Nov 21, 2019 Flashcards
When should you suspect blood transfusion associated graft-v-host
Donor lymphocytes attack host tissue in immunocompromized or close HLA matched patients
4-30 days post transfusion have erythematous/maculopapular rash
Anorexia, Abd pain, hepatomegaly, liver dysfunction, diarrhea
Pancytopenia from bone destruction
What is the mortality rate of blood transfusion associated graft-v-host disease?
80-90%
What is the decision point cut off size for pulmonary nodules in low to intermediate risk individuals?
8mm or >
FDG-PET or biopsy
<8mm
if 5-7mm serial CT
if 4 or less and intermediate risk then serial CT otherwise no follow up
PPx CD4 cutoffs
<200
PCP
<150
Histoplasma capsulatum
<100
Toxoplasma gondii
VZV
Any close contact with infective person and no hx of prior disease or negative antibody
PPx for PCP in HIV
CD4 <200 or Oropharyngeal candidiasis or hx of PCP
TMP/SMX or
Dapsone; Atovaquone; Pentamidine
PPx for Toxoplasma in HIV
CD4 <100 & Positive IgG antibody
TMP/SMX or
Dapsone + Pyrimethamine + Leucovorin; Atovaqone +- Pyrimethamine + Leucovorin
PPx for Histoplasma capsulatum in HIV?
CD4 < 150 & endemic area
Itraconazole
PPx for VZV in HIV?
If exposed with no prior hx of disease or negative ab
Give VariZIG or IVIG within 4 days of exposure
Antibodies in Drug-Induced Lupus?
DNA-histone complex
DNA-histone complex associated condition?
Drug induced lupus
Ab in SLE?
dsDNA
Sm
Antibodies in systemic sclerosis?
RNA polymerase II and III
Scl-70/anti-topoisomerase I
RNA polymerase II and III as well as Scl-70/anti-topoisomerase I are associated with?
Systemic Sclerosis
Ab in MCTD?
RNP (ribonucleoprotein) ie Anti-U1-RNP
RNP (ribonucleoprotein) ie Anti-U1-RNP Ab is associated with?
MCTD
Ab in Sjogren’s
SS-A/Ro, SS-B/La
SS-A/Ro, SS-B/La Asoociated with?
Sjogren’s
Ab associated with Limited scleroderma?
Centromere
Centromere Ab associated with?
Limited scleroderma
Ab associated with Polymyositis/Dermatomyositis?
Aminoacyl-tRNA synthetases (Jo-1)
Aminoacyl-tRNA synthetases (Jo-1) associated with?
Polymyositis, Dermatomyositis
Ab associated with Microscopic polyangiitis?
Myeloperoxidase
Myeloperoxidase Ab associated with?
Microscopic polyangiitis
Ab associated with Granulomatosis with polyangiitis (Wegener’s)
C-ANCA Proteinase 3 (PR3)
C-ANCA Proteinase 3 (PR3) associated with?
Granulomatosis with polyangiitis (Wegener’s)
Diagnostic criteria for MCTD?
Serologic Anti-U1-RNP ab
+ 3 or more of:
Swollen hands or fingers
Myositis or myalgia
Synovitis
Raynaud’s
Most common cause of death in MCTD?
Pulmonary HTN
What form of MCTD has the worst prognosis?
Those with scleroderma and polymyositis symptoms
Ab associated with cutaneous systemic sclerosis?
Anti-DNA Topoisomerase
Anti-DNA Topoisomerase is associated with?
systemic sclerosis
Ab associated with microscopic polyangiitis?
P-ANCA, ie Myeloperoxidase (MPA)
P-ANCA, ie Myeloperoxidase (MPA) is associated with?
Microscopic polyangiitis
What is the treatment for Toxicodendron dermatitis?
(Poison ivy/oak) 2 weeks of therapy
Topical mid to high potentcy corticosteroids if early disease
Oral pred at 1mg/kg/day for severe or in cases with facial/periocular involvement or widespread disease
What are the features of Systemic Sclerosis?
Systemic: Fatigue, Weakness
Skin: Telangiectasia, sclerodactyly, digital ulcers, calcinosis cutis
Extremities: Arthralgias, contractures, myalgias
GI: Esophageal dysmotility, dysphagia, dyspepsia
Vascular: Raynaud phenomenon
ANA, Anti-topoisomerase I (Anti-Scl-70) and anticentromere
What are common complications of systemic sclerosis?
Lung: Interstitial lung disease, PAH
Kidney: HTN, Scleroderma renal crisis (oliguira, thrombocytopenia, MAHA)
Cardiac: Myocardial fibrosis, pericarditis, pericardial effusion
Ab associated with RA?
Anti-CCP and RF
Anti-CCP and RF associated with?
RA
Antimitochondrial Ab (AMA) associated with?
Primary Biliary Cirrhosis
Ab associated with Primary Biliary Cirrhosis?
Antimitochondrial Ab (AMA)
What two carbapenems have better outcomes in ESBL?
Imipenem and Meropenem
Causes of Hyperhidrosis?
Idiopathic
EtOH abuse
Opiod withdrawal
Hyperthyroidism
DM/Hypoglycemia
Menopause
Antidepressants
Insulin/oral hypoglycemics
SERM’s
Niacin
How do you treat hyperhidrosis?
Topical aluminum chloride solution
Iontophoresis (Palms and soles)
Botulinum toxin
Diagnostic criteria for pericarditis?
2 or more:
Typical chest pain
Pericardial friction rub
ECG changes (diffuse ST elevation, PR depression)
New or worsening pericardial effusion
Diagnostic criteria for myopericarditis?
Definite pericarditis diagnosis
AND
Elevated cardiac enzymes
New depressed left ventricular function
Imaging (MRI) showing myocarditis
Causes of pericardidis and myopericarditis?
Viral
Idiopathic
Bacteria
Fungi
Autoimmune (Lupus)
Neoplasm
ESRD
Post-cardiac injury (Dressler)
How do you treat uncomplicated myopericarditis?
ie normal EF and no arrhythmias?
NSAIDS
+
Colchicine
Treat any identified underlying cause
Clinical features of Microscopic colitis?
Watery, non-bloody diarrhea with fecal urgency and incontinence
Abdomial pain, fatigue, wt loss, arthraligas
Commoonly affects middle-aged women
Diagnosis of microscopic colitis?
Normal CSP with biopsy of:
Collagenous colitis subtype: Thickented subepithelial collagen band
Lymphocytic colitis subtype: High levels of intraepithelial lymphocytes (20 or > for every 100 epi), focal cryptitis can be seen
What are potential triggers for microscopic colitis?
Smoking
NSAIDs
PPIs
SSRIs
Ranitidine
What is the treatment for microscopic colitis?
Stop possible triggers
Anti-diarrheal agents
Oral budesonide in persistant cases
Causes of acute severe anemia in sickle cell?
Splenic sequestration crisis (children before autosplenectomy)
Aplastic crisis (Infection with B19, EBV, Strep pneumo, Salmonella)
Hyperhemolytic crisis (unclear etiology though may be due to multiple transfusions)
Diagnostic criteria for MM?
Monoclonal protien in serum or urine (alternatively can use serum free light chain)
10% or greater clonal plasma cells in bone marrow or soft tissue/bone plasmacytoma
End-Organ damage (CRAB)
Senile Purpura
Older adults due to vessel fragility from years of sun related damage
Ecchymotic lesions with occasional hyperpigmentation due to hemosiderin deposition
Depression medication duration?
Single episode, 6months after control of symptoms then taper
Recurrent, chronic (2 or more years), severe (suicide) - 1-3 years following remission
Highly recurrent 3 or more lifetime episodes, severe/chronic MDD - Consider lifetime
