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Step 2 > ID:Immuno > Flashcards

ID:Immuno Flashcards

1
Q

DILATED pupils, atrophic nasal, HTN, tachycardia

A

Cocaine –>IV benzos, Nitrates, CCBs = BBs are CI!

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2
Q

tinnitus, N/V overdose

A

Aspirin —> alkalinize urine

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3
Q

Vertical nystagmus overdose, aggression

A

PCP

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4
Q

Bitter almond breath

A

CN poisoning - burning rubber or plastic

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5
Q

Miosis, bradycardia, hypotension, RR 6/min, dec bowel sounds OD

A

Opioid

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6
Q

Ataxia, tremor, bradykinesia, rigidity, hyperreflexia, seizures

A

Lithium toxcitiy

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7
Q

When to obtain serum Acetaminophen level

A

After 4 hours

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8
Q

Tx for acetaminophen OD

A

Activated charcoal w/in 4hrs –> serum level @4hrs –> ? NAC w/in 8hrs

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9
Q

Caustic ingestion tx

A

Decontamination –> IVFs, CXR r/o perf, lavage, ENDOSCOPY 12-24hrs

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10
Q

pH 7.43, PaO2 100, PaCO2 25, HOC3- 16 cause?

A

Aspirin toxicity - resp alk + metabolic acid

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11
Q

Tactile, visual hallucinations, confusion, sweating, tachy, HTN

A

DTs - 48-96hrs

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12
Q

tx etOH abuse

A

AA&raquo_space; Disulfram (ST only), Naltrexone, benzos, thiamine, folate, vitamins

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13
Q

Slurred speech, ataxia, drowsiness, incoordination, normal pupils, normal respiration

A

Benzo OD

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14
Q

Horizontal nystagmus, ataxia, confusion

A

Phenytoin OD

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15
Q

Constipation, abd pain, polyuria, polydipsia

A

VitD OD –> hyperCa

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16
Q

Unimmunized or unknown or <3Td doses + clean minor wound

A

Td toxoid only

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17
Q

Unimmunized or unknown or <3Td doses + severe or dirty wound

A

Td + immune globulin

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18
Q

> 3 Td doses + clean wound

A

No tx or Td booster if last was >10yrs

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19
Q

> 3 Td doses + dirty or severe wound tx

A

Td toxoid bosster if last was >5yrs

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20
Q

Pregnant <3mo after MMR vaccination next step?

A

Reassurance

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21
Q

Cat scratch

A

Bartonella hensale —> azithromycin

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22
Q

Leukopenia, thrombocytopenia, elevated liver enzymes slightly, tick but no rash

A

erhliciosis = Doxy, chloramphenicol if pregnant

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23
Q

Colicky abd pain, swelling of face, arms, legs, genitals, recurrent URIs

A

Angioedema d/t C1 inhibitor/esterase deficiency

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24
Q

Low C1q

A

Familial SLE

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25
Q

Fever, Neutrophils <1500 next step?

A

Neutropenic fever = Admit + IV cefepime, Imipenem (cover PA)

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26
Q

Eosinophilic intranuclear and basophilic intracytoplasmic inclusions

A

CMV (Owl’s eye) —> ganciclovir or forcarnet

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27
Q

Encephalitis in immunocompetent ppl

A

Herpes viruses

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28
Q

High fever, AMS, seizures, focal neuro deficits, high CSF WBC, protein, >lymphocytes

A

Viral encephalitis –> IV acyclovir

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29
Q

Lyme disease tx in pregnant and kids <8 yo

A

Amoxicllin

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30
Q

RUQ pain, smooth round big cyst + daughter cysts on liver US - occupation?

A

Sheep breeder = echinococcus

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31
Q

Nocardia tx

A

TMP-SMX, 2nd = Minocycline

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32
Q

Post-transplant porphylaxis drugs?

A

TMP-SMX + prednisone + cyclosporine

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33
Q

Ulcerated skin lesion, lytic lesions, 3mo fever, weight loss, upper lobe consolidation

A

Blastomycosis

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34
Q

Tooth extraction, right mandilbe abscess, G+ anaerobe, yellow granular pus

A

Actinomycosis —> PCN for 12 wks

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35
Q

Splinter hemorrhages, peri-orbital edema, chemosis, muscle pain, no murmur

A

Trichinellosis - undercooked pork

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36
Q

Nonproductive cough –> obstipation, SBO, high eosinophils

A

Ascariasis

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37
Q

Warm, tender, erythematous raised rash with good borders on face, fever, chills

A

Erysipelas - Strep pyogenes

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38
Q

Several purple skin masses, nodular contrast enhanced lesion in liver

A

Bacillary angiomatosis —> dx by bx but can hemorrhage

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39
Q

Bright red, friable, exophytic skin nodules in HIV person

A

Bacillary angiomatosis –> erythromycin

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40
Q

verrucous, ulcerated violet heaped lesions on arm, sharp border w/ microabscesses, yeast

A

Blasto

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41
Q

Low WBC, transplant pt, CXR dense mass + crescent or halo sign in upper lobe

A

Aspergillosis

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42
Q

DKA, necrotic nose, hyphae

A

Mucormycosis —> debridement + IV amphotericin

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43
Q

Time of onset to tx influenza

A

<48hrs = Ostelamavir or Zanamivir (w/ lung problems)

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44
Q

P vivax and P ovale tx

A

Primaquine

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45
Q

Sub-saharan and India Malaria prophylaxis

A

Chloroquine resistant = MEFLOQUINE

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46
Q

Meningitis newborn

A

ampicillin + gentamicin

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47
Q

Meningitis 2-50 y/o

A

N. meningitidis, strep pneumo —> vanco + 3rd gen ceph

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48
Q

Meningitis >50 y/o

A

N. meningitidis, Strep, pneumo, Listeria —> Vano, amp + 3rd gen ceph

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49
Q

Meningitis neurosurgery/ penetrating skull trauma

A

GNR, SA, Coag- staph —> vanco + cefepime

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50
Q

HA, seizures, multiple fluid filled cysts in brain parenchyma

A

Neurocysticercosis = T. solium = undercooked pork

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51
Q

High fever, AMS, red macropapular, non-blanching eruption –> petechiae

A

Meningitis

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52
Q

Meningitis 1st steps

A

Admit –> blood, csf cultures/LP –> vanco + ceftiaxone

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53
Q

Prophylaxis for close contacts of meningitis pt

A

Cipro or Rifampin

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54
Q

Meningitis with low glucose and MYALGIAS, purpura

A

Meningococcal meningitis

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55
Q

0-1mo sepsis/meningitis bugs

A

GBS (full-term), EC (Pre-term), Listeria = Amp + gent

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56
Q

1-3mo sepsis/meningitis bugs

A

GBS, S. pneumo, Listeria = Amp + cefotaxime

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57
Q

3mo-3yrs sepsis/meningitis bugs

A

S. pneumo, Hib, Neisseria = Cefotaxime

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58
Q

PMNs, high protein low glucose CSF

A

Bacterial meningitis

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59
Q

Lymphs, very high protein, very low glucose

A

TB

60
Q

Lymphs, normal protein, low glucose CSF

A

Fungal

61
Q

PMNs –> Mo + lymph, normal protein, glucose

A

Viral meningitis (HSV has RBCs)

62
Q

Reduce hearing loss in Hib meningitis (#1 complication)

A

Steroids w/ 1st dose Abx

63
Q

Normal glucose, few WBC, protein 1000

A

Guillan-Barre –> plasmaphoresis or human IG

64
Q

Bacterial meningitis Tx

A

Vanco + ceftriaxone or cefotaxime

65
Q

Bacterial meningitis Tx <28d

A

Amp + gent or amp + cefotaxime

66
Q

Indications for CT b4 LP

A

Trauma, hydrocephalus, shunt, coma, focal neuro deficits

67
Q

Long term sequelae from meningitis

A

Hearing loss, cognitive/regression, seizures, MR, spacticity or paresis

68
Q

Hypothermia, 12d old, poor feeding, lethargy, jaundice, vomiting

A

Neonatal meningitis –> blood cultures and LP

69
Q

Enteroviruses = #1, spring and fall

A

ECHOvirus & Coxsackie

70
Q

<5 y/o Basilar enhancement on CT, rapid progression to CN deficits

A

TB - 50% have (-) CXR, PPD

71
Q

Intracellular GN diplococci, mucopurulent vaginal discharge

A

Gonorrhea —> Ceftriaxone + Azithromycin (Chlamydia)

72
Q

Other tests to order on pt w/ PID?

A

HIV, RPR, Hep B, pap smear, HCV if IVDU

73
Q

Non-tender penile ulcer, raised smooth base, B/L LAD

A

Syphilus —> Benzathine PCN x3, doxy if allergic

74
Q

Additional screening for pt dx w/ syphilus?

A

HIV by ELISA

75
Q

6mo old, Low IgA, G, M, D, No CD19+ B-cells, normal CD3

A

Bruton’s agammaglobulinemia –> IVIG

76
Q

Defect in Bruton’s

A

TK

77
Q

15 y/o, sinus infections, dec Ig’s, NORMAL # B-cells

A

Common variable immunodeficiency

78
Q

Wiskott-Aldrich deficiency

A

Platelets

79
Q

Thrombocytopenia, bruising, bloody stool, pneumonia, dry scales on legs

A

Wiskott-Aldrich (impaired platelet production)

80
Q

Howell-Jolly bodies

A

Aplenia

81
Q

No skin candida response

A

T-cell defects

82
Q

NBT test, NADPH oxidase deficiency, catalse + bacteria, skin abscesses, adenitis

A

CGD (phagocytic defect) - Aspergillus, SA –> daily TMP-SMX & gamma-IF

83
Q

High IgM, no IgG, IgA, many PNA/PCP, otitis media infections

A

Hyper IgM syndrome

84
Q

Low IgG, normal or variable IgA, IgM, >6mo

A

Transient hypogammaglobulinemia of infancy

85
Q

Transfusion –> anaphylaxis

A

IgA deficiency

86
Q

Persistent rotavirus, oral candida, otitis media, no B, T-cells, no thymus, or LNs

A

SCID

87
Q

Repeated sinopulmonary infections, Giardia, PNA

A

Abn B-cell maturation/IgA deficiency

88
Q

Chronic puruitis dermatitis, recurrent staph, hyper IgE, coarse facies

A

Job syndrome

89
Q

No pus, delayed umbilical separation, periodontitis, skin & mucosal infections

A

Leukocyte adhesion deficiency –> CD18 integrin –> no neutrophils in tissue, high in blood

90
Q

Phagocytic deficiency –> ?

A

Chediak-higashi, CGD, Job, defective leukocyte adhesion

91
Q

Absolute CI to organ donation

A

HIV+

92
Q

Vascular thrombosis w/in minutes of organ transplant

A

Hyperacute rejection = PREformed Abs –> ABO matching

93
Q

Organ dysfxn 5d - 3mo, rising GGT, alk phos, bili after organ transplant

A

Acute rejection –> US, doppler, ventricular bx –> steroids, OKT3

94
Q

Years after organ transplant loss of fxn

A

Chronic rejection

95
Q

Summer, SE US, fever, myalgia, malaise –> maculopapular limbs –> trunk on d3-5

A

RMSF –> doxy

96
Q

Dx RMSF

A

Low WBC, platelet, hypoNa, high LFTs –> serology

97
Q

Expanding erythematous macule w/ central clearing

A

Lyme disease

98
Q

Disseminated Lyme disease

A

Bell’s palsy, meningitis, carditis, complete heart block –> arthritis

99
Q

HIV, dry cough, fatigue, weight loss, DOE, fever, B/L ground glass infiltrates, high LDH

A

PCP —> TMP-SMX, prophylaxis CD4 <200

100
Q

Indications for steroid use w/ TMP-SMX in tx PCP

A

PaO2 35

101
Q

HIV, encapsulated yeast

A

Cryptococcus neoformans = Amphotericin B + Flucytosine

102
Q

HIV vaccines

A

Flu, Tdap, strep pneumo, Hep A, B

103
Q

PPD + in HIV

A

> 5mm = INH + pyridoxine for 9mo

104
Q

HIV pt w/ bloody diarrhea, normal stool examination

A

CMV —> colonoscopy w/ bx

105
Q

Only live vaccine given to HIV pts if CD4 >200?

A

MMR

106
Q

HIV profuse watery diarrhea

A

Cryptosporidium

107
Q

HIV bloody diarrhea, trophozoites in stool, flask shaped lesions

A

Entamoeba histolytica

108
Q

HIV screen & confirmatory tests

A

ELISA —> Western blot

109
Q

Inc rate of HIV transmission

A

Anal, lesions from other STDs, #2 = IVDU

110
Q

How to reduce post-exposure risk

A

Immediate cleaning of wound + antiretrovirals w/in 2hrs for 4wks

111
Q

Routine labs for HIV pt

A

3-6mos - CD4, CBC, CMP, UA, toxo, CMV, HBV, HCV, G/C, PPD, pap

112
Q

Crystal induced nephropathy, hematuria retroviral drug

A

Protease inhibitors - IndiNAVIR

113
Q

Didanosine SE

A

Pancreatitis

114
Q

Abacavir SE

A

Hypersensitivity syndrome

115
Q

NRTIs SE

A

Lactic acidosis

116
Q

NNRTIs SE

A

Steven-Johnson syndrome

117
Q

Nevirapine SE

A

Liver failure

118
Q

Prophylaxis for MAI w/ CD4 <50

A

Azithromycin or clarithromycin

119
Q

Tx for unknown source exposure

A

NOT warrant prophylaxis, but inform of risks/benefits if in high-risk setting

120
Q

Kaposi sarcoma virus

A

HHV-8

121
Q

Seizure, IC calcifications, chorioretinitis, hydrocephalus, microcephaly, inc bili, thrombocytopenia

A

Congenital TOXO –> pyramethamine + sulfadiazine

122
Q

Microcephaly, microophthalmia, hearing loss, deafness, PDA/ASD, glaucoma, cataract/white pupillary reflex

A

Congenital rubella - risk >in 1st trimester

123
Q

Clear rhinorrhea, ulcers on feet/hands, jaundice, anemia, perioral fissure

A

Congenital syphilis –> PenG

124
Q

IUGR, chorioretinitis, periventricular calcifications, petechiae, jaundice

A

Congenital CMV

125
Q

IGUR, hypoplasia of distal phalanges/fingernails, low hairline, MR, facial clefts

A

Fetal Phenytoin –> give VitK in last trimester

126
Q

Neuro drug w/ NTDs, high forehead, cleft lip, broad nose, long philtrum

A

Valproic acid

127
Q

Microcephaly, microphthalmia, flat philtrum, small palpebral fissures, thin vermillion/upper lip, FTT, ADHD, VSD

A

Fetal etOH = #1

128
Q

Microotia, thymic hypoplasia

A

Isotretioin

129
Q

Flipper hands

A

Thalidomide

130
Q

Hypoplastic nose, nails

A

Warfarin

131
Q

High-pitched cry, sweating, sneezing, tachypnea, tremor, poor feeding, NO facial abn

A

Heroin - neonatal abstinence syndrome

132
Q

Malar rash, + RPR, + ANA, anemia, leukpoenia next step?

A

SLE –> anti-Smith Abs or dsDNA

133
Q

P23 vs. P7

A

P7 good for <2 y/o

134
Q

No vaccine w/ epilepsy

A

DTaP

135
Q

HIV + exposure

A

Need immunoglobulin = passive

136
Q

Sick infant <28d old next step

A

Hospitalization + IV Abx

137
Q

CI to Rotavirus vaccine

A

Hx intusussception, SCID, uncorrected Meckels etc

138
Q

Live vaccine Cis (MMR,

A

Pregnant

139
Q

CI to DT vaccine

A

Anaphylaxis - caution w/ illness, guillan-barre

140
Q

CI to Pertussis vaccine

A

Anaphylaxis, epilepsy, encephalopathy - caution w/ fever, seizure

141
Q

B/L ptosis, slow pupillary reflexes, floppy, no suck or gag, constipation, drooling, California/PA/UT

A

Infant botulism –> human IG

142
Q

Pinworm tx

A

Albendazole; second = pyrantel pamoate

143
Q

Hx sore throat tx w/ PCN –> 10d later utricaria, joint pain, neck, axilla, inguinal LNs

A

Drug reaction - serum sickness (type III HS)

144
Q

Gradual FTT, intractable diarrhea, thrush, HSM, lymphadenopathy in 1st year

A

HIV –> PCR, p24 or viral culture

145
Q

Lyme disease tx 8 y/o or younger & pregnant women

A

Amoxicillin

146
Q

Tx cat scratch

A

Augmentin

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