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Flashcards in ID:Immuno Deck (146)
1

DILATED pupils, atrophic nasal, HTN, tachycardia

Cocaine -->IV benzos, Nitrates, CCBs = BBs are CI!

2

tinnitus, N/V overdose

Aspirin ---> alkalinize urine

3

Vertical nystagmus overdose, aggression

PCP

4

Bitter almond breath

CN poisoning - burning rubber or plastic

5

Miosis, bradycardia, hypotension, RR 6/min, dec bowel sounds OD

Opioid

6

Ataxia, tremor, bradykinesia, rigidity, hyperreflexia, seizures

Lithium toxcitiy

7

When to obtain serum Acetaminophen level

After 4 hours

8

Tx for acetaminophen OD

Activated charcoal w/in 4hrs --> serum level @4hrs --> ? NAC w/in 8hrs

9

Caustic ingestion tx

Decontamination --> IVFs, CXR r/o perf, lavage, ENDOSCOPY 12-24hrs

10

pH 7.43, PaO2 100, PaCO2 25, HOC3- 16 cause?

Aspirin toxicity - resp alk + metabolic acid

11

Tactile, visual hallucinations, confusion, sweating, tachy, HTN

DTs - 48-96hrs

12

tx etOH abuse

AA >> Disulfram (ST only), Naltrexone, benzos, thiamine, folate, vitamins

13

Slurred speech, ataxia, drowsiness, incoordination, normal pupils, normal respiration

Benzo OD

14

Horizontal nystagmus, ataxia, confusion

Phenytoin OD

15

Constipation, abd pain, polyuria, polydipsia

VitD OD --> hyperCa

16

Unimmunized or unknown or <3Td doses + clean minor wound

Td toxoid only

17

Unimmunized or unknown or <3Td doses + severe or dirty wound

Td + immune globulin

18

>3 Td doses + clean wound

No tx or Td booster if last was >10yrs

19

>3 Td doses + dirty or severe wound tx

Td toxoid bosster if last was >5yrs

20

Pregnant <3mo after MMR vaccination next step?

Reassurance

21

Cat scratch

Bartonella hensale ---> azithromycin

22

Leukopenia, thrombocytopenia, elevated liver enzymes slightly, tick but no rash

erhliciosis = Doxy, chloramphenicol if pregnant

23

Colicky abd pain, swelling of face, arms, legs, genitals, recurrent URIs

Angioedema d/t C1 inhibitor/esterase deficiency

24

Low C1q

Familial SLE

25

Fever, Neutrophils <1500 next step?

Neutropenic fever = Admit + IV cefepime, Imipenem (cover PA)

26

Eosinophilic intranuclear and basophilic intracytoplasmic inclusions

CMV (Owl's eye) ---> ganciclovir or forcarnet

27

Encephalitis in immunocompetent ppl

Herpes viruses

28

High fever, AMS, seizures, focal neuro deficits, high CSF WBC, protein, >lymphocytes

Viral encephalitis --> IV acyclovir

29

Lyme disease tx in pregnant and kids <8 yo

Amoxicllin

30

RUQ pain, smooth round big cyst + daughter cysts on liver US - occupation?

Sheep breeder = echinococcus

31

Nocardia tx

TMP-SMX, 2nd = Minocycline

32

Post-transplant porphylaxis drugs?

TMP-SMX + prednisone + cyclosporine

33

Ulcerated skin lesion, lytic lesions, 3mo fever, weight loss, upper lobe consolidation

Blastomycosis

34

Tooth extraction, right mandilbe abscess, G+ anaerobe, yellow granular pus

Actinomycosis ---> PCN for 12 wks

35

Splinter hemorrhages, peri-orbital edema, chemosis, muscle pain, no murmur

Trichinellosis - undercooked pork

36

Nonproductive cough --> obstipation, SBO, high eosinophils

Ascariasis

37

Warm, tender, erythematous raised rash with good borders on face, fever, chills

Erysipelas - Strep pyogenes

38

Several purple skin masses, nodular contrast enhanced lesion in liver

Bacillary angiomatosis ---> dx by bx but can hemorrhage

39

Bright red, friable, exophytic skin nodules in HIV person

Bacillary angiomatosis --> erythromycin

40

verrucous, ulcerated violet heaped lesions on arm, sharp border w/ microabscesses, yeast

Blasto

41

Low WBC, transplant pt, CXR dense mass + crescent or halo sign in upper lobe

Aspergillosis

42

DKA, necrotic nose, hyphae

Mucormycosis ---> debridement + IV amphotericin

43

Time of onset to tx influenza

<48hrs = Ostelamavir or Zanamivir (w/ lung problems)

44

P vivax and P ovale tx

Primaquine

45

Sub-saharan and India Malaria prophylaxis

Chloroquine resistant = MEFLOQUINE

46

Meningitis newborn

ampicillin + gentamicin

47

Meningitis 2-50 y/o

N. meningitidis, strep pneumo ---> vanco + 3rd gen ceph

48

Meningitis >50 y/o

N. meningitidis, Strep, pneumo, Listeria ---> Vano, amp + 3rd gen ceph

49

Meningitis neurosurgery/ penetrating skull trauma

GNR, SA, Coag- staph ---> vanco + cefepime

50

HA, seizures, multiple fluid filled cysts in brain parenchyma

Neurocysticercosis = T. solium = undercooked pork

51

High fever, AMS, red macropapular, non-blanching eruption --> petechiae

Meningitis

52

Meningitis 1st steps

Admit --> blood, csf cultures/LP --> vanco + ceftiaxone

53

Prophylaxis for close contacts of meningitis pt

Cipro or Rifampin

54

Meningitis with low glucose and MYALGIAS, purpura

Meningococcal meningitis

55

0-1mo sepsis/meningitis bugs

GBS (full-term), EC (Pre-term), Listeria = Amp + gent

56

1-3mo sepsis/meningitis bugs

GBS, S. pneumo, Listeria = Amp + cefotaxime

57

3mo-3yrs sepsis/meningitis bugs

S. pneumo, Hib, Neisseria = Cefotaxime

58

PMNs, high protein low glucose CSF

Bacterial meningitis

59

Lymphs, very high protein, very low glucose

TB

60

Lymphs, normal protein, low glucose CSF

Fungal

61

PMNs --> Mo + lymph, normal protein, glucose

Viral meningitis (HSV has RBCs)

62

Reduce hearing loss in Hib meningitis (#1 complication)

Steroids w/ 1st dose Abx

63

Normal glucose, few WBC, protein 1000

Guillan-Barre --> plasmaphoresis or human IG

64

Bacterial meningitis Tx

Vanco + ceftriaxone or cefotaxime

65

Bacterial meningitis Tx <28d

Amp + gent or amp + cefotaxime

66

Indications for CT b4 LP

Trauma, hydrocephalus, shunt, coma, focal neuro deficits

67

Long term sequelae from meningitis

Hearing loss, cognitive/regression, seizures, MR, spacticity or paresis

68

Hypothermia, 12d old, poor feeding, lethargy, jaundice, vomiting

Neonatal meningitis --> blood cultures and LP

69

Enteroviruses = #1, spring and fall

ECHOvirus & Coxsackie

70

<5 y/o Basilar enhancement on CT, rapid progression to CN deficits

TB - 50% have (-) CXR, PPD

71

Intracellular GN diplococci, mucopurulent vaginal discharge

Gonorrhea ---> Ceftriaxone + Azithromycin (Chlamydia)

72

Other tests to order on pt w/ PID?

HIV, RPR, Hep B, pap smear, HCV if IVDU

73

Non-tender penile ulcer, raised smooth base, B/L LAD

Syphilus ---> Benzathine PCN x3, doxy if allergic

74

Additional screening for pt dx w/ syphilus?

HIV by ELISA

75

6mo old, Low IgA, G, M, D, No CD19+ B-cells, normal CD3

Bruton's agammaglobulinemia --> IVIG

76

Defect in Bruton's

TK

77

15 y/o, sinus infections, dec Ig's, NORMAL # B-cells

Common variable immunodeficiency

78

Wiskott-Aldrich deficiency

Platelets

79

Thrombocytopenia, bruising, bloody stool, pneumonia, dry scales on legs

Wiskott-Aldrich (impaired platelet production)

80

Howell-Jolly bodies

Aplenia

81

No skin candida response

T-cell defects

82

NBT test, NADPH oxidase deficiency, catalse + bacteria, skin abscesses, adenitis

CGD (phagocytic defect) - Aspergillus, SA --> daily TMP-SMX & gamma-IF

83

High IgM, no IgG, IgA, many PNA/PCP, otitis media infections

Hyper IgM syndrome

84

Low IgG, normal or variable IgA, IgM, >6mo

Transient hypogammaglobulinemia of infancy

85

Transfusion --> anaphylaxis

IgA deficiency

86

Persistent rotavirus, oral candida, otitis media, no B, T-cells, no thymus, or LNs

SCID

87

Repeated sinopulmonary infections, Giardia, PNA

Abn B-cell maturation/IgA deficiency

88

Chronic puruitis dermatitis, recurrent staph, hyper IgE, coarse facies

Job syndrome

89

No pus, delayed umbilical separation, periodontitis, skin & mucosal infections

Leukocyte adhesion deficiency --> CD18 integrin --> no neutrophils in tissue, high in blood

90

Phagocytic deficiency --> ?

Chediak-higashi, CGD, Job, defective leukocyte adhesion

91

Absolute CI to organ donation

HIV+

92

Vascular thrombosis w/in minutes of organ transplant

Hyperacute rejection = PREformed Abs --> ABO matching

93

Organ dysfxn 5d - 3mo, rising GGT, alk phos, bili after organ transplant

Acute rejection --> US, doppler, ventricular bx --> steroids, OKT3

94

Years after organ transplant loss of fxn

Chronic rejection

95

Summer, SE US, fever, myalgia, malaise --> maculopapular limbs --> trunk on d3-5

RMSF --> doxy

96

Dx RMSF

Low WBC, platelet, hypoNa, high LFTs --> serology

97

Expanding erythematous macule w/ central clearing

Lyme disease

98

Disseminated Lyme disease

Bell's palsy, meningitis, carditis, complete heart block --> arthritis

99

HIV, dry cough, fatigue, weight loss, DOE, fever, B/L ground glass infiltrates, high LDH

PCP ---> TMP-SMX, prophylaxis CD4 <200

100

Indications for steroid use w/ TMP-SMX in tx PCP

PaO2 35

101

HIV, encapsulated yeast

Cryptococcus neoformans = Amphotericin B + Flucytosine

102

HIV vaccines

Flu, Tdap, strep pneumo, Hep A, B

103

PPD + in HIV

>5mm = INH + pyridoxine for 9mo

104

HIV pt w/ bloody diarrhea, normal stool examination

CMV ---> colonoscopy w/ bx

105

Only live vaccine given to HIV pts if CD4 >200?

MMR

106

HIV profuse watery diarrhea

Cryptosporidium

107

HIV bloody diarrhea, trophozoites in stool, flask shaped lesions

Entamoeba histolytica

108

HIV screen & confirmatory tests

ELISA ---> Western blot

109

Inc rate of HIV transmission

Anal, lesions from other STDs, #2 = IVDU

110

How to reduce post-exposure risk

Immediate cleaning of wound + antiretrovirals w/in 2hrs for 4wks

111

Routine labs for HIV pt

3-6mos - CD4, CBC, CMP, UA, toxo, CMV, HBV, HCV, G/C, PPD, pap

112

Crystal induced nephropathy, hematuria retroviral drug

Protease inhibitors - IndiNAVIR

113

Didanosine SE

Pancreatitis

114

Abacavir SE

Hypersensitivity syndrome

115

NRTIs SE

Lactic acidosis

116

NNRTIs SE

Steven-Johnson syndrome

117

Nevirapine SE

Liver failure

118

Prophylaxis for MAI w/ CD4 <50

Azithromycin or clarithromycin

119

Tx for unknown source exposure

NOT warrant prophylaxis, but inform of risks/benefits if in high-risk setting

120

Kaposi sarcoma virus

HHV-8

121

Seizure, IC calcifications, chorioretinitis, hydrocephalus, microcephaly, inc bili, thrombocytopenia

Congenital TOXO --> pyramethamine + sulfadiazine

122

Microcephaly, microophthalmia, hearing loss, deafness, PDA/ASD, glaucoma, cataract/white pupillary reflex

Congenital rubella - risk >in 1st trimester

123

Clear rhinorrhea, ulcers on feet/hands, jaundice, anemia, perioral fissure

Congenital syphilis --> PenG

124

IUGR, chorioretinitis, periventricular calcifications, petechiae, jaundice

Congenital CMV

125

IGUR, hypoplasia of distal phalanges/fingernails, low hairline, MR, facial clefts

Fetal Phenytoin --> give VitK in last trimester

126

Neuro drug w/ NTDs, high forehead, cleft lip, broad nose, long philtrum

Valproic acid

127

Microcephaly, microphthalmia, flat philtrum, small palpebral fissures, thin vermillion/upper lip, FTT, ADHD, VSD

Fetal etOH = #1

128

Microotia, thymic hypoplasia

Isotretioin

129

Flipper hands

Thalidomide

130

Hypoplastic nose, nails

Warfarin

131

High-pitched cry, sweating, sneezing, tachypnea, tremor, poor feeding, NO facial abn

Heroin - neonatal abstinence syndrome

132

Malar rash, + RPR, + ANA, anemia, leukpoenia next step?

SLE --> anti-Smith Abs or dsDNA

133

P23 vs. P7

P7 good for <2 y/o

134

No vaccine w/ epilepsy

DTaP

135

HIV + exposure

Need immunoglobulin = passive

136

Sick infant <28d old next step

Hospitalization + IV Abx

137

CI to Rotavirus vaccine

Hx intusussception, SCID, uncorrected Meckels etc

138

Live vaccine Cis (MMR,

Pregnant

139

CI to DT vaccine

Anaphylaxis - caution w/ illness, guillan-barre

140

CI to Pertussis vaccine

Anaphylaxis, epilepsy, encephalopathy - caution w/ fever, seizure

141

B/L ptosis, slow pupillary reflexes, floppy, no suck or gag, constipation, drooling, California/PA/UT

Infant botulism --> human IG

142

Pinworm tx

Albendazole; second = pyrantel pamoate

143

Hx sore throat tx w/ PCN --> 10d later utricaria, joint pain, neck, axilla, inguinal LNs

Drug reaction - serum sickness (type III HS)

144

Gradual FTT, intractable diarrhea, thrush, HSM, lymphadenopathy in 1st year

HIV --> PCR, p24 or viral culture

145

Lyme disease tx 8 y/o or younger & pregnant women

Amoxicillin

146

Tx cat scratch

Augmentin