Immunology/Toxicology Flashcards
1
Q
What/how does the following laboratory method test: ELISA
A
measures Ig G/M/A
used in dz detection and allergen identification
2
Q
What/how does the following laboratory method test: RAST
A
quantifies IgE
3
Q
What/how does the following laboratory method test: IgG
A
delayed hypersensitivity rxn to antigen
4
Q
What/how does the following laboratory method test: IgE
A
immediate hypersensitivity rxn to antigen
5
Q
IgG is associated with what and is a measure of what?
A
long term exposure/delayed rxns (food allergy)
marker of exposure, not sucessful tx
6
Q
IgM is associated with what and is a measure of what?
A
acute phase rxns
marker of recent infection or reexposure
7
Q
IgA is associated with what and is a measure of what?
A
secretory Ig (serum, stool, saliva)
shows mucosal response and is a good marker of successful tx
8
Q
IgE is associated with what and is a measure of what?
A
anaphylaxis (type 1 rxn)
9
Q
what would the folowing ab testing results indicate:
high IgG
low IgM or IgA
A
probable past infxn/exposure that is inactive or cured
in food allergy testing, ig G is always considered active, but delayed response allergy
10
Q
A
11
Q
what would the folowing ab testing results indicate:
low IgG
high IgM
A
new infxn / exposure
12
Q
what would the folowing ab testing results indicate:
high IgG
high IgM
A
reactivated infection / exposure
13
Q
what would the folowing ab testing results indicate:
high IgG
low IgM
high IgA
A
current immune response (mucosal) that is past the initial IgM response window (ongoing problem)
14
Q
ANA is the typical screening test for which type of disorders?
A
RA, SLE, lupus, MCTD, CREST syndrome, scleroderma, polymyositis
15
Q
what titer level for ANA is positive?
A
> 1:160
16
Q
what is what of the only conditions the nonspecific measure of ESR can be diagnostic in?
A
giant cell arteritis
17
Q
what testing would you consider in someone with a RA like presentation who tested negative for RF?
A
parvo B19 viral assay
18
Q
HLA B27 is what type of testings and gives diagnostic information about what conditions/when will it be elevated?
A
glycoproteins; seronegative arthritities; AS, reiters, MS, chronic active hepatitis, gluten sensitive enteropathy, SLE, DM, hemochromatosis
also done for tranplantation matches
19
Q
what infection would you want to test for in a patient with reiters?
A
chlamydia
20
Q
anti-thyroid ab (anti microsomal or TPO Ab) is a marker for which disorders?
A
hashimotos thyroiditis
atophic thyroiditis
graves disease
21
Q
antithyroglobulin (Anti TG) ab is a marker for what disorders?
A
autoimmune thyroiditis
hashimoto thyroiditis
22
Q
thyroid stimulating ig (TSI) (thytrophin receptor ab) is a marker for what disorder(s)? when would you order this testing?
A
graves dz
order when graves sn/sx and TPO elevation
23
Q
what testing would you run in someone you suspect is having post streptococcal sequelae? what would be a positive result?
A
anti streptolysin O (ASO) test
pos >200 iu/ml
24
Q
what types of testing is available for EBV?
A
monospot (sx, more sensitive in first infxn, IgM for 4-21 days)
PCR (chronic reactivating cases)
panel (early phase IgM antiVCA, acute illness IgG anti VCA and anti EA, convalescence/reactivation anti EBNA)
25
e coli testing
stool ag testing O157-H7
26
giardia testing
stool assay in sx pt
27
h pylori testing
nitrogen breath test
igG (PAST infxn)
igM (current, will dec regardless of tx status)
serum/salivary/**stool IgA** (rises with ifxn, falls with tx)
28
HAV testing
IgM (acute)
IgG (years after)
29
HBV testing
HbsAg - detected 1-4 months post infection
appearance past >6 mo exhibit chronic illness
antiHbs Ab - protected against HBV
HbcAg- IgM and IgG
30
HCV testing
PCR
HCV ab - 4x inc foir HCC
31
HDV testing
coexists with HB and makes HB more deadly; worst in pregnancy
32
HSV testing
IgG/M type (1 or 2) specific serology best for dx
PCR available
virus isolation (tzank smear) is OLD method, not specific to 1 or 2 and can have false pos
33
HIV testing
ELISA measures anti HIV titers; confirmed by western blot analysis
*may take 6 months to seroconvert*
decreased CD4/8 ratio
newly dx: t cell subset
earliest dx: PCR
34
types of HPV common causes for plantar and genital warts
6, 11
35
types of HPV common causes for cervical cancer and how to test for them
16, 18, 31, 33
PCR on pap smear
36
what testing would indicate a present infection of rubella
presence of IgM and/or four fold inc in IgG
37
syphilis testing
VDRL/RPR
nontreponemal tests used primarily for detection of primary syphilic infection
38
tuberculosis testing
intradermal skin test; read 48-72 hours for induration
BCG: post ID, check serology results
39
lyme testing
> 250 rxn units
skin, blood, synovial, CSF
ELISA or western blot checking for ab detection
PCR now available
40
nystatin MOA
disrupts fungal wall
41
nystatin uses
cutaneous, intestinal, vaginal, and mucocutaneous candida infxns
42
nystatin adverse effects
contact dermatitis
poorly absorbed/ better for topical
43
miconazole MOA
disrupts fungal wall
44
miconazole uses
tineas, cutaneous and vulvovaginal candida
45
miconazole adverse effects
pruritis, skin irritation, burning, contact dermatitis
46
amphotericin class, uses
IV only (unless compounded) antifungal; two types
high potential side effect profile
47
triazole drugs are what type of drugs and end in what suffix
antifungals
-conazole aside from terbinafine
48
triazole MOA
inhibits fungal p450, degrading fungal cell wall
49
main side effect concern with triazoles
liver damage; inhibits p450
dont take with other drugs with hepatotoxicity risks
50
terbinafine uses
topical and oral; toenail fungus
51
where can nystatin be used?
topical infxns (includes GI tract)
52
nystatin dosing
GI infxns: 500k-1 mil units po tid
53
fluconazole dosing
varies based on infxn and immunocompetence
150-200mg single dose
200 mg bid for 2-4 weeks
100 mg daily for months (long term may dose 5 days on/2 days off rotation)
54
terbinafine dosing
fingernail onychomycosis: 250 mg qd x 6 weeks
toenail: 250 mg qd x 12 weeks
55
permethrin MOA/uses
causes paralysis by disrupting sodium current in the parasite
scabies, pedivulosis
56
permethrin adverse effects
pruritis, edema, rash, burning, stinging
if a child gets a hold of permethrin and drinks it they can have seizures and die since it is a CNS irritant
57
permethrin method of dosing
topical
58
mebendazole class/MOA/uses
antihelminthic; irreversibly inhibits nutrient uptake by helminthes
pinworms, roundworks, hookworks
59
mebendazole adverse effects
abdominal pain
diarrhea
fever
60
mebendazole dosing
pinworm: 100 mg single dose, repeat 2-3 weeks
roundworm, hookwork, whipworm: 100 mg po bid x 3 days, repeat 3 weeks
61
metronidazole class/MOA/uses
antiprotozoal; inhibits DNA synthesis in microorganism causing cell death
amoebas, trich, giardia
62
metronidazole AEs
GI distress, seizures, ataxia, cramping, rash, joint pain
63
metronidazole CIs
do NOT take with Etoh (acts like antabuse)
potentizes p450 metabolized drugs
64
hyroxychloroquinine class/MOA/uses
antimalarial; unknown MOA
malaria, extraintestinal amebiasis
65
hyroxychloroquinine AEs
HA
dizziness
pruritis
neuropathy
seizures
retinal changes
ototoxic
66
metronidazole dosing
intestinal amebiasis: 750 mg bo BID 5-7 days > then iodoquinol rx
trich: 750 mg po TID 7 days OR 1 g po bid x 1 day, repeat in 4-6 weeks
BV: 500 mg po bid x 7 days
67
is the following medication/medication class safe for lactation: gentamycin
generally safe due to low transfer and low oral availability
68
is the following medication/medication class safe for lactation: cephalosporins
considered safe; low transfer into milk (third generation have greater potential to alter bowel flora)
69
is the following medication/medication class safe for lactation: ciproflaxin
avoid fluroquinolones due to theoretical risk of arthopathies
70
is the following medication/medication class safe for lactation: macrolides
generally safe; may alter bowel flora
71
is the following medication/medication class safe for lactation: amoxycillin
generally safe
72
is the following medication/medication class safe for lactation: tetracyclines
avoid where feasible due to possible risks of dental staiing and averse effects on bone development
73
is the following medication/medication class safe for lactation: acyclovir
safe
74
is the following medication/medication class safe for lactation: fluconazole
potential for accumulation esp in premature infants
75
is the following medication/medication class safe for lactation: metronidazole
controversial as exposure may be high; with high doses consider expressing and discarding milk
76
is the following medication/medication class safe for lactation: nitrofurantoin
avoid in G6PD def infants due to risk of hemolysis
77
is the following medication/medication class safe for lactation: sulfamethoxazole
avoid in infants with hyperbilirubinemia and G6PD def
78
bactericidal antibiotics that target:
bacterial cell wall
penicillins
cephalosporins
79
bactericidal antibiotics that target:
bacterial cell membrane
polymixins
80
bactericidal antibiotics that interfere with essential bacterial enzymes
quinolones, sulfonamides usually
81
bacteriostatic abx (target protein synthesis)
aminoglycosides
macrolides
tetracyclines
82
ab for gram pos
penicillin G
vancomycin
bacitracin
83
ab for gram neg
aminoglycosides
polymixins
84
broad spectrum ab
quinolones
ampicillin
cephalosporins
tetracyclines
chloramphenicol
sulfonamides
85
ab side effects
GI tract - kill good flora; dysbiosis
kidneys (usu injected/IV) - inc kidney excretion
liver (less common)
systemic superinfection with bacteria or fungi that are not effected by the abx given
86
what are the B lactam ab
penicillins
cephalosporins
carbapenems
monobactams
87
penicillin MOA/uses
break down / inhibit bacterial cell wall synthesis
gram + cocci, anaerobic bacteria, syphilis
88
penicillin adverse effects
N/V, rash, seizures, anaphylaxis, neurotoxic, nephrotoxic
89
penicillin CI/caution
not effective against B lactamase producing organisms or gram - anaerobes
90
ampicillin class/MOA/uses
penicillin; inhibits cell wall synthesis;
some gram + and gam - organisms, prophylaxis for dental procedures
91
ampicillin CI/caution
not effective against B lactamase producing organism
92
amoxicillin class/MOA/uses
penicillin; inhibits cell wall synthesis;
some gram + and gam - organisms, prophylaxis for dental procedures
93
amoxicillin CI/caution
not effective against B lactamase producing organism UNLESS used with clavulanate
94
clavulanate MOA/uses
used with amoxicillin; makes it effective against B lactamese producing organisms
95
what ab should you be cautious of concerning allergies?
penicillin, cephalosporin (cross allergy; if your pt is allergic to penicillin, dont give them cephalosporins either)
96
cephalexin uses
URI, GI infxn, cutaneous ifxn, soft tissue ifxn
97
cephalosporins AEs
nausea, diarrhea, maculopapular rash, anaphylaxis, serum sickness, GI distress
98
cephalosporins CI/caution
dont give to pts with penicillin allergy
99
cephalosporin MOA
bactericidal by inhibiting cell wall synthesis
100
cefactor uses
UTI, URI, OM
101
cefdinir/cefixime uses
more resistant to gram - B lactamase organisms
102
cefepime uses
e coli, proteus, k pneumoniae, enterobacteria, b fragilis, staph/strep
103
what are the common cephalosporins
1st gen - cephalexin
2 - cefactor
3 - cefixime, cefdinir
4 - cefepime
104
what are the macrolide abx
erythromycin
clarithromycin
azithromycin
105
macrolide MOA
inteferes with bacterial DNA synthesis
106
erythromycin uses
M pneumo
pertussis
neonatal c pneumo
strep thraot
URI
107
erythromycin AEs
abdominal pain, nausea/vomiting, diarrhea, anaphylaxis
108
macrolides CI/caution
CI in pregnancy; caution with impaired renal function
109
clarithromycin AEs
abdominal pain, nausea/vomiting, diarrhea, anaphylaxis
110
clarithromycin uses
bronchitis
non gonococcal urethritis
cervicitis
chancroid
111
azithromycin uses
bronchitis
non gonococcal urethritis
cervicitis
chancroid
112
which macrolide has less GI side effects and requires less medication to achieve the same effect?
azithromycin
113
macrolides safety in preg
CI in preg in general
clarithromycin Cat C (benefits > risks)
azithromycin cat B (safest)
114
macrolide suffix
-ROmycin (be careful as other meds also end in mycin)
115
tetracyclines MOA/uses
inteferes with bacteria protein synthesis;
susceptible gram + and gram - organisms including chlamydia and lyme disease
sebulytic (acne)
116
tetracyclines AEs
intracranial HTN
GI distress
rash
photosensitivity
inc pigmentation
117
tetracyclines CI/caution
avoid in pregnancy and lactation
avoid in children under 9 due to permanent discoloration/other dental effects and possible bone effects
118
sulfonamides MOA/uses
interfere with bacterial folic acid synthesis
UTI, OM, URI, pneumocystis, travelers diarrhea
119
sulfonamides AEs
rash, seizures, stevens johnson syndrome (SJS) / toxic epiderml necrolysis (TEN)
N/V, diarrhea, nephrotoxic, hepatic necrosis, anaphylaxis
120
sulfonamides CI/caution
many potential side effects
interefere w OCPs (all abx can do this)
121
nitrofurantoin uses
specific UTI indication
122
nitrofurantoin CI/cautions
anuria, oligura, or renal impairement are CI (cleared almost exclusively through kidneys)
pregnant pts at term, during labor/delivery, neonates (hemolytic anemia risk if born with it in their system)
123
clindamycin class/MOA/uses
lincosamide; interferes with peptide elongation in bacterial protein synthesis
gram + cocci and anaerobes; often alternative to penicillin
124
suffixes
aminoglycosides
lincosamides
macrolides
aminoglycosides: - mycin / -micin
lincosamides: only clindamycin
macrolides: - romycin
125
floroquinolones naming
ciprofloxacin family - "flox"'s
126
fluoroquinolones MOA/uses
bactericidal by interfering with bacterial DNA synthesis
wide spectrum ab ; URI, UTI, cutaneous ifxn, bone/joint infxn, abdominal infxns
127
fluoroquinolones AEs
achilles tendon rupture/other tendon pathology
rash, arthralgias, nausea, diarrhea, seizures, GI/CNS effects
128
fluoroquinolones CI
do not use in kids under 18; can arrest growth plate in children
129
aminoglycosides MOA/uses
bactericidal by interfering with bacterial DNA synthesis
serious infxns of enterobacter, e coli, k pneumonia, psedomonas
130
aminoglycosides AEs
**severe ototoxicity**
nephrotoxic, seizures, anaphylaxis, neurotoxic
131
isoniazid class/MOA/uses
antituberculosis drug; inhibits cell wall synthesis in mycobacterium TB
132
antituberculosis AEs
neuropathies
hepatotoxic
GI disturbance
fever
rash
sexual side effects
133
what is the CI/caution that all antituberculosis drugs share?
hepatotoxicity
134
rifampin class/MOA/uses
antituberculosis drug; impairs RNA synthesis
135
what should rifampin and other antituberculosis drugs be rx with?
B6
136
neomycin class/MOA/uses
topical antibiotic; disrupts bacterial protein synthesis
topical bacterial infxns
137
neomycin AEs
contact dermatitis, rash, nephrotoxic, ototoxic
138
mupirocin class/MOA/uses
topical antibiotic; bacterial RNA inhibition
impetigo, MRSA prophylaxis
139
antiviral suffixes
-cyclovir
140
antivirals MOA
inhibits viral multipication by interering with DNA synthesis
141
metabolism/dosing differences between the antivirals
valacyclovir and famcyclovir both metabolize to acyclovir in the body, but require lower dosing.
142
antiviral AEs
nausea/vomiting, rash, headache, seizures, coma
143
antivirals used for: human herpes virus 1-7 (except CMV)
acyclovir, valcyclovir, famcyclovir
144
antivirals used for: hepatitis B and C
interpheron alpha, peglyated interferon
145
antivirals used for: influenza
oseitamivir
146
types of HIV pharm tx
Nucleoside reverse-transcriptase inhibitiors (NRTI)
Non-Nucleoside reverse-transcriptase inhibitiors (NNRTI)
protease inhibitors
triple therapy (2 NRTIs and PI or NNRTI)
147
types of NRTIs
type A: zidovudine, stavudine, azidothymidine
148
adalimumab & etanercept class/moa/uses
TNFa inhibitor
RA, PA, anklylosing spondylitis, chrohns, chronic psoriasis and juvenile idiopathic arthritis
149
adalimumab & etanercept CI/cautions
prolonged tx with adalimumab may slightly increase the risk of developing infections and cancer
150
montelucast class/MOA/uses
leukotriene receptor antagonist
phrophylaxis and chronic tx of asthma in pts 12 mo +, seasonal allergic rhinitis 2+, exercise induced bronchoconstriction prevention
151
montelucast AEs
LOTS in multiple systems!
152
interferon alpha uses
hep B/C, HPV, hairy cell leukemia, kaposis sacroma
153
interferon beta uses
MS
154
interferon AEs
flu like sx
**hypothyroidism**
low blood cell counts
n/v, diarrhea
155
tacrolimus class/MOA/uses
CMI suppressor; suppresses cell mediated immune rxns and some humoral immunity
PO and IV prophylaxis of organ rejection in pts getting allogenic liver, kidney, or heart transplants; used in conjunction with adrenal corticosteroids
topical second line therapy for short term/noncont chronic tx of atopic dermatitis
156
cyclosporine class/MOA/uses
CNI blocker; inhibits cell mediated immune responses; inhibition of lymphocytic proliferation and function
dry eye drops, psoriasis
157
cyclosporine AEs
nephrotoxic (dose dependent, reversible)
157
anastrazole class/MOA/uses
aromatase inhibitor; dec estrogen formation
tx breast CA after surgery and in mets in both pre and post menopausal women
158
anastrazole AEs
similar to SERMS; menopausal type sx
159
doxorubicin class/MOA/uses
chemotherapeutic agent; anthracycline antiobiotic, intercalates DNA
wide range of cancers including hematological malignancies, carcinomas, and soft tissue sarcomas
160
doxorubicin AEs
life-threatening heart damage
161
paclitaxel class/MOA/uses
taxanes; mitotic inhibitior isolated from bark of pacific yew tree (taxus brevifolia); stabilizes microtubules and interferes with their breakdown during cell division
lung, ovarian, breast CA
head and neck CA
advanced forms of kaposis sarcoma
162
paclitaxel AEs
N/V
loss appetite
chagne in taste
thinned/brittle hair
pain in joints
change in color of nails
tingling in hands/toes
163
methotrexate class/MOA/uses
competitively inhibits dihydrofolate reductase; inhibits synthesis of DNA, RNA, thymidylates, and proteins
alone or in combo for chemo with breast, head and neck, leukemia, lymphoma, lung, osteosarcoma, bladder, trophoblastic neoplasms
abortions/ectopic pregnancies, AI disorders
164
methotrexate AEs
ulcerative stomatitis
low WBC count > predisposition to infection, nausea, abdominal pain, fatigue, fever, and dizziness
165
common dermatologic SE findings with chemo/radiation
cellulitis
mucositis > N/V
ecchymosis/thrombocytopenia
purpura/petichiae
nose/face rash
tongue lesions
radiation burns/hypopigmentation
photosensitivity
nail changes
tumor seeding to skin
166
penicillamine MOA/uses
chelates heavy metals esp copper
wilsons dz, RA, mercury or lead poisoning
167
penicillamine AEs
optic neuritis, GI distress, stomatitis, nephrotic syndrome, GN, leukopenia, skin rash, arthralgia
168
lead poisonin medication
EDTA
169
add purpose of immunizations, shcedules, not in fevers, other admin/hygeiene rules***
170
ankylosing spondylitis etiology, presentation
chronic inflammatory arthritis, SI joints > vertebral column
RF: M; HLAB27
LBP, stiffness in AM improves w 30 min movement, dec lumbar lordosis, inc thoracic kyphosis, uveitis, loss of chest expansion, neuro sx, aortic valve insuff, restrictive lung dz, cauda equina
"bamboo spine" erosion/sclerosis of vertebral body corders, pseudo widening of SI joint > bony effusion
171
ankylosing spondylitis tx/prognosis
NSAIDs, celecoxib, sulfasalazine, adalimumab, glucocorticoids, hip replacement
spont remissions/relapses
good prog if F onset <40
172
myasthenia gravis presentation/etiology
NEURO EMERGENCY DUE TO RISK OF RESP FAILURE
autonomic disorder of postsynaptic NM transmission; auto ab agaisnt Ach receptors; HSII rxn
inc risk thymoma (thymic hyperplasia), pstosis, diplopia, weakness in prox muscles, dysphagia; worse w preg, menses, infxn
normal reflex, sensory, coordination. edrophonium (tensilon) test inhibits achesterase > dec sx
173
tx myasthenia gravis
NEURO EMERGENCY DUE TO RISK OF RESP FAILURE
donepezil, rivastigmine, corticosteroids, cyclosporine, thymectomy
174
polymyositis presentation/etiology
t cell mediated inflammatory myopathy with symmetrical, proximal muscle weakness
shoulder/hip weakness, heliotrope eylids (racoon eyes), gottrons patches (purple papules over PIPS), CHF, ventricular hypertrophy, dysphagia/reflux
ANA, inc CK, inc AST/ALT, muscle biopsy shows lymphocytic infiltrate, MRI/CT to screen for malignancy
175
dermatomyositis
is the same as polymyositis but has skin manifestations and is ab mediated
176
polymyositis tx
PT/OT
high dose CS with taper
methotrexate, cyclosporine
177
reiter syndrome/reactive arthritis etiology/presentation
2-4 weeks post GI/GU infxn (shigella, salmonella, campylobacter, chlamydia)
men, self limited, resolution 3-12 mo
cant see (uveitis), cant pee (urethritis) cant dance with me/cant bend my knee (asymettric arthralgia)
hyperkeratosis on palms/sole, oral ulcers, achilles tendinitis
HLAB27
178
reiter syndrome tx
abx for non-auricular infxns
NSAIDs
PT
CS
sulfasalazine
methotrexate
TNF inh for spinal inflammation
179
RA etiology, presentation, tx
HLADR4; pot triggered by mycoplasma, EBV, rubella
morning stiff >1 hr, better movement, symmetric joint pain PIPS/DIPs, BL ulnar dev, boutonniere deformity
RF+, inc ESR/CRP, radiography
NSAIDS, PT, acetominophen w or w/o opiods, prednisone, adalimumab, sulfasalazine
180
scleroderma etiology/presentation
T cell release of cytokines > excess collagen production
F 35-65
CREST syndrome, skin pigmentation changes, skin tightness, rayauds, LES incompetatence (GERD, consripation/diarrha), dysphgia, **respiratory failure**
antinuclear ab, Scl 70
181
scleroderma tx
- derm sx: low dose prednisone
- raynauds: CCB
- GERD: PPI, H2 block
- SIBO: abx
- myositis: sys steroids
182
sjogrens etiology/presentation
HLA B8
destruction of minor salivary glands and lacrimal glands by lymphocytic infiltration
xerophthalmia, xerostomia, parotid enlergment, dental caries, angular chelitis
anti SSA/Ro, anti SSB/La, RF, ANA, salivary biopsy with focal lymphocytic sialadenitis
183
sjogrens tx
artificial tears, dental hygiene
pilocarpine
cyclosporine
prednisone
184
SLE etiology/presentation
HLA DR2, HLA DR 3, ANA, anti-dsDNA ab, antiSith ab, proteinuria, RBC/hb casts
malar rash, discoid rash, oral ulcers, photosensitivity, GN, pleural effusion, seizures, HA
185
tx for SLE
topical steroids
hydroxychloroquine
NSAIDs
bisphosphonates
cal/vit D
high dose prednisone or IV methylprednisone
avoid estrogens
186
hx of what disorder is a RF for giant cell arteritis?
polymyalgia rheumatica
187
tx giant cell arteritis
high dose IV prenisone right away, do not wait for biopsy if suspected
188
necrotizing vasculitis eitology/presentation
inflammation of BV walls > ischemia and necrosis
common with polyarteritis nodosa, RA, scleroderma, SLE, wegeners granulomatosis
multiple organ ichemia, systemic illness w no evidence malignancy or infxn
inc WBC, inc ESR, abnormal UA, biopsy muscle, organ tissue, angiography, anemia
189
necrotizing vasculitis tx
corticosteroids, immunosuppressors
190
polyarteritis nodosa etiology/presentation
necrotizing medium vessel vasculitis involving renal, coronary, mesenteric arteries
40-60, M>F
wt loss, myalgias/weakness, livedo reticularis, neuropathy, testicular pain, DBP >90, inc Cr or BUN, HBV, arteriographic abnormality (biopsy)
191
polyarteritis nodosa tx
corticosteroids
192
tx anaphylaxis
0.3-0.5 mL of 1:1000 epi (IM) repeat q5-15 min
diphenhydramine 50 mg IM or IV q4-6h
193
what medication to avoid with urticaria?
NSAIDs
194
tx fibromyalgia
NSAIDs
low dose amitriptyline for sleep
gabapentin
195
erythema infectiosum
parvovirus B19
respiratory droplets
"slapped cheek" rash, fever, rhinorrhea
can cause joint pain, aplastic crisis in sickle cell
196
roseola
HHV 6 or 7
saliva transmission
high fever > rash
febrile seizures
197
rubella
respiratory transmission
fever, rash, swollen lymph nodes
birth defects if congenital
198
rubeola/measles
respiratory transmission
high fever, rhinorrhea, koplik spots, rash
pneumonia, encephalitis
199
scarlet fever
group A (pyogenes) strep
respiratory transmission
