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step II > amboss 6/24 > Flashcards

amboss 6/24 Flashcards

1
Q

what areas are endemic for hepatitis A

A

South America, Africa, Asia, Eastern Europe, Mexico, central America

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2
Q

when is flu season; when should the vaccine be offered

A

in the fall around October - April

offered from May-October

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3
Q

when is the shingles vaccine recommended

A

greater than 50 regardless of history

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4
Q

when is DEXA scanning recommended

A

65 + or in younger post menopausal women with a history of fracture

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5
Q

what are the indications for using oseltamivir for flu

A

asthma, young children, elderly individuals. It can shorten the duration of the illness and reduce the complications

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6
Q

what type of medication is oseltamivir

A

neuramidase inhibitor

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7
Q

when must oseltamivir be used to be effective

A

within the first 48 hours of symptom onset

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8
Q

what are the recommendations for low dose ct scan screening for lung cancer

A

annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 55–80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years.

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9
Q

what are the recommendations for pneumococcal vaccine 13

A

PCV13 is currently recommended for all individuals ≥ 65 years with an immunocompromising condition (e.g., CLL, chemotherapy) and should be followed by the pneumococcal polysaccharide vaccine 23 (PPSV23) at least 8 weeks later

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10
Q

what are the recommendations for pneumoccocal 23

A

Pneumococcal polysaccharide vaccine 23 (PPSV23) offers protection against several subtypes of Streptococcus pneumoniae and related diseases. PPSV23 should be administered to healthy individuals ≥ 65 years of age.

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11
Q

Is Hep B given to low birth weight infants

A

not until 1 month of age, since they are low birth weigh t

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12
Q

when is rotavirus vaccine given and what is a contraindication

A

2, 4, 6 months

intussusception

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13
Q

what is a relative contraindication for pertussis

A

uncontrolled seizure disorder

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14
Q

what type of vaccine is meningococcal

A

polysaccharide conjugate

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15
Q

what is normal sleep latency

A

<30 min

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16
Q

what are the normal changes in sleep architecture as we age

A

increased sleep latency, longer light stages of sleep with increasing frequency of nighttime awakenings, decreased time in the deep sleep phase (stage 3), shorter REM phases, as well as waking up earlier, all of which can make individuals feel more tired.

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17
Q

when is a child expected to be able to feed themselves with a spoon?

A

when they are 15 months old

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18
Q

How many words should a child know by the time they are 12 motnsh

A

1-3 words

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19
Q

what is the presentation of growing pains

A

commonly occur between 3-12; pain episodes by the end of the day or at night. almost always in the long bones. This can be severe at times.

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20
Q

what is the treatment for growing pains

A

massages and analgesics

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21
Q

what is the gene and the type of mutation for Duchenne muscular dystrophy

A

this is the dystrophin gene and frameshift mutations

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22
Q

what is the treatment for iron poisoning

A

IV deferoxamine –this is an iron chelator that is filtered in the kidneys and excreted in the urine

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23
Q

what language development should a 3 year old have

A

be able to speak in 2-3 word sentences that are intelligible to other people

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24
Q

what social development should a three year old have

A

be able to leave the parents and play with other children

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25
Q

what is the development of a three year old

A

By the age of 3 years, most children can copy a circle, can handle a spoon quite well, begin to engage in group play, share toys with other children, and have minimal separation anxiety (since they begin to develop a drive for independence).

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26
Q

what should a 6 month old infant be able to do for fine motor devleoopmen t

A

they should be able to grasp a rattle and transfer it from hand to hand. this is usually accomplished from 4-5 months

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27
Q

what are the signs of vitamin A def.

and who commonly gets this?

A

night blindness, xerophthalmia, xeroderma and follicular hyperkeratosis
people that have trouble with fat soluble vitamin absorption like cystic fibrosis

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28
Q

how many words should a normal 18 month old be able to say

A

6 words

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29
Q

what is the first step in diagnosing a language development issue

A

audiology

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30
Q

is gripe water recommended

A

no. it is not FDA approved and could contain toxins

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31
Q

what is the first line treatment for infantile colic

A

parental reassurance. possibly changing the feeding volumes and length

32
Q

an important gross and fine motor milestones for a 2 year old

A

An important developmental milestone of a 2-year-old child is being able to kick a ball. Other gross and fine motor skills expected by the age of 2 years include jumping on both feet, climbing stairs with both feet on each step, and building a stack of 6 blocks.

33
Q

how many words should a 2 year old know

A

~75

34
Q

when do kids begin role playing

A

around three

35
Q

which diuretics can cause hearing loss

A

loops

36
Q

what are the side effects of loop diuretics

A

Hypokalemia, hypomagnesemia, hypocalcemia, hypochloremia, hyponatremia (moderate)
Metabolic alkalosis
Hyperuricemia/gout
Hyperglycemia
Ototoxicity (potentially permanent hearing damage)
Dehydration/hypovolemia
Sulfonamide hypersensitivity (except ethacrynic acid) → rash, interstitial nephritis

37
Q

what is a complicated presentation of hepatitis C

A

liver enzymes are normal; mixed cryoglobinemia with positive rheumatoid factor, IgM and IgG elevations. there will be no cryoprecipitate
literally Hep C without the hep…
90% of mixed cryoglobinemias are associated with Hep C.

38
Q

remember that someone with a history of chemo that comes in with a fever could have neutropenic fever even if they have a normal WBC and they need what type of treatment

A

they need antipseudomonal. immediate coverage with cefepime, meropenem, zosyn should initiated

39
Q

What is the treatment for a hypersensitivity reaction?

A

Once all potential offending drugs are discontinued and anaphylaxis is ruled out, intravenous glucocorticoids (e.g., methylprednisolone), H1 blockers (e.g., diphenhydramine), and H2 blockers (e.g., ranitidine) are indicated to treat the symptoms of acute drug allergy in this patient. Fast-acting antihistamines would decrease both the urticaria and angioedema, while glucocorticoids (which require several hours to take effect) combat delayed recurrence.

40
Q

what is C4d a marker for?

A

antibody mediated damage

41
Q

what is the typical cause of multi-system tuberculosis

A

IL-12 receptor dysfunction. this is INF-gamma

42
Q

what is the presentation of X-linked agammaglobinemia and what is the cause

A

Although recurrent infections can be a feature of many immunodeficiency disorders, tonsillar hypoplasia (due to low B-cell volume) is suggestive of XLA. The diagnosis is confirmed with flow cytometry showing reduced levels of B cells and normal levels of T cells.

due to bruton kinase a tyrosine kinase gene

43
Q

what is the treatment for X-linked agammaglobinemia

A

IV immunoglobulin

44
Q

what is the typical presentation for IgA deficiency

A

multiple mucosal infections. Fore example, pyogenic URI, giardiasis…suggestive of IgA mucosal deficiency

45
Q

what are people with IgA def at risk for

A

anaphylactic transfusion reactions

46
Q

what is the presentation of wiskott-aldrich

A

bloody diarrhea, thrombocytopenia, recurrent infections (otitis media). eczema and skin rashes.
impaired actin-cytoskeletal reorganization

47
Q

what is the presentation of severe combined immunodeficiency

A

this presents with several infections very early, can present with eczematous reactions, failure to thrive, absence of a thymic shadow

48
Q

what is hyper IgM syndrome

A

A defective CD40 ligand is the mechanism of type 1 hyper-IgM syndrome. A defect in the CD40 ligand renders T cells unable to switch IgM production in B cells to the production of other immunoglobulins resulting in decreased IgA titers, as seen here, and decreased humoral immunity. The onset of symptoms in type 1 hyper IgM syndrome can occur during early infancy and failure to thrive may occur as a result of recurrent infections.

49
Q

what are infections with viral and fungal pathogens suggestive of

A

deficit T cell immunity

50
Q

what is the presnetation of leukocyte adhesion deficiency type I

A

caused by an autosomal recessive defect in CD18, a subunit of beta-2 integrin, which results in an inability of leukocytes to migrate to the site of infection. Patients subsequently have recurrent infections and a characteristic absence of pus with infection. Other characteristic features of the condition include poor wound healing with large skin ulcers, omphalitis, and severe periodontitis/gingivitis. A very high neutrophil count (as high as 100,000/mm3 during active infection) is seen because neutrophil activation and recruitment of neutrophils from the non-circulating pool occurs, but neutrophils are unable to extravasate into tissues, causing pooling within circulation.

51
Q

Do you need to give deferoxime to spherocytosis patients after splenectomy

A

NO. the spleen removal will remove the need for transfusions and thus defereoxime

52
Q

what is given to patients after a splenectomy for prophylaxis

A

daily penicillin prophylaxis for the risk of sepsis from encapsulated bacteria until the age of 5

53
Q

what organisms are you at risk for after a splenectomy

A

neisseria, H flu, s pneumoniae

54
Q

what is serum sickness like reaction

A

this is a reaction to antibiotics that occurs after streptococcal infections, viral infections and certain vaccines. usually presents with a erythematous, pruritic rash. discontinue the antibiotics

55
Q

what is the presentation of psoriatic arthritis

A

nail pitting, brittle nails, dactylitis, DIP joint inflammation.

56
Q

what is the work up for erythema nodosum

A

checking ASO titers, chest x ray for perihilar fullness for sarcoidosis and ESR for systemic inflammation

57
Q

what are some of the most common side effects of cyclosporine

A

hirsutism, gingival hyperplasia, hypertension

58
Q

side effects of mycophenolate mofetil, include

A

bone marrow suppression, vomiting, diarrhea, hypertension, back pain, coughing, peripheral edema, elevated BUN, and hyperglycemia. Hypercholesterolemia is also common.

59
Q

what is the presentation of bacillary angiomatosis

A

skin lesions that are typically painless, red, and have vascular proliferation with small black bacteria on a warthin-starry stain.

60
Q

what is the treatment for bacillary angiomaottsis

A

erythromycin

61
Q

what are the risk factors for vertical transmission of HIV and what is the presentation

A

She was delivered vaginally (highest risk of transmission) at home, her mother did not receive any prenatal care, and she is breastfed.

sick child with aids defining illnesses and lymphadenopathy

62
Q

patients with HIV should be vaccinated against what

A

measles mumps and rubella if their CD4 count is above 200.

63
Q

what is given for prophylaxis in HIV/AIDS CD4<50

A

TMP-SMX and azithromycin if they do not plan on going back on their antiretroviral meds for protection against MAC

64
Q

what is a leukemoid reaction

A

A leukemoid reaction is characterized by profound leukocytosis with a proportionate increase in all elements of the myeloid lineage (neutrophils, immature and mature precursors) and elevated leukocyte alkaline phosphatase (LAP), as seen in this patient. The B symptoms, chronic fatigue, and hepatosplenomegaly in this patient indicate an underlying malignancy. Together with his respiratory complaints (cough, breathlessness) and a pulmonary mass on chest x-ray, these findings are highly suggestive of a leukemoid reaction secondary to lung cancer.

65
Q

what are the causes of leukemoid reactiojn

A

drugs, malignancy, stress, infection

66
Q

what is eosinophilic polyangitis

A

previously churg-strauss. presents with adult-onset asthma, chronic sinusitis, mononeuritis multiplex (foot drop, loss of sensation in the distribution of the ulnar nerve), subcutaneous skin nodules, and palpable purpura, all of which are consistent with eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome). Systemic signs of inflammation such as fatigue and fever are also commonly seen in EGPA. Moreover, patients with EGPA typically have pronounced eosinophilia and renal involvement (indicated by elevated BUN and serum creatinine), as seen here.

67
Q

should splenectomy patients be vaccinated immediately after surgery

A

no. optimal antibody response is 2 weeks after surgeyr

68
Q

what is most common acid fast bacteria in AIDS patients

A

MAC!

69
Q

what is the presentation of MAC in AIDS

A

cough, fever, bacteremia, skin lesions

70
Q

what is the treatment for MAC in AIDS

A

azithromycin and ethambutol

can also use clarithromycin

71
Q

what lab tests can confirm PCP

A

elevated beta-D-glucan levels; bronchiolar lavage with disc-shaped cysts with central spores.

72
Q

what are the side effects of tacrolimus

A

kidney injury, hyperkalemia, hypertension, glucose intolerance, and neurotoxicity

73
Q

what does both decreases in inspiration and expiration indicatre

A

fixed upper airway blockage. this will look like a flattened flow loop curve

74
Q

what is indinavir and what is a common side effect

A

this is a protease inhibitor used for AIDS/HIV treatment. it has poor solubility and thus can cause urolithiasis

75
Q

what is a common HIV/AIDS associated infection when CD4 < 100 that leaves chronic ulcers in the esophagus

A

HSV esophagitis

76
Q

what CD4 count implies CMV esophagitis

A

< 50

step II (22 decks)

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