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1
Q

example of live attenuated vaccine

A

mmr

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2
Q

example of inactivated

A

hep A, polio

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3
Q

example of toxoid vaccine

A

diphtheria, tetanus

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4
Q

eg of subunit vaccine

A

hep B, influenza, pertussis

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5
Q

which vaccine type needs refrigerati

A

live attenuated vaccine

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6
Q

precautions for live attenuated - 5

A

-avoid in pregnancy
-usually not in infants <1
-not in severely immunocompromised
-spaced at least 3-10 months from antibody containing products ike immunoglobulins and blood transfusions
-avoid giving another vaccine in 28 days

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7
Q

precautions for live attenuated - 5

A

-avoid in pregnancy
-usually not in infants <1
-not in severely immunocompromised
-spaced at least 3-10 months from antibody containing products ike immunoglobulins and blood transfusions
-avoid giving another vaccine in 28 days

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8
Q

national childhood immunisation schedule

A

BCG, Tdap, MMR, varicella, Hep B, polio, hemophilus influenzae type b, pneumococcal, HPV, influenza (aged 6mo - 4 years)

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9
Q

national adult immune schedue

A

tdap (if other indications), varicella, MMR, HPV, influenza (if other indications), pneumococcal (if other indications), Hep B

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10
Q

contraindications

A

allergy to vaccine or components, bleeding risk, severe illness (eg fever more than 38), live attenuated not for pregnant and immunocmprimsed

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11
Q

exception to rule of simultaneous vaccine administration

A

pneumococcal conjugate and meningococcal conjugate vaccine in those with asplenia–> 4 wk interval

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12
Q

how long should live attenuated via IM or SQ be spaced

A

28 days

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13
Q

what is surgical AB prophylaxis

A

admin of antimicrobials just prior to clean and clean contaminated surgeries to prevent post op surgical site infections

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14
Q

SSI are defined as

A

infections that occur within 30 days after operation of 1 year if an implant was left in place

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15
Q

SSI are considered

A

health care associated infections

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16
Q

SSI can be

A

superficial or Deep incisional affecting body spaces and organs

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17
Q

deep incisional SSI affects

A

fascia and muscle layers

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18
Q

superficial incisional SSI affects

A

skin and SQ tissue

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19
Q

patient related risk factors for SSI

A

extreme age, smoking, coexisting infection at other sites, immunosuppressed, length of hospital stay, MRSA infection, recent surgical procedure, obese, malnourished, diabetes, underlying disease

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20
Q

operation related risk factors for SSI

A

pre op shaving, inadequate sterilisation, antimicrobial prophylaxis, foreign material in surgical site, skin antisepsis, duration of surgery and surgical scrub

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21
Q

SAP indicated for

A

clean surgery when implant is inserted

clean contaminated surgery always need SAP

contaminated surgery needs AB used as treatment not prophylaxis

always needed for immunocompromised pts or those w conditions that increase risk of SSI

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22
Q

clean contaminated surgery examples

A

respiratory, alimentary and genitourinary tract penetrated

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23
Q

examples of clean surgery and is SAP recommended for these?

A

healthy skin incised (not)

mucosa of respiratory, alimentary and genitourinary tract and oropharyngeal cavity not traversed (not)

insertion of prosthesis or artificial device (recommended)

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24
Q

broad or narrow spectrum preferred for SAP

A

narrow

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25
should conc be high or low at site prior to infections
high
26
ABs with high risk of Cdiff infections
3rd gen cefalosporins, clindamycin, FQ
27
common pathogens and recommended abntimicrobials for coronary artery bypass, implants
staph aureus, staph epidermidis use cefazolin or cefuroxime
28
for GI ops w entry into GI lumen common pathogens and AB for SAP
enteric G neg bacilli and G pos cocci use cefazolin
29
cefazolin IV can begin as SAP for all ops except
Genitourinary use ciprofloxacin (PO or IV) or cotrimoxazole (PO) unless open laparoscopic surgery (cefazolin)
30
MRSA choice of AB for SAP
screen for MRSA for pts who are going through high risk surgeries (cardiac, orthopedic, neurosurgery with implant) use vancomycin for pts w known MRSA colonisation recent MRSA infection can add cefazolin to Vanco to cover MSSA in MRSA colonised patients
31
choice of AB for SAP in B lactam allergy
verify true allergy If severe penicillin allergy (anaphylaxis, urticaria, angioedema, SJS, TEN), should not receive a B lactam If uncomplicated non IgE mediated reaction to penicillin eg maculopapular rash --> consider cephalosporins or cefazolin which has unique R1 side chain
32
when to start administration before surgical incision
30 - 60 min but for Vanco and FQs, start 60-120 min before
33
when is intra operative re dosage required
when duration of exposure exceeds 2 half lives of drug or extensive blood loss (more than 1.5l) or extensive burns
34
duration of SAP should not exceed
24h
35
what happens if SAP given more for than 24h
risk of Cdiff infection, acute kidney injury, increase section pressure and risk or MDR orgs
36
non SAP strategies
don't remove hair unless necessary and don't shave (use depilators or clippers) control post op blood glucose to be below 180mg/dL maintain normothermia (more than 35.5) during peri op period use alcohol contains pre op skin prep agents maintain adequate oxygenation of tissue use impervious plastic wound protectors for GI and biliary tract surgery
37
useful resources for travel health
CDC Health information for travellers, CDC Yellow book, WHO Travel advice, Ministry of foreign affairs travel restriction and requirements
38
medical considerations before international travel
pre travel consult 4-6 weeks before look for individual risk factors include post op advice if relevant focussed education eg precautions etc
39
information for risk assessment during ore travel lconsult
PMH, special conditions, immunisation history, prior travel experience (experience with malaria chemoprophylaxis and altitude), itinerary, timing, reason for travel, travel style, special activities
40
major routes of infection
food/water borne infections via fecal oral, insect vector borne transcutaneous, respiratory, blood and body fluids via sex or sharing contaminated needles
41
travel vaccines - 14 not all are compulsory for all countries
respiratory - influenza, meningococcus *, deptheria, MMR, pertussis food and waterborne - hep A, typhoid, cholera, polio * vector borne - yellow fever*, Japanese encephalitis blood/fluid borne - hep B Transact - tetanus, rabies
42
hep A virus is cholera is hep B is influenza is jap encephalitis is mmr is
inactivated live atten recombinant inactivated or recombinant inactivated live atten
43
muslims taking Hajj and pilgrimages in Saudi Arabia should be vaccinated against
meningococcal
44
participating in injury prone activities should take
tap (tetanus dipth) - toxoid vaccine
45
vaccines take __ to elicit protective effects
2 weeks
46
can 2 live vaccines be administered on same day
can be done, of not second should be given 28 days after first
47
coadministration of which 2 vac is recommended
yellow fever and MMR
48
missed dose
don't give additional dose continue w the overdue dose there is no max interval between doses of primary vaccine series
49
which vac has oral ROA
cholera
50
influenza ROA
instransal or IM
51
SQ vacs
polio and MMR and yellow fever
52
which parasite causes malaria
protozoan parasite called plasmodium
53
5 species of plasmodium
P falciparum, malariae, ovale, vivax and Knowlesi
54
most prevalent plasmodium:
vivax and falciparum (most dangerous is falc)
55
clinical features of malaria
fever, chills, body ache, cough, vomitingm diarrhoea, sweats, headaches, abdominal pain, nausea
56
what transmits malaria
female anopheles mosquito or transfusions organ transplant and meter to foetus (vertical transmission)
57
risk of transmission is higher during
higher between dusk and dawn cold season at end of rainy season decreases at high altitudes
58
does SEA have malaria risk
no
59
those who developed malaria as children have immunity as adults/
yes
60
plasmodium life cycle
exo erythrocytic cycle (grow an d multiply in human liver) - P vivax and oval have possible dormancy erythrocytic cycle in human blood - differentiate into gametocytes -clincal symptoms mosquito (sporagenic cycle)
61
strategies for malaria prevention
awareness bite prevention chemoprophylaxis diagnosis through blood smear and seeing parasite in blood environments
62
drugs used for malaria chemoprophylaxis
atovaquone + proguanil (malarone) chloroquine doxycycline mefloquine
63
3 types of malaria risk prevention
A- bite prevention B (non falciparum risk) - bite prevention + chloroquine or doxy or malrone or mefloquine C (falciparum malaria risk = high resistance to chloroquine) - use bite prevention + malarone or doxy or mefloquine
64
malaria advice after returning
no blood transfusion fr 4 month monitor for fever and flu like symptoms for a year
65
insect repellant precautions
- only on exposed skin - not on broken skin - don't spray on face directly -wash hands after - wash skin an clothes when home
66
active ingredients in insect repellants
DEET, picaridine, oil of lemon eucalyptus, IR 3535, 2 undecanone
67
which repellant ingredient is most effective
DEET provides 6-12h protection
68
protection against malaria
wear light coloured clothing stay indoors between dusk and dawn expose less skin sleep under a permethrin impregnanted bed net sealed aircon room with or screened windows with fan
69
atovaquone proguanil - regimen - CI - ADR - DDI - avoid in - classification in SG
- start 1-2 days before travel and continue for 7 days after return (WITH FOOD OR MILKY DRINKS) - renall impairment (CrCl below 30) and hypersensitivity - nausea, vomiting, diarrhoea, headache, dizziness - rifampicin, metoclo[ramide - preg and lac - POM w exemption
70
chloroquine - regimen - CI -precautions - ADR - DDI - classification in SG
- weekly in one dose, with or after meals. start 1-2 weeks before departure, continue toll 4 weeks after return - hypersensitivity, chloroquine resistance -exacerbates psoriasis, myasthenia graves, seizure, liver impairment - NV, stomach pain, rash - QT prolonging CYP3A4 inhibitors eg clarithromycin and voricinazole - P only
71
doxyxline - regimen - CI -precautions - ADR - DDI - classification in SG
- daily with or after meals w FULL glass of water. start 1-2 days prior to top and continue till4 weeks after return - hypersens, children below 8, preg and lact - GI discomfort, photosens - reduce F w multivalent ions - prescription only if a;rdy taking for acne, don't need additional regimen
72
least expensive malaria agent
doxy
73
women prone to vaginal yeast infections when taking ABs should avoid
doxy
74
mefloquine - regimen - CI -precautions - ADR - DDI - classification in SG
one dose weekly after meals. start 1 week prior at least and continue till 4 weeks after return - hypersens, regions w meflo resistance, psychiatric conditions, convulsive disorders, cardiac conduction abnormalities (can cause QT prolongation) - GI, dizziness, headache, insomnia, vivid dreams, NEUROPSYCHIATRIC DISORDER - ketoconazole - pharmacy only - can be used in preg and lact and children above 5

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