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Allergy / Immunology > Immunology > Flashcards

Immunology Flashcards

1
Q

Which microorganisms are splenectomy patients particularly at risk from?

A
  • Strep pneumoinae
  • Haemophilus influenzae type B
  • Nisseria meningitidis
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2
Q

Which vaccines should be offered to splenectomy patients?

A
  • HiB
  • Men WACY
  • Men B
  • Pneumococcal
  • Influenza

Where possible vaccines should be administered 2 weeks prior to elective splenectomy, though if not vaccinated surgery should not be delayed

In emergency splenectomy, vaccinations should be administered after 2 weeks, unless risk of failure to vaccinate, in that case can be given earlier

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3
Q

Which prophylactic Abx should be given to splenectomy patients? - for how long?

A
  • Phenoxymethylpenicillin 250mg BD
    – Or Amoxicillin 250gm OD
  • Erythromycin 500mg BD if Pen allergic

Should be given for at least the first 2 years, then continued lifelong if at continued high risk of pneumococcal infection (strep pneumoniae)

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4
Q

Which are the live vaccines?

A

MMR BOYZZ

  • MMR
  • BCG
  • Oral polio
  • Yellow fever
  • vZv (chickenpox / shingles)
  • influenZa (live attenuated intranasal vaccine)
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5
Q

What are the risks for pregnant women who are exposed to VZV (chickenpox or shingles)?

A

Women who are seropositive to VZV IgG are not at risk

The risk to seronegative women is:
- Fetal varicella syndrome before 28 weeks
- Neonatal infection if delivered within 4 weeks of infection

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6
Q

How should a pregnant woman who has had contact with chickenpox be assessed?
(exposed, not developed rash)

A
  • Determine significance of the exposure
  • Women with absent or uncertain history of VZV immunity (previous chicken pox / shingles / vaccine) should have bloods checked for VZV IgG
  • If not immune, and had significant exposure, should be offered IVIG as soon as possible- it is effective if given within 10 days of exposure
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7
Q

what is the treatment for pregnant women who develop VZV in pregnancy?
(have a rash)

A
  • If they present within 24 hours of rash onset and at 20+ gestation (consider use before 20 weeks also), then give Oral Aciclovir (800mg 5 times daily for 7 days)
  • Avoid contact with susceptible individuals (pregnant women, neoneates…) until all lesions crusted over (around 5 days after onset of rash)
  • Referral to fetal medicine to be arranged at 16-20 weeks, or 5 weeks after infection
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8
Q

What are the complications of Fetal Varicella Syndrome?

A
  • Skin scarring in dermatomal distribution
  • Eye defects (microphthalmia, chorioretinitis, cataracts)
  • Hypoplasia of the limbs
  • Neurological abnormalities (microcephaly, cortical atrophy, mental retardation, bowel and bladder sphincter dysfunction)
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9
Q

What are the possible complications of Rubella in pregnancy?

A
  • Can result in fetal loss
  • CRS congenital rubella syndrome:
    • Cateracts
    • Deafness
    • CArdiac abnormalities
    • Microcephaly
    • IUGR

CRS most likely to cause damage when infected in first 8 weeks gestation
After 20 weeks gestation, only deafness reported

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10
Q

When is antibody testing necessary to guide rubella vaccination?

A

Healthcare workers need to be immune to measles and rubella
Satisfactory evidence includes:
- evidence of having received 2 doses of MMR, or
- positive antibody test for measles and rubella

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11
Q

Interpretation of Hep B serology; what is the relevance of HBsAg?

A

(Hepatitis B surface antigen)

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12
Q

Interpretation of Hep B serology; what is the relevance of anti-HBs?

A

(Hepatitis B surface antibody)

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13
Q

Interpretation of Hep B serology; what is the relevance of Total antibody to Hepatitis B core antigen?

A
  • note, positive Total anti-HBc with other serology negative can mean:
  • Transfer of maternal antibodies to an infant
  • Resolved infection where anti-HBs levels have weaned
  • A false positive
  • A mutant HBsAg strain that is not detectable by lab assay
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14
Q

Interpretation of Hep B serology; what is the relevance of IgM antibody to Hepatitis B core antigen?

A
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15
Q

Which patients are most at risk of developing chronic Hep B infection?

A
  • Infants- 9 in 10 infected infants will go on to develop chronic infection
  • Before age six 1 in 3 infected children will develop chronic infection
  • At age 6 and above almost all infected individuals recover completely and do not develop chronic infection
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16
Q

Who should be screened for Hep B infection?

A
  • All adults above the age of 18 should be screened at least once during their lifetime
  • All infants born to mothers who are HBsAg positive at 9-12 months, or 1-2 months after a course of vaccination
  • Pregnant women should all be screened in the first trimester regardless of testing / vaccination status
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17
Q

Who should be periodically screened for Hep B?

A
  • Anybody who requests it- regardless of disclosure of risk, as they may be reluctant to disclose stigmatising risks
18
Q

What factors put people at increased risk of Hep B?

A
  • Infants born to HBsAg-positive mothers
  • People born in regions of the worls with infection prevalence >2%
  • Injection drug use
  • Prison / detention setting
  • HIV infection
  • Hep C infection
  • MSM
  • STIs or multiple sexual partners
  • Household contacts of people with known HepB infection
  • Needle sharing / sexual contact with known HBV carriers
  • Maintenance dialysis
  • Elevated AST / ALT of unknown origin
19
Q

Who should receive post-vaccination Hep B testing?

A
  • Healthcare workers / public safety workers at risk of continued exposure to blood or body fluids
  • Infants born to people who test positive for HBsAg
  • Patients on haemodialysis / HIV / immunocompromised
  • Sexual partners of people with chronic HBV infection
20
Q

How is HBV infection managed?

A

Mostly supportive, occasionally require antivirals

21
Q

Interpretation of Hep C serology- what is tested for?

A

HCV antibody will be checked first, if positive should be re-checked along with HCV RNA

If the person is immunocompromised, both HCV antibody and RNA will be checked

HCV antibody positive =
Past infection, or
Current infection, or
False positive…

HCV RNA detected =
Current infection

22
Q

What are the complications of HCV?

A
  • Acute infection
    • This rarely progresses to fulminant infection (<1%)
  • Chronic infection can lead to:
    • Liver cirrhosis (10-30% after 20 years infection)
    • HCC (1-3% cirrhosis progresses to HCC annually)
    • Liver failure
23
Q

Which are the 4 most common comorbidities seen in people with HCV infection?

A
  • Depression
  • Diabetes mellitus
  • Sjorgen syndrome
  • CKD
24
Q

How should suspected Hep C infection be managed in primary care?

A
  • If acute HCV suspected (positive antibody with clinical features or recent source of transmission), arrange same-day assessment or immediate clinical advice
  • If chronic HCV suspected (antibody and RNA positive with no clinical features), arrange urgent referral
  • Notify local health protection team
  • Consider screening for other STIs if thought to be sexually acquired
25
Q

What are the treatment options for HCV infection in secondary care?

A
  • Up to 45% people with HCV spontaneously clear the virus in 6 months, no antivirals required
    Although if needed should be started promptly (when are they needed??)
  • All people with chronic infection should be considered for antiviral therapy
26
Q

How should a person with HCV be followed up in primary care?

A

Monitor glucose levels they are at risk of hypoglycaemia
Monitor INR if taking anticoagulation, they can cause fluctuations of INR

Give lifestyle advice on reducing risk of disease progression (smoking, BMI, fatty liver, alcohol)

27
Q

When might someone be considered for Antiviral treatment for Covid?

A

Must have all 3 of:

  • Onset of Covid symptoms in the last 7 days
  • Positive PCR or lateral flow test for Covid in the last 7 days
  • A member of the highest risk group
28
Q

Who is the Covid primary immunisation programme available to?

A

Primary immunisation
= 2 doses (or 3 if severely immunosuppressed at the time of vaccination)
Everyone born from Sept 2017 onwards is eligible for a primary vaccination course.
Younger children in an at-risk group or are a household contact of an immunosuppressed individual

29
Q

Who are eligible for Covid booster vaccination?
(Autumn 2023)

A

Booster programme

Available to people in a clinical at-risk or other high-risk groups:

  • Residents in care homes for older adults
  • Everyone 65+
  • 5+ who are in clinical at-risk groups (includes pregnancy and morbid obesity)
  • Frontline health and social care workers
  • People 12 - 64 who are household contacts of people with immunosuppression
  • People aged 16 - 64 (?who are carers?)
30
Q

Which patients are in the clinical at-risk group for Covid?

A
31
Q

Which vaccinations should all healthcare staff be up to date with?

A
  • DTP
  • MMR
    • Proof of positive Ab test to rubella and measles, or
    • documentation of receiving 2 doses of MMR
  • BCG
    • If in close contact with TB
  • Hep B and relevant booster
    • If contact with bloods / sharps
    • If risk of being injured or bitten by patients
  • VZV
    • If no Hx of chickenpox, or
    • Or blood test showing no immunity
  • Annual influenza vaccine
  • (Covid- in line with guidelines)
32
Q

How to manage someone exposed to needlestick injury?

A
  • History- determine need for HIV PEP, HBV prophylaxis and follow up BBV testing

*Take bloods for BBV

  • If HIV PEP started arrange follow up with ID
  • Occ Health appt if further HBV vaccine / testing required
  • Hep B vaccine should be given ASAP after exposure- ideally within 48 hours, but at the latest within 7 days
33
Q

What are the IM adrenaline doses for anaphylaxis?

A

0 - 5 = 150 mcg (0.15ml of 1:1000)

6 - 12 = 300 mcg

13+ = 500 mcg

34
Q

Alternative investigation for Coeliac disease if TTG / IgA negative?

A

IgG EMA- Endomysial antibodies

35
Q

What is the gold standard test for diagnosing food allergies?

A

Oral food challenge- only in secondary care closely supervised

36
Q

What are the risk factors for developing an allergic drug reaction?

A
  • Previous hypersensitivity
  • SLE
  • Female gender
  • HIV

(atopy is not a known risk factor)

37
Q

Extrinsic allergic alveolitis; which are the common offending respiratory antigens?

A

Thermophilic actinomycetes - farmers, mushroom growing units, people exposed to mould spores

Avian bloom - pidgeon fancier’s lung

Alternaria - soil-borne type of fungi, found in plants / potatoes

Aspergillus clavatus - soil-borne fungus, malt-worker’s lung

Sitophilus granarius - grain handlers

38
Q

What is the pathophysiology of acute and chronic extrinsic allergic alveolitis?

A
  • Acute- Type 3 hypersensitivity reaction
  • Chronic- Type 4 cell mediated hypersensitivity reaction. Characterised by lymphocyte infiltration, giant cells, granulomata, lung fibrosis, bronchiolitis obliterans

Acute inflammation which subsides usually leaves minimal pulmonary fibrosis. Repeated exposure results in significant fibrosis- terminal complications being resp failure and cor pulmonale

39
Q

What is the management of extrinsic allergic alveolitis?

A

Allergen avoidance!!

Occupational health / health and safety

Oxygen in acute cases

Steroids occasionally
— Not an alternative to allergen avoidance

40
Q

Which autoimmune conditions most commonly have skin manifestations?

A

Coeliac disease - Dermatitis herpetiformis
- Intensely itchy, symmetrical, blistering rash

Psoriasis

Thyroid disease, RA, IDDM, Addison - Vitiligo

DM, HIV (especially MSM), immune suppression - Kaposi sarcoma
- Commonly caused by kaposi herpesvirus
- red / purplish macules / papules / nodules

Allergy / Immunology (1 decks)

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