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Year 3 Sem 1 > Week 10 > Flashcards

Week 10 Flashcards

1
Q

which disease has vaccines eradicated?

A

small pox

on the verge of polio

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2
Q

what diseases have reduced in mortality and morbidity due to vaccines?

A

diphtheria, pertussis, tetanus, measles

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3
Q

what are the different types of vaccines?

A

live
killed/ inactivated
acellular/ toxoid

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4
Q

incubation period of measles?

A

~10 days onset fever

~14 days onset rash

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5
Q

when is the measles vaccines give?

A

12 months

18 months

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6
Q

case definition of measles?

A

cough, coryza, conjuntivitis, maculopapular rash

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7
Q

contraindications to vaccines?

A

absolute: anaphylactic response to vaccine
relative: immunocompromised, pregnant, fever >38.5, recent <4w live vaccine, recent <7m blood products, GBS influenza

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8
Q

what are the 5 categories of reporting adverse events to a vaccine?

A 
vaccine product related reaction
vaccine quality related reaction
immunization error related reaction 
immunization anxiety related 
coincidental event
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9
Q

what immunizations are given at brith?

A

hep B

TB (ABTSI)

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10
Q

what immunizations are given at 2 and 4 months?

A

DTPa-HepB-IPV-Hib
pneumococcal
rotavirus

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11
Q

what immunizations are given at 6 months?

A

DTPa-HepB-IPV-Hib

pnemococcal (ABTSI, infants with medical risk, premie (<28w))

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12
Q

what are some autoimmune diseases and their immunopathogenic mechanisms?

A

Ab against cell surface or matrix Ag (hemolytic anaemia, AFR)

immune complex disease (RA, SLE)

T cell mediated disease (CD, MS, RA, T1DM)

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13
Q

exposure of hidden mechanism in autoimmune disease?

A

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

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14
Q

what is an example of molecular mimicry in RA?

A

Ab to cell wall M protein of group A strep may reaction with cardiac myosin

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15
Q

what are some cancers that are curative with radiotherapy?

A

head and neck
lung
cervical
prostate

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16
Q

what are some cancers that require adjuvant therapy with radiotherapy?

A

head and neck
breast cancer
brain

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17
Q

which are some cancers that are usually curable?

A

lymphoma, leukemia, germ cell, sarcomas

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18
Q

what are the teams involved in cancer management?

A 
medical oncologist 
radiation oncologist t
palliative care 
oncological surgeon
allied health (dietician, physio, social work)
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19
Q

benefits of telehealth?

A

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

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20
Q

prognostic factors for early cancer?

A 
size of primary
histological differentiation 
node involvement 
receptor status 
age 
molecular markers
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21
Q

what are the steps in staging?

A 
history
examination
tumour markers 
FBC, LFTs, bone marrow 
histology
Xray, CT scan, bone scan, MRI, pet scan
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22
Q

what is the most common spot in the breast for a tumour?

A

upper outer quadrant

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23
Q

what cancers is EtOH a risk for?

A 
breast cancer
pancreatic
liver
coloractal 
esophagus
head and neck
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24
Q

retinoblastoma histology?

A
  • small round blue tumour (very basophilic)
  • more viable cells closer to the BV core
  • pink fizzy cells = necrotic because they rapidly outgrow blood supply
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25
Q

sentinel node biopsy?

A

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.

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26
Q

most common location of tumour in breast?

A

upper outer quadrant

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27
Q

clinical presentation of breast cancer?

A

nipple discharge, skin tethering and palpable mass

screen detected cancer

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28
Q

dx and staging to breast cancer?

A

mammogram, UC and core biopsy
also need to differentiate between DCI and invasive carcinoma
ultrasound of axillary lymph nodes

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29
Q

where does breast cancer metastases go?

A

first lymphatics to draining lymph nodes

hematogenous spread = liver, lung and bone

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30
Q

what are the common primary tumours that metastasize to the lungs?

A

breast, kidney, uterus, testes, melanoma, colorectal, thyroid

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31
Q

peak incidence of lung cancer?

A

60-70 years old

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32
Q

molecular basis for lung cancer?

A

activation of oncogenes - EGFR, MYC, k-RAS

inactivation of TSG TP53

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33
Q

what type of genes are affected in NSCLC and SCLC?

A 
NSCLC= oncogene mutations (kras, EGFR)
SCLC= TSG mutations (Rb and P53)
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34
Q

clinical presentation of lung cancer?

A

respiratory symptoms
- dry cough, dyspnoea, recurrent pneumonia, wheezing, haemoptysis

normal physical exam

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35
Q

management of SCLC?

A

limited disease treated with chemo (podophyllotoxins and platinum compounds) and radiation to the primary site

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36
Q

management of NSCLC?

A

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)

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37
Q

where does adenocarcinoma arise from?

A

NSCLC

mucus cells in bronchial epithelium

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38
Q

where can adenocarcinoma spread too?

A

mediastinal LN/ pleura and spreads to bone and brain

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39
Q

squamous cell carcinoma?

A

more aggressive

usually causes bronchial obstruction leading to infection

40
Q

prevalence of the lung cancers?

A

adenocarcinoma = 40%
squamous cell carcinoma = 25%
large cell carcinoma = 10%
small cell carcinoma = 20%

41
Q

morphology of colorectal cancer?

A

1/3 arise from rectum for rectosigmoid

1/4 arise from sigmoid

42
Q

where does colorectal cancer metastasize?

A

liver via portal vein then heart then lungs

43
Q

what is melanocytic nevi and what are the mutations?

A

mole

activation mutations in BRAF and NRAS

44
Q

malignant epidermal tumours? mutations?

A

basal cell carcinoma (PTCH1 LOF)
squamous cell carcinoma (LOF TP53, GOF RAS)

both strongly locally infiltrating
good prognosis

45
Q

clinical presentation of BCC and SCC?

A

BCC is pink, nodular raised lesion with ‘pearly edges’ or flat pink

SCC is white/ pink, scaly/ crusted lesion

46
Q

role of lactate dehydrogenase in metastatic melanoma?

A

LDH leaks out of metastatic melanoma and can be used as a biomarker in melanoma for metastatic or recurrent melanoma

47
Q

what drugs have improved response/ rate of survival in melanoma?

A

TK inhibitors

checkpoint inhibitors

48
Q

complications in pregnancy with a mother that has rubella?

A

worst case: spontaneous loss of pregnancy, fetal death in utero, major organ system malformation
most common defects: eye problems and deafness

49
Q

what are the live vaccines?

A

measles
varicella
OPV (now use IPV)
rubella

50
Q

what diseases does maternal Ab protect infant from?

A

measles

rubella

51
Q

what disease does herd immunity protect against? which diseases does it not protect from?

A

diseases that propagate through the population (measles, polio, influenza)

does not protect against salmonella or tetanus because these are acquired from a common source

52
Q

incubation period of measles?

A

10 days onset fever

14 days onset rash

53
Q

measles period of communicability?

A

prodrome to 4 days after onset rash

54
Q

case definition of measles?

A

cough, coryza, maculopapulary rash

55
Q

measles vaccine?

A

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

56
Q

transmission of rubella?

A

airborne droplet spread, contact with mucus membranes

infants with CRS shed virus in pharyngeal secretions and urine

57
Q

incubation period for rubella?

A

14-21 days

58
Q

rubella symptoms?

A 
low grade fever
malaise 
coryza, conjunctivitis 
lymphadenopathy
arthralgia 
leukopenia and thrombocytopenia
59
Q

complications of rubella

A

post viral encephalitis and congenital rubella syndrome

60
Q

rubella vaccine

A

live, attenuated
interferes with over live vaccines
dosing interval 4 weeks

61
Q

transmission of pertussis?

A

airborne droplet spread

highly infectious

62
Q

period of communicability for pertussis?

A

21 days after onset cough

63
Q

incubation period for pertussis?

A

7-20 days

64
Q

susceptibility of pertussis?

A

infants who have not received2 dose vaccines because not old enough
adults with waning immunity
maternal Ab does not provide reliable protection

65
Q

cause definition of pertussis?

A

cough greater than 14 days with at least one post-jussive symptom: vomit, apnoea or whoop

66
Q

complications of pertussis?

A

seizures
pneumonia
hypoxic encephalopathy

67
Q

pertussis vaccine?

A

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)

68
Q

absolute contraindications to vaccine?

A

anaphylactic response

69
Q

relative contraindications to vaccines?

A 
immunosuppressed or pregnant (live)
fever more than 38.5
recent live vaccine (<4m)
recent blood products (<7m)
influenza
70
Q

when is hepB vaccine given?

A

birth, 2,4,6 months for healthy kids

12 months as well for premature babies

71
Q

when is pneumococcal (PCV) vaccine given?

A

2,4,12 months for healthy kids

+ 6 months for ABTSI, medically at risk, premature

72
Q

when is rotavirus vaccine given?

A

1st dose <15 weeks
2nd dose <25 weeks

2 and 4 months
can’t be given after this

73
Q

when is hepA vaccine given?

A

to ABTSI at 12 and 18 m

74
Q

how many vaccines are given to children?

A

16 vaccines all children
20 for ABTSI
18 for infants with medical risk factor and premature babies

75
Q

how does the interaction of live vaccines affect administration?

A

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

76
Q

what vaccines are funded for ABTSI?

A

influenza

Japanese encephalitis

77
Q

school based vaccines?

A

HPV 2 doses separated by 6-12 months

dTpa 5th dose 12-17 years

78
Q

zoster vax?

A

boost immunity to prevent shingles in people over 70
live vaccine
not the same as MMRV

79
Q

Pathogenic mechanisms leading to autoimmune disease?

A

exposure to hidden epitops
exposure to infectious agent
molecular mimicry

80
Q

mechanism of an eye infection?

A

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

81
Q

EBV and molecular mimicry?

A

AB to EBV DNA polymerase may react with myelin basic protein initiating MS

82
Q

graves disease?

A

AutoAb against TSH = hyperthyroidism

83
Q

hashimotos thyroiditis?

A

AutoAb and autoreactive T cells against thyroid Ag = destruction of thyroid tissue = hypothyroidism

84
Q

what is pannus?

A

thick swollen synovial membrane with fibroblasts and inflammatory cells

85
Q

what do activated synovial cells secrete?

A

proteases that break down cartilage (MMP)

86
Q

what is RF?

A

IgM Ab against Fc portion of IgG

87
Q

RA dx?

A

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

88
Q

how does genetic susceptibility affect lupus?

A

may have decreased ability to clear nuclear antigens (decreased FASL)

may have genes that are more likely to recognize nuclear Ag as foreign

89
Q

tests to dx lupus?

A

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)
90
Q

how does ANA recognition work in elisa?

A 
ANA recognize different nuclear Ag so it can present as:
nucleolar 
fine speckled
coarse speckled
homologous
91
Q

what kind of hypersensitivity reaction is SLE?

A

type 3

92
Q

what kind of hypersensitivity reaction is MS?

A

type 4

93
Q

what type of hypersensitivity reaction is ARF?

A

type 2

94
Q

what in the cold chain?

A

system of transporting/ storing vaccines within safe temps (2-8C, pref 5C)

95
Q

stages in the cold chain?

A 
manufacturer
supplier
transportation to distrubution center
transportation to clinic 
clinic storage
administration to patient
96
Q

main requirements for vaccines fridge?

A

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

Year 3 Sem 1 (12 decks)

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