ID:Immuno Flashcards
1
Q
DILATED pupils, atrophic nasal, HTN, tachycardia
A
Cocaine –>IV benzos, Nitrates, CCBs = BBs are CI!
2
Q
tinnitus, N/V overdose
A
Aspirin —> alkalinize urine
3
Q
Vertical nystagmus overdose, aggression
A
PCP
4
Q
Bitter almond breath
A
CN poisoning - burning rubber or plastic
5
Q
Miosis, bradycardia, hypotension, RR 6/min, dec bowel sounds OD
A
Opioid
6
Q
Ataxia, tremor, bradykinesia, rigidity, hyperreflexia, seizures
A
Lithium toxcitiy
7
Q
When to obtain serum Acetaminophen level
A
After 4 hours
8
Q
Tx for acetaminophen OD
A
Activated charcoal w/in 4hrs –> serum level @4hrs –> ? NAC w/in 8hrs
9
Q
Caustic ingestion tx
A
Decontamination –> IVFs, CXR r/o perf, lavage, ENDOSCOPY 12-24hrs
10
Q
pH 7.43, PaO2 100, PaCO2 25, HOC3- 16 cause?
A
Aspirin toxicity - resp alk + metabolic acid
11
Q
Tactile, visual hallucinations, confusion, sweating, tachy, HTN
A
DTs - 48-96hrs
12
Q
tx etOH abuse
A
AA»_space; Disulfram (ST only), Naltrexone, benzos, thiamine, folate, vitamins
13
Q
Slurred speech, ataxia, drowsiness, incoordination, normal pupils, normal respiration
A
Benzo OD
14
Q
Horizontal nystagmus, ataxia, confusion
A
Phenytoin OD
15
Q
Constipation, abd pain, polyuria, polydipsia
A
VitD OD –> hyperCa
16
Q
Unimmunized or unknown or <3Td doses + clean minor wound
A
Td toxoid only
17
Q
Unimmunized or unknown or <3Td doses + severe or dirty wound
A
Td + immune globulin
18
Q
> 3 Td doses + clean wound
A
No tx or Td booster if last was >10yrs
19
Q
> 3 Td doses + dirty or severe wound tx
A
Td toxoid bosster if last was >5yrs
20
Q
Pregnant <3mo after MMR vaccination next step?
A
Reassurance
21
Q
Cat scratch
A
Bartonella hensale —> azithromycin
22
Q
Leukopenia, thrombocytopenia, elevated liver enzymes slightly, tick but no rash
A
erhliciosis = Doxy, chloramphenicol if pregnant
23
Q
Colicky abd pain, swelling of face, arms, legs, genitals, recurrent URIs
A
Angioedema d/t C1 inhibitor/esterase deficiency
24
Q
Low C1q
A
Familial SLE
25
Fever, Neutrophils <1500 next step?
Neutropenic fever = Admit + IV cefepime, Imipenem (cover PA)
26
Eosinophilic intranuclear and basophilic intracytoplasmic inclusions
CMV (Owl's eye) ---> ganciclovir or forcarnet
27
Encephalitis in immunocompetent ppl
Herpes viruses
28
High fever, AMS, seizures, focal neuro deficits, high CSF WBC, protein, >lymphocytes
Viral encephalitis --> IV acyclovir
29
Lyme disease tx in pregnant and kids <8 yo
Amoxicllin
30
RUQ pain, smooth round big cyst + daughter cysts on liver US - occupation?
Sheep breeder = echinococcus
31
Nocardia tx
TMP-SMX, 2nd = Minocycline
32
Post-transplant porphylaxis drugs?
TMP-SMX + prednisone + cyclosporine
33
Ulcerated skin lesion, lytic lesions, 3mo fever, weight loss, upper lobe consolidation
Blastomycosis
34
Tooth extraction, right mandilbe abscess, G+ anaerobe, yellow granular pus
Actinomycosis ---> PCN for 12 wks
35
Splinter hemorrhages, peri-orbital edema, chemosis, muscle pain, no murmur
Trichinellosis - undercooked pork
36
Nonproductive cough --> obstipation, SBO, high eosinophils
Ascariasis
37
Warm, tender, erythematous raised rash with good borders on face, fever, chills
Erysipelas - Strep pyogenes
38
Several purple skin masses, nodular contrast enhanced lesion in liver
Bacillary angiomatosis ---> dx by bx but can hemorrhage
39
Bright red, friable, exophytic skin nodules in HIV person
Bacillary angiomatosis --> erythromycin
40
verrucous, ulcerated violet heaped lesions on arm, sharp border w/ microabscesses, yeast
Blasto
41
Low WBC, transplant pt, CXR dense mass + crescent or halo sign in upper lobe
Aspergillosis
42
DKA, necrotic nose, hyphae
Mucormycosis ---> debridement + IV amphotericin
43
Time of onset to tx influenza
<48hrs = Ostelamavir or Zanamivir (w/ lung problems)
44
P vivax and P ovale tx
Primaquine
45
Sub-saharan and India Malaria prophylaxis
Chloroquine resistant = MEFLOQUINE
46
Meningitis newborn
ampicillin + gentamicin
47
Meningitis 2-50 y/o
N. meningitidis, strep pneumo ---> vanco + 3rd gen ceph
48
Meningitis >50 y/o
N. meningitidis, Strep, pneumo, Listeria ---> Vano, amp + 3rd gen ceph
49
Meningitis neurosurgery/ penetrating skull trauma
GNR, SA, Coag- staph ---> vanco + cefepime
50
HA, seizures, multiple fluid filled cysts in brain parenchyma
Neurocysticercosis = T. solium = undercooked pork
51
High fever, AMS, red macropapular, non-blanching eruption --> petechiae
Meningitis
52
Meningitis 1st steps
Admit --> blood, csf cultures/LP --> vanco + ceftiaxone
53
Prophylaxis for close contacts of meningitis pt
Cipro or Rifampin
54
Meningitis with low glucose and MYALGIAS, purpura
Meningococcal meningitis
55
0-1mo sepsis/meningitis bugs
GBS (full-term), EC (Pre-term), Listeria = Amp + gent
56
1-3mo sepsis/meningitis bugs
GBS, S. pneumo, Listeria = Amp + cefotaxime
57
3mo-3yrs sepsis/meningitis bugs
S. pneumo, Hib, Neisseria = Cefotaxime
58
PMNs, high protein low glucose CSF
Bacterial meningitis
59
Lymphs, very high protein, very low glucose
TB
60
Lymphs, normal protein, low glucose CSF
Fungal
61
PMNs --> Mo + lymph, normal protein, glucose
Viral meningitis (HSV has RBCs)
62
Reduce hearing loss in Hib meningitis (#1 complication)
Steroids w/ 1st dose Abx
63
Normal glucose, few WBC, protein 1000
Guillan-Barre --> plasmaphoresis or human IG
64
Bacterial meningitis Tx
Vanco + ceftriaxone or cefotaxime
65
Bacterial meningitis Tx <28d
Amp + gent or amp + cefotaxime
66
Indications for CT b4 LP
Trauma, hydrocephalus, shunt, coma, focal neuro deficits
67
Long term sequelae from meningitis
Hearing loss, cognitive/regression, seizures, MR, spacticity or paresis
68
Hypothermia, 12d old, poor feeding, lethargy, jaundice, vomiting
Neonatal meningitis --> blood cultures and LP
69
Enteroviruses = #1, spring and fall
ECHOvirus & Coxsackie
70
<5 y/o Basilar enhancement on CT, rapid progression to CN deficits
TB - 50% have (-) CXR, PPD
71
Intracellular GN diplococci, mucopurulent vaginal discharge
Gonorrhea ---> Ceftriaxone + Azithromycin (Chlamydia)
72
Other tests to order on pt w/ PID?
HIV, RPR, Hep B, pap smear, HCV if IVDU
73
Non-tender penile ulcer, raised smooth base, B/L LAD
Syphilus ---> Benzathine PCN x3, doxy if allergic
74
Additional screening for pt dx w/ syphilus?
HIV by ELISA
75
6mo old, Low IgA, G, M, D, No CD19+ B-cells, normal CD3
Bruton's agammaglobulinemia --> IVIG
76
Defect in Bruton's
TK
77
15 y/o, sinus infections, dec Ig's, NORMAL # B-cells
Common variable immunodeficiency
78
Wiskott-Aldrich deficiency
Platelets
79
Thrombocytopenia, bruising, bloody stool, pneumonia, dry scales on legs
Wiskott-Aldrich (impaired platelet production)
80
Howell-Jolly bodies
Aplenia
81
No skin candida response
T-cell defects
82
NBT test, NADPH oxidase deficiency, catalse + bacteria, skin abscesses, adenitis
CGD (phagocytic defect) - Aspergillus, SA --> daily TMP-SMX & gamma-IF
83
High IgM, no IgG, IgA, many PNA/PCP, otitis media infections
Hyper IgM syndrome
84
Low IgG, normal or variable IgA, IgM, >6mo
Transient hypogammaglobulinemia of infancy
85
Transfusion --> anaphylaxis
IgA deficiency
86
Persistent rotavirus, oral candida, otitis media, no B, T-cells, no thymus, or LNs
SCID
87
Repeated sinopulmonary infections, Giardia, PNA
Abn B-cell maturation/IgA deficiency
88
Chronic puruitis dermatitis, recurrent staph, hyper IgE, coarse facies
Job syndrome
89
No pus, delayed umbilical separation, periodontitis, skin & mucosal infections
Leukocyte adhesion deficiency --> CD18 integrin --> no neutrophils in tissue, high in blood
90
Phagocytic deficiency --> ?
Chediak-higashi, CGD, Job, defective leukocyte adhesion
91
Absolute CI to organ donation
HIV+
92
Vascular thrombosis w/in minutes of organ transplant
Hyperacute rejection = PREformed Abs --> ABO matching
93
Organ dysfxn 5d - 3mo, rising GGT, alk phos, bili after organ transplant
Acute rejection --> US, doppler, ventricular bx --> steroids, OKT3
94
Years after organ transplant loss of fxn
Chronic rejection
95
Summer, SE US, fever, myalgia, malaise --> maculopapular limbs --> trunk on d3-5
RMSF --> doxy
96
Dx RMSF
Low WBC, platelet, hypoNa, high LFTs --> serology
97
Expanding erythematous macule w/ central clearing
Lyme disease
98
Disseminated Lyme disease
Bell's palsy, meningitis, carditis, complete heart block --> arthritis
99
HIV, dry cough, fatigue, weight loss, DOE, fever, B/L ground glass infiltrates, high LDH
PCP ---> TMP-SMX, prophylaxis CD4 <200
100
Indications for steroid use w/ TMP-SMX in tx PCP
PaO2 35
101
HIV, encapsulated yeast
Cryptococcus neoformans = Amphotericin B + Flucytosine
102
HIV vaccines
Flu, Tdap, strep pneumo, Hep A, B
103
PPD + in HIV
>5mm = INH + pyridoxine for 9mo
104
HIV pt w/ bloody diarrhea, normal stool examination
CMV ---> colonoscopy w/ bx
105
Only live vaccine given to HIV pts if CD4 >200?
MMR
106
HIV profuse watery diarrhea
Cryptosporidium
107
HIV bloody diarrhea, trophozoites in stool, flask shaped lesions
Entamoeba histolytica
108
HIV screen & confirmatory tests
ELISA ---> Western blot
109
Inc rate of HIV transmission
Anal, lesions from other STDs, #2 = IVDU
110
How to reduce post-exposure risk
Immediate cleaning of wound + antiretrovirals w/in 2hrs for 4wks
111
Routine labs for HIV pt
3-6mos - CD4, CBC, CMP, UA, toxo, CMV, HBV, HCV, G/C, PPD, pap
112
Crystal induced nephropathy, hematuria retroviral drug
Protease inhibitors - IndiNAVIR
113
Didanosine SE
Pancreatitis
114
Abacavir SE
Hypersensitivity syndrome
115
NRTIs SE
Lactic acidosis
116
NNRTIs SE
Steven-Johnson syndrome
117
Nevirapine SE
Liver failure
118
Prophylaxis for MAI w/ CD4 <50
Azithromycin or clarithromycin
119
Tx for unknown source exposure
NOT warrant prophylaxis, but inform of risks/benefits if in high-risk setting
120
Kaposi sarcoma virus
HHV-8
121
Seizure, IC calcifications, chorioretinitis, hydrocephalus, microcephaly, inc bili, thrombocytopenia
Congenital TOXO --> pyramethamine + sulfadiazine
122
Microcephaly, microophthalmia, hearing loss, deafness, PDA/ASD, glaucoma, cataract/white pupillary reflex
Congenital rubella - risk >in 1st trimester
123
Clear rhinorrhea, ulcers on feet/hands, jaundice, anemia, perioral fissure
Congenital syphilis --> PenG
124
IUGR, chorioretinitis, periventricular calcifications, petechiae, jaundice
Congenital CMV
125
IGUR, hypoplasia of distal phalanges/fingernails, low hairline, MR, facial clefts
Fetal Phenytoin --> give VitK in last trimester
126
Neuro drug w/ NTDs, high forehead, cleft lip, broad nose, long philtrum
Valproic acid
127
Microcephaly, microphthalmia, flat philtrum, small palpebral fissures, thin vermillion/upper lip, FTT, ADHD, VSD
Fetal etOH = #1
128
Microotia, thymic hypoplasia
Isotretioin
129
Flipper hands
Thalidomide
130
Hypoplastic nose, nails
Warfarin
131
High-pitched cry, sweating, sneezing, tachypnea, tremor, poor feeding, NO facial abn
Heroin - neonatal abstinence syndrome
132
Malar rash, + RPR, + ANA, anemia, leukpoenia next step?
SLE --> anti-Smith Abs or dsDNA
133
P23 vs. P7
P7 good for <2 y/o
134
No vaccine w/ epilepsy
DTaP
135
HIV + exposure
Need immunoglobulin = passive
136
Sick infant <28d old next step
Hospitalization + IV Abx
137
CI to Rotavirus vaccine
Hx intusussception, SCID, uncorrected Meckels etc
138
Live vaccine Cis (MMR,
Pregnant
139
CI to DT vaccine
Anaphylaxis - caution w/ illness, guillan-barre
140
CI to Pertussis vaccine
Anaphylaxis, epilepsy, encephalopathy - caution w/ fever, seizure
141
B/L ptosis, slow pupillary reflexes, floppy, no suck or gag, constipation, drooling, California/PA/UT
Infant botulism --> human IG
142
Pinworm tx
Albendazole; second = pyrantel pamoate
143
Hx sore throat tx w/ PCN --> 10d later utricaria, joint pain, neck, axilla, inguinal LNs
Drug reaction - serum sickness (type III HS)
144
Gradual FTT, intractable diarrhea, thrush, HSM, lymphadenopathy in 1st year
HIV --> PCR, p24 or viral culture
145
Lyme disease tx 8 y/o or younger & pregnant women
Amoxicillin
146
Tx cat scratch
Augmentin
