Term
| Differentiate b/t active and passive immunity. |
|
Definition
| Active - stim. of immune system to produce immunity. Passive - mother to baby, vaccines |
|
|
Term
| Differentiate b/t live attenuated and inactivated vaccines. |
|
Definition
| Live - life-long immunity, minute possibility of causing dz. Inactive - not alive, cannot replicate, req. multiple doses. |
|
|
Term
| What vaccines are live attenuated? (6) |
|
Definition
| Measles, mumps, rubella, varicella, rotavirus, flu mist |
|
|
Term
| What vaccines are inactivated, whole cell? (3) |
|
Definition
|
|
Term
| What vaccines are inactivated fractional? |
|
Definition
| Hep B, influenza, acellular pertussis, HPV, anthrax |
|
|
Term
| What vaccines are inactivated bacterial toxins (toxoid)? |
|
Definition
|
|
Term
| What vaccine type is composed of a sugar molecule that makes up the surface capsule of certain bacteria? Does it respond to booster doses? |
|
Definition
| Polysaccharide vaccine, no - not a lasting immune response |
|
|
Term
| The capsule of which vaccine type is combined with a protein leading to an Ab booster response? |
|
Definition
| Unconjugated polysaccharide |
|
|
Term
| Name 3 ex. of unconjugated polysaccharide vaccines. Who should it be given to? |
|
Definition
| Hib, pneumococcal, meningiococcal. Children <2yo |
|
|
Term
| What is the etiology of diptheria? |
|
Definition
| Corynebacterium diptheria |
|
|
Term
| What happens physiologically in diptheria? |
|
Definition
| Toxin causes progressive deterioration of myelin sheaths in CNS and PNS |
|
|
Term
| Which is more severe, respiratory or cutaneous diptheria? |
|
Definition
|
|
Term
| What sx occur in cutaneous diptheria? |
|
Definition
| chronic nonhealing sores or shallow ulcers w/ gray dirty membranes |
|
|
Term
| Name 3 s/sx of respiratory diptheria. |
|
Definition
| 1) Sore throat 2) Low grade fever 3) Gray membrane on tonsils, pharynx, or nose |
|
|
Term
| What physical sign can occur in severe diptheria? |
|
Definition
| Bull neck (neck swelling) |
|
|
Term
| Name 3 complications of diptheria. |
|
Definition
| 1) Myocarditis 2) Polyneuritis 3) Airway obstruction |
|
|
Term
| Tx for severe cases of diptheria? |
|
Definition
|
|
Term
| Abx of choice to tx diptheria? |
|
Definition
|
|
Term
| What vaccination is given to protect against diptheria? What is the schedule? |
|
Definition
| DTap - 3 doses (2m, 4m, 6m) + boosters (4-6, 11-12yo, and every 10yrs thereafter) |
|
|
Term
| What is the etiology of tetanus? |
|
Definition
|
|
Term
| Where are tetanus spores found? |
|
Definition
|
|
Term
| Explain pathogenesis of tetanus. |
|
Definition
| Toxin is produced in the body and binds in CNS and interferes w/ NT release to block inhibitor impulses, leads to unopposed mus. cotraction and spasm |
|
|
Term
| Name 5 pre-disposing conditions to tetanus. |
|
Definition
| 1) Penetrating injury resulting in inoculation of c. tetani 2) Co-infected w/ other bacteria 3) Devitalized tissue 4) Foreign body 5) Localized ischemia |
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|
Term
| Name 4 clinical manifestations of tetanus. |
|
Definition
| 1) trismus (lock jaw) 2) Dysphagia 3) Mus. rigidity 4) Spasms |
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|
Term
|
Definition
| Yes, intensely b/c consciousness is spared |
|
|
Term
|
Definition
| 1) Tetanus immunoglobulin IV or IM 2) IV Metronidazole 3) Diazepam 4) Tetanus vaccination |
|
|
Term
| Vaccination schedule for tetanus? |
|
Definition
| 3 doses (12-15m, 4-6yo, 11-12yo) + booster q 10 yrs |
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|
Term
| If a pt presenting with a wound has had 3 previous doses of Td, when would you give another shot? |
|
Definition
| Clean, minor wound - if <10yrs since last dose. All others - if <5yrs. |
|
|
Term
| Etiology of whooping cough? |
|
Definition
|
|
Term
| How is pertussis transmitted? |
|
Definition
|
|
Term
| what are the 3 stages of pertussis? |
|
Definition
| 1) Catarrhal - rhinorrhea, occ. cough X 1-2 wks 2) Paroxysmal - on/off forceful cough w/ whoop X 1-6wks 3) Covalescent - gradual resolution, wks to mths |
|
|
Term
|
Definition
| 1) Consider in all kids w/ h/o cough >14d 2) Bacterial culture 3) Polyemerase chain reaction testing |
|
|
Term
|
Definition
| Supportive tx, macrolide abx (azithromycin preferred) |
|
|
Term
| Vaccination schedule for pertussis? |
|
Definition
| 3 doses + booster (12-15m, 4-6yo, 11-12yo) |
|
|
Term
|
Definition
| Haemophilus influenzae type B, polysaccharide capsule |
|
|
Term
|
Definition
| direct contact w/ respiratory droplets |
|
|
Term
| What accounted for 50-65% of cases of Hib in prevaccine era and caused hearing impairment or neurologic sequelae in 15-30% |
|
Definition
|
|
Term
|
Definition
| Erythromycin, azithromycin |
|
|
Term
| Vaccination schedule for Hib? |
|
Definition
| 3 doses (2, 4, 6m) + booster at 12-13m |
|
|
Term
|
Definition
| enterovirus (3 serotypes: 1, 2, and 3) |
|
|
Term
| Describe pathogenesis of polio. |
|
Definition
| Virus enters through mouth and replicates in GI tract, spreads through blood to CNS where it destroys motor neuron cells |
|
|
Term
|
Definition
| 95% - no sx, 4-6% - GI sx, <1% - permanent paralysis of limbs |
|
|
Term
| What is the cause of death in 5-10% with paralysis from polio? |
|
Definition
| When paralysis strikes respiratory mus. |
|
|
Term
| What is the vaccination schedule for polio? |
|
Definition
| 4 doses: 2m, 4m, 6m, booster at 4-6yrs |
|
|
Term
| Etiology of measles? What inactivates it? |
|
Definition
| paramyxovirus, by heat and light |
|
|
Term
| How is measles transmitted? How contagious is it? |
|
Definition
| respiratory droplets, contagious 4 days before to 4 days /p rash dev. |
|
|
Term
| Describe clinical presentation in the prodrome phase of measles. (5) |
|
Definition
| Inc. fever, cough, coryza, conjunctivitis, koplick spots |
|
|
Term
| Describe rash present in measles. |
|
Definition
| dev. 2-4 days /p prodrome, maculopapular, erythematous, starting at scalp line and descending, persists 5-6d |
|
|
Term
| Name 4 complications that dev. in ~20% of cases of measles. |
|
Definition
| 1) Pna 2) Otitis media 3) Diarrhea 4) Subacute sclerosing panencephalitis |
|
|
Term
|
Definition
| MMR - 2 doses (12m and 4y) - gives lifelong immunity |
|
|
Term
|
Definition
|
|
Term
| How is mumps transmitted? How contagious is it? |
|
Definition
| respiratory droplets, contagious days b/f onset of parotid swelling and 9 days after onset |
|
|
Term
| Name 4 clinical findings in mumps. |
|
Definition
| 1) fever 2) HA 3) Fatigue 4) Painful swelling of parotid glands |
|
|
Term
| Diagnostic testing for mumps? |
|
Definition
| IgM Ab testing w/i 5d of onset (re-test 2-3 later if neg.), swab from parotid duct |
|
|
Term
| 4 complications of mumps? |
|
Definition
| 1) Meningitis 2) Orchitis 3) Spontaneous abortions 4) Deafness |
|
|
Term
|
Definition
| Sx - Tylenol/Ib for pain, cold or warm compress, avoid foods that induce salivation |
|
|
Term
| Vaccination schedule for mumps? |
|
Definition
|
|
Term
| Etiology of rubella (German measles)? What inactivates it? |
|
Definition
| Togavirus (RNA), chemical agents, UV light, low pH, heat |
|
|
Term
| How is rubella transmitted? How contagious? |
|
Definition
| direct contact w/ nasopharyngeal secretions that crosses placental barrier, contagious 7d before and 5-7d /p rash onset |
|
|
Term
| Describe progression of clinical findings in rubella. |
|
Definition
| 1) Prodrome of low-grade fever 2) Lymphadenopathy in 2nd wk 3) Maculopapular rash 14-17d /p exposure |
|
|
Term
| Name 5 s/sx of congenital rubella syndrome. |
|
Definition
| 1) Deafness 2) Cataracts 3) Heart defects 4) Microcephaly 5) MR |
|
|
Term
| what complication of rubella occurs in 70% of adults and is very rare in children. |
|
Definition
|
|
Term
| Vaccination schedule for rubella? |
|
Definition
| MMR - 1-2 doses (12-15m and 4-6 y), all unvaccinated women of child-bearing age |
|
|
Term
| What is the leading cause of bacterial meningitis in children <5yo? |
|
Definition
|
|
Term
| Etiology of pneumococcal? |
|
Definition
| Streptococcus penumoniae, polysaccharide capsule |
|
|
Term
| How is pneumococcal transmitted? |
|
Definition
|
|
Term
| 3 clinical syndromes of pneumococcal? |
|
Definition
| pneumonia, bacteremia, meningitis |
|
|
Term
| Clinical presentation of pneumococcal pna? |
|
Definition
| abrupt onset: fever, shaking chills, pleuritic CP, productive cough, dyspnea, tachypnea, hypoxia |
|
|
Term
| Pneumococcal pna is a common bacterial complication of what 2 diseases? |
|
Definition
|
|
Term
| Pneumococcal meningitis is at increased risk in people w/ ______. |
|
Definition
|
|
Term
| The pneumococcal polysaccharide vaccine is not effective in who? What is it less effective at preventing? |
|
Definition
| children <2yo, pneumococcal pna |
|
|
Term
| Who is rec to get the pneumococcal polysaccharide vaccine? |
|
Definition
| 1) Adults >65 2) Kids >2yo w/ chronic illness, asplenia, immunocompromised, high risk environments) |
|
|
Term
| Who is rec. to get the pneumococcal conjugate vaccine? |
|
Definition
| 1) All kids <2yo 2) Unvaccinated kids 24-59m w/high-risk medical condition |
|
|
Term
| Vaccine schedule for conjugate? |
|
Definition
| Dose 2m, 4m, 6m, + booster at 12-15m |
|
|
Term
| What is the most common pathologic presentation of meningococcal dz? |
|
Definition
|
|
Term
| 3 clinical findings of meningococcal meningitis? |
|
Definition
|
|
Term
| What is meningococcemia? Name 4 clinical finding. |
|
Definition
| bloodstream infxn, 1) Petechial/purpuric rash 2) fever 3) hypotension 4) MOF |
|
|
Term
| 4 diagnostic tests for meningococcal dz? |
|
Definition
| 1) Bacterial culture 2) Gram stain 3) Antigen detection in CSF 4) Serology |
|
|
Term
| Tx for confirmation of N. meningitidis? |
|
Definition
|
|
Term
| Who is the meningococcal conjugate vaccine rec. for? |
|
Definition
| 1) All 11-19yo 2) College freshman living in a dorm 3) All 2-55yo at inc. risk of invasive meningococcal dz |
|
|
Term
| What is the primary infxn of varicella zoster? Secondary? |
|
Definition
| Chickenpox, herpes zoster (shingles) |
|
|
Term
| How is varicella zoster transmitted? |
|
Definition
| respiratory secretions or fluid from vesicles |
|
|
Term
| Clinical findings of varicella zoster? |
|
Definition
| mild fever, rhinorrhea, gen, pruritic vesicular rash w/ crops of lesions in sev. stages of dev. |
|
|
Term
| What are the clinical findings in herpes zoster? |
|
Definition
| erythematous, papular lesions turning into vesicular lesions lasting for 7-10 days |
|
|
Term
| What is acute neuritis in shingles? |
|
Definition
| Pain in the dermatome preceding the rash |
|
|
Term
| What is a common complication of shingles? |
|
Definition
| postherpetic neuralgia, pain can last for mths, more likely if >60yo |
|
|
Term
| What meds are used for postherpetic neuralgia? |
|
Definition
|
|
Term
| What is ophthalmic zoster? |
|
Definition
| Involvement of the ophthalmic division of the trigeminal n. and eye |
|
|
Term
| What is varicella in a previously vaccinated person? |
|
Definition
| Varicella breakthrough dz |
|
|
Term
| Vaccination schedule for varicella? |
|
Definition
| 2 doses (12-15mths and 4-6yo) |
|
|
Term
| Vaccination schedule for zoster? |
|
Definition
| One dose, Zostavax, for >60yo |
|
|
Term
| What type of virus is rotavirus? |
|
Definition
| nonenveloped, double-shelled virus |
|
|
Term
| How is rotavirus transmitted? When do epidemics occur? |
|
Definition
| fecal-oral, Nov. to April |
|
|
Term
| 4 clinical findings in rotavirus? |
|
Definition
| 1) Vomiting 2) Watery diarrhea 3) Fever 4) Abd pain |
|
|
Term
|
Definition
| stool specimen - rapid antigen detection |
|
|
Term
| Vaccination schedule for rotavirus? |
|
Definition
|
|
Term
| What the vaccination schedule for Hep B? |
|
Definition
| monovalent to all newborns b/f hospital d/c. 2nd dose - 1-2m, Final no earlier than 24wks. |
|
|
Term
| When are 4 Hep B vaccine permissible? |
|
Definition
| When combo vaccines containing Hep B are admin. /p birth dose |
|
|
Term
| Who should receive the Hep A vaccine? What is the schedule? |
|
Definition
| All children aged 1 yr. 2 doses at least 6mths apart. |
|
|
Term
| When can the vaccine for Hep A be given <6mths apart? |
|
Definition
| Kids not fully vaccinated by 2 yo |
|
|
Term
| Which form of infectious hepatitis is food-borne? |
|
Definition
|
|
Term
| How is Hep B transmitted? |
|
Definition
|
|
Term
| What is rec. for a pt infected w/ Hep A who is unvaccinated? |
|
Definition
| single dose HepA vaccine or immune globulin |
|
|
