amboss 6/24 Flashcards
what areas are endemic for hepatitis A
South America, Africa, Asia, Eastern Europe, Mexico, central America
when is flu season; when should the vaccine be offered
in the fall around October - April
offered from May-October
when is the shingles vaccine recommended
greater than 50 regardless of history
when is DEXA scanning recommended
65 + or in younger post menopausal women with a history of fracture
what are the indications for using oseltamivir for flu
asthma, young children, elderly individuals. It can shorten the duration of the illness and reduce the complications
what type of medication is oseltamivir
neuramidase inhibitor
when must oseltamivir be used to be effective
within the first 48 hours of symptom onset
what are the recommendations for low dose ct scan screening for lung cancer
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.
what are the recommendations for pneumococcal vaccine 13
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
what are the recommendations for pneumoccocal 23
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.
Is Hep B given to low birth weight infants
not until 1 month of age, since they are low birth weigh t
when is rotavirus vaccine given and what is a contraindication
2, 4, 6 months
intussusception
what is a relative contraindication for pertussis
uncontrolled seizure disorder
what type of vaccine is meningococcal
polysaccharide conjugate
what is normal sleep latency
<30 min
what are the normal changes in sleep architecture as we age
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.
when is a child expected to be able to feed themselves with a spoon?
when they are 15 months old
How many words should a child know by the time they are 12 motnsh
1-3 words
what is the presentation of growing pains
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.
what is the treatment for growing pains
massages and analgesics
what is the gene and the type of mutation for Duchenne muscular dystrophy
this is the dystrophin gene and frameshift mutations
what is the treatment for iron poisoning
IV deferoxamine –this is an iron chelator that is filtered in the kidneys and excreted in the urine
what language development should a 3 year old have
be able to speak in 2-3 word sentences that are intelligible to other people
what social development should a three year old have
be able to leave the parents and play with other children
what is the development of a three year old
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).
what should a 6 month old infant be able to do for fine motor devleoopmen t
they should be able to grasp a rattle and transfer it from hand to hand. this is usually accomplished from 4-5 months
what are the signs of vitamin A def.
and who commonly gets this?
night blindness, xerophthalmia, xeroderma and follicular hyperkeratosis
people that have trouble with fat soluble vitamin absorption like cystic fibrosis
how many words should a normal 18 month old be able to say
6 words
what is the first step in diagnosing a language development issue
audiology
is gripe water recommended
no. it is not FDA approved and could contain toxins
what is the first line treatment for infantile colic
parental reassurance. possibly changing the feeding volumes and length
an important gross and fine motor milestones for a 2 year old
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.
how many words should a 2 year old know
~75
when do kids begin role playing
around three
which diuretics can cause hearing loss
loops
what are the side effects of loop diuretics
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
what is a complicated presentation of hepatitis C
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.
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
they need antipseudomonal. immediate coverage with cefepime, meropenem, zosyn should initiated
What is the treatment for a hypersensitivity reaction?
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.
what is C4d a marker for?
antibody mediated damage
what is the typical cause of multi-system tuberculosis
IL-12 receptor dysfunction. this is INF-gamma
what is the presentation of X-linked agammaglobinemia and what is the cause
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
what is the treatment for X-linked agammaglobinemia
IV immunoglobulin
what is the typical presentation for IgA deficiency
multiple mucosal infections. Fore example, pyogenic URI, giardiasis…suggestive of IgA mucosal deficiency
what are people with IgA def at risk for
anaphylactic transfusion reactions
what is the presentation of wiskott-aldrich
bloody diarrhea, thrombocytopenia, recurrent infections (otitis media). eczema and skin rashes.
impaired actin-cytoskeletal reorganization
what is the presentation of severe combined immunodeficiency
this presents with several infections very early, can present with eczematous reactions, failure to thrive, absence of a thymic shadow
what is hyper IgM syndrome
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.
what are infections with viral and fungal pathogens suggestive of
deficit T cell immunity
what is the presnetation of leukocyte adhesion deficiency type I
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.
Do you need to give deferoxime to spherocytosis patients after splenectomy
NO. the spleen removal will remove the need for transfusions and thus defereoxime
what is given to patients after a splenectomy for prophylaxis
daily penicillin prophylaxis for the risk of sepsis from encapsulated bacteria until the age of 5
what organisms are you at risk for after a splenectomy
neisseria, H flu, s pneumoniae
what is serum sickness like reaction
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
what is the presentation of psoriatic arthritis
nail pitting, brittle nails, dactylitis, DIP joint inflammation.
what is the work up for erythema nodosum
checking ASO titers, chest x ray for perihilar fullness for sarcoidosis and ESR for systemic inflammation
what are some of the most common side effects of cyclosporine
hirsutism, gingival hyperplasia, hypertension
side effects of mycophenolate mofetil, include
bone marrow suppression, vomiting, diarrhea, hypertension, back pain, coughing, peripheral edema, elevated BUN, and hyperglycemia. Hypercholesterolemia is also common.
what is the presentation of bacillary angiomatosis
skin lesions that are typically painless, red, and have vascular proliferation with small black bacteria on a warthin-starry stain.
what is the treatment for bacillary angiomaottsis
erythromycin
what are the risk factors for vertical transmission of HIV and what is the presentation
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
patients with HIV should be vaccinated against what
measles mumps and rubella if their CD4 count is above 200.
what is given for prophylaxis in HIV/AIDS CD4<50
TMP-SMX and azithromycin if they do not plan on going back on their antiretroviral meds for protection against MAC
what is a leukemoid reaction
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.
what are the causes of leukemoid reactiojn
drugs, malignancy, stress, infection
what is eosinophilic polyangitis
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.
should splenectomy patients be vaccinated immediately after surgery
no. optimal antibody response is 2 weeks after surgeyr
what is most common acid fast bacteria in AIDS patients
MAC!
what is the presentation of MAC in AIDS
cough, fever, bacteremia, skin lesions
what is the treatment for MAC in AIDS
azithromycin and ethambutol
can also use clarithromycin
what lab tests can confirm PCP
elevated beta-D-glucan levels; bronchiolar lavage with disc-shaped cysts with central spores.
what are the side effects of tacrolimus
kidney injury, hyperkalemia, hypertension, glucose intolerance, and neurotoxicity
what does both decreases in inspiration and expiration indicatre
fixed upper airway blockage. this will look like a flattened flow loop curve
what is indinavir and what is a common side effect
this is a protease inhibitor used for AIDS/HIV treatment. it has poor solubility and thus can cause urolithiasis
what is a common HIV/AIDS associated infection when CD4 < 100 that leaves chronic ulcers in the esophagus
HSV esophagitis
what CD4 count implies CMV esophagitis
< 50
