Questions from S 23 Flashcards
What is casirivimab?
Where does it bind to?
Humanised monoclonal antibody
SARS-CoV-2 spike protein
RBD - receptor binding domain
Combined with imdevimab to make Regeneron
What is imdevimab?
Where does it bind to?
Humanised monoclonal antibody
SARS-CoV-2 spike protein
RBD - receptor binding domain
Combined with casivirimab to make Regeneron
Inmazeb
What is it?
What does it bind to?
Fully human monoclonal antibodies
The three antibodies bind to non-overlapping
epitopes on the Ebola glycoprotein
Atoltivimab - glycoprotein 1 head
Maftivimab - glycoprotein 2 fusion loop
Odessivimab - outer glycan cap
Ebola Zaire infection
RSV prophylaxis
Why does Nirsevimab have longer half life?
longer half life due to change in modification in the Fc (fragment crystallizable) region
Ebola outbreak
What is most efficient use of vaccine?
Vaccinate in concentric circles e.g
close contacts
partial contacts
everyone else
What are differences between HIV 1 and 2
HIV2
- only 1 type. HIV1 has 4 groups MNOP. M has clades
- lower viral load set point
- higher CD4 nadir
- longer incubation - 90 days v 60 days for HIV1
- less transmissible
- intrinsic resistance to NNRTI/ Entry inhibitor/ fusion inhibitor
- epidemiology - only West Africa
Which countries have HIV2 infection?
Gambia
Burkina Faso
Cape Verde
Ivory Coast
Guinea
Guinea Bissau
Liberia
Mali
Angola
Mozambique
former Portuguese/ French colonies
Patient from Guinea. Had sexual exposure 4 weeks ago. Concerned for HIV
HIV 4th generation assay is negative
How would you report?
HIV 1/2 Not detected
If there has been a recent exposure, please send a follow up sample at 6/12 weeks
Patient from Guinea. Had sexual exposure 4 weeks ago. Concerned for HIV
HIV 4th generation assay is negative at 4 weeks
2 weeks later it is positive
How do you explain?
HIV2 infection
HIV1 infection should be detectable from 3 weeks due to p24.
HIV2 does not have p24
HIV2 incubation period is 90 days
Which Geenius proteins are positive in HIV1 and HIV2?
HIV1
p24
p31
gp41
gp160
HIV2
p17
gp36
gp140
cross-reactive findings such as p17 are common
gp41 reactivity is only seen in HIV1.
So if see gp41 neg, with other widespread reactivity, then it suggests HIV2 infection
What is metavir score?
Histological staging fibrosis
F0 none
F1 mild
F2 moderate
F3 moderate-severe
F4 cirrhosis
What is case fatality rate of Rift Valley Fever
1%
But 90% in neonates and >65s
What is structure of answering viva question
Clinical assessment - ask for more information about symptoms/ exposure// vaccine
Summarise specific issues - e.g suspected Measles. Managing index case, IPC, PHE
Investigations
Interpretations of results
Treatment plan
IPC
Approach and communication
Pregnant woman VZV
Neonate exposed
What is mortality of neonatal infection?
50-60% mortality
haemorrhagic chickenpox
7 year old with 3 days of fever
not eating
nausea
headache
muscle pain
What information do you want to know?
What is likely diagnosis?
Mumps likely diagnsosi
MMR status
unwell contacts
travel
facial swelling
rash
abdominal pain - pancreatitis/ oophritis/ epididymoorchitis
