llbgurl's version from 2015-09-27 18:31

Section 1

Question Answer
gram positive bacillusdiptheria
gram negative bacteriapertussis
anaerobic, gram positive, spore formingtetanus
toxin production only occurs when infected by virus carrying tox genediptheria
involve any mucous membrane pharyngeal/tonsillar, exudate on tonsilsdiptheria
exudate from pharyngitis spreads and becomes pseudomembranous which causes respiratory obstructiondiptheria
arthus type reactiondiptheria
arthus type reactionbig red swelling common after booster of dipthera, usually means person has very high serum antitoxin levels and should NOT be given further emergency booster doses more often then every 10 years
highly contagiouspertussis
bacteria attaches to cilia of respiratory epethelial cells. Inflammation occurs and interferes with clearance of pulmonary secretionpertussis
catarrhal stage (pertussis)1-2 weeks
paroxysmal stage (pertussis)1-6 weeks
convalescence stage (pertussis) recovery weeks to months
whole cell pertussis very effective but too many adverse reactions no longer used
acellular pertussisDTaP and Tdap
Children over 7Tdap or Td
every 10 years after Tdap boosterTd
temperature of 105 or greater within 48 hours of vaccine and no other causeDTaP
hypotonic hyporesponsive episodecollapse or shock like state seen with DTaP
persistenet, inconsolable crying over 3 hours within 48 hours of vaccineDTap precaution
complications of pertussispneumonia, seizures, encephalopathy, death
prior seizure, suspected neuro disorder, neuro event between dosesdelay and assess DTaP
stable or resolved neuro disordervaccinate with DTaP
vaccinating child who recovered from pertussisdocumented disease on culture or typical sx and clinical course that can be linked to a culture-confirmed cases, do NOT NEED additional doses of pertussis vaccine
DTaP and Tdap adverse reactionslocal reactions, low grade temp 100.4 or 101 and higher
4th and 5th DTaP doseincreased localized reactions, swelling of entire limb, extensive swelling of arm NOT a contraindication to 5th dose
extensive arm swelling after 4th DTaP doseNOT a contraindication for next round
spores found in soil, animal fecesTetanus
multiple toxins are produced with growth of bacteria. Toxins bind in the neurologic system and interfere with neurotransmittersTetanus
Toxins cause unopposed muscle conttraction and spasmTetanus
Generalized (most common), Cephalic (rare), Local (not common)Tetanus
descending symptoms of trismus, lockjaw, difficulty swallowing, muscle rigidity and spasmTetanus
neonatal tetanusinfant born without maternal immunity usually leads to death
complications of tetanuslaryngospasm, fractures, hypertension, nosocomial infections, pulmonary emobli, aspiration pneumonia, death
unknown or <3 Td with dirty/serious woundgive tetanus immunoglobulin, more than 10 yrs last dose
hx of guillian barrewithin 6 weeks of a previous tetanus toxid containing vaccine

Section 2

Question Answer
aerobic gram negative bacteriaHib
polysachacaride capsule with 6 different serotypes a-f with type b most invasiveHib
causes severe bacterial infection particularly in infantshib
h flu polysaccharide conjugateNeed the conjugate part which is an ineffective antigen that binds with the protein carrier which makes it more effective with booster doses
minimum age for hib vaccine6 weeks, prior to that may induce a tolerance to hib antigen
8 weeks a part first and second dosehib
max age for hib vaccine59 months or 5 years
high risk for hib over 59 monthsasplenia, immunodeficiency, HIV infection, stem cell transplant

Section 3

Question Answer
hepadnaviridae family DNAhep b
humans only hosthep b
bloodborne pathgogenhep b
human carcinogen hepatocellular carcinoma hep b
chronic hepatitis and cirrhosishep b
prodrome of malaise, fever, headache, myalgiahep b
complications of hep bfulminate hepatitis, cirrhosis, liver cancer, death
second dose at least 8 weeks after dose 1 and third dose at least 16 weeks after first dosehep b
birth, 2 months, 9 monthshep b
babies of mothers who are HBsAG+ or unknown should have third doseshould start series right away and, at 6 months of age
premature infants under 2000 gramsderceased response to vaccine, delay giving if mom is negative, if negative give and will need extra dose
adolescent hep b vaccine3rd dose must be seperated from first dose by at least 16 weeks

Section 4

Question Answer
small DNA virusHPV
type 16/18Highest risk, cervical and anogenital cancer females, anal cancer and transmission to female in males
cervarixapproved girls 10-25 years, dose 0,2, 6 months
HPV vaccinecan be given to person with abnormal pap test, positive HPV DNA test, genital warts, immunosuppresion or breastfeeding!
infect mucosal epithelium HPV
HPV clinical featuresaniogenital warts,papillomatosis, cancer precursor CIN, cervical, anal, vulvar, penile and head and neck cancers
sexually transmitted or by direct contactHPV

Section 5

Question Answer
single stranded RNA Orthomyxovirade familyInfluenza
three types (trivalent vaccine) A, B, CInfluenza
Subtypes determined by Hemaggluttinin and neuraminidase h1n2, h3n1
type amoderate to severe illness, all age groups, humans and animals
type bmilder disease, primarily affects children,humans only
type crarely reported in humans
antigenic SHIFTMAJOR change in hemaggluttinin and neuraminidase = Pandemic
antigenic DRIFTMINOR change = epidemic
inactivated flupreg women during flu season, children 6m-18 y on ASA rx
Flu mist contraindicationschildren under 2 or over 50, chronic illness, ASA rx, immunosuppressed, severe anaphylactic reaction to egg or other vaccine component, children younger than 5 yo with recurrent wheezing, moderate or sever illness
7 days or morechildren with live flue will shed this long and replicate the virus in nasopharngeal mucousa

Section 6

Question Answer
paramyxovirus RNAmeasles
highly contagious transmitted by respiratory dropletmeasles
Replicates in nasopharynx and regional lymph nodesmeasles
Primary viremia is 2-3 days after exposure and seoncdary viremia is 5-7 days after exposuremeasles
fever above 103, cough, coryza, conjunctivitis, rash, koplick spots, diarrhea measles
koplick spots in mouthmeasles
Maculopapular rash starts on face and head and becomes confluent measles
rash fades in order of appearancemeasles
all children 12 months and older and again at 4-6 yearsMMR
can get second dose 4 weeks after first doseMMR
second dose is NOT a repeat booster its a re-vaccination for those who do not mount response MMR
grow in chick embryo fibroblast culturemeasles and mumps, OK to give with egg allergy and NO testing needing prior
severe immunosuppresionMMR contraindicated
MMR adverse reactionsfever, rash, joint sx, thrombocytopenia, parotitis, deafness, encephalopathy
Paramyxovirus RNAmumps
respiratory transmission and replicates in nasopharynx and regional lymph nodesmumps
viremia 12-25 days after exposure with spread to tissuesmumps
prodrome of myalgia, malaise, fever and headachemumps
parotitis occurs in about 30-40%mumps
cns involvement, pancreatitis, Orchitis, Deafness, deathmumps
Diagnosed by PCR, positive IgM and IgG increase mumps
Little red Togavirus RNArubella
transmitted by respiratory droplet and replicated in nasopharynx and regional lymph nodesrubella
placenta and fetus infected during viremia phaserubella
maculopapular rash 14-17 days after exposurerubella
arthralgias, thrombocytopenia, purpura, encephalitis, Neuritis, orchitisrubella
Rubella vaccine arthropathyacute arthritis in adult women, acute arthritis s/s
may lead to fetal demise or premature deliveryrubella
infection can affect any organrubella
damage to fetus in first trimester effects it the mostrubella: cataracts, heart defects, microcephaly, mental retardation, bone alterations, liver and spleen damage

Section 7

Question Answer
aerobic gram negative bacteriameningococcal
13 serogroups most invasive A,B,C,Y and W-135meningococcal
does NOT cover B strain which is most common meningococcal
colonizes in nasopharynx and blood streammeningococcal
sever acute bacterial infectionmeningococcal
fever, headache, stiff neckmeningococcal
meningcoccemiablood infection that can occur with menningitis
fever, petechial or purpuric rash, hypotension, shock, multiorgan failuremeningococcal
MPSV4 menomunepolysaccharide acyw135, sub-q injection
MCV4 menactraconjugate with diptheria protein acyw135, IM injection
increased risk for meningococcal military, HCP, travel outside US where epidemic, revaccinate every 5 yrs as long as at an increased risk
HIVNOT a reason to give meningococcal
meningococcal risk for infectionterminal complement deficiency, asplenia, genetic risk factors

Section 8

Question Answer
gram positive bacteria 90 known serotypespneumococcal
abrupt onset fever, shaking chills, chest pain, productive cough, OM, dyspnea, tachypnea, hypoxia, pneumonia pneumococcal
pneumococcal polysaccharidePPSV23
pneumococcal conjugatePCV13
PPSV23not effective kids under 2, accounts for 88% of bactermic pneumococcal disease
PCV13above 90% against invasive disease
PPSV23 recommended for2 or older with: chronic illness, anatomic/functional asplenia, HIV infection, immunocompromised, cochlear implant
dosed 2, 4, 6 and 15 monthsprevnar

Section 9

Question Answer
entovirus RNApolio
enters mouth, replicates in pharynx, GI, local lymphatics and spreads to hematologic and CNSpolio
viral spread among nerve fibers and destruction of motor neurons = paralysispolio
oral polio not available in US, caused vaccine associated paralytic polio, provides gut protection
IPVhighly effective after first dose, duration of immunity unknown, does NOT provide gut protection
2, 4, 6 months and again at 4 yearsIPV

Section 10

Question Answer
reovirus RNArotavirus
oral fecal transmission and replicates in epithelium of small intestinerotavirus
leads to isotonic diarrhea and most common cause of diarrhea in infants and childrenrotavirus
severe dehydration diarrhea with fever and vomiting, metabolic acidosisrotavirus
max age first dose14 weeks
minimum between doses rotavirus 4 weeks
max age for any dose8 months
latex allergy, hx of intussusception, SCIDScontraindication for rotavirus
pre-exsisting gi problem, recently recieved antibody containing productgive rotavirus
preterm infants rotavirusvaccinate when chronological age 6 weeks and out of NICU
pregnant women with infantgive rotavirus

Section 11

Question Answer
spread by respiratory droplet and replicates in nasopharynx and regional lymph nodes including sensory gangliavaricella
Herpes DNA virusvaricella
primary infectioncauses chicken pox
recurrent infectioncauses shingles
rash that starts on head and concentrated on upper trunk, successive crops appearvaricella
reactivation of herpesvirus in a nerve root associated with: aging, immunosupression, intrauterine exposure, chicken pox PRIOR to 18 monthsshingles
bacterial skin infections, pneumonia, cns manifestations, rye syndrome, post herpetic neuralgia, deathvaricella
most at risk for varicellaolder than 15, under one year, immunoompromised, newborns of women with rash onset within 5 days before and 2 days after delivery
congenital varicella syndromefrom maternal infection during pregnancy, low birth wieght, atrophy of extremity, skin scarring, eye abnormalities, neuro abnormalities, period of risk through first 20 weeks but risk is overall low
immunosuppressed patient absolute contraindicatedvaricella
hive infection patient absolute contraindicationvaricella
contraindication varicella vaccinepregnancy
conraindication varicella vaccinerecent blood product
person or family history of seizures of ANY eitologyvaricella contraindicated
3 months between doses under age 13varicella
breakthrough disease much milder with fewer complicationsvaricella
post exposure varicella in person with no immunitycan give within 72 hours of exposure, not ANY good after 5 days exposure
CDC = MMR and Varicella vaccineshould be given as seperate vaccines at 12 months can give combo at 4-6yrs