Homeless / Low SES Flashcards
(11 cards)
Tuberculosis (TB)
Clue: Cough + weight loss + night sweats in a homeless person
• Pathogen: Mycobacterium tuberculosis
• Test: PPD, IGRA, chest x-ray (upper lobe cavitations)
• Highly tested: Reactivation TB is common in immunosuppressed and malnourished
Step 1 Tip: Homeless + hemoptysis + cavitary lesion = reactivation TB
Substance Use Disorders
Alcohol use disorder: Liver disease, Wernicke-Korsakoff, pancreatitis
• IV drug use: HIV, Hepatitis B/C, tricuspid endocarditis (Staph aureus)
• Crack cocaine: Coronary vasospasm, chest pain, MI
• Heroin/opioids: Respiratory depression, pinpoint pupils, abscesses
Tip: “Homeless + track marks + new murmur” = right-sided endocarditis
Hepatitis B & C
Transmission: IV drug use, unprotected sex
• Complications: Cirrhosis, hepatocellular carcinoma
• Diagnosis: Serology panels (know how to interpret HBsAg, anti-HBc, anti-HBs, etc.)
HIV / AIDS
Risk factors: IV drug use, unprotected sex, poor access to testing
• Opportunistic infections: PCP, TB, toxoplasmosis, candidiasis
• Diagnosis: ELISA → Western blot or PCR
Mental Illness
Common conditions:
• Schizophrenia (especially disorganized subtype)
• Major depressive disorder
• Bipolar disorder
• Often comorbid with substance use and contributes to poor medical adherence
Tip: Homeless + disorganized thoughts = schizophrenia likely; look for flat affect, social withdrawal
Common conditions:
• Schizophrenia (especially disorganized subtype)
• Major depressive disorder
• Bipolar disorder
• Often comorbid with substance use and contributes to poor medical adherence
Tip: Homeless + disorganized thoughts = schizophrenia likely; look for flat affect, social withdrawal
Vitamin B1 (thiamine): Wernicke-Korsakoff (alcoholics)
• Wernicke: Ataxia + confusion + ophthalmoplegia
• Korsakoff: Confabulation, memory loss
• Vitamin C (ascorbic acid): Scurvy (bleeding gums, poor wound healing)
• Vitamin B12: Macrocytic anemia + neuro signs (dorsal column degeneration)
• Iron: Microcytic anemia from poor diet
Hypothermia & Exposure Injuries
Frostbite, trench foot
• Hypothermia: J wave (Osborn wave) on EKG
• Burns/injuries from exposure to harsh environments
Infectious Skin Conditions
• Scabies, lice, impetigo
• Cellulitis (often from poor hygiene or injection sites)
Poor Prenatal Care
Higher rates of:
• Preterm labor
• Low birth weight
• Congenital infections (syphilis, HIV, etc.)
• Lack of folic acid → neural tube defects
Vaccine-Preventable Illnesses
Often under-immunized due to access issues
• Measles, Hep B, tetanus, influenza
USMLE Step 1 Tips
Recognize socioeconomic red flags: “homeless,” “shelter,” “no insurance,” “missed follow-ups”
• Think in systems: infectious (TB, HIV), psych (schizophrenia), nutritional (B1, B12), derm (lice/scabies)
• Be comfortable with interpreting labs for hepatitis, TB testing, and HIV diagnostics
• Questions may integrate public health and ethics (e.g., need for free clinics, DOT therapy for TB)
