18
Q

2 reasons prophylactic AB cover is needed in chemo pts

A
  • pt neutropenic at time of tx

- tx likely to induce bacteraemia

19
Q

detail antibiotic prophylaxis

A
  • amoxycillin 3g
  • if allergic to penicillin –> clindamycin 600mg orally 1 hr before procedure
  • in hospital –> IV 1g amoxicillin or 300mg clindamycin
20
Q

2 best times in chemo cycle to give dental tx and why

A

-just before chemo
-2-3 days after chemo
highest neutrophil count

21
Q

3 most common anti-rejection drugs for transplant pts

A

cyclosporin
azathioprin
prednisolone

22
Q

2 complication of cyclosporin and management

A
  • hypersensitive to UV light –> skin malignancies

- gingival hyperplasia –>refer to hosp for surgical removal

23
Q

est number of people living with HIV

A

34 million

24
Q

number of new HIV infections in 2010

A

2.7 million

25
Q

number of deaths due to aids in 2010

A

1.8million

26
Q

area of the world with most HIV/aids

A

subsaharan africa

27
Q

% of undiagnosed HIV

A

25-30%

28
Q

cellular change in HIV

A

dec CD4 helper cells

29
Q

classical progression of HIV

A

initial infection-3 months: seroconversion illness (flulike symptoms)
3 months-8-10yrs: asymptomatic, HIV antibody positive, gradually decreasing numbers of CD4 cells
8-10yrs +: AIDS symptoms, gradual decline, death

30
Q

CD4 cell count

a. normal count
b. initial immune suppression
c. severe immunosuppression

A

CD4 cell count

a. normal count: >600
b. initial immune suppression: 400-600
c. severe immunosuppression:

31
Q

risk group of HIV

A

any sexually active male or female

32
Q

explain HAART and 2 examples of drug types

A

Highly Active Anti Retroviral Therapy: triple therapy using different drugs which target different parts of viral replication cycle
eg -nucleoside analogues
-protease inhibitors

33
Q

what CD4 count is required for triple therapy

A
34
Q

3 oro-facial manifestations of HIV

A
  • cervical lymph node enlargement
  • salivary gland enlargement
  • skin disorders (molluscum contagiosum, dermatitis, papillomas)
35
Q

intra oral manifestations of HIV 7

A
  • candidosis
  • hairy leukoplakia
  • kaposis sarcoma
  • apthous and viral ulcers (HAVE HALOS, apthous angel)
  • periodontal disease –> ANUG
  • papillomavirus infections
  • non hodgkins lymphoma
36
Q

what virus is hairy leukoplakia associated with

A

epstein barr virus

37
Q

symptoms and tx of hairy leukoplakia

A 
hairy tongue, tiger stripes on lateral borders
systemic acyclovir (only works sometimes)
38
Q

cause of kaposis sarcoma and common site

A

HHV8

palate (can progress to black lesions on palate)

39
Q

who has kaposis sarcoma

A

HIV pts WITHOUT ACTIVE TX

40
Q

Progression of periodontal disease in HIV / AIDs pts

A

linear gingival erythema

  • -> necrotising ulcerative gingivitis
  • -> necrotising ulcerative periodontitis (ANUG)
  • -> cancrum oris (untreated HIV and malnutrition only)
41
Q

bacterial cause of ANUG/ cancrum oris

A

fusiform bacteria: fusobacterium nucleatum, treponema vincentii

42
Q

3 types of immunodeficiency

A
  • B cell / humoral (affects antibody production)
  • T cell / cell mediated
  • mixed deficiency

Year 3 Human Disease (28 decks)

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