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1
Q

Tx. nocardia?

A

TMP-SMX. Carbapenem if brain involved (6-12 months)

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2
Q

Tx actinomyces

A

Penicillin for 12 weeks

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3
Q

Tx. malignant otitis externa?

A

Think pseudomonas. IV ciprofloxacin (fluoroquinolones). Those resistant to quinolone do anti-pseudomanl penicillin or cephalosporin (pipercillin and ceftazidime/cefepime)

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4
Q

Another name for S. bovis type one?

A

S. gallolyticus

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5
Q

How to differentiate HSV encephalitis vs pure encephalitis?

A

HSV has meningeal signs

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6
Q

HSV encephalitis gold standard diagnosis and tx.?

A

CSF w/ viral DNA on PCR and start IV acyclovir after CSF fluid

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7
Q

Testing for Parvovirus B19?

A

Acute infection immunocompetent-B19 IgM antibodies
Acute infection immunocompromised-NAAT (nucleic acid amplification testing).
Immunity and previous infection-B19 IgG antibodies

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8
Q

Diagnosis and tx rubella virus?

A

Anti-rubella IgM and IgG. Supportive care

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9
Q

Rubella congenital vs. child presentation?

A

Congenital-“can’t see, can’t hear, can’t beat, can’t think” Cataracts, sensorineural hearing loss, congenital cardiac anomalies, intellectual disability, “blueberry rash”
Child-Coryza/conjunctivitis, cervical lymph, cephalocaudal spread of rash (spares palms and soles)

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10
Q

Molluscum contagiosum concern and presentation and tx.?

A

Presence with HIV. Hundreds of widely distributed papules with testing if large >1cm, numerous, or widespread. tx. curretage, cryo, topical (podophyllotoxin)

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11
Q

How to differentiate CMV from EBV?

A

No cervical lymphadenopathy, no pharyngitis, negative monospot.

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12
Q

Infectious diarrhea best initial/most accurate test?

A

Best initial-Blood and/or fecal leukocytes (lactoferrin if presents as answer choice)
Most accurate-Stool culture

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13
Q

Tx. cryptosporidium cystoisospora?

A

Tx underlying AIDS or nitazoxanide

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14
Q

Tx. Giardia

A

Metronidazole/tinidazole

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15
Q

C. perfringens diarrhea assoc?

A

Reheated/refrigerated foods (eg reheated meat)

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16
Q

Salmonella diarrhea assoc?

A

Poultry, eggs

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17
Q

Vibrio vulnificus diarrhea assoc?

A

Seafood/shellfish

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18
Q

E coli diarrhea assoc?

A

Undercooked beef or foods contaminated with bovine feces (O157:H7)

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19
Q

What should you avoid if you suspect EHEC?

A

Antibiotics b/c increased risk of HUS

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20
Q

Shigella diarrhea assoc?

A

Contaminated food or water with travel outside of US

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21
Q

Two bacterial causes of bloody diarrhea?

A

Shigella and campylobacter

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22
Q

What drug besides abx has increased risk of C diff?

A

PPI (prolonged gastric suppression risk factor)

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23
Q

Serious complication of C diff?

A

Toxic megacolon

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24
Q

Tx. of cysticercosis and neurocysticercosis?

A

Cysticercosis (T solium)-Praziquantel

Neuro-Albendazole

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25
Q

Hyatid cyst with echinococcus granulosus or echinococcus multiocularis definite, intermediate and dead end accidental intermediate host?

A

Definite-dogs feces that have eggs, intermediate-sheep, and humans-dead end accidental intermediate

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26
Q

Hyatid cyst imaging and tx.?

A

“Eggshell” calcification on CT scan (most commonly found in liver than lung). Tx. albendazole w/ surgical resection (ethanol or hypertonic saline injection before removal). Do not aspirate b/c risk of anaphylaxis

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27
Q

What should all PPD + HIV patients be given prophylactically?

A

Isoniazid and pyroxidine for 9 months

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28
Q

Two most common organisms of epiglottitis?

A

H influenzae and S pyogenes

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29
Q

Tx. hepatitis B and indication?

A

1) Interferon-younger pt., compensated liver dz
2) Lamivudine-HIV patient b/c high drug resistance
3) Entecavir-decompensated cirrhosis
4) Tenofovir-most potent w/ limited resistance (preferred in countries that have it)

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30
Q

Hep B post exposure prophylaxis protocol?

A

Immunized-reassurance, but if no HbsAb + immunity can give Hb booster vaccine
No immunized-vaccine and Ig ASAP

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31
Q

Tx of cryptococcal meningoencephalitis?

A

IV amphotericin B and flucytosine for 2 weeks followed by 8 weeks fluconozole and maintenance therapy >1 year.

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32
Q

Empiric antibiotics for meningitis age 2-50 and most common organism?

A

N. meningitidis and S. pneumoniae. Vancomycin and third gen cephalosporin

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33
Q

Empiric antibiotics for meningitis age >50

A

S. pneumoniae, N. meningitis, Listeria. Vancomycin and ampicillin and 3rd gen cephalosporin

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34
Q

Empiric antibiotics for neurosurgery/shunt or penetrating skull trauma?

A

Gram neg rods, S. aureus, and coagulase-negative streptococcus. Vancomycin and cefepime

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35
Q

Empiric antibiotics immunocompromised?

A

Pneumococcus, N. meningitidis, Listeria, gram neg rods. Vancomycin plus ampicillin plus cefepime

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36
Q

Alternate drugs to cefepime?

A

Ceftazidime or meropenem

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37
Q

Alternate drugs to ampicillin for listeria?

A

Trimethoprim and sulfathizole

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38
Q

PML association?

A

Natalizumab or rituximab.

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39
Q

Unique features of HIV that differentiate from mono?

A

Maculopapular rash, painful mucocutaneous lesions, and diarrhea

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40
Q

Best initial/confirmatory screening HIV?

A

Best initial-HIV p24 antigen and HIV antibodies screening assay
If positive-testing with HIV-1/HIV-2 antibody differentiation immunoassay

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41
Q

CD4 count at risk Prophylaxis P. jirovecii?

A

Less than 200. TMPSMX and corticosteroids

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42
Q

CD4 count at risk Prophylaxis and tx. T. gondii?

A

Less than 100. Prophylaxis TMPSMX. Tx. sulfadiazine and pyrimethamine

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43
Q

CD4 count at risk, prophylaxis and tx. MAC?

A

Less than 50. Azithromycin and clarithromycin. Azithromycin

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44
Q

CD4 count and prophylaxis histoplasma?

A

Less than 150. Itraconazole

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45
Q

CD4 count and prophylaxis and tx. cryptosporidium

A

Less than 180. Filtering water. Nizazoxanide

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46
Q

What CD4 level is esophagitis a complication of HIV?

A

Less than 100

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47
Q

If patient has more pain with swallowing (severe odynophagia) without dysphagia, what type of esophagitis is more common?

A

Viral

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48
Q

When is HAV vaccine indicated?

A

IVDU, MSM, chronic liver disease (including HBV and HCV)

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49
Q

When is HBV vaccine indicated?

A

No documented immunity

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50
Q

When is HPV indicated?

A

men and women 9-26

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51
Q

When is influenza indicated?

A

Annually for all patients

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52
Q

When is meningococcus indicated?

A

All patients 11-18. large groups in proximity (college, military, incarcerated)

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53
Q

When is pneumococcus indicated?

A

PCV13 once, PPSV23 8 years later, than every 5 years

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54
Q

When is Tdap indicated?

A

Tdap once and repeat if pregnant, Td every 10 years after Tdap

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55
Q

What are live vaccines and when are they contraindicated?

A

MMR, varicella, zoster, live attenuated influenza and if CD4

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56
Q

HIV prophylaxis protocol?

A

Two NRTI PLUS integrase inhibitor or protease inhibitor or NNRTI

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57
Q

Ddx of any BMT recipient with lung and intenstinal involvement?

A

CMV pneumonitis

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58
Q

What should be done before therapy is started for HIV associated diarrhea?

A

Rule out other possible causes! Stool culture, ova and parasite examination and test for C.diff toxin

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59
Q

Primary syphillis tx and if allergic what tx.?

A

IM penicillin 1 dose. 14 days doxycycline

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60
Q

Secondary syphillis tx. and if allergic what tx.?

A

IM penicillin 1 dose. 14 days doxycycline

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61
Q

Latent syphillis tx. and if allergic what tx?

A

IM penicillin 3 dose. 28 days doxycycline

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62
Q

Tertiary syphillis tx. and if allergic what tx?

A

IV penicillin G 14 days. 14 days ceftriaxone

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63
Q

Pregnancy syphilis tx. and if allergic what tx.?

A

Penicillin. Desensitize and administer penicillin

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64
Q

Diagnosis and Treatment disseminated gonococcal infection?

A

Nucleic acid amplification. IV ceftriaxone (1 g/day) for 7-14 days. Azithromycin (single 1 g) OR doxycycline for 7 days of concomitant chlamydial infection. Tx. sexual partners

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65
Q

Diagnosis and tx of trachoma?

A

Diagnosis-giemsa stain from conjunctival scrapings. Tx. Topical tetracycline OR oral azithromycin

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66
Q

Urethritis diagnosis and tx?

A

Diagnosis-nucleic acid amplification/first catch. Azithromycin OR doxy and ceftriaxone if gonococcus not ruled out

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67
Q

Gold standard diagnosis malaria?

A

Thin and thick peripheral blood smears (gold standard)

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68
Q

Babesiosis tx.?

A

Atovaquone and azithromycin

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69
Q

Malaria tx for sensitive and resistant?

A

Sensitive-chloroquine, resistant-atovaquone-proguirl/mefloquine

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70
Q

Tx cellulitis?

A

IV nafcillin or cefazolin

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71
Q

How do you differentiate peritonsillar abscess from epiglottitis?

A

Peritonsillar abscess has uvula deviation and unilateral lymphadenopahty

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72
Q

Diagnosis for influenza and post-influenza complications

A

Nasal swab for influenza antigens. S. aureus infection that must be treated with anti-staphylococcal abx

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73
Q

Cause of osteo from history of nail puncture?

A

P aeruginosa

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74
Q

What is febrile neutropenia and what is management?

A

ANC

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75
Q

Diagnosis and tx of leprosy?

A

Diagnosis: Acid fast bacilli on skin biopsy
Treatment: Tuberculoid (dapsone and rifampin). Lepromatous (Dapsone and rifampin and clofazimine)

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76
Q

PEP for rabies?

A

Healthy appearing domesticated: Observe animal for 10 days w/o PEP b/c incubation period can be long after bite for animals
Unvaccinated individuals: PEP (rabies Ig and rabies vaccine) is example of passive-active immunity

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77
Q

Most common valvular abnormality in patients with infective endocarditis?

A

MVP with coexisting mitral regurg

78
Q

Testing endocarditis?

A

Best initial: Blood culture

Most accurate: TEE

79
Q

Tx endocarditis?

A

Vancomycin empiric initial and subsequent based on cultures

80
Q

Modified duke criteria endocarditis?

A

Major-+culture (viridans, aureus, enterococcus), +valvular lesion ECHO
Minor-fever, IV drug, predisposing cardiac lesion, emboli, + blood culture
Definite: 2 major OR 1 major and 3 minor
Possible: 1 major and 1 minor OR 3 minor

81
Q

MCC healthcare associated IE and assoc. conditions and tx.?

A

S. aureus. Prosthetic valves, Intravascular catheters, implanted devices, IV drug. vancomycin

82
Q

MCC community associated IE and assoc. conditions and tx.?

A

Viridans (S. mitis, sanguis, mutans, salivarius). Dental procedures and procedures involving incision and biopsy of resp. tract. aqueous penicillin G.

83
Q

culture - bacteria that can cause endocarditis due to poor dentition or periodontal manipulation?

A

E corrodens is gram - that is part of normal oral flora and HACEK organism

84
Q

Tx. uncomplicated pyelo

A

Mild: ORAL Fluoroquinolone, TMP-smx
Severe: IV Ceftriaxone, fluoroquinolone, TMP-sMX

85
Q

Tx. complicated pyelo

A

Mild to moderate (Ceftriaxone, cefepime, fluoroquinolone)

Severe (Ampicillin-sulbactam, ticarcillin/piperacillin-cavulonate/tazobactam, meropenem, imipenem, aztreonam)

86
Q

Pregnancy pyelo

A

IV ceftraxone +/- gentamicin, aztreonam

87
Q

Acute vs chronic prostatitis tx.?

A

Acute-tmp-smx or fluoroquinolones, chronic-fluoroquinolines

88
Q

Cause of erysipelas and location?

A

Group A B-hemolytic strep (S. pyogenes) commonly found on legs

89
Q

Giardia vs E. histolytica (amebiasis) presentation, test, and tx.?

A

Presentation
Giardiasis (bloating, flatulence, foul smelling fatty diarrhea)
Amebiasis (dysenteray, RUQ pain, liver abscess)
Test
Giardiasis-stool for trophozites. E. histolytica-serology b/c stool microscopy insensitive when localized liver abscess formed.
Tx. Metro for giardiasis. metro (liver cyst) and paromycin (intestinal colonization) for amebiasis

90
Q

How do identify difference in bacillary angiomatosis vs kaposi sarcoma?

A

Bacillary angiomatosis-neutrophil infiltrate. Be careful with tissue biopsy b/c hemorrhage risk
Kaposi -lymphocyte infiltrate

91
Q

Tx of bacillary angiomatosis?

A

Oral azithromycin/erythromycin

92
Q

MCC ventilator assoc. pneumonia?

A

P. aeruginosa

93
Q

Most common causes of secondary bacterial superinfection after viral infection?

A

S. pneumo, S. aureus, H influenzae

94
Q

Specific findings of MAC in addition to nonspecific fever, cough, abdominal pain, and diarrhea?

A

Splenomegaly and elevated Alk phos

95
Q

Tx for lyme disease sequence?

A

1) Doxy (if not pregnant or not child)
2) Amoxy (best pregnant or >8 year child)
3) Azithro
* Ceftriaxone if neuro or cardiac involvement

96
Q

Histopalsmosis location, cause, presentation, testing, and tx.?

A

Location-ohio/missippi, bird and bad droppings in soil. Pulmonary (immunocompetent)-mediastinal and hilar lymph nodes with arthralgias and erythema nodosum
Dissminated-lymphadenopathy, pancytopenia, hepatosplenomegaly
Testing-Urinary antigen
Tx. itraconazole (first line)/fluconazole oral for local and IV amphotericin B dissminated

97
Q

How can you tell sarcoidosis from histo?

A

Condition worsens after immunosuppression (eg steroids)

98
Q

Blastomycosis location, cause, presentation, testing, and tx.?

A

South central states, Upper midwest and great lakes states, soil or rotting wood contact. Inflammatory lung disease that can disseminate to skin (wartlike lesions, violaceous nodules) or bone (osteomyelitis)., Culture(broad based budding), Tx.Tx. itraconazole/fluconazole oral for local and IV amphotericin B dissminated

99
Q

Coccidiomyocosis location, cause, presentation, testing, and tx.?

A

Southwestern US. Earthquake/dust storms where spores thrown into air and can be inhaled. that can dissmeinate to bone (arthralgias) and skin (erythema nodosum). tx. is itraconazole/fluconazole and IV amphotericin B

100
Q

Clenched fist bite injury tx?

A

Amoxicillin-clavulanate

101
Q

Tx of enterobius vermicularis (pinworm)

A

Albendazole OR pyrantel pamoate

102
Q

Prophylaxis for cat or bite?

A

Concern for pasteurella multocida so tx with amoxicillin/clavulanate

103
Q

Didanosine side effect?

A

Pancreatitis

104
Q

Abavavir side effect?

A

Hypersensitivity syndrome

105
Q

NRTI side effect?

A

Lactic acidosis

106
Q

NNRTI side effecT?

A

SJS

107
Q

NEvirapine side effect?

A

liver failure

108
Q

Until what aminotransferase level can you take RIPE drugs?

A

100

109
Q

PPSV23 alone vs PCV13 and PPSV23 5 yrs after 19-64 age group

A

PPSV23-chronic lung, heart, or liver disease. Diabetes, alcoholics, or smokers
PCV13 and PPSV23-cochlear implants, CSF leaks, sickle cell, asplenia, immunocompromised, CKD

110
Q

Recommended vaccine north africa?

A

Hep A, B, typhoid and polio

111
Q

Recommended vaccine sub saharan africa?

A

Yellow fever, meningococcal

112
Q

Recommended vaccine asian?

A

Meningococcal

113
Q

Recommended vaccine south america?

A

Yellow fever

114
Q

Recommended vaccine chronic liver disease?

A

Tdap once for Td booster, than Td every 10 years, influenza annually, PPSV23 then regular regimen once 65, Hepatitis A, Hepatitis B

115
Q

Recommended vaccines for asplenic adult patients?

A

Pneumococcus (PCV13 and PPSV23 8 wks later. PPSV23 5 yrs later and at 65, H influenzae, Meningococcus (revaccinate every 5 years), Infleunza, HAV and HBV, Tdap

116
Q

Meningococcal vaccination series?

A

Primary-11-12 (or 13-18) or 19-21 (if not previous vaccinated high risk paitnets and first year college or incarceration)
Booster-16-19 if primary vaccination before 16th Bday

117
Q

What vaccines recommended post transplant?

A

TMPSMX, influenza, pneumococcus, Hep B

118
Q

Main organism bronchitis and empirical abx?

A

Virus. Moraxella, H. influenzae. Generally none maybe doxy or macrolide

119
Q

Main organism pneumonia (typical) and empirical abx?

A

S. pneumo. H. influenzae. Azithromycin or Third gen cephalosporin

120
Q

Main organism pneumonia (atypical) and empirical abx?

A

Mycoplasma, Chlamydia. Macrolide or doxycycline

121
Q

Osteomyelitis main organism and empirical abx?

A

S. aureus or salmonella. Oxacillin, cefazolin. Vanco

122
Q

Cellulitis main organism and empirical abx?

A

Streptococci. Staphylococci. Cephalexin or dicloxacillin. TMP-SMX, doxy, or clindamycin

123
Q

Meningitis (neonate) main organism and empirical abx?

A

Strep. E.coli, Listeria. Ampicillin and aminoglycoside (usually gentamicin); expanted third gen cpehalosporin if gram - suspected

124
Q

Meningitis (child/adult)main organism and empirical abx?

A

S. pneumoniae. Neisseria meningitidis. Cefotaxime or ceftriaxone+vancomycin

125
Q

Endocarditis (native valve)main organism and empirical abx?

A

Staph or strep. Antistaph penicillin+aminoglycoside

126
Q

Endocarditis (prosthetic valve)main organism and empirical abx?

A

Vancomycin + gentamicin+ cefepime or a carbapenem

127
Q

Sepsismain organism and empirical abx?

A

Gram negative organisms, streptococci, staph. Third gen penicillin/cephalosporin+aminoglycoside, or imipenem

128
Q

Septic arthritis main organism and empirical abx?

A

S. aureus. Gram neg bacilli. Gonococci. Vanco (staph aureus). Ceftazidime or ceftriaxone (gram neg bacilli). Ceftriaxone, cipro, or spectinomycin (gonococci)

129
Q

Gram negative coccobacilli?

A

Haemophilus species

130
Q

Gram negative diplococci?

A

Neisseria species

131
Q

Plump gram negative rod with thick capsule (mucoid appearance)

A

Klebsiella

132
Q

Gram positive rods that form spores

A

Clostridium and bacillus species

133
Q

Pseudohyphae

A

Candida

134
Q

Differentiating chlamydia and mycoplasma pneumonia because both have similar presentation?

A

Chlamydia has a negative cold-agglutinin antibody titers

135
Q

Pneumonia in patients with silicosis is what?

A

TB

136
Q

Cause of squamous cell bladder cancer in middle east or africa?

A

Schistosoma haematobium

137
Q

Worm infection in children, diagnosis, and tx?

A

Enterobius species, perianal itching with positive tape test. Treat with mebendazole or albendazole

138
Q

Tx. legionella?

A

Azithromycin or levofloxacin

139
Q

Burn wound with blue-green color?

A

Pseudomonas

140
Q

Presentation of rocky mountain spotted fever and tx.??

A

Hx of tick bite 1 week before development of high temp/chills, severe headache, and severe malaise. Rash 4 days later starts on palms/wrists and soles/ankles and spreads rapidly to trunk and face. Tx. doxy and chloramphenicol as second choice.

141
Q

Tx impetigo?

A

Dicloxacillin, cephalexin, or clindamycin. Topical mupirocin may also be used

142
Q

Most common neurologic sequalae of meningitis?

A

Hearing loss

143
Q

Kaposi sarcoma tx.?

A

Antiretroviral and chemo in severe cases

144
Q

Cutaneous larvae migrans bug and tx?

A

Ancylostoma braziliense (dog and cat hookworm). bendazoles or pyrantel pamoate

145
Q

Swelling of submandibular and sublingual spaces with fever, dysphagia and odynophagia cause and diseasE?

A

Infection of tooth with streptococcus or anarobes causing bacterial cellulitis known as ludwig angina

146
Q

Most common behavioral risk factor of TB in US?

A

Substance abuse (tobacco and IV drug abuse)

147
Q

Recommended vaccines HIV?

A

HAV, HBV, Tdap, Pneumococcus (PCV13 now and PPSV23 8 months and later and every 5 years later), MMR if over 200.

148
Q

Chronic UTI with alkaline urine cause?

A

Proteus. Urease alkalinizes urine and chronic infection from struvite stone where bacteria grown inside releasing bacteria. Chronic indwelling catheter have chance of being infected with urease producing organisms

149
Q

Trichinosis cause and presentation?

A

Undercooked meat (usually pork).

1) Intestinal stage (within 1 week) is asymptomatic or include abdominal pain, nausea, vomiting, and diarrhea from gastric acid releasing larvae that reproduce in small intestine
2) Muscle stage (up to 4 weeks after)-myositis, fever, periorbital edema, conjunctival and retinal hemorrhages. where female worms migrate and encyst striated muscle

Tx. Bendazoles

150
Q

Patient has high fever, headache, myalgias and chills after camping in the south with no rash. Leukopenia and thrombocytopenia common. What is cause and tx?

A

Human monocytic ehrlichiosis, Doxy or chloramphenicol

151
Q

Patient has high fever and severe polyarthralgias with maculopapular rash, lymphopenia, thrombocytopenia, and elevated liver enzymes after a trip to the carribbean?

A

Chikungunya fever

152
Q

Tx. for chloroquine reistant P falciparum?

A

Atovaquone, Doxy, Mefloquine (choice in pregnant)

153
Q

What areas are w/o P. falciparum and tx?

A

South america, mexico and tx. with primaquine

154
Q

Tx of diphyllobotrium latum?

A

Praziquantel

155
Q

Any patient with CMV needs what examination and tx.?

A

Ocular exam to rule out concurrent retinitis. Valganciclovir

156
Q

PCV13 vs PCV23 immunologic response?

A

T cell dependent B cell response for 12 and T cell independent B cell response for PCV23

157
Q

Cause of perisistent nonbloody diarrhea that is >2 weeks in travelers?

A

Cryptosporidium due to poor water sanitation

158
Q

Tx. candida albicans?

A

Oral/esophageal-nysatin, caspofungin, or fluconazole
Vaginal-topical azole
Systemic-fluconazole/voriconazole, caspofungin, or amphotericin B

159
Q

Aspergillus manifestation and tx.

A

ABPA-type I hypersensitivity. avoid exposure and corticosteroids may be beneficial
Pulmonary aspergilloma-inhalation of spores to lungs assoc with TB and may cause massive hempotysis with lobectomy needed
Invasive-hyphae invade typically in immunosuppressed causing bilateral pulm infiltraties and can have hematogenous spread to sinuses, orbits, or brain. Tx. IV amphotericin B, voriconazole, or caspofungin

160
Q

Negative PPD in patient who has never had PPD before next best step?

A

repeat PPD

161
Q

If PPD is positive next test?

A

CXR to rule out active disease

162
Q

1st line tx for active TB?

A

Isolation until sputum negative for AFB

163
Q

TB pathophys?

A

Primary-1st line alveolar macrophages eat acid fast bacilli. 2nd line surviving TB is walled off by granulomas in apex of lung. Usually asymptomatic
Secondary-weakened immunity leads toclinical manifestation of TB leads to poossible hematogenous or lymphatic spread. Classic symptoms here
Extrapulm leads toweakned has lymphatic and organ spread with reticulonodular infiltrate

164
Q

Difference in anaphylaxis vs anaphylactoid?

A

Anaphylaxis needs preceeding sensitization to antigen before repeat exposure b/c IgE related. Anaphylactoid clinically identical but not IgE related so no preceeding sensitization to antigen. Antigen directly binds to mast cells here

165
Q

Classic 4 symptoms anaphylaxis?

A

Hypotension, Tachy, SOB/wheezing, Rash

166
Q

Condition causing angioedema underlying and characteristics?

A

C1 esterase inhibitor deficiency. Swelling of eyes, airway, face, tongue

167
Q

Best initial test and tx of angioedema?

A

Test-decrease C2/C4 in complement and deficiency of C1 esterase inhibitor
Tx. 1) ABC, 2) FFP/Ecallantide 3) Androgens: Danazol and stanazol (increaes c1 esterase liver production)

168
Q

Tx urticaria?

A

Antihistamines: hydroxyzine, diphenhydramine, fexofenadine, loaratidine, cetirizine, ranitidine or leukotriene receptor antagonists including montelukast or zafirlukast

169
Q

Tx allergic rhinitis?

A

Remove trigger followed by intranasal corticosteroid followed by antihistamines or intranasal anticholinergic

170
Q

Common Variable Immunodeficiency Defect, presentation, and findings, testing, and tx.?

A

B cell differentiation. Recurrent sinopulmonary infections in adults (bronchitis, pneumonia, sinusitis, and otitis media). Increased risk autoimmune disease, bronchiectasis, lymphoma. Decreased number of all Ig and decreased response to antigen stimulation of B cells. IVIG regular infusion for maintenence

171
Q

X-linked (bruton) agammaglobulinemia Defect, presentation, and findings, testing, and tx.?

A

B cell maturation defect b/c tyrosine kinase defect. more present in males w/ absent or scant lymph nodes, adenoids, tonsils, and spleen. Recurrent sinopulmonary infections after 6 months (decrease maternal IgG). Absent B cells in peripheral blood and decreased Ig. IVIG regular infusion for maintenence

172
Q

Selective IgA deficiency Defect, presentation, and findings, testing, and tx.?

A

No IgA. Airway and GI infection (spruelike infection), Autoimmune, Atopy, Anaphylaxis to transfusion from normal IgA levels. Recurrent sinopulmonary infections. Decreased serum IgA. Blood from IgA deficient donors. No IVIG becasue trace IgA in product is too insignificant to be therapeutic.

173
Q

SCID Defect, presentation, and findings, testing, and tx.?

A

Deficiency B cells and T cells. Recurrent sinopulm infection as early as 6 month age (B cell defect). T cell defect (infection like AIDS: PCP, varicella, Candida). No thymic shadow (CXR), No germinal center (lymph node biopsy), no t cell (flow cytometry) and no gammaglobulin. Tx. BMT

174
Q

Hyper IgE defect, presentation, and findings, testing and tx?

A

STAT3 mutation. FATED (coarse Facies, cold staph Abscesses, retained primary Teeth, increase IgE, Dermatologic (eczema). Tx dicolacillin or cephalexin

175
Q

WisEkott Aldrich Syndrome defect, presentation, and findings, testing and tx?

A

Mutation in WAS gene. WATER (Wiskott Aldrich, Thrombocytopenic purpura, Eczema, Regurrent infection). Increase IgE/IgA, Decrease IgM/IgG. Tx. BMT

176
Q

CGD defect, presentation, and findings, testing and tx?

A

NADPH oxidase. Increae suceptibility to catalase + (Need PLACESS). Nocardia, Pseudomonas, Listeria, Aspergillus, Candida, E coli, S. aureus, Serratia. Lymph nodes with purulent material leaking out. Aphthous ulcers and inflammation of nares common/ Granulomas obstructing GI or uinary tract. Abnormal nitroblue tetrazolium testing means defect in NADPH oxidase. Lifelong pphx with TMP-SMX and itraconazole. IFN gamma for severe phenotype to boost intracellular killing

177
Q

Example of Type II hypersensitivity?

A

IgG and IgM autoantibody mediated. Cytotoxic. AIHA and Good pasture

178
Q

Hyper IgM defect, presentation, findings, testing, and tx?

A

Defect in CD40L Th cells with class switching. Severe pyogenic infection early and pneumocystis, cryptosporidium, and CMV. Increase IgM and decrease IgG, IgE, and IgA

179
Q

Triad of SCID?

A

Recurrent viral, fungal, or opportunistic (Pneumocystis) infections, failure to thrive, chronic diarrea

180
Q

Problemc causing chronic granulomatous disease?

A

Deficiency in NADPH oxidase preventing phagocytic oxidative burst impairing intracellular phagocytic killing

181
Q

Leukocyte adhesion deficiency, presentation, findings, testing, and tx?

A

Defect LFA-1 integrin on leukocytes, which normally allow neutrophils to adhere to vascular endothelium and migrate to areas of infection or inflamation leads to impaired neutrophil migration. Recurrent skin and mucosal bacterial infection with NO PUS along with poor wound healing. delay umbilical cord separation (>30 days) and marked peripheral leukocytosis and neutrophilia

182
Q

Mechanism of Cyclosporine and side effects?

A

calcineurin inhibitor binds cyclophilin preventing IL-2 transcription that blocks T-cell activation. Nephrotoxic, Neurotoxic, ginigval hyperplasia, hirsutism, hyperlipidemia

183
Q

Mechanism of tacrolimus and side effects?

A

calcineurin inhibitor binds FKBP preventing IL-2 blocking T-cell activation. Nephrotoxic, Neurotoxic, hyperlipidemia

184
Q

Mechanism of sirolimus and side effects?

A

mtor inhibitor lbocking T-cell activation and preventing IL-2 response. Anemia, thrombocytopenia, leukopenia, insulin resistance

185
Q

Azathioprine mechanism and side effect?

A

antimetabolite of 6MP preventing nucleotite synthesis. Diarrhea, leukopenia, hepatotoxicity

186
Q

Mycophenalate mechanism and side effect?

A

IMPDH inhibitor limiting de novo purine synthesis. Bone marrow suppression

187
Q

How to recognize chediak higashi?

A

Giant granules in neutrophils, infections, and often oculocutaneous albinism

188
Q

When to start antiretroviral therapy for HIV?

A

CD4

189
Q

Bactrim allergy or intolerance agent used? (ie sulfa)

A

Dapsone, aerosolized pentamidine, atovaquone

190
Q

Two pathogens that can cause chronic diarrhea only in AIDS?

A

Cryptosporidium and isospora

191
Q

C5-C9 deficiency cause recurrent infection with what genus of bacteria?

A

Neisseria

192
Q

Why is positive HIV antibody test in newborn unreliable?

A

Maternal antibodies in neonate can give false positive for first 6 months

Step 2 CK (16 decks)

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