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Immunodeficiency Flashcards

1
Q

what are the two categories of immunodeficiency?

A

Acquired and congential

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2
Q

which out of acquired and congenital causes of immunodef is more rare?

A

congenital

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3
Q

what is an example of congenital causes of immunodef?

A

wiskott-aldrich syndrome

cyclic neutrpaenia

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4
Q

what is wiskott aldrich syndrome?

A

x linked recessive disease asscioated with exczema, bloody diorrhoea, thrombocytopaenia and immunnodef

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5
Q

what is cyclic neutropaenia?

A

absolute reduction in circulating neutrophils
cyclic depression in neutrophils from the blood and bone marrow
AD

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6
Q

what are the signs and symptoms of cyclic neutropaenia?

A

fever, malaise, lymphadeonpathy, infections and oral ulcers on non keratinzed tissue, prone to sevre perio

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7
Q

what are acquired conditions associated with Immunosuppression?

A 
steroid therapy
malignancy
chemotherapy
organ transplant
Viral: HIV
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8
Q

which cells are affected in immunodef?

A

t cells
b cells
plasma cells
mixed

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9
Q

what is the normal range for neutrophils?

A

2.0-7.5 x 10^9

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10
Q

what do activated lymphocytres produce and what is this product used for?

A

lymphokines

used to activate macrophages

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11
Q

which organisms are macrophages mostly involved fighting against?

A

mycobacteria
fungi
viruses

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12
Q

which types of diseases would be treated with immunosupressive therapy?

A

lymphopoliferative neoplasms
transplant recipients
connective tissue diseases
autoimmine diseases

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13
Q

which immunosupressive agents are there and what are their side effects?

A 
Corticosteriods: multiple system issues
Cicllosporin: nephro/hep/tox and gingival hper
Tacroliumus: cardiomyopathy
Myocphenalate: marrow supression
Azothioprine: marrow supression
Cylcophsohamide: marrow supression
Colchicine: amrrow supression
Dapsone: hameolysis
Thalidomide: ATNF teratogenic and neurotoxic
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14
Q

what are the side effects of steroids?

A 
predisposition to diabetes
wieght gain
increased susceptibilty to oppurtunitics infections and cataracts
hypertension
osteoporosis
adrenal supression
gastric ulceration
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15
Q

what are the dental implications of steroid usage?

A 
hypotensive crisis
underlying disease process
oppurtunistic infections
delayed healing
osteroporosis
avoid NSAID and aspirin
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16
Q

how can a steroid crisis arise?

A

HPA axis becomes supressed by long term steriod usage, during periods of stress body fails to cope and goes into shock

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17
Q

What effect do chemotherapeutics have on the bone marrow?

A

they cause bone marow supression, leukopaenia,

anaemia, thrombocytopaenia, neutropaneia

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18
Q

what should all patients prior to having chemo have?

A

dental screen, get rid of any hopeless teeth

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19
Q

in the immunocompromised pt if neutrophil count is less than ? what should you do?

A

if likely to induce a bacteriamia and if less than 1.5 x 10^9 need to give antibiotics

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20
Q

when is the best time to treat pateints undergoing chemoitherapy?

A 
just before chemo
just after (2-3) days

ALWAYS CHECK PLATELET AND NEUTROPHIL COUNT

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21
Q

what type of bone marrow transplants exist?

A

stem cell transplant

Bone marrow transplant

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22
Q

when are stem cell transplants used?

A

high dose chemo

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23
Q

when are bone marrow transplants used?

A

treatment of some malignancies and genetic disorder eg sickle cell anaemia

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24
Q

what are people following bone marrow transplants susceptible to getting?

A

GvHD

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25
what is GvHD?
people that have undergone an allogenic BMT HLA matched donor used to replace BM in recipient if HLA not exact then recipeint develops GvHD
26
what types of GvHD are there?
acute and chronic acute occurs within 100 days of allogenic BMT (50%) of epople will develop this CHronic is after 100days
27
what are the symptoms of acute GvHD?
GI problems, skin rash, livr problems
28
what are the symptoms of chronic GvHD?
white reticulated lesions, candida, burning mouth and xerostomia
29
how do you manage GvHD?
good HLA matching immunosupressives PUVA (Psoralen and UV therapy)on cutanous lesions
30
when should treatment be performed in patients that have had BMT?
avoid treatment within the first three months following transplant after three months, use ab if likely to induce bacteramia
31
what is a viral cause of immunodef?
HIV
32
what is HIV?
a progressive disease impairing the function of the CD4 helper cells
33
which receptor does HIV bind onto on the CD4 cells?
gp120
34
what are the lase symptoms of HIV?
``` weight loss lethargy malaise night sweats diarrhoea poor apaetite ```
35
what three incfections can occur once the CD4 count drops below 200?
CMV toxoplasmosis Pneumocysitis pneumonia
36
what is different about pneumocystis pneumonia compared to other types of pneumonia?
caused by fungua | usually pneumocysistis jiroveci
37
what other fungal infection is seen i people with HIV?
oesophageal candida
38
what are the symptoms of oesophageal candida
sore throat dysphagia restrosternal pain
39
what are the signs and symptoms of pneumocysitisis pneuomnia
fatigue cough dysponea
40
what is the normal CD4 count in health?
>600mm^3
41
what is AIDS?
when CD4 count is less than 200mm^3
42
WHat are the 5 groups of drugs used to manage HIV?
Non nuceloside reverse transcirpatse inhibitors work protease inhibitors Nucleoside reverse transcripatse inhibitors Fusion inhibitors integrase inhibitors
43
how do NRTI work?
prevent HIV from copying its geentic materal
44
how do protease inhibitors work?
they prevent HIV from assembling its orotective coat before they leave CD4 cell
45
how do NNRTI?
similar to NRTI but fewer side effects
46
when are fusion inhibitors used?
used for those whose disease is no lonfger managed by other drugs
47
how do integrase inhibitors work?
they prevent HIV inserting viral DNA into host DNA since integrase is one of the three enzymes it needs to replicate
48
which antifungals can you consider in patients with HIV for prophylaxis against infection?
not really advised to but can give fluconazole and itraconazole
49
which antivirals can you consider in patients with HIV for prophylaxis against infection?
FAG foscarnet aciclovir ganciclovir
50
which antibacterials can you consider in patients with HIV for prophylaxis against infection?
septrin and pentamidine
51
which anti TB can you consider in patients with HIV for prophylaxis against infection?
RIES rifampicin isonizid ethamputal streptomycin
52
which infections are people with HIV predisposed to?
viral fungal mycobacterial
53
which neoplasms are people with HIV predisposed to?
kaposis sarcoma | lymphoma
54
which autoimmune diseases are people wtih HIV predisposed to?
idiopathic thrombocytopenic purpura
55
what are the common extra oral manifestations of HIV?
``` cervical lymph node enlargement salivary gland enlargement skin disorders (molluscum contagiosum, dermatitis, papillomas, zoster) ```
56
what are the common I/O manifestations of HIV?
``` candida hairy leukoplakia kaposi sarcoma ulceration ANUG papillomas Non hodgkin ```
57
how do you treat candida in patients with HIV?
if CD4 count less than 250 use systemic
58
how do you treat kaposis sarcoma?
local radiotherapy intralesional chemi systemic chemo combination therapy
59
which periodontal diseases are associated with HIV?
linear gingival erythema NUG NUP
60
What is the two causative agents in hairy leukoplakia in HIV?
HIV and EBV
61
What can you give to the patient to try and resolve the hairy leukoplakia?
Systemic aciclovir
62
How does hairy leukoplakia resolve in HIV?
Following HAART
63
What are the names of the protease inhibitors?
Saquinivir Ritonivir Indinvir Nelfanivir
64
What are the NRTIs?
``` AZ is a DLS AZT Zalciatbine Didanosine Lamuvidine Stavudine ```
65
Name the NNRTI
Efavirenz | Nevirapine
66
Name the fusion inhibitors
Enfuviritide | Maraviroc
67
What is the name of the intefrase inhibitor?
Raltefravir
68
Which agent is implicated in HIV gingivitis and perio?
CMV
69
What are the oral complications of human stem cell transplant?
``` Mucosots Infection Ulceration (neutropenia) Bleeding Hypos Hypo salivation Malignancy ```

Oral Med (31 decks)

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