New: our faculty are still reviewing these cards. Spotted an error? Use “Report an issue” on the card in the app, or contact us.

Vaccines, PEP & asplenia flashcards

13 high-yield MRCP Part 1 cards from the Intellect Medicos Infectious Diseases course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.

Study these 13 cards Save progress — free account

1. Name four live attenuated vaccines used in the UK.

   Show answer

   Any four of: BCG, MMR, varicella, yellow fever, oral typhoid (Ty21a), rotavirus, live intranasal influenza (LAIV).

   Why? Live vaccines can cause disease in the severely immunosuppressed and are generally avoided in pregnancy.

2. Is BCG vaccine given to people living with HIV in the UK?

   Show answer

   No — BCG is contraindicated in HIV infection.

   Why? It is a live mycobacterial vaccine and can cause disseminated BCG disease in immunosuppression.

3. Above what CD4 count can an adult with HIV receive MMR or varicella vaccine?

   Show answer

   CD4 >200 cells/mm³ (and clinically stable).

   Why? Below this the risk from the live vaccine outweighs its benefit.

4. Which three encapsulated organisms most commonly cause overwhelming post-splenectomy infection?

   Show answer

   Streptococcus pneumoniae (commonest), Haemophilus influenzae and Neisseria meningitidis.

   Why? The spleen's macrophages clear opsonised encapsulated bacteria. Capnocytophaga canimorsus after dog bites is another classic risk.

5. What long-term antibiotic prophylaxis is offered after splenectomy?

   Show answer

   Oral phenoxymethylpenicillin (penicillin V); erythromycin if penicillin allergic.

   Why? Lifelong in children and in high-risk adults; at least the first 2 years in other adults.

6. When should vaccines be given for an elective splenectomy?

   Show answer

   Ideally 4–6 weeks (and at least 2 weeks) before surgery: pneumococcal (PCV20 or PPV23), MenACWY and MenB, plus annual influenza.

   Why? An intact spleen gives a better antibody response. If this is not possible, vaccinate at least 2 weeks after surgery. Extra Hib vaccine is no longer recommended; pneumococcal vaccine is repeated every 5 years.

7. What is the first-line HIV post-exposure prophylaxis regimen in the UK (BHIVA/BASHH), and for how long?

   Show answer

   Tenofovir disoproxil/emtricitabine plus raltegravir for 28 days.

   Why? Start as soon as possible, ideally within 24 hours; PEP is not started beyond 72 hours after exposure.

8. Is HIV PEP recommended after a human bite?

   Show answer

   Generally no — transmission risk is negligible.

   Why? It is considered only in exceptional cases (blood-stained saliva, high source viral load and deep injury). Spitting carries no indication.

9. A vaccinated healthcare worker who is a known non-responder (anti-HBs <10 mIU/mL) has a needlestick from an HBsAg-positive patient. What is given?

   Show answer

   HBIG plus a booster dose of hepatitis B vaccine, with a second dose of HBIG one month later.

   Why? Non-responders have no protective antibody, so passive immunity is needed. Known responders need only a booster dose if their last dose was a year or more ago.

10. What is the post-exposure management after a needlestick from a hepatitis C-positive source?

    Show answer

    No vaccine or PEP; baseline testing, then follow-up HCV RNA/antibody testing (e.g. at 6 weeks, 3 and 6 months), with early referral if infection occurs.

    Why? Early HCV infection is curable with direct-acting antivirals.

11. What is the preferred post-exposure prophylaxis for most contacts of hepatitis A?

    Show answer

    Hepatitis A vaccine (within 14 days of exposure).

    Why? HNIG is added (if susceptible) for contacts aged 60 or over and for those with chronic liver disease, chronic hepatitis B or C, HIV or immunosuppression.

12. Which oral drug combination is used for HIV pre-exposure prophylaxis (PrEP) in the UK?

    Show answer

    Tenofovir disoproxil + emtricitabine (TD-FTC), taken daily or event-based; tenofovir alafenamide + emtricitabine (TAF-FTC) is an alternative, e.g. under 18s or eGFR <60.

    Why? Before starting, confirm HIV-negative status and check renal function and hepatitis B status (offer HBV vaccine if non-immune).

13. Is the shingles vaccine used in the UK programme (Shingrix) live?

    Show answer

    No — it is a non-live recombinant (adjuvanted glycoprotein E) vaccine given as two doses.

    Why? Because it is not live, it can be given to immunosuppressed people, who are at the highest risk of shingles.