UWORLD ID, Immunology, HEME/ONC Flashcards
Tetanus prophylaxis clean wound
No tetanus immune globulin
Give toxoid-containing vaccine if >10 years from last dose or less than 3 doses.
Tetanus prophylaxis dirty or severe wound
Give toxoid-containing vaccine if >5 years from last dose or less than 3 doses (plus TIG)
Acute rhematic fever major features
JoNES
J- joints Migratory arthritis
<3 (o)- carditis
N- nodules (subcutaneous)
E- erythema marginatum
S- sydenham chorea
Acute rheumatic fever other features
Minor:
Fever
arthralgias
elevated ESR/CRP
prolonged PR interval
Other:
5-15yo
twice common in girls
1-8 months after strep infection
Acute rheumatic fever tx
prevention: penicillin for group a strep pharyngitis
SC affected pts receive long acting IM penicillin until adulthood for secondary prevention
eradicate GAS to prevent recurrent rheumatic fever
Sydenham chorea (SC) presentation
Emotional lability and decline in school performance
distal hand movements
Facial grimacing
Feet jerking
Decreased strength
Relaxation phase of patelar reflex delayed
Pronator Drift present
Tx of sydenham chorea (SC)
long acting IM penicillin to prevent recurent ARF
SC itself is supportive TX. Resulution within months.
Corticosteriods can reduce duration- reserved for severe cases.
Dengue clinical features
-Travel to dengue endemic area
-flu-like febrile ilness with marked myalgia/ arthralgia
-diffuse maculopapular rash
-leukopenia
-positive torniquet test
Dengue warning signs clinical features
-Abd pain/ persistent vomiting
-fluid accumulation (ascites, pleural effusion)
-mucosal bleeding
-lethargy or restlessness
-Hepatomegaly >2cm
-increased hematocrit with rapidly decreasing platelet count
Severe dengue clinical features
- Severe plasma leakage causing shock or respiratory distress
-Severe bleeding - Severe organ involvement (AST or ALT >1000, impaired consciousness, organ failure)
Dengue Shock Syndrome
Greatest risk of progression (increased risk with previous exposure to a different dengue virus serotype)
Severe capillary leakage
pleural effuion
asicties
circulatory collapse
end-organ damage
arises as pt deferveses, day 3-5 of illness
infection complication: life threatening cerebral edema
microorganism ?
plasmodium falciparum malaria
infection complication: intestinal perforation
microorganism?
Typhoid fever- salmonella enterica
infection complication: splenic rupture
microorganism?
Rare complication of Mono.
Manifestation of typhoid fever, Salmonella enterica
Proceeds over weeks not days
rising fever & relative bradycardia (wk 1)
Abd pain & “rose spots” (wk2)
Hepatosplenomegaly & intestinal bleeding/ perf (wk3)
Viral meningoencephalitis clinical features
Fever
Headache
Vomiting
Altered mental status
nuchal rigidity
Viruses causing viral meningoencephalitis
Enterovirusus (eg. coxackievirus)
Herpesvirus (eg HSV)
Arbovirus (eg. West Nile)
BIT for meningioencephalitis
Lumbar puncture required for definitive dx.
Initiate while waiting results:
Empiric Acyclovir
Empiric Abx (vancomycin and 3rd gen cephalosporin).
tx viral meningioencephalitis
treatment for VIRAL is supportive.
unless HSV- acyclovir
dont give corticosteroids (do not improve outcomes)
rabies preexposure prophylaxis
Rabies Vaccine (4 doses)
rabies post exposure prophylaxis
Unvaccinated:
Rabies immunoglobulin
rabies vaccine (4 does abridged schedule)
Vaccinated:
Rabies vaccine (2doses)
diagnostic criteria for anaphylaxis
rapid onset &1 of the following:
-skin/mucosa involvement & respiratory distress
->2 organ system involvement
-hypotension after exposure to known allergen
initial episode might be subtle
primary CNS lymphoma
common malignancy in patients with advanc HIV.
Strongly related to EBV.
SIgnificant immunosupression (major determinant of survival)
