Miscellaneous Flashcards

Question

Kikuchi's disease?

Answer 1

Benign, occurs in young adults (usually women) with fever and cervical LAD (usually posterior and unilateral) Sx: arthritis, aseptic meningitis, HSM, rash, uveitis, Mono like syndrome Dx: lymph node biopsy with necrotizing histiocytic infiltrate (without neutrophils) and fragments of nuclear debris

Answer 2

+ rheumatoid factor Neutropenia Splenomegaly INCREASED risk for NHL

Answer 3

Steroids Methotrexate Cyclophosphamide

Answer 4

Inflammation of the fat cells under the skin Sx: tender red nodules on extensor surfaces of lower extremities Hilar LAD (bx: non caseating granulomas) Association btw: erythema nodosum and HLA B 27

Answer 5

Multi system small vessel vasculitis with allergic rhinitis, asthma, peripheral and lung eosinophilia Usually involves lung, skin, but can also affect heart, GI tract, and CNS Blood eosinophilia, Peripheral lung infiltrates in setting of asthma, use of leukotriene receptor antagonist and tapering off steroids Can be P-ANCA positive Buzz words: long standing asthma and new infiltrates and eosinophilia as steroids are tapered

Answer 6

Sarcoidosis syndrome Fever, parotid gland enlargement, anterior uveitis, facial nerve palsy, Can present with lethargy, papilledema, meningismus

Answer 7

Medium and small artery vasculitis Upper and lower respiratory tracts and kidney Tend to be younger F, can also involve joints, eyes, skin, CNS Dx: C-ANCA and biopsy PR3-ANCA MPO-ANCA Buzz words: nasal sx and lung sx, cavitary lung nodules in chest CT Resp symptoms and abnormal u/a Saddle nose

Answer 8

Cyclophosphamide | Glucocorticoids

Answer 9

Multi system granulomatosis ``` Bilateral hilar LAD, pulmonary retic opacities, Skin, joint, eye involvement Fever Night sweats Cough Weight loss 3-4x greater in African Americans Females > males ``` ``` Lab: Incr ESR incr ACE Incr eosinophils Incr hypergammaglobulinemia Anemia Increases calcium ```

Answer 10

All 3: Clinical or radiographic evidence Histology with non caseating granulomas Negative stains for fungus and AFB

Answer 11

Due to certain anticonvulsants that break down into oxide metabolites (Carbamazepine, oxcarbazepine, phenytoin, primidone, phenobarbital) Sx: fever, rash, hepatitis, adenopathy Tx: stop the drug, don't give it again

Answer 12

``` Form of sarcoidosis Hilar LAD Erythema nodosum Arthritis (typically of lower extremities) Increased in Caucasians ```

Answer 13

Bilateral sarcoidosis of the parotid, submandibular, sublingual, and lacrimal glands

Answer 14

Common complication of arteriography, vasc surgery, and thrombolysis Dx: livedo reticularis, ARF, eosinophilia Tx: supportive

Answer 15

Diffuse brick red mac pap rash Prodrome with fever and uri Spreads from head and neck to trunk and extremities 4 C's: conjunctivitis, Cortez's, cough, cracked red lips Koplik spots Complications: Encephalitis Subacute sclerosing panencephalitis (SSPE) is a rare, but fatal degenerative disease of the central nervous system characterized by behavioral and intellectual deterioration and seizures that generally develop 7 to 10 years after measles infection. The virus is transmitted by direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs, or sneezes. Measles virus can remain infectious in the air for up to two hours after an infected person leaves an area.

Answer 16

Detection of measles-specific IgM antibody and measles RNA by real-time polymerase chain reaction (RT-PCR) are the most common methods for confirming measles infection. Healthcare providers should obtain both a serum sample and a throat swab (or nasopharyngeal swab) from patients suspected to have measles at first contact with them. Urine samples may also contain virus, and when feasible to do so, collecting both respiratory and urine samples can increase the likelihood of detecting measles virus

Answer 17

People exposed to measles who cannot readily show that they have evidence of immunity against measles should be offered post-exposure prophylaxis (PEP) or be excluded from the setting (school, hospital, childcare). MMR vaccine, if administered within 72 hours of initial measles exposure, or immunoglobulin (IG), if administered within six days of exposure, may provide some protection or modify the clinical course of disease. If MMR vaccine is not administered within 72 hours of exposure as PEP, MMR vaccine should still be offered at any interval following exposure to the disease in order to offer protection from future exposures. People who receive MMR vaccine or IG as PEP should be monitored for signs and symptoms consistent with measles for at least one incubation period. Except in healthcare settings, unvaccinated people who receive their first dose of MMR vaccine within 72 hours after exposure may return to childcare, school, or work.

Answer 18

people who are at risk for severe illness and complications from measles, such as infants younger than 12 months of age, pregnant women without evidence of measles immunity, and people with severely compromised immune systems, should receive IG.

Answer 19

If a healthcare provider without evidence of immunity is exposed to measles, MMR vaccine should be given within 72 hours, or IG should be given within 6 days when available. Exclude healthcare personnel without evidence of immunity from duty from day 5 after first exposure to day 21 after last exposure, regardless of post-exposure vaccine.

Answer 20

Parotitis, epididymoorchitis, fever, aseptic meningitis (lymphocyte predominant), encephalitis, deafness, facial palsy, gbs, pancreatitis, myocarditis, Tx: symptomatic, analgesics

Answer 21

Similar rash to measles but pt not as sick + LAD, posterior auricular, posterior cervical, occipital, Higher incidence in Latin America and Eastern Europe Prodrome: 1-5 d of fever, malaise, anorexia Rash; face -> to rest of body (lasts 3 days), can also have arthritis (greater in females)

Answer 22

Live vaccine, part of MMR, Rubella vaccination is particularly important for non-immune women who may become pregnant because of the risk for serious birth defects if they acquire the disease during pregnancy In kids, nonimmune women of childbearing age, HCW Adult females, association of symmetric arthritis of hands, wrists, knees about 2 weeks after vaccine administration

Answer 23

Vesicles on red base Lesions in different stages of development Can spread in household due to aerosol droplets or direct contact Incubation: 14-16 days Prodrome: fever, malaise, pharyngitis Then rash in 24 hours Rash crusts over by day 6 in healthy individuals, occurs in crops Complications: secondary strep/staph infections (-> Nec fasc, TSS) Neuroencephalitis, aseptic meningitis, transverse myelitis, Reye's syndrome, Pneumonia (major m and m in adults) Hepatitis

Answer 24

Immunize pts older than 13 w/o immunity 2 doses, 4-8 weeks apart Pregnant pts, give in hospital after birth HIV positive pts with cd4>200

Answer 25

Acyclovir in adults at onset, within 24 hours Treat all household contacts IV tx for pna, hepatitis, encephalitis

Answer 26

Varicella vaccine is recommended for postexposure administration for unvaccinated healthy people aged ≥12 months and without other evidence of immunity, to prevent or modify the disease. The vaccine should be administered as soon as possible within 5 days after exposure to rash, if there are no contraindications to use. Among children, protective efficacy was reported as ≥90% when vaccination occurred within 3 days of exposure. No data are available regarding a potential benefit of administering a second dose to 1-dose vaccine recipients after exposure. However, administration of the second dose is recommended for exposed people to bring them up-to-date on vaccination. Varicella Zoster Immune Globulin People without evidence of immunity who have contraindications for vaccination and who are at risk for severe varicella and complications are recommended to receive postexposure prophylaxis with varicella zoster immune globulin. The varicella zoster immune globulin product licensed in the United States is VariZig. People who should receive VariZIG after exposure include immunocompromised people, pregnant women without evidence of immunity, and some infants. VariZIG provides maximum benefit when administered as soon as possible after exposure but may be effective if administered as late as 10 days after exposure. If VariZIG is not available, intravenous immune globulin (IVIG) can be considered (also within 10 days of exposure). Additionally, in the absence of both VariZIG and IVIG, some experts recommend prophylaxis with acyclovir (80 mg/kg/day, administered 4 times per day for 7 days; maximum dose, 800 mg, 4 times per day), beginning 7–10 days after exposure for people without evidence of immunity and with contraindications for varicella vaccination. Published data on the benefit of acyclovir as postexposure prophylaxis among immunocompromised people are limited.

Answer 27

After close contact with a person who has active varicella or herpes zoster, HIV-infected adolescents and adults who are susceptible to VZV should receive VariZIG as soon as possible, but within 10 days after exposure Note: Patients receiving monthly high dose IVIG (i.e., >400 mg/kg) are likely to be protected against VZV and probably do not require VariZIG if the last dose of IVIG was administered

Answer 28

Releases phage encoded toxin via lysogenic conversion Sx: bull neck (submandibular swelling, anterior neck) Grey adherent pseudo membrane - extends on to palate, uvula, bleeds when scraped, 1. ) Myocarditis (1st degree heart block) 2. ) neuropathies (paralysis of soft palate, cranial neuropathies, peripheral neuropathies wks to mos later)

Answer 29

Chronic non healing ulcer with dirty gray membrane | Outbreaks in homeless in us

Answer 30

Dx: isolation of c. Diphtheria and demonstration of exotoxin Tx: horse serum antitoxin AND abx (procaine penicillin g or erythromycin) * antitoxin prevents neuronal and cardiac toxicity Droplet isolation for resp disease and contact isolation for cutaneous disease Give toxoid after infection clears PEP: Tdap or Td AND erythromycin x 7-10 days

Answer 31

Clostridium botulinum toxin Spores are heat stable, germinate with decreased oxygen and low acidity Mostly food borne illness (home canned foods), also Botox parties Sx: nystagmus, diplopia, dysphagia, ptosis, dysarthria, facial weakness, descending weakness, respiratory issues, PT STAYS ALERT Dx: serum assay, isolate from wound Tx: hospitalize Horse serum antitoxin Abx: penicillin or flagyl

Answer 32

Usually secondary to subcutaneous black tar heroin or inhaled cocaine (no person to person spread)

Answer 33

``` Gbs (ascending paralysis) Tick paralysis (ascending paralysis) Inflammatory myopathy (elevated CK) ```

Answer 34

``` 1.) incubation period: 1-3 weeks Check culture (grow on reagan-Lowe and bordet - gangou media) or pcr ``` 2.) catarrhal phase: 7-10 days with URI (Rhinorrhea, cough, fever, incr WBC) * most infxs to others Check culture or * pcr, can tx with abx 3.) paroxysmal phase: 1-6 weeks, whooping cough, post tussive emesis 3-4 wks sx: Check pcr and serology 4.) convalescent phase: 2-3 weeks, no cough After 4 wks of sx, Check serology

Answer 35

Give antibiotics for patients with less than 4 weeks of symptoms Up to 8 weeks sx for HCW Tx: erythromycin x 7-14 days Azithromycin x 5 days Clarithromycin x 7 days If allergic to macrolides, tx with Bactrim * patient is infectious until on tx for 5 days

Answer 36

Close contacts of a confirmed case within 3 wks of exposure (household contacts) - give abx (erythromycin, Clarithromycin, azithromycin) or bactrim Immunize pts with Tdap Pts can return to work after completing abx

Answer 37

Serogroups: A, B, C, Y, W B and C are most common in US B is NOT in vaccine Incr incidence in pts with terminal complement or properdin deficiency Meningococcemia: 25% of pts - mortality is 20% Rash is mac pap -> petechial -> hemorrhagic (purpura fulminans) Hypotensive, thrombocytopenic, Adrenal infarction (Waterhouse friderichson) Tx: 7d pcn or ctx Droplet isolation for 1st 24 hrs

Answer 38

Only for close contacts, household, roommates Tx: Cipro 500 mg x1 Rifampin 600 mg po bid, x 2d CTX 250 mg IM x 1

Answer 39

Atypical lymphocytosis Dx: + heterophile ab test Or + IgG and IgM 10% mono is secondary to cmv, HIV, toxo, hhv6, hhv7 Elderly: transaminitis into hundreds, fuo, fatigue Complications: rash after ampicillin (no actual allergy), wbc > 50,000, anemia, thrombocytopenia, aplastic anemia, GBS, 7th N palsy, splenic rupture, Rare: myocarditis, pancreatitis, glomerulonrphritis,peritonsillar abscess

Answer 40

T cell proliferation secondary to EBV or CMV or heme malignancy Fever, HSM, LAD, hepatitis, Incr ferritin, histiocytic proliferation in bone marrow and lymph nodes, incr CD 25

Answer 41

HLH, burkitts, Hodgkin's disease, nasopharyngeal carcinoma, non Hodgkin's lymphoma in HIV pts (especially CNS lymphomas)

Answer 42

E. Coli Staph saprophyticus 2-3 fold

Answer 43

Ischemic necrosis of skeletal muscle in DM (usually IDDM) Dx: muscle bx with edema and eos Tx: Asa, NSAIDs

Answer 44

Systemic medial calcification of arteries that leads to ischemia, sub q necrosis, painful in areas of fat often occurs in ESRD pts on HD, or after renal txplt Or pts on warfarin Dx: skin bx: incr calcium within blood vessels and inflammation of fat)

Answer 45

Strep pneumo H influenza Moraxella catarhallis Tx: amoxicillin or amoxicillin/clavulanate

Answer 46

1-14 hrs post ingestion Sx: headache, myalgia, backache, neck pain, nausea, diaphoresis, tingling, flushing, palpitations, chest heaviness, urticaria and angioedema

Answer 47

Usually secondary to sulfas, B lactams, allopurinol, antileptics, NSAIDs

Answer 48

Assoc with EBV, CMV, and Parvovirus Or autoimmune illness (sle, RA) and heme malignancies Sx: fever, HSM, rash, LAD, Neuro sx, cytopenias Dx: elevated TG, incr CD25 GS: BM biopsy

Answer 49

• Definitions: sepsis defined in terms of SIRS plus documented infection. » Systemic inflammatory response syndrome (SIRS) as 2 or more of the following: – Fever (T>38°C, 100 °F) or hypothermia (T90) – Tachypnea (RR>20) or arterial partial pressure of C02less than 4.3 kPa (32 mmHg) – Leukocytosis (WBC>12,000cells/mm3 or differential w/ >10% bands or

Answer 50

SLE Myeloproliferative d/o Polyarteritis nodosa

Miscellaneous Flashcards

(74 cards)