Vaccinating a lymphoma patient! - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 12-08-2011
USMLE Forums Addict
 
Steps History: Not yet
Posts: 129
Threads: 18
Thanked 188 Times in 62 Posts
Reputation: 198
Syringe Vaccinating a lymphoma patient!

A 60 year old man with T cell lymphoma is currently on chemotherapy. He visits his primary care physician. He was just diagnosed with this malignancy 2 months ago aand has been seeing his oncologist since that time. He has not received any immunizations over the past 10 years which of the following vaccines should his physician administer ?
a) Hep A
b) Hep B
c) Hep A+B
d) Inactivated influenza vaccine
e) Inactivated influenza vaccine + pneumococcal polysaccharide vaccine
f) Pneumococcal polysaccharide vaccine

I dont know this question got me a little bit confused
Reply With Quote Quick reply to this message



  #2  
Old 12-08-2011
bassatom's Avatar
USMLE Forums Veteran
 
Steps History: Step 1 Only
Posts: 260
Threads: 28
Thanked 156 Times in 54 Posts
Reputation: 166
Send a message via Skype™ to bassatom
Default

I think it would probably be E. Since he is immunocompromised it makes more sense to give him and influenza and pneumococcal vaccine
Reply With Quote Quick reply to this message
  #3  
Old 12-08-2011
USMLE Forums Addict
 
Steps History: Not yet
Posts: 129
Threads: 18
Thanked 188 Times in 62 Posts
Reputation: 198
Default

Well this is what i thought first and answered
Reply With Quote Quick reply to this message
 
  #4  
Old 12-08-2011
bassatom's Avatar
USMLE Forums Veteran
 
Steps History: Step 1 Only
Posts: 260
Threads: 28
Thanked 156 Times in 54 Posts
Reputation: 166
Send a message via Skype™ to bassatom
Default

Quote:
Originally Posted by sam88 View Post
Well this is what i thought first and answered
Then whats the answer?
Reply With Quote Quick reply to this message
  #5  
Old 12-08-2011
jaimin's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 264
Threads: 15
Thanked 98 Times in 56 Posts
Reputation: 108
Default

Quote:
Originally Posted by sam88 View Post
Well this is what i thought first and answered
I would also say E - Both Pnemo and Influenza
What is answer then?
Reply With Quote Quick reply to this message
  #6  
Old 12-08-2011
USMLE Forums Addict
 
Steps History: Not yet
Posts: 129
Threads: 18
Thanked 188 Times in 62 Posts
Reputation: 198
Default

Kaplan q bank said its only pneumococcal...but i dont know.. what do u think ?
Reply With Quote Quick reply to this message
  #7  
Old 12-08-2011
bassatom's Avatar
USMLE Forums Veteran
 
Steps History: Step 1 Only
Posts: 260
Threads: 28
Thanked 156 Times in 54 Posts
Reputation: 166
Send a message via Skype™ to bassatom
Default

Cancer patients can become significantly immunocompromised, particularly in the case of blood dyscrasias such as leukemia and lymphoma, and in advanced disease.[4] Radiation and chemotherapy can also significantly impair the immune system. Immunosuppressive cancer chemotherapy agents include alkylating agents, antimetabolites, mitotic inhibitors, and antibiotic antineoplastic agents.[4]
To protect oncology patients against vaccine-preventable diseases, health care providers should verify that these patients have received all universally recommended vaccines, as well as pneumococcal and influenza vaccines. Patients who have not been fully vaccinated should receive the necessary immunizations soon after their cancer is diagnosed. If this is not possible, they should be vaccinated during disease remission at least 3 months after chemotherapy or radiation therapy.[4,7]
However, because of the seasonal nature of influenza outbreaks, there may be more risk than benefit to delaying the administration of influenza vaccine for 3 months. The American Academy of Pediatrics recommends waiting just 3 to
4 weeks after immunosuppressive therapy before administering influenza immunization. If peripheral granulocytes and lymphocytes exceed 1,000 cells/mm[3], a reasonable response to vaccination can be expected.[30]
Live vaccines should generally be avoided in immunosuppressed oncology patients. However, leukemia patients in remission may receive live-virus vaccines 3 months after their last round of chemotherapy.[7] In addition, varicella-zoster vaccine may be indicated for children with acute lymphocytic leukemia who might be exposed to chickenpox. To receive this live vaccine, the child must have been in remission for at least 1 year, must have lymphocyte counts greater than 700 cells/mL and platelet counts greater than 100,000 cells/mL 24 hours before the immunization.[31,32]


source :http://www.medscape.com/viewarticle/421487_6
Reply With Quote Quick reply to this message
The above post was thanked by:
sam88 (12-08-2011)
  #8  
Old 12-08-2011
pass7's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS+3
Posts: 406
Threads: 30
Thanked 141 Times in 109 Posts
Reputation: 151
Default

e) Inactivated influenza vaccine + pneumococcal polysaccharide vaccine
Reply With Quote Quick reply to this message
  #9  
Old 12-08-2011
jaimin's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 264
Threads: 15
Thanked 98 Times in 56 Posts
Reputation: 108
Default

Quote:
Originally Posted by bassatom View Post
Cancer patients can become significantly immunocompromised, particularly in the case of blood dyscrasias such as leukemia and lymphoma, and in advanced disease.[4] Radiation and chemotherapy can also significantly impair the immune system. Immunosuppressive cancer chemotherapy agents include alkylating agents, antimetabolites, mitotic inhibitors, and antibiotic antineoplastic agents.[4]
To protect oncology patients against vaccine-preventable diseases, health care providers should verify that these patients have received all universally recommended vaccines, as well as pneumococcal and influenza vaccines. Patients who have not been fully vaccinated should receive the necessary immunizations soon after their cancer is diagnosed. If this is not possible, they should be vaccinated during disease remission at least 3 months after chemotherapy or radiation therapy.[4,7]
However, because of the seasonal nature of influenza outbreaks, there may be more risk than benefit to delaying the administration of influenza vaccine for 3 months. The American Academy of Pediatrics recommends waiting just 3 to
4 weeks after immunosuppressive therapy before administering influenza immunization. If peripheral granulocytes and lymphocytes exceed 1,000 cells/mm[3], a reasonable response to vaccination can be expected.[30]
Live vaccines should generally be avoided in immunosuppressed oncology patients. However, leukemia patients in remission may receive live-virus vaccines 3 months after their last round of chemotherapy.[7] In addition, varicella-zoster vaccine may be indicated for children with acute lymphocytic leukemia who might be exposed to chickenpox. To receive this live vaccine, the child must have been in remission for at least 1 year, must have lymphocyte counts greater than 700 cells/mL and platelet counts greater than 100,000 cells/mL 24 hours before the immunization.[31,32]


source :http://www.medscape.com/viewarticle/421487_6
According to your explanations and as given in Kaplan Live bacterial and viral vaccine are contraindicated .
But why INactivated should not be given?
Reply With Quote Quick reply to this message
  #10  
Old 12-08-2011
drnrpatel's Avatar
Guest
 
Steps History: 1+CK+CS
Posts: 441
Threads: 153
Thanked 396 Times in 211 Posts
Reputation: 419
Default

e) Inactivated influenza vaccine + pneumococcal polysaccharide vaccine

http://www.immunize.org/catg.d/p3072.pdf (These are CDC recommendations and it clearly shows no C/I to immunodeficiency in Injectable inactivated Influenza Vaccine and Pneumococcal,too.
Reply With Quote Quick reply to this message
  #11  
Old 12-11-2011
Adamentium's Avatar
USMLE Forums Scout
 
Steps History: 1+CK+CS+3
Posts: 64
Threads: 12
Thanked 95 Times in 20 Posts
Reputation: 105
Default

Quote:
Originally Posted by sam88 View Post
Kaplan q bank said its only pneumococcal...but i dont know.. what do u think ?
May be because they haven't mention Winter months in the stem. Influenza vaccine is given only during winter months when the chances of developing it are high. Usually they mention any of the four months esp Dec and Jan when they want to take you to Influenza vaccine. This is what I think as per many questions that had Influenza in answer also mentioned winter in the stem.
Reply With Quote Quick reply to this message



Reply

Tags
Infectious-Diseases, Preventive-Medicine-, Step-2-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
why B cell type lymphoma is more common than T cell type lymphoma? HaipengWang USMLE Step 1 Forum 1 10-15-2011 08:47 AM
immunization in lymphoma aghammoud85 USMLE Step 2 CK Forum 1 08-05-2011 04:21 AM
What would you expect to have in this Lymphoma! usmle2011 USMLE Step 1 Forum 9 07-27-2011 03:22 AM
Vaccinating this alcoholic man! Drre USMLE Step 2 CK Forum 4 07-06-2011 06:01 PM
Lymphoma Translocation! khushboo USMLE Step 1 Forum 3 05-24-2010 08:50 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)