immunology Flashcards
HIV early appearence
flue like prodrome
fever night sweats and weight loss
aids + CD4
CD4 <200 cells and or the presence of an opportunistic infection
AIDS labs
Elisa for initial screening is >99% sensitive
Western blot is confirmatory
AIDS absolute CD4 lymphocyte count
normal is >800
CD4 lymphocyte percentage to AIDS is high when <20%
AIDS viral load
should be zero, results correlate with progression of HIV
HIV PJC pneumonia propholaxysis
pneumocystis (pneumonia) jirovecii -leading cause of death in AIDS patinetns
Bactrium propholactally
Antiretrovetrial therapy
HAART
start at the time of HIV diagnosis
but not later than CD4 of 350
osteoarthritis
degenerative joint diseasease
weight bearing joints
swelling but NOT redness or heat
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OA heberdines
distal interphalangeal joints DIPS where you hold the herb
OA Bouchards
Prohimal interphalangeal joints PIPS
OA pain
better in the morning gets worse over the day
OA x-ray findings
narrowng of the joint space
osteophytes
juxta articular sclerosis
subchondral bone
OA meds
ASA
Tylenol
Nsaids
Celebrex cox-2 inhibitor
OA supportive care
weight loss cane on opposite side ICE to improve ROM moist heat to decrease spasm and relieve stiffness PT refer for joint replacement
RA def
systemic autoimmune disease causing inflammation of the connective tissue
RA inflammation is
symetrical
RA age
35-50 yonger than OA
RA gender
women more than men 3-1
RA pain
worse in morning better as day goes on
RA labs
ESR usually elevated, ANA in 1/5 patients
RA diagnostics
synovial aspirate with inflammatory changes and WBC’s
RA x-ray
Joint swelling - OA is narrowing, cortical thinnin, osteopenia,
RA drugs
high dose salicylates nsaids DMARDS corticosteroids methotrexate antimalarials gold salts injections
RA management
early rheum referral
rest
PT
surgery
Orthor term avulsion
bone fragments pulled off by attached ligaments or tendons
dislocation vs subluxation
disloction is disruption of normal relationship of bones, subluxation is incomplete discloction, dislocation is confirmed by x-ray
methotrexate lab
watch LFTs
Open fracture treatment
IV abx, sterile dressing, tetanus prophylazis and surgical debredment.
Compartment syndrome
in the closed facial compartment, sever pain, skin profusion and arterial pulses are NORMAL, passive streth of the muscle is painful, repeated limb measurements are necessary
lupus affects primarily
primarily wome of childbearing age
butterfly rash- affects 50% of paitntes but will be on test
ana will be +
lupus management
bedrest
naps
avoid fatigue
sun protection
drugs that make you look like lupus
INH methaldopa qunidine thorazine hydralzine procanimide
giant cell arteritis
temperoal arteritis inflammtory condition primarily affeting patients ove the age of 50, can lead to permanaet blindenss. 50% of all cases fo fever of unknown origin over age 65
giant cell arteritis
fever 103-104 scalp pain rigors and chills nodular enlarded or tender high esr and normal WBC temproal artery biopsy is positive in 85%
giant cell areritis tx
referral and prednisone taper
sinusitis most pronounced feature
post nasal drip
optic disk
doughnut with orange/pink neurorential rim, and a central white depression
cup disk ratio
cup should be no more than 1/2 the side of the disc diameter (if bigger consider glaucoma)
eye arteries are brighter red and NARROWER than veins ratio is
2-3 or 4-5 A-V
macula centered
2-2.5 disc dimeters temporal to the optic disc and is avascular
Fovea centralis looks slightly darker and lies
in the center of the macular region, if macula is hard to see have the patient look directly into the light.
common eye problems diabetic retinopathy
diabetic retinopathy- microanurysms are the earliest detectable sign, either superficial (flame shaped) or deeper (blot and dot) cotton wool spots
eye problem asociated with chronic hypertension
AV nicking-
arcus senilis
cloudy appearence of the cornea iwth a gray white arc or circle around the limbus due to deposition of the lipid material, has no effect on vision
conjunctivitis
msot common eye disorder, inflammation/infection of the conjunctiva (pink eye) resulting from alergies, bacteria, virusis or std sti NO PAIN
Conjunctivitis S and S Bacterial
purulent discharge- self limiting, abx drops: levofloxacin ofloxin ciprofloxacin tobramycin gentamycin eye drops
gonococcal or chlamydial conjunctivitis
copious purulent drainage gonoccal ceftriaxone, 250 mg IM chlamydia erythromycin ointment oral tetracycline, clarimycin, or doxy
allergic conjunctivitis
stringy, increased tearing, oral antihistamines
viral conjunctivitis
water dranage symptomatic
corneal abriasion def
trauma to the epithelia surfac of the eye INTENSE PAIN
corneal abrasion tx
sodium fluroesen stan detects abrasion
topical abx or sulfonamide drops
pressure patch for 24 hours
steroid drops are contraindicated and pain drops after exam cauuse u want to eval progress
should be heald in 24 hours if not refer.
glaucoma
increased IOP
open angle is chronic
CLOSED ANGLE is emergence
10-20mmhg is normal
glaucoma chronic
cupping of optic disc
constriction of visual fields
glaucoma acute
closed angle extreme pain blurred vision halos around the lights pupil fixed or dialated
glaucoma test
tonometry- national screening by age 40
management - glaucoma open
alpha 2 agonist- brimonidine, alhagan, beta adrenergic blocker- timolol
management glaucoma closed
emergency
diamox- carbonic anyhydrase inhibitors
mannitol
surgery
cataract def
cluding and opacificatoin of the normally clear lense of the eye
highest cause of treatable blindness
most common surgical procedure in 65+, senile cataracts
cataract S and S
painless clouded or blurred vision, sensitivity to light iwth ellowing of colors DOUBLE VISION IN A SINGLE EYE no red light reflex opacity of the lense
refer to opto for sx
