Week 10 Flashcards
which disease has vaccines eradicated?
small pox
on the verge of polio
what diseases have reduced in mortality and morbidity due to vaccines?
diphtheria, pertussis, tetanus, measles
what are the different types of vaccines?
live
killed/ inactivated
acellular/ toxoid
incubation period of measles?
~10 days onset fever
~14 days onset rash
when is the measles vaccines give?
12 months
18 months
case definition of measles?
cough, coryza, conjuntivitis, maculopapular rash
contraindications to vaccines?
absolute: anaphylactic response to vaccine
relative: immunocompromised, pregnant, fever >38.5, recent <4w live vaccine, recent <7m blood products, GBS influenza
what are the 5 categories of reporting adverse events to a vaccine?
vaccine product related reaction vaccine quality related reaction immunization error related reaction immunization anxiety related coincidental event
what immunizations are given at brith?
hep B
TB (ABTSI)
what immunizations are given at 2 and 4 months?
DTPa-HepB-IPV-Hib
pneumococcal
rotavirus
what immunizations are given at 6 months?
DTPa-HepB-IPV-Hib
pnemococcal (ABTSI, infants with medical risk, premie (<28w))
what are some autoimmune diseases and their immunopathogenic mechanisms?
Ab against cell surface or matrix Ag (hemolytic anaemia, AFR)
immune complex disease (RA, SLE)
T cell mediated disease (CD, MS, RA, T1DM)
exposure of hidden mechanism in autoimmune disease?
some Ag are hidden from the immune system (immune privileged site) upon injury the may become visible so T/B cell response will be directed against self Ag because the lymphocytes are not tolerized to this Ag
when large amounts of Ag:Ab complexes are formed, new epitope on Fc region may be exposed
new Ab formed form aggregates that can be deposited into tissues and cause inflammation
what is an example of molecular mimicry in RA?
Ab to cell wall M protein of group A strep may reaction with cardiac myosin
what are some cancers that are curative with radiotherapy?
head and neck
lung
cervical
prostate
what are some cancers that require adjuvant therapy with radiotherapy?
head and neck
breast cancer
brain
which are some cancers that are usually curable?
lymphoma, leukemia, germ cell, sarcomas
what are the teams involved in cancer management?
medical oncologist radiation oncologist t palliative care oncological surgeon allied health (dietician, physio, social work)
benefits of telehealth?
improve patient access to health care
reduce travel and inconvenience to patients, careers, abilities and health professionals
provide health professional with access to peer support and education
prognostic factors for early cancer?
size of primary histological differentiation node involvement receptor status age molecular markers
what are the steps in staging?
history examination tumour markers FBC, LFTs, bone marrow histology Xray, CT scan, bone scan, MRI, pet scan
what is the most common spot in the breast for a tumour?
upper outer quadrant
what cancers is EtOH a risk for?
breast cancer pancreatic liver coloractal esophagus head and neck
retinoblastoma histology?
- small round blue tumour (very basophilic)
- more viable cells closer to the BV core
- pink fizzy cells = necrotic because they rapidly outgrow blood supply
sentinel node biopsy?
Sentinel node biopsy is a surgical procedure used to determine whether cancer has spread beyond a primary tumor into your lymphatic system. It’s used most commonly in evaluating breast cancer and melanoma. The sentinel nodes are the first few lymph nodes into which a tumor drains.
most common location of tumour in breast?
upper outer quadrant
clinical presentation of breast cancer?
nipple discharge, skin tethering and palpable mass
screen detected cancer
dx and staging to breast cancer?
mammogram, UC and core biopsy
also need to differentiate between DCI and invasive carcinoma
ultrasound of axillary lymph nodes
where does breast cancer metastases go?
first lymphatics to draining lymph nodes
hematogenous spread = liver, lung and bone
what are the common primary tumours that metastasize to the lungs?
breast, kidney, uterus, testes, melanoma, colorectal, thyroid
peak incidence of lung cancer?
60-70 years old
molecular basis for lung cancer?
activation of oncogenes - EGFR, MYC, k-RAS
inactivation of TSG TP53
what type of genes are affected in NSCLC and SCLC?
NSCLC= oncogene mutations (kras, EGFR) SCLC= TSG mutations (Rb and P53)
clinical presentation of lung cancer?
respiratory symptoms
- dry cough, dyspnoea, recurrent pneumonia, wheezing, haemoptysis
normal physical exam
management of SCLC?
limited disease treated with chemo (podophyllotoxins and platinum compounds) and radiation to the primary site
management of NSCLC?
limited = curable with surgery
limited and lymphatic spread = operable tumour treated with chemo and then surgery
wide spread disease = chemo (vinca alkaloids, taxanes, antimetabolites, platinum compounds)
where does adenocarcinoma arise from?
NSCLC
mucus cells in bronchial epithelium
where can adenocarcinoma spread too?
mediastinal LN/ pleura and spreads to bone and brain
squamous cell carcinoma?
more aggressive
usually causes bronchial obstruction leading to infection
prevalence of the lung cancers?
adenocarcinoma = 40%
squamous cell carcinoma = 25%
large cell carcinoma = 10%
small cell carcinoma = 20%
morphology of colorectal cancer?
1/3 arise from rectum for rectosigmoid
1/4 arise from sigmoid
where does colorectal cancer metastasize?
liver via portal vein then heart then lungs
what is melanocytic nevi and what are the mutations?
mole
activation mutations in BRAF and NRAS
malignant epidermal tumours? mutations?
basal cell carcinoma (PTCH1 LOF)
squamous cell carcinoma (LOF TP53, GOF RAS)
both strongly locally infiltrating
good prognosis
clinical presentation of BCC and SCC?
BCC is pink, nodular raised lesion with ‘pearly edges’ or flat pink
SCC is white/ pink, scaly/ crusted lesion
role of lactate dehydrogenase in metastatic melanoma?
LDH leaks out of metastatic melanoma and can be used as a biomarker in melanoma for metastatic or recurrent melanoma
what drugs have improved response/ rate of survival in melanoma?
TK inhibitors
checkpoint inhibitors
complications in pregnancy with a mother that has rubella?
worst case: spontaneous loss of pregnancy, fetal death in utero, major organ system malformation
most common defects: eye problems and deafness
what are the live vaccines?
measles
varicella
OPV (now use IPV)
rubella
what diseases does maternal Ab protect infant from?
measles
rubella
what disease does herd immunity protect against? which diseases does it not protect from?
diseases that propagate through the population (measles, polio, influenza)
does not protect against salmonella or tetanus because these are acquired from a common source
incubation period of measles?
10 days onset fever
14 days onset rash
measles period of communicability?
prodrome to 4 days after onset rash
case definition of measles?
cough, coryza, maculopapulary rash
measles vaccine?
live
dosing between 4 week intervals
can interact with other live vaccines so either give them tougher or 1 month apart
MMR and MMRV at 12m and 18m
transmission of rubella?
airborne droplet spread, contact with mucus membranes
infants with CRS shed virus in pharyngeal secretions and urine
incubation period for rubella?
14-21 days
rubella symptoms?
low grade fever malaise coryza, conjunctivitis lymphadenopathy arthralgia leukopenia and thrombocytopenia
complications of rubella
post viral encephalitis and congenital rubella syndrome
rubella vaccine
live, attenuated
interferes with over live vaccines
dosing interval 4 weeks
transmission of pertussis?
airborne droplet spread
highly infectious
period of communicability for pertussis?
21 days after onset cough
incubation period for pertussis?
7-20 days
susceptibility of pertussis?
infants who have not received2 dose vaccines because not old enough
adults with waning immunity
maternal Ab does not provide reliable protection
cause definition of pertussis?
cough greater than 14 days with at least one post-jussive symptom: vomit, apnoea or whoop
complications of pertussis?
seizures
pneumonia
hypoxic encephalopathy
pertussis vaccine?
acellular
available in combo with polio, hit and hep b
given at 2,4,6 months and booster at 4 months (DTPa)
5th dose at 12-17 years (dTpa)
absolute contraindications to vaccine?
anaphylactic response
relative contraindications to vaccines?
immunosuppressed or pregnant (live) fever more than 38.5 recent live vaccine (<4m) recent blood products (<7m) influenza
when is hepB vaccine given?
birth, 2,4,6 months for healthy kids
12 months as well for premature babies
when is pneumococcal (PCV) vaccine given?
2,4,12 months for healthy kids
+ 6 months for ABTSI, medically at risk, premature
when is rotavirus vaccine given?
1st dose <15 weeks
2nd dose <25 weeks
2 and 4 months
can’t be given after this
when is hepA vaccine given?
to ABTSI at 12 and 18 m
how many vaccines are given to children?
16 vaccines all children
20 for ABTSI
18 for infants with medical risk factor and premature babies
how does the interaction of live vaccines affect administration?
2 or more live vaccines must be given on the same day or 4 weeks apart
inactivated and live vaccine may be given on the same day
what vaccines are funded for ABTSI?
influenza
Japanese encephalitis
school based vaccines?
HPV 2 doses separated by 6-12 months
dTpa 5th dose 12-17 years
zoster vax?
boost immunity to prevent shingles in people over 70
live vaccine
not the same as MMRV
Pathogenic mechanisms leading to autoimmune disease?
exposure to hidden epitops
exposure to infectious agent
molecular mimicry
mechanism of an eye infection?
trauma in 1 eye results in sequestered release of intraocurlar protein Ag
these Ag travel to the LN and activate T cells
auto reactive T cells travel back to both eyes
EBV and molecular mimicry?
AB to EBV DNA polymerase may react with myelin basic protein initiating MS
graves disease?
AutoAb against TSH = hyperthyroidism
hashimotos thyroiditis?
AutoAb and autoreactive T cells against thyroid Ag = destruction of thyroid tissue = hypothyroidism
what is pannus?
thick swollen synovial membrane with fibroblasts and inflammatory cells
what do activated synovial cells secrete?
proteases that break down cartilage (MMP)
what is RF?
IgM Ab against Fc portion of IgG
RA dx?
morning stiffness for greater than an hour
symmetrical arthritis
weakness/ fatigue
ESR, RF, CRP, ACPA
x-rays to distinguish what type of erosion it is
how does genetic susceptibility affect lupus?
may have decreased ability to clear nuclear antigens (decreased FASL)
may have genes that are more likely to recognize nuclear Ag as foreign
tests to dx lupus?
anti-nuclear Ab test - very sensitive but not specific (can be present in other conditions)
- requires correlation with other investigations and clinical symptoms
anti- extractable nuclear Ag
- anti smith ab (specific)
- anti-double stranded DNA ab (specific)
- anti-phospholipid (less specific)
how does ANA recognition work in elisa?
ANA recognize different nuclear Ag so it can present as: nucleolar fine speckled coarse speckled homologous
what kind of hypersensitivity reaction is SLE?
type 3
what kind of hypersensitivity reaction is MS?
type 4
what type of hypersensitivity reaction is ARF?
type 2
what in the cold chain?
system of transporting/ storing vaccines within safe temps (2-8C, pref 5C)
stages in the cold chain?
manufacturer supplier transportation to distrubution center transportation to clinic clinic storage administration to patient
main requirements for vaccines fridge?
ability to record max and min temps reliably - alarm for low temps and when the door is left open
check thermometer 2x daily and annual battery change
