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Year 3 Sem 1 > Week 10 > Flashcards

Week 10 Flashcards

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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
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.
26
most common location of tumour in breast?
upper outer quadrant
27
clinical presentation of breast cancer?
nipple discharge, skin tethering and palpable mass | screen detected cancer
28
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
29
where does breast cancer metastases go?
first lymphatics to draining lymph nodes | hematogenous spread = liver, lung and bone
30
what are the common primary tumours that metastasize to the lungs?
breast, kidney, uterus, testes, melanoma, colorectal, thyroid
31
peak incidence of lung cancer?
60-70 years old
32
molecular basis for lung cancer?
activation of oncogenes - EGFR, MYC, k-RAS | inactivation of TSG TP53
33
what type of genes are affected in NSCLC and SCLC?
``` NSCLC= oncogene mutations (kras, EGFR) SCLC= TSG mutations (Rb and P53) ```
34
clinical presentation of lung cancer?
respiratory symptoms - dry cough, dyspnoea, recurrent pneumonia, wheezing, haemoptysis normal physical exam
35
management of SCLC?
limited disease treated with chemo (podophyllotoxins and platinum compounds) and radiation to the primary site
36
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)
37
where does adenocarcinoma arise from?
NSCLC | mucus cells in bronchial epithelium
38
where can adenocarcinoma spread too?
mediastinal LN/ pleura and spreads to bone and brain
39
squamous cell carcinoma?
more aggressive | usually causes bronchial obstruction leading to infection
40
prevalence of the lung cancers?
adenocarcinoma = 40% squamous cell carcinoma = 25% large cell carcinoma = 10% small cell carcinoma = 20%
41
morphology of colorectal cancer?
1/3 arise from rectum for rectosigmoid | 1/4 arise from sigmoid
42
where does colorectal cancer metastasize?
liver via portal vein then heart then lungs
43
what is melanocytic nevi and what are the mutations?
mole | activation mutations in BRAF and NRAS
44
malignant epidermal tumours? mutations?
basal cell carcinoma (PTCH1 LOF) squamous cell carcinoma (LOF TP53, GOF RAS) both strongly locally infiltrating good prognosis
45
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
46
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
47
what drugs have improved response/ rate of survival in melanoma?
TK inhibitors | checkpoint inhibitors
48
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
49
what are the live vaccines?
measles varicella OPV (now use IPV) rubella
50
what diseases does maternal Ab protect infant from?
measles | rubella
51
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
52
incubation period of measles?
10 days onset fever | 14 days onset rash
53
measles period of communicability?
prodrome to 4 days after onset rash
54
case definition of measles?
cough, coryza, maculopapulary rash
55
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
56
transmission of rubella?
airborne droplet spread, contact with mucus membranes | infants with CRS shed virus in pharyngeal secretions and urine
57
incubation period for rubella?
14-21 days
58
rubella symptoms?
``` low grade fever malaise coryza, conjunctivitis lymphadenopathy arthralgia leukopenia and thrombocytopenia ```
59
complications of rubella
post viral encephalitis and congenital rubella syndrome
60
rubella vaccine
live, attenuated interferes with over live vaccines dosing interval 4 weeks
61
transmission of pertussis?
airborne droplet spread | highly infectious
62
period of communicability for pertussis?
21 days after onset cough
63
incubation period for pertussis?
7-20 days
64
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
65
cause definition of pertussis?
cough greater than 14 days with at least one post-jussive symptom: vomit, apnoea or whoop
66
complications of pertussis?
seizures pneumonia hypoxic encephalopathy
67
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)
68
absolute contraindications to vaccine?
anaphylactic response
69
relative contraindications to vaccines?
``` immunosuppressed or pregnant (live) fever more than 38.5 recent live vaccine (<4m) recent blood products (<7m) influenza ```
70
when is hepB vaccine given?
birth, 2,4,6 months for healthy kids 12 months as well for premature babies
71
when is pneumococcal (PCV) vaccine given?
2,4,12 months for healthy kids + 6 months for ABTSI, medically at risk, premature
72
when is rotavirus vaccine given?
1st dose <15 weeks 2nd dose <25 weeks 2 and 4 months can't be given after this
73
when is hepA vaccine given?
to ABTSI at 12 and 18 m
74
how many vaccines are given to children?
16 vaccines all children 20 for ABTSI 18 for infants with medical risk factor and premature babies
75
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
76
what vaccines are funded for ABTSI?
influenza | Japanese encephalitis
77
school based vaccines?
HPV 2 doses separated by 6-12 months | dTpa 5th dose 12-17 years
78
zoster vax?
boost immunity to prevent shingles in people over 70 live vaccine not the same as MMRV
79
Pathogenic mechanisms leading to autoimmune disease?
exposure to hidden epitops exposure to infectious agent molecular mimicry
80
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
81
EBV and molecular mimicry?
AB to EBV DNA polymerase may react with myelin basic protein initiating MS
82
graves disease?
AutoAb against TSH = hyperthyroidism
83
hashimotos thyroiditis?
AutoAb and autoreactive T cells against thyroid Ag = destruction of thyroid tissue = hypothyroidism
84
what is pannus?
thick swollen synovial membrane with fibroblasts and inflammatory cells
85
what do activated synovial cells secrete?
proteases that break down cartilage (MMP)
86
what is RF?
IgM Ab against Fc portion of IgG
87
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
88
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
89
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)
90
how does ANA recognition work in elisa?
``` ANA recognize different nuclear Ag so it can present as: nucleolar fine speckled coarse speckled homologous ```
91
what kind of hypersensitivity reaction is SLE?
type 3
92
what kind of hypersensitivity reaction is MS?
type 4
93
what type of hypersensitivity reaction is ARF?
type 2
94
what in the cold chain?
system of transporting/ storing vaccines within safe temps (2-8C, pref 5C)
95
stages in the cold chain?
``` manufacturer supplier transportation to distrubution center transportation to clinic clinic storage administration to patient ```
96
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

Year 3 Sem 1 (12 decks)

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