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209 Cards in this Set
- Front
- Back
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Passive Immunity (Natural & Artificial) |
Transfer of performed antibodies, short-term, immune system not involved |
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Adaptive Natural- Active |
Immunity gained from infection by pathogen itself |
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Adaptive Artificial - Active |
acquired immunity through receiving vaccination |
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Immunization |
The process of conferring increased resistance (decreased susceptibility) to infection |
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The reason vaccines are made |
To fight against diseases that cause most deaths, prevent severe diseases and prevent significant suffering |
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Herd Immunity |
Spread of contagious disease is contained by most of the population getting immunized |
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What are some parent/patient barriers of immunizations? |
Problems of logistics (Lack of access to transportation), Finance (insurance), or knowledge and attitude issues, such as concerns about vaccine safety issues |
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What year was the very first vaccine made? |
1890 - Tetanus |
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What year was the first vaccine made to target a cause against cancer? |
1981 - Hep B |
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What is a vaccine? |
Introduction into the body of a substance that will prevent infection by a certain pathogen. |
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What type of memory do vaccines create? |
Immune memory.
Not ALL vaccines create immune memory, but MOST do.
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What type of cells remain after exposure to a vaccine? |
T&B lymphocytes |
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What percentage of herd immunity is needed to stop spread of disease |
80-95% - to stop a virus. Depends on the particular VPD |
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Who monitors vaccine safety continually? |
the CDC |
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Two main points regarding Vaccine Safety |
- must not cause the disease - side effects minimal
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Two main points regarding Vaccine Efficacy |
-Activation of humoral (and cell mediated) immune response shown by a particular antigen -Development of immunologic memory by the particular antigen |
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Vaccine component: Adjuvant |
Chemical substance added to vaccine to enhance immune response |
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Vaccine component: Alum |
Inorganic salt, slowly dissolves - releasing vaccine |
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Vaccine component: Bacterial extracts |
Enhance immune response |
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Live, Attenuated Vaccine |
Virulent strain grown - adverse conditions. Both cell mediated & humoral response |
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Killed or Inactivated Vaccine |
Bacteria/Virus completely killed by chemical means (formaldehyde). Humoral response. |
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Toxoids |
Pathogenic toxin modified into harmless toxoid |
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Subunit and Conjugate Vaccines |
Specific, purified macromolecules derived pathogens |
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Contradictions for Killed, inactivated vaccines |
Allergy to vaccine component |
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Contradictions for Live, Attenuated vaccines |
Allergy Pregnant Immunocompromised host HIV Chemotherapy Cancers |
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A common misconception among those choosing not to be vaccinated or to not vaccinate their children: |
Many vaccine preventable diseases are not longer a threat and can easily be cured by miracles of modern medicine |
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3 Clinician Barriers for Vaccination: |
1. Inadequate Clinical Knowledge 2. Missed opportunities 3. Language Barriers |
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Other names for Diptheria |
Bull neck "Strangling angel" |
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MOA for Diptheria |
Toxin attacks nervous system, difficulty speaking, swallowing, tonsillar membrane can obstruct breathing |
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Other names for Tetanus: |
Neonatal tetanus Lockjaw |
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Unsterile cutting of the umbilical cord puts the patient at risk for what? |
Neonatal tetanus. |
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Another name for Pertussis |
Whooping cough |
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diphtheria, tetanus, and pertussis are what type of diseases? |
Bacterial
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DTaP schedule: |
2months, 4months, 6months, 18months, 4-6 years |
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Age you receive Tdap |
11~12 |
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Adults need on Td booster every _____ years. |
10 |
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What type of vaccine in DTaP? |
Toxoids - Pathogenic toxin modified into harmless toxoid. |
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Other names for Measles |
Rubeola Morbille English measles |
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what causes measles? |
Paramyxovirus of the genus Morbillivirus.
Highly contagious!
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what causes Mumps? |
Rubula virus from paramyxovirus family. |
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What is the only virus to cause Epidemic Parotitis? |
Mumps |
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Other names for Rubella: |
Congenital Rubella German measles 3 day measles |
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What causes rubella? |
Rubella virus.
Highly contagious |
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If you are pregnant when you contract _______, the consequences for your unborn child can be severe. |
Rubella.
Get vaccinated before you get pregnant! |
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MMR Vaccine Schedule (or MMRV) |
12months, 4-6years |
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MOA of Polio |
Attacks neurons. Specific to humans. |
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Who created the first Polio vaccine and when? |
Jonas Salk - 1952
IPV - Inactivated Poliovirus Vaccine |
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Who created the second Polio vaccine, what type, and when? |
Albert Sabin - 1962
OPV - Live attenuated oral poliovirus vaccine |
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What is the schedule for IPV? (Polio) |
2months, 4months, 6months, 4-6years |
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What is the causative agent of Haemophilus Influenzae? |
a Bacterium, Pasteurellaceae family. |
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What is the MOA of HiB? |
Opportunistic - often attacks after preceding viral infection. |
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What is another name for Haemophilus Influenzae Type B? |
Bacterial influenza |
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HiB vaccine schedule: |
2months, 4months, 6months, 12months |
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What is the most common cause of invasive bacterial disease in U.S. children? |
Streptococcus pneumoniae |
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Before vaccination, what 3 main diseases were caused by streptococcus pneumoniae? |
- Pneumonia 50,000 - Meningitis 3,000 - Otitis Media 7million |
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What is a major cause of morbidity and mortality in the US, especially in infants and the elderly? |
Pneumococcal Disease |
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What VPD has been eliminated from the U.S? |
Polio |
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What VPD has been eradicated from the planet? |
Smallpox |
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Which type of Pneumococcal Vaccine results only in temporary immunity? |
PPV
-Repeated doses do not produce a boost in antibody titers. |
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______ is effective in older children and adults, but children younger than 2 years do not produce reliable immune reposes to polysaccharide antigens. |
PPV |
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Which Pneumococcal Vaccine stimulates long term T-cell immunity and produces herd immunity? |
PCV |
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In children younger than 2 years, ______ in effective against bacteria including penumococcus. |
PCV |
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At what age do older adults receive a PPV booster? |
65+, one dose |
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PCV schedule: |
2months, 4months, 6months, 12-15months |
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MOA of Meningococcal: |
Invasive: bacterium penetrates the nasal mucosa and invades the bloodstream |
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What occurs in 50% of invasive meningococcal disease? |
Meningitis |
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What causes Meningococcal disease? |
Neisseria meningitidis |
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Risks for Meningococcal? |
Smokers Asplenic URI household crowding - COLLEGE DORMS
probably also HIV |
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Who should receive MPSV4? |
Ages 2 and older. high risk.
Stimulates temporary protective antibody production but produces poor immunogenicity in children younger than 2 years. |
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Who should receive MCV4? |
*All children 11-12 years. College freshman living in dorms Adolescents not previously vaccinated should receive it before entering high school (15 yrs) |
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How is Hep B transmitted? |
Sexually, Infected needles, Perinatal |
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What is the main cause of death from HepB? |
Acute and chronic liver disease |
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What happened in 1990 with Hep B? |
U.S. PHS modified its high-risk strategy and recommended universal infant vaccination! |
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Hep B schedule: |
BIRTH, 2months, 6-12 months |
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What causes Hep A? |
Nonenveloped RNA picornavirus |
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How is Hep A spread? |
by fecal-oral transmission |
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Hep A causes about _____ deaths per year in the U.S. |
100 |
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What are the two types of inactivated whole-virus vaccines for Hep A? |
Havrix & Vaqta |
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Hep A schedule: |
12 months; 18months |
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ABC's of Influenza virus |
C - is mildest B - can make a person such as A but not cause pandemic A - is most virulent and behind pandemics
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Other names for Influenza |
La Grippe |
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How many types of vaccinations for Influenza? |
2 - Live attenuated and Killed inactivated |
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What year was the first quadrivalent 4 strain flu vaccine produced? |
2012 |
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Influenza schedule: |
**12months Adolescents 7-18: Annual flu shot 19-49: secondary to risk factors 50+: Annual flu shot |
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Another name for Varicella |
Chickenpox |
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What causes Varicella? |
Varicella zoster virus |
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Varicella vaccine schedule: |
12months, 4-6years
MMRV is possible |
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What is Herpes Zoster? |
Varicella zoster that is re-activated (Shingles) |
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Herpes Zoster Vaccine Schedule: |
60+ : one dose |
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Principle cause of death from diarrheal disease in children under 5 occurs in: |
Rotavirus |
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Which vaccine was withdrawn from market in 1999 because it caused intussusception? |
Rotavirus |
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How is RotaTeq administered and what is the schedule? |
Orally. 2months, 4months, 6months. |
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Is rotarix licensed in the U.S.? |
Not as of 2007 |
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What is the most commonly sexually transmitted infection in the U.S.? |
HPV - estimated 20 million americans are currently infected. |
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In a minority of women, persistent infection of HPV can lead to what? |
Cervical Cancer |
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Two types of HPV vaccine: |
Gardasil & Cervarix |
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Who can receive Gardasil? |
Male and female |
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Who can receive Cervarix? |
Females |
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HPV Vaccine Schedule: |
0, 2, and 6 month intervals.
Ages 11-12
Women up to age 26 |
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What two diseases causes the most child deaths? |
Rotavirus and Pneumococcal |
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Children in low-income countries are _______ times more likely to die under age 5 from VPD than high-income countries. |
18 times |
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What vaccines should world travelers get? |
HepA, HepB, Meningococcal, Japanese encephalitis, polio, plaque, rabies, typhoid fever. |
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Primary debate/Controversy over self-examination |
whether self-examination reduces morbidity or mortality |
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How many breast cancers are FIRST detected by a patient? |
50%-90% |
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How many breast cancers are detected between exams/office visits? |
13%-17% |
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Key barriers to compliance of self-exams |
- Fear of finding an abnormality - Embarrassment - Lack of time - Forgetting |
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How should testicles feel? |
smooth, rubbery, and slightly tender
(no lumps) |
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what do some people mistake for an abnormal lump when palpating the testes? |
the epididymis |
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Where should you perform a testes self-exam |
warm bath or shower |
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Objections to teaching self-examination |
- not enough time to teach proper technique - lack of evidence that teaching is effective - self-reports of performance may not correlate with either actual performance or improved detection |
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Potential harms of self-exams |
- patients finding no abnormalities may forego routine clinical examinations - a negative clinical finding for a patient-detected abnormality might cause patient to discontinue further screening - not clear whether standardized self-examination is better than incidental detection |
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Summery of breast self-exam controversy |
breast self-examination has the potential to reduce morbidity and mortality through early detection |
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what are you looking for in step 1 of breast exam |
- breasts are their usual size, shape and color - breasts that are evenly shaped without visible distortion or swelling
bad signs: dimpling, puckering, bulging, nipple that changed position or inverted, redness, soreness or swelling |
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Does screening improve survival rates with testicular cancer? |
For testicular cancer, survival is good even without screening |
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sensitivity for physicians breast exam vs patient BSE |
physician - 40-69%
BSE - 26-41% |
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Why are self breast exams thought to have a low predictive power? |
a large proportion of abnormalities are actually benign |
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What are women who perform routine self breast exams also most likely to do? |
Undergo clinical screening and routine mammograms |
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how many steps in the skin exam? |
8 |
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What are useful adjuncts to teaching self-exams? |
Patient education materials |
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Offices and clinics should have what things for self-exams? |
-should have private examination rooms for teaching and counseling - models, diagrams, and illustrations are useful teaching aids - materials that define and illustrate abnormal results are very important - photographs of malignant and pre-malignant skin lesions may hep the patient identify important skin findings |
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3 chemoprophylactic situations discussed |
1. estrogen receptor modulators to prevent breast cancer 2. aspirin to prevent heart disease, stroke, and cancer 3. postmenopausal hormone therapy to chronic conditions such as heart disease |
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The most commonly diagnosed non-skin cancer among women in the US |
Breast Cancer |
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Strongest risk factors for breast cancer |
1. Age 2. Family history (genetics) |
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what hormone levels plays a role is breast cancer |
estrogen |
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Tamoxifen Success |
- Reduced the risk of new cancer in the opposite breast by 47%
- 38% reduction in breast cancer incidence after 5 years of therapy |
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Raloxifen Success |
- 72% reduction in breast cancer incidence in postmenopausal women with osteoporosis after 4 years of therapy
- 44% reduction in breast cancer incidence in postmenopausal women with coronary heart disease after 4 yeas of therapy |
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In the STAR trial - directly comparing Tamoxifen and Raloxifen - what was the percent that they BOTH effectively reduced expected breast cancer? |
50% |
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Risk of Tamoxifen and Raloxifen
(PUSH SVD) |
- pulmonary embolism - stroke - deep venous thrombosis - strage 1 endometrial cancer - uterine sarcome - hot flashes - vaginal discharge
(actual number of evens are small - not statistically significant) |
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USPSTF recommendations on Tamoxifen and Raloxifen |
- recommends against routine use of tamoxifen and raloxifen for the primary prevention of breast cancer in women at low or moderate risk
-recommends that clinicians discuss chemoprevention with women at hight risk for breast cancer and at low risk for adverse effects of chemoprovention |
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What group is mostly likely to benefit from counseling about pros and cons of breast cancer prevention? |
The Young women at higher risk for breast cancer |
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An estimated 5-year risk can be calculated from what? |
The Gail risk model calculator |
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What women does the tamoxifen and raloxifen not apply to? |
Women with genetic abnormalities such as BRAC1 and BRAC2 |
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Contraindications for Tamoxifen and Raloxifen
(SLVC) |
- Vaginal bleeding - Chest pain - shortness-of-breath -leg pain or swelling |
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What kind of dose should be given for primary prevention of heart disease, stroke and possibly cancer? |
Low dose (50-325mg/day) |
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Why is use of aspirin for primary prevention controversial? |
- benefits and adverse effects in low risk patients are closely more balanced
- patients who should take aspirin require careful consideration of risk and patient preferences |
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USPSTF recommendations on aspirin |
USPSTF recommends that clinicians discuss aspirin prophylaxis with patients having a 10-year risk of CHD events 6 percent or greater |
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Clinical Trials: Aspirin and Women |
- aspirin reduced the risk of ischemic stroke by 24%
- aspirin has no overall effect on MI but did reduce the risk of MI in women age >65
- the risks of adverse events was similar to previous clinical trials |
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Clinical Trails: Aspirin and Men |
- men who take aspirin reduce their relative odds of coronary evens by 28%
- aspirin may reduce the risk of fatal CHD events by 13% (not statistically significant)
- aspirin did NOT reduce the risk of ischemic stroke |
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aspirin and stoke |
shown to decrease risk in women by 24% but not in men |
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Aspirin adverse events in Men |
- GI bleeding - Hemorrhagic stroke |
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Counseling on Aspirin |
discuss the risks and benefits of routine aspirin use with men and women older than 40 |
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Counseling AGAINST aspirin use based on 10-year risk of Cardiovascular heart disease |
men with a 10-year CHD risk <5 %
women with a 10year CHS risk <2 % |
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When is it okay for aspirin to be recommended? |
aspirin can be recommended for patients with increased CHD risk who are not at increased risk for adverse events |
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Routine aspirin use may not be appropriate for patients with a history of: |
- peptic ulcer disease - GI bleeding - cerebral hemorrhage - uncontrolled hypertension - bleeding diathesis - allergy to aspirin - liver or kidney disease - diabetic retinopathy |
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Women's health study indicated the prophylactic use of estrogen resulted in increased risk of: |
- breast cancer - myocardial infarction - stroke - deep vein thrombosis
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The use of prophylactic estrogen reduced the risk of: |
Colorectal cancer and fractures |
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USPSTF recommendations on postmenopausal estrogen
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recommends against the routine use of any type of estrogen for the prevention of chronic conditions in postmenopausal women |
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Estrogen therapy and osteoporosis |
Estrogen is effective for prevention of osteoporosis and fractures, although other FDA- approved treatment are also available. |
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Contraindications for Estrogen therapy:
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- prior or current breast cancer - pregnant - thrombophlebitis - endometrial cancer - unevaluated abnormal vaginal bleeding |
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What percentage of women aged 15-44 practice some form of birth control |
64% |
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What percentage of pregnancies are unintended? |
49% |
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What percentage of pregnancies in women older than 35 are unintended? |
more than 30% |
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How effective in preventing pregnancy are OCAs IF taken correctly? |
99% |
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Responsible Sexual Behavior definition |
"Sexual health is a state of physical, emotion, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled. |
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How many days do you have to report primary and secondary syphilis? |
telephone the local reporting authority within 1 business day and submit form within 7 business days |
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What type of male condom reduces the risk of STIs and HIV if used correctly? |
latex |
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Most frequently reported STD in US |
Chlamydia |
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What are the rates of chlamydia in females vs males |
2.5x higher in females
(Higher screening rates in women) |
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Strategies for Counseling about STIs |
1. Be matter of fact 2. Ask permission to discuss 3. Acknowledge & support positive change 4. Avoid assumptions concerning sexual orientation 5. Communicate clearly with appropriate language 6. No judging! 7. Dispel myths, misconceptions & misinformation 8. Focus the encounter & use open-ended questions 9. Negotiate for concrete behavioral change that will reduce STI & HIV risk 10. Provide skill-building opportunities |
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2nd most commonly notifiable disease |
Gonorrhea |
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Who has the highest rates of gonorrhea? |
Women highest rates age 15-24 years old
Men highest rates 20-24 |
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What year had the lowest national reporting on Gonorrhea? |
2009 |
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What year and disease had the most reported cases to the CDC for any condition? |
2010 - Chlamydia |
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What two diseases commonly co-occur in men who have sex with men? |
HIV and syphilis |
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When should you screen sexually active teens for STIs? |
at whatever age! |
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when do you begin counseling, screening and preforming preventative care? |
@ 13-15 years |
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When do you begin pap smears? |
Begin within 3 years of 1rst intercourse |
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Contraceptive methods |
- barrier - chemical - hormonal - family planning - postcoital contaception - sterilization - abstinence |
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Unreliable Contraceptive Methods |
- coitus interruptus (withdrawal) - withdrawal of penis from vagina before ejaculation - post-coital douching - lactation prolongation - lactational amenorrhea method (LAM) |
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What is the failure rate of fertility awareness methods? |
20% |
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What is the method and advantages of Fertility Awareness Methods? |
Avoid intercourse during "fertile" days
Advantage: self-knowledge of a women's cycles |
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disadvantages of FAM? |
- high failure rate - should not be used in women with irregular menstrual cycles - requires frequent monitoring of body functioning and requires time |
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Barrier method types |
- condoms - male - females - cervical cap - diaphragm - sponge |
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failure rate and risk of male condom? |
11%; irritation and allergic reaction |
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Advantages of male condoms: |
- offers some protections against STIs if latex or polyurethane - can be used in combination with other methods - no Rx needed - readily available and inexpensive - use as a back-up |
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Disadvantages of male condoms: |
- patients find distracting, uncomfortable, embarrassing, non-private - risk of improper placement and removal - one-time use - applied immediately before intercourse - high failure rate |
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Failure rate and risk of female condoms: |
21%; irritation and allergic reaction
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Advantages of Female condoms: |
- offers some protection against STIs - can be placed up to hours before intercourse - no Rx needed - use as a back-up method |
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Disadvantages of Female condoms: |
- patients find distracting, uncomfortable, embarrassing, non-private - risk of improper placement and removal - one-time use - high failure rate |
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What is the method and failure rate of the sponge? |
Spermicidal; blocks semen from entering cervical canal
29% |
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Advantages of the sponge: |
- OTC - can be placed immediately before intercourse or up to 20 min prior - provides lubrication - can be used as a back-up plan method
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Disadvantages of the sponge: |
- High failure rate - messy
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Failure rate of Diaphragms |
17% |
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Risk and Contraindications of Diaphragms: |
Risks: Irritation, allergic reaction, UTI
Contraindication: History of toxic shock syndrome (TTS) |
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Advantages to Diaphragms: |
- Privacy of use - inserted before intercourse and left in place for at least 6 hours after intercourse - use with spermicides
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Disadvantages of the Diaphragm: |
- Require RX and office visit for proper fitting - weight changes require re-fitting |
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Description of a diaphragm: |
rubber dome-shaped device |
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Chemical methods: method of BC and failure raite |
Inactivate sperm
20-50% failure rate if used alone |
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Risk of Chemical methods |
irritation, allergic reaction, UTI |
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Advantages of chemical methods: |
- privacy of use - variety of forms (gel, creams, foam, suppositories, film) - NO RX required - inserted 5-90 min before intercourse - you can use it in conjunction with other methods (condoms, diaphragms, ext) |
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Disadvantages of Chemical methods: |
- irritation - high failure rate if used alone - messy
(only recommend this if you also recommend a condom or barrier) |
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Types of Hormonal contraceptives |
- the pill - the patch - the ring - the shot - implants - IUD* - postcoital* |
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What is the overall failure rate of hormonal methods |
<2 |
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what is the overall failure rates of barrier methods with/without chemicals |
15-25 |
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What method is 100% effective? |
abstinence |
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When should you never ever ever recommend an OCA to a women? |
if she smokes |
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What is the primary goal of all contraception? |
to prevent the sperm and oocyte from uniting |
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How do OCAs work: |
- inhibiting ovulation - altering cervical mucous - atrophy of endometrium (implantation site) - altering tubal motility and secretion |
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How many women use the pill |
1/3 of all women |
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what is the most used reversible form of contraceptive used in the US? |
the pill |
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Failure rate of OCA/the pill |
<1
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Contraindications for oral contraceptives: |
age >35 and smoke history of or current Coronary artery disease, TED(thromboembolic disease), CVA, breast cancer, liver disease |
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Advantages of oral contraceptives: |
- reversible - offers other benefits in addition to contraception - can be used continuously - fewer cycles per year - decrease risk of endometrial and ovarian cancer |
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Disadvantages of oral contraceptives: |
- Rx needed - daily schedule use important - cost varies by brand & insurance plan allowances - occasional wt gain |
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Therapeutic Uses of OCA |
- contraception - cycle control - manage menometrorrhagia, menorrhagia, pelvic pain - PMS, Acne, Hirsuitism, PCO, ovarian cysts - Lower incidence of benign breast disease - lower cancer risk (ovarian and endometrial) - hormone replacement therapy |
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Failure rate of the ring: |
1-2% |
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Disadvantages to the Ring: |
- RX NEEDED - if the ring is expulsed outside of the Vagina for more than 3 hours, an alternative method is required - irritative side effects - higher costs |
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Advantages for the Ring: |
- Reversible - offers other benefits - places weekly by patient - local administration so less systemic side effects expected |
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Contraindications to the Ring |
Age >35 and smoke history of or current CAD, TED, CVA, breast cancer, liver disease |
