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Infectious disease / Vaccination Flashcards

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1
Q

6 month vaccination

A

Infanrix hexa (DTP, Hep B, HiB, polio)

+ pneumococcal if at risk

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2
Q

What STI screening to perform in asymptomatic heterosexual persons?

(5)

A
  1. First pass urine NAAT gonococcal
  2. First pass urine NAAT Chlamydia
  3. Syphilis Serology

(4. HIV serology if exposed, requested or at high risk like travel)

(5. Hep B , if not vaccinated or unsure)

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3
Q

What STDs to test for in a Women with vaginal discharge and no vulvar symptoms?

A
  1. HIGH vaginal swab for
    a. gonorrhoea
    b. chlamydia
    c. trichomonas
  2. High Vaginal swab for bacterial MCS
  3. other regular screening: syphilis +/- HIV +/- Hep B
  4. Add mycoplasma genitalium IF cervicitis or PID
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4
Q

What are the 4 year old vaccinations as recommended by the NIS?

A

Just 1 jab of Infanrix IPV (DTP + polio)

(+ pneumovax 23 if at risk)

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5
Q

14 year old recommended vaccine?

A

Nimenrix (Meningococcal ACWY)

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6
Q

How to approach vaccine hesitant individuals and parents?

A
  1. prepare to spend time with the parent and child
  2. Explore and address concerns
  3. Do not dismiss concerns
  4. Discuss the risks of vaccines and the disease it’s supposed to prevent
  5. Have resources to support your argument
  6. Avoid overwhelming with too many stats
  7. Offer further opportunities to come back
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7
Q

How to approach parents who REFUSE to have their child vaccinated? how does this differ from those who are only hesitant.

A
  1. Keep the discussion brief, but let them know they can return (vs. taking time to explore concerns)
  2. Acknowledge concerns (don’t indulge)
  3. Do not be forceful around their firmly held beliefs (vs. discussion benefits and risks of vaccines and the disease)
  4. Do not confront with scientific facts and figures (versus having resources and easy stats ready)
  5. Provide resources (same)
  6. Offer opportunities to discuss vaccination when they are ready (opposed to pre-arranging a further consult)
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8
Q

What are the aspects of adequate cold chain storage of vaccinations?

A
  1. Need a purpose build refrigerator
  2. Monitor the min and max temperature twice a day every day that the fridge is used
  3. Take appropriate action if the temperature is not stable or within the required range
  4. Safe range is between +2 and +8 degrees Celcius.
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9
Q

What are the serious adverse reactions to some or all childhood immunisations?

A
  1. Anaphylaxis
  2. Infection- encephalitis, osteomyelitis
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10
Q

For vaccination generally, which of the following are contraindications for all, or some (listed) vaccines?

A
  1. Anaphylaxis to the same vaccine previously
  2. Current treatment with immunosuppressants for live vaccines
  3. Current febrile illness with fever > 38.5dC
  4. High dose steroids
  5. A live vaccine within the last month
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11
Q

What immunisations are recommended in older adults?

A
  1. yearly influenza vaccination
  2. Recommended 2nd booster for COVID-19 in age > 50. i.e. 4 doses
  3. Pneumococcal 23. prevenar 23
  4. Shingles Vaccination
    Zostervax (live vaccine) funded in ages 71-79.
    Shingrix if zostervax is contraindicated
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12
Q

A. What is the screening recommendation for STIs? For low risk heterosexual individuals

B. Those heteros under 20 and living in remote areas are at medium risk, what should you add to screening?

C. How often?

(non aboriginal or torre straight islanders)

A

A. Screening for chlamydia in all sexually active individuals up to 29 years old is recommended. Via a urine NAAT

B. In those < 20 or living remote/rural, or even most hetersexual couples you can add on
- gonorrhoea urine NAAT
- syphilis serology

C. No set testing interval. do so opportunistically

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13
Q

For Aboriginal and Torre Strait Islander persons, what STD screening is recommended?

How often is this adviced?

A

urine NAAAT Chlamydia
urine NAAT Gonorrhoea
Serology HIV
Serology Syphilis

If not vaccinated or immune then Serology
-Hepatitis B, and
-Hepatitis A

Annual testing

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14
Q

A. For high risk individuals such as sex workers or injecting drug users, what STD screening is recommended.

B. how often?

(Keep in mind that M2M is not included in this group)

A

A
-urine NAAT chlamydia
-urine NAAT gonorrhoea
-serology syphilis
-serology HIV

if not vaccinated or immune then
-Hep B serology
-Hep A serolgy

If injecting drugs then
-Hep C serology

B. Repeat testing yearly

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15
Q

Men who have sex with men are in the highest risk group.

Within this group itself what is considered even higher risk behaviours?

(3)

A

Unprotected anal sex
>10 partners in the last year
participate in group sex or use recreational drugs during sex

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16
Q

A. What is the recommended STD testing for M2M individuals?

B. How often

A

Urine NAAT for chlamydia
Urine NAAT for gonorrhoea
Serology Syphilis
Serology HIV
throat and rectal swab for chlamydia
throat and rectal swab for gonorrhoea

If not vaccinated or immune then
-Hepatitis B serology
-Hepatitis A serology

B. repeat 12 monthly

C. If in the higher risk of these men, then repeat 3-6 monthly.

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17
Q

What should prompt you to test for HIV?

A

any AIDs condition

TB

STIs (or part of screening)

Hep B and Hep C

Malignant Lymphoma

Head and neck cancer

Recurrent shingles or multidermatomal

Severe or recalcitrant psoriasis or seborrheic dermatitis

Unexplained thromboctopenia

Anal and cervical intraepithelial neoplasia grade 2 or above

Extensive warts or molluscum contangiousum

Oral hairy leukoplakia

Florid and difficult to treat fungal infections

Unexplained retinopathy

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18
Q

Regular STD screening in low risk hetero groups, includes:

Chlamydia urine NAAT

Gonorrhoea urine NAAT

Syphilis serology.

In the following situations what extra tests to you add?
A. Men with urethral symptoms
B. Women with Pelvic pain
C. Women with discharge but no pelvic symptoms

A

A. Urine NAAT mycoplasma genitalium

  • treat for mycoplasma with doxy
    -or if discharge treat for gonorrhea

B. Cervical SWAB for chlamydia, gonorrhoea, mycoplasma, trichomonas AND a swab for bacterial MCS

  • treat as PID

C. High vaginal swab for chlaymydia, gonorrhoea, trichomonas, and if cervicitis present then mycoplasma

-treat for PID or just chlamydia or gonorrhoea first

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19
Q

How do you treat asymptomatic chlamydia STDs?

How far back do you contact trace?

and

When do you perform a test for cure?

A

A. Doxycycline 100mg, orally, 12 hourly, 7 days

OR
Azithromycin 1gram orally, single dose

B. 6 months of contact tracing

C. Test for cure not always needed, but can be done 3 weeks after STARTING treatment in those who are
- pregnant
-with anorectal infection or
-PID

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20
Q

Treatment of Gonorrhoea ?
genital vs. pharyngeal

When do you do a test for cure?

A

A. Genital

Ceftriaxone 500mg in 2ml of 1% lidocaine given Intramuscularly stat, (can give 500mg IV).

PLUS

azithromycin 1gram orally, stat as a single dose

Pharyngeal, same, but azithromycin is 2grams stat

B. 2 weeks after starting treatment using a URINE NAAT or 1 week after using a culture

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21
Q

What is PID?

What is the most cause of it?

A

Pelvic Inflammatory disease is infection of the upper female genital tract which could be any of
fallopian tubes
ovaries
adjacent pelvic structures
uterus

Can cause endometritis, salpingitis, tuboovarian abscess, peritonitis.

Usually caused by Chlamydia
if not then Gonorrhoea or Mycoplasma

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22
Q

What is severe PID?

What treatment is needed?

A

A. If there is PID with
FEVER > 38
Severe pelvic pain
Tachycardia or other signs of sepsis
other systemic features: vomiting

B. Needs hospital treatment

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23
Q

What is empiric treatment for NON SEVERE PID?

A

Ceftriaxone 500mg in 2ml 1% Lidocaine given Intramuscularly

PLUS

Azithromycin 1gram, orally, stat with a dose one week later
(or Doxy 100mg, 12 hourly, orally, 14 days)

PLUS

Metronidazole 400mg, oral, 12 hourly for 14 days

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24
Q

Who is at risk of a hepatitis C infection?

(9)

A

Injecting drug use, past or current

Being in prison

sexual partner of someone with HCV

HIV or Hep B co infection

Child of mother with HCV

Evidence of liver disease, say increased ALT

Birth in a high prevalent region: Egypt, Pakistan, mediterranean, Eastern Europe, Africa, Asia

Blood transfusion before 1990

Tattoos or body piercings

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25
What blood tests do you order for a suspected hepatitis C infection?
HCV antibody - will indicate an infection but unsure if it is acute, or cleared Then HCV RNA - will tell you if there is acute infection And HCV genotyping - helps plan drug regimes
26
What ways can you assess cirrhosis in someone with hepatitis C
A. gold standard would be biopsy B. Transient Elastography (Fibroscan) C. APRI = AST:Platelet ratio
27
What advice do you give someone who is Hep C positive, and not yet treated, or about to start treatment?
Do not share needles Do not get pregnant until treated Inform workplace Advise healthcare workers you interact with Inform sexual partners Do not donate bloods Do not share personal grooming equipment like razor blades Do not get tattoos or piercings Continue normal safe sex practices
28
Is there monitoring needed during / after Hepatitis C treatment, and if so what?
1. No monitoring is needed during treatment 2. Need to test for HCV RNA after treatment as a "test for cure" this is done 12 weeks after treatment FINISHES. usually treatment is 8-12 weeks then 12 weeks after that so about 6 months later order the HCV RNA
29
How prevalent is hepatitis B and C in australia?
Hep B - 1% prevalence, 4% in ATSI Hep C, usually just over 100,000 live with chronic hepatitis C.
30
How does hepatitis B spread?
Vertical from mother to child (this accounts for the majority of transmission in high risk groups coming to australia. 95% of children with Hep B will go on to develop Chronic Hep B) Cracked bleeding skin to skin Injection drug use Needle use like in tattoos Unprotected any sex Blood transfusion
31
What are complications of hepatitis B?
HCC Cirrhosis Liver failure
32
What are the parts of the hepatitis B serology we are interested in?
Hepatitis B surface antigen - "HbsAg" Hepatitis B surface antibody "Anti-HBs" Hepatitis B core antibody - "Anti-HBc" Hepatitis B 'e' antibody - "Anti-HBe"
32
What are the 4 parts of the hepatitis B serology we are interested in?
Hepatitis B surface antigen - "HbsAg" Hepatitis B surface antibody "Anti-HBs" Hepatitis B core antibody - "Anti-HBc" Hepatitis B 'e' antibody - "Anti-HBe"
33
What would a chronic Hepatitis B serology look like?
1 Positive for the s antigen. (s antigen positive is always a marker of infection active or resolving if the antibodies have JUST started rolling out) 2. Negative for antibody against the s antigen i.e. anti-HBs negative. Antibodies against the S antigen will determine state of the host against the infection (resolving or immune) 3. Positive for the core antibody. Core antibody detection does not imply immunity. However you do test for it, for if it is positive i.e. Anti-HBc + but there is anti-HBs negative, then you have a chronic infection.
34
What is the goal of treatment for hepatitis B?
The goal is immune control. That is Low HBV DNA load, normal LFTs, HBeAg negative, anti-HBe positive. There is NO such thing as a 'healthy carrier.'
35
What are initial bloods/tests to order when a person is Hep B positive?
HBV DNA anti-HBe HBeAg LFTs U/S liver or fibroscan Alpha-fetoprotein also check Hep A, hep C, HIV, hep D Also screen family members, partners, household contacts
36
What is the monitoring protocol behind Hep B?
6 monthly LFTs 12 monthly HBV DNA Why? determines the disease phase and if it has changed and therefore when treatment is indicated. Treatment is indicated in immune escape or immune clearance phases.
37
On who should you perform early detection tests for HCV? This is not screening per say
Asian males >40 years old Asian Females >50 years old African decent > 20 years old ALL patients with cirrhosis Family history of HCC Aboriginal and Torre Strait islanders > 50 years old
38
What percentage of all Australian RESIDENTS have latent tuberculosis?
5% 17% of ALL overseas born residents have TB (ALL not just those with TB) vs 0.4% of ALL Australian born residents
39
The course of progression for latent TB is Initial infection --> mostly asymptomatic and then spontaneously is put under control --> latent TB --> lifetime risk of reactivation. 90% of people with Latent TB will never have a reactivation. What conditions might predispose to a reactivation of TB?
1. HIV 2. use of TNF-Alpha inhibitors 3. Use of corticosteroids 4. Diabetes 5. use of chemotherapy 6.Haemodialysis. Though most people with reactivation DON'T have a risk factor or clear trigger.
40
In regards to TB, what is a A. TBT and B. IGRA C. What do they diagnose? D. And what can't they diagnose?
Tuberculin Skin Test Interferon Gamma Release Assay They can diagnose TB However they cannot distinguish between latent and active TB. So you need to look at clinical features and potentially have a CXR.
41
How soon after arrival should TB testing be done in refugee arrivals?
within one month
42
A. What medication can GPs provide to treat LATENT TB (not active)? B. What should be co-prescribed? C. What are some side effects (4) ? D. In what patient is GP treatment feasible Vs. who should be referred on.
In patients aged under 35, with normal LFTs can be prioritised to be treated in general practice. Ioniazid is the only PBS funded medication 10mg/kg up to 6-9 months. Taken orally, daily. SE: G.I upset, acne, hepatoxicity and... Because peripheral neuropathy is common co-prescribe Vitamin B6.
43
In somebody with BCG vaccination, what is the better diagnostic test for TB, not for vaccination evidence?
IGRA- interferon gamma release asssay (vs. TST) A Tuberculin skin test will react after a vaccination, though not by as much as a full infection. hence if testing for active/latent TB infection you need to use the IGRA as this doesn't react to vaccination.
44
When should a GP suspect active pulmonary TB as a diagnosis?
Cough > 3 weeks Fever > 3 weeks Loss of 10% of body weight AND Epidemiological risk factors
45
Who should you suspect TB in? 4 main groups
1. Elderly patients (1933-1967) especially if coming from or worked overseas or returned from the veitnam war 2. Aboriginal and TSI 3. Migrants or refugees from endemic countries; sub-saharan Africa and students from India, China, other Asian countries 4. Health care workers that have worked in an endemic country
46
What are 4 main subgroups of causes for acute infectious diarrhoea?
Viral pathogens Toxin mediated either from a bacteria or from toxins from food like fish Infective proctitis. caused by STIs (gonorrhoea and chlamydia) or amoebas. Bigger risk if having receptive anal sex Bacterial
47
What are 4 main subgroups of causes for acute infectious diarrhoea?
Viral pathogens Toxin mediated either from a bacteria or from toxins from food like fish Infective proctitis. caused by STIs (gonorrhoea and chlamydia) or amoebas. Bigger risk if having receptive anal sex Bacterial
48
Who is the ZosterVax indicated for?
adults aged ≥60 years adults aged ≥50 years who are household contacts of a person who is immunocompromised Also given to all babies at 18months A second dose of the vaccine is recommended 4 months after the first, however it is not part of the immunisation schedule
49
What is the treatment for non-severe PID? (3)
ceftriaxone 500 mg in 2 mL of 1% lidocaine intramuscularly, or 500 mg intravenously, as a single dose PLUS metronidazole 400 mg orally, 12-hourly for 14 days PLUS doxycycline 100 mg orally, 12-hourly for 14 days
50
Women with pelvic pain should get what investigations? (4)
(1) Cervical swab for gonorrhea, chlamydia, trichomonas (esp for ABTSI) and mycoplasma genitalium (2)Cervical swab for bacterial MCS (3) Urine MCS (4) Consider TVUS if other diagnosis is considered such as ectopics Serology for hep b, syphilis isn't entirely needed for pelvic pain presentations alone
51
How often should MSM be screened for STIs, and what for? (3)
1. 12 monthly OR 2. 6 monthly if multiple sexual partners 3. gonorrhoea, chlamydia, HIV, syphilis (consider Hep B if not immune)
52
In addition to gonorrhea, chlamydia and syphilis, what should ATSI be screened for? (1)
HIV
53
What type of tests (specifically mediums and pathologies) should be tested in MSM individuals?
1. Urine NAAT gonorrhoea, chlamydia 2. Throat and rectal swab for chlammydia, gonorrhoea 3. Serology (blood test) for HIV and syphilis 4. Serology for Hepatitis A AND B if not vaccinated or unsure
54
How do you treat an asymptomatic chlamydial infection?
Doxycycline 100mg, oral, 12 hourly for 7 days
55
What other option do you have to treat asymptomatic chlamydial infection, that is not doxycycline?
azithromycin 1 gram, oral, as a single dose Best if person is likely to be non compliant
56
What is the dosing for treating a gonorrhea infection Genital vs throat?
1. Ceftriazone 500mg in 2ml lidocaine IM + azithromycin genital: 1gram , oral, stat oral: 2grams, oral, stat
57
When do you perform a test of cure in chlamydia and gonorrhea?
1. Chlamydia - 3 weeks after starting treatment with a urine NAAT 2. Gonorrhoea - 2 weeks after completing treatment with a NAAT PCR test of 1 week after completing treatment if using a culture
58
If there is discharge from the vagina, what type of swabbing is needed?
high vaginal swab for chlamydia, gonorrhea, trichomonoas and mycoplasma (if cervicitis)
59
What tests should be ordered before starting PrEP? (3)
HIV testing Assessment of renal function Hep A, B and C serology
60
Apart from investigations ordered prior to starting PrEP, what else needs to be checked?
Assessment and guidance about STIs: frequency, symptoms Assessment of bone health as some forms of PrEP can lower BMD. consel, advice: reduce alcohol and smoking, regular weight bearing exercise, and calcium + vitamin D. Though effects on BMD are usually reversed once the PrEP is finished Pregnancy or breastfeeding. Though PrEP can be safely used in both
61
How does on-demand PrEP work?
On-demand† PrEP involves taking two tablets of TD*/FTC 2–24 hours before a potential sexual exposure to HIV, followed by a third tablet 24 hours after the first dose and a fourth tablet 48 hours after the first dose. If sex continues beyond one day, a user of on-demand† PrEP can stay protected by continuing to take a pill every 24 hours for each day that sex occurs. A PrEP pill should be taken each day for the two days following the last day that sex occurred
62
How is appropriateness for PrEP evaluated?
high risk behaviour in the last 3 months e.g. condomless sex with any casual partner not just MSM, engaging in chemsex (sexualised drug use mainly for MSM), anal or vaginal (receptive or insertive) sex with a HIV positive person not on treatment or with a detectable viral load. or risky behaviour foreseen in the next three months. e.g. travel to an endemic area, plans to have condomless sex, reporting drug use or alcohol during or preceding sexual encounters
63
After prescribing PrEP when should follow up be arranged?
Initially at 1 month, then every 3 months
64
What should be done at the 1 month mark after starting PrEP? (4)
Assess for compliance Assess side effects re test for HIV and symptoms Pregnancy test
65
Every 3 months an STI screen for gonorrhoea, chlamydia and syphilis should be done for someone on PrEP, what else should be done? (5)
1. Assess side effects 2. Assess compliance 3. HIV testing 4. Renal function testing eGFR and ACR at the first three months, but not necessarily every 3 months. Can extend out to every 6 months. 5. Pregnancy test.
66
What vaccination is given at birth?
Hepatits B
67
What vaccinations are due at 2 months old?
Infanrix Hexa Rotarix prevenar 13
68
What is in infanrix Hexa?
DTP, Hep B, HiB, polio
69
When is Infanrix Hexa given?
2-4-6 months
70
What vaccinations are given at 12 months MNOP
MMR Nimerix "ococcals"; pneumococcal (& meningococcal ACWY above in nimerix)
71
What is Infanrix IPV and when is it given?
DTP + polio It is the only vaccine given at 4 years old (unless child is at risk in which case they also get Pneumovax 23)
72
DTP is given at 6 occasions when is that?
With infanrix hexa at 2-4-6 months (thats 3) at 18 months in priorix hexa and 4 years old in infanrix IPV and again at 12-13 just as a boostrix
73
What vaccines are due at ages 12-13 and then 14?
12-13: gardisil and boostrix girls and boys gardisil and boostrix 14: Nimerix (meningococcal ACWY) 14 year olds are nimrods.
74
what is the 3-3-1-3-3-1 cheat code to remember vaccines?
1- vaccine at birth then 3 vaccines at 2 months 3 vaccines at 4 months 1 vaccine at 6 month 3 vaccines at 12 months 3 vaccines at 18 months 1 vaccine at 4 years old
75
What are the additional requirements for vaccinations in ATSI children? what is an easy way to remember it?
Basically at each age Aboriginal and TSI get an extra vaccine From 2-4-6-12 months it is Meningococcal B (Bexsero) And at 18 months and 4 years it is Hepatitis A (Vaqta Paediatric) It does get abit more complicated with pneumococcal. ATSI get pneumococcal vaccines at every age BESIDES at birth and 18 months. So that includes : -an extra Prevenar 13- extra at 6 month mark (which the normal schedule doesn't get) -and a Prevenar 23 at 4 years old
76
What vaccinations are given at 6 months old Name vaccines and pathogens.
3-2 mothns 3-4 months 1-6months Answer Infanrix Hexa (diptheria, tetanus, pertussis and polio) (+ prevenar 13 for at risk)
77
Vaccines given at 18 months old? 8 pathogens things at 18 months PIA
3-2 3-4 1-6 3-12 3-18 Three vaccines at 18 months Priorix tetra : measles mumps rubella and Varicella. Infanrix: Diptheria, tetanus, pertsussis ActHib: Haemophilus Influenzae type b

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