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Flashcards in Immunocompromised pt Deck (42):
1

what are Abs produced by

plasma cells

2

structure and subtypes of antibodies

immunoglobulins (proteins)
5: GAMDE

3

where is IgA secreted

exocrine glands

4

where are t lymphocytes produced

thymus

5

cycle of activity of t cells

T lymphocytes --> activated --> lymphokines --> modulate activity of macrophages, mop up invasive cells (funghi, bacteria, viruses)

6

examples of these causes of immune deficiency; which is more common
a. congenital 2
b. acquired 4


a. congenital 2 RARE:-cyclic neuropenia
-wiskott-aldrich syndrome
b. acquired 4: corticosteroid therapy
-malignancy (leukaemia/ myeloma)
-chemotherapy/ bone marrow/ organ transplantation
-viral eg HIV

7

7 side effects of long term steroids

-predisposition to diabetes mellitus
-cushingoid appearance (moon face)
-inc risk of fungal infections
-hypertension
-osteoporosis
-adrenal suppression
-gastric ulceration

8

6 orodental problems associated with steroids

-hypotensive crisis
-underlying disease process
-candidal infection
-delayed healing
-osteoporosis
-avoid aspirin and NSAIDs (cause gastric ulceration)

9

what axis does steroid crisis affect

hypothalamic-pituitary-adrenocortical axis

10

what causes suppression of HPA axis and outcome of this

oral corticosteroids
--> hypoadrenal crisis --> shock, circulatory collapse

11

BDH recommendations for pts currently taking steroids or who have had steroids in the last 3 months

-under 10 mgs prednisolone daily --> fine
->10mgs predisolone daily --> consider inc steroid dose pre-op. for immediate tx, give 100mg hydrocortisone hemisuccinate iv prior to procedure

12

4 reasons people have chemo

-have had surgery to remove malignancy
-may have received radiotherapy too
-malignancy of haemopoeitic tissue (eg leukemia)
-prior to bone marrow transplant

13

3 side effects of chemo on bone marrow

-dec WBC (leukopenia, neutropenia
-dec platelets (thrombocytopenia)
-dec RBCs (anaemia)

14

which of these causes coagulation defect

thrombocytopenia

15

value of
a. normal platelet count
b. normal bleeding time
c. inc bleeding time that needs transfusion
d. platelet count that risks spontaneous bleeding

value of
a. normal platelet count:150-400x10^9
b. normal bleeding time: 100-150
c. inc bleeding time that needs transfusion: 20-100
d. platelet count that risks spontaneous bleeding:

16

6 oral side effects of chemo

-mucositis
-oral ulceration superimposed with opportunistic infections
-pseudomonas
-candida inc pseudomembranous (white plaques that rub off)
-herpes simplex (both sides)
-herpes zoster (travels down dermatome, stops at midline)

17

what to prescribe chemo pt who is pyrexic and neutropenic

1st line ABs: fluconazole/ itraconazole
anti virals: acyclovir

18

2 reasons prophylactic AB cover is needed in chemo pts

-pt neutropenic at time of tx
-tx likely to induce bacteraemia

19

detail antibiotic prophylaxis

-amoxycillin 3g
-if allergic to penicillin --> clindamycin 600mg orally 1 hr before procedure
-in hospital --> IV 1g amoxicillin or 300mg clindamycin

20

2 best times in chemo cycle to give dental tx and why

-just before chemo
-2-3 days after chemo
highest neutrophil count

21

3 most common anti-rejection drugs for transplant pts

cyclosporin
azathioprin
prednisolone

22

2 complication of cyclosporin and management

-hypersensitive to UV light --> skin malignancies
-gingival hyperplasia -->refer to hosp for surgical removal

23

est number of people living with HIV

34 million

24

number of new HIV infections in 2010

2.7 million

25

number of deaths due to aids in 2010

1.8million

26

area of the world with most HIV/aids

subsaharan africa

27

% of undiagnosed HIV

25-30%

28

cellular change in HIV

dec CD4 helper cells

29

classical progression of HIV

initial infection-3 months: seroconversion illness (flulike symptoms)
3 months-8-10yrs: asymptomatic, HIV antibody positive, gradually decreasing numbers of CD4 cells
8-10yrs +: AIDS symptoms, gradual decline, death

30

CD4 cell count
a. normal count
b. initial immune suppression
c. severe immunosuppression

CD4 cell count
a. normal count: >600
b. initial immune suppression: 400-600
c. severe immunosuppression:

31

risk group of HIV

any sexually active male or female

32

explain HAART and 2 examples of drug types

Highly Active Anti Retroviral Therapy: triple therapy using different drugs which target different parts of viral replication cycle
eg -nucleoside analogues
-protease inhibitors

33

what CD4 count is required for triple therapy

34

3 oro-facial manifestations of HIV

-cervical lymph node enlargement
-salivary gland enlargement
-skin disorders (molluscum contagiosum, dermatitis, papillomas)

35

intra oral manifestations of HIV 7

-candidosis
-hairy leukoplakia
-kaposis sarcoma
-apthous and viral ulcers (HAVE HALOS, apthous angel)
-periodontal disease --> ANUG
-papillomavirus infections
-non hodgkins lymphoma

36

what virus is hairy leukoplakia associated with

epstein barr virus

37

symptoms and tx of hairy leukoplakia

hairy tongue, tiger stripes on lateral borders
systemic acyclovir (only works sometimes)

38

cause of kaposis sarcoma and common site

HHV8
palate (can progress to black lesions on palate)

39

who has kaposis sarcoma

HIV pts WITHOUT ACTIVE TX

40

Progression of periodontal disease in HIV / AIDs pts

linear gingival erythema
--> necrotising ulcerative gingivitis
--> necrotising ulcerative periodontitis (ANUG)
--> cancrum oris (untreated HIV and malnutrition only)

41

bacterial cause of ANUG/ cancrum oris

fusiform bacteria: fusobacterium nucleatum, treponema vincentii

42

3 types of immunodeficiency

-B cell / humoral (affects antibody production)
-T cell / cell mediated
-mixed deficiency