Immune

Question 1

Migratory arthritis and rash in peds

Answer 1

Rheumatic fever
JONES criteria
Penicillin, erythromycin

Question 2

Indications for cardiac monitoring after an electrical injury

Answer 2

Cardiac arrest, documented loss of consciousness, abnormal ECG, observed dysrhythmia, history of cardiac disease, presence of significant cardiac disease risk factors, chest pain or hypoxia

Question 3

Immune throbocytopenia

Answer 3

Seen in kids after viral illness
Petechia and bruisng; thrombocytopenia on labs
Antibody mediated destruction of platelets

Question 4

Shock refractory to volume resuscitation and vasopressors

Answer 4

adrenal crisis

Question 5

Adrenal crisis

Answer 5

Hyponatremia, hypoglycemia, shock (hypotension, tachy)
Give steroids (hydrocortisone or dexamethasone if rapid ACTH stim is ordered)

Question 6

When is oseltamivir indicated?

Answer 6

Pt’s at high risk for complications (<2, >65, pregnant, immunocompromised etc)
Greatest benefit if given within 48hrs of onset of symptoms

Question 7

Treat pheocromocytoma

Answer 7

Phentolamime and then labetalol (don’t want unopposed alpha)

Question 8

Trousseau syndrome

Answer 8

Migratory superficial thrombophlebitis

Assoc w/hypercoaguable state

Question 9

Lupus pernio

Answer 9

Seen in sarcoidosis
Smooth brown/purple plaques on head and neck
Initially start as papules on nasal ala

Question 10

Chronic lymphocytic thyroiditis

Answer 10

Hashimotos
Euthyroid, firm/nontender thyroid on exam
Seen in young girls often

Question 11

Treat Raynaud flare

Answer 11

Nifedipine or amlodipine
Sildenafil
2% NTG ointment
Fluoxetine

Question 12

Dermatomyositis

Answer 12

Progressive, symmetric proximal muscle weakness
Malar rash involvement of the nasolabial fold
Heliotrope sign, shawl sign, gottron papule, mechanic’s hands
Interstitial lung disease, arthralgia, cardiac conduction, occult malignancy

Question 13

Pellagra

Answer 13

3 Ds! Diarrhea, dermatitis, dementia

B3 (niacin)

Question 14

Erythema nodosum

Answer 14

Delayed hypersensitivity
Tender, blue hue
Symmetrical pretibial involvement, extensor surfaces
Arthralgia 90%

Question 15

Enlarged left supraclavicular lymph node

Answer 15

Aka Virchow node or Troisier sign

Deep seated carcinomas eg gastric, other solid organs

Question 16

TTP

Answer 16

Fever, thrombocytopenia, hemolytic anemia, neuro changes, AKI
Plasmapharesis

Question 17

Autoimmune hemolytic anemia

Answer 17

Fatigue, pallor, jaundice
Give steroids