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2019 ABIM > Nov 21, 2019 > Flashcards

Nov 21, 2019 Flashcards

(54 cards)

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1
Q

When should you suspect blood transfusion associated graft-v-host

A

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

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2
Q

What is the mortality rate of blood transfusion associated graft-v-host disease?

A

80-90%

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3
Q

What is the decision point cut off size for pulmonary nodules in low to intermediate risk individuals?

A

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

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4
Q

PPx CD4 cutoffs

A

<200

PCP

<150

Histoplasma capsulatum

<100

Toxoplasma gondii

VZV

Any close contact with infective person and no hx of prior disease or negative antibody

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5
Q

PPx for PCP in HIV

A

CD4 <200 or Oropharyngeal candidiasis or hx of PCP

TMP/SMX or

Dapsone; Atovaquone; Pentamidine

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6
Q

PPx for Toxoplasma in HIV

A

CD4 <100 & Positive IgG antibody

TMP/SMX or

Dapsone + Pyrimethamine + Leucovorin; Atovaqone +- Pyrimethamine + Leucovorin

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7
Q

PPx for Histoplasma capsulatum in HIV?

A

CD4 < 150 & endemic area

Itraconazole

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8
Q

PPx for VZV in HIV?

A

If exposed with no prior hx of disease or negative ab

Give VariZIG or IVIG within 4 days of exposure

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9
Q

Antibodies in Drug-Induced Lupus?

A

DNA-histone complex

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10
Q

DNA-histone complex associated condition?

A

Drug induced lupus

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11
Q

Ab in SLE?

A

dsDNA

Sm

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12
Q

Antibodies in systemic sclerosis?

A

RNA polymerase II and III

Scl-70/anti-topoisomerase I

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13
Q

RNA polymerase II and III as well as Scl-70/anti-topoisomerase I are associated with?

A

Systemic Sclerosis

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14
Q

Ab in MCTD?

A

RNP (ribonucleoprotein) ie Anti-U1-RNP

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15
Q

RNP (ribonucleoprotein) ie Anti-U1-RNP Ab is associated with?

A

MCTD

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16
Q

Ab in Sjogren’s

A

SS-A/Ro, SS-B/La

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17
Q

SS-A/Ro, SS-B/La Asoociated with?

A

Sjogren’s

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18
Q

Ab associated with Limited scleroderma?

A

Centromere

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19
Q

Centromere Ab associated with?

A

Limited scleroderma

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20
Q

Ab associated with Polymyositis/Dermatomyositis?

A

Aminoacyl-tRNA synthetases (Jo-1)

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21
Q

Aminoacyl-tRNA synthetases (Jo-1) associated with?

A

Polymyositis, Dermatomyositis

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22
Q

Ab associated with Microscopic polyangiitis?

Study These Flashcards
A

Myeloperoxidase

23
Q

Myeloperoxidase Ab associated with?

Study These Flashcards
A

Microscopic polyangiitis

24
Q

Ab associated with Granulomatosis with polyangiitis (Wegener’s)

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A

C-ANCA Proteinase 3 (PR3)

25
C-ANCA Proteinase 3 (PR3) associated with?
Granulomatosis with polyangiitis (Wegener's)
26
Diagnostic criteria for MCTD?
Serologic Anti-U1-RNP ab **+ 3 or more of:** Swollen hands or fingers Myositis or myalgia Synovitis Raynaud's
27
Most common cause of death in MCTD?
Pulmonary HTN
28
What form of MCTD has the worst prognosis?
Those with scleroderma and polymyositis symptoms
29
Ab associated with cutaneous systemic sclerosis?
Anti-DNA Topoisomerase
30
Anti-DNA Topoisomerase is associated with?
systemic sclerosis
31
Ab associated with microscopic polyangiitis?
P-ANCA, ie Myeloperoxidase (MPA)
32
P-ANCA, ie Myeloperoxidase (MPA) is associated with?
Microscopic polyangiitis
33
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
34
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
35
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
36
Ab associated with RA?
Anti-CCP and RF
37
Anti-CCP and RF associated with?
RA
38
Antimitochondrial Ab (AMA) associated with?
Primary Biliary Cirrhosis
39
Ab associated with Primary Biliary Cirrhosis?
Antimitochondrial Ab (AMA)
40
What two carbapenems have better outcomes in ESBL?
Imipenem and Meropenem
41
Causes of Hyperhidrosis?
Idiopathic EtOH abuse Opiod withdrawal Hyperthyroidism DM/Hypoglycemia Menopause Antidepressants Insulin/oral hypoglycemics SERM's Niacin
42
How do you treat hyperhidrosis?
Topical aluminum chloride solution Iontophoresis (Palms and soles) Botulinum toxin
43
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
44
Diagnostic criteria for myopericarditis?
Definite pericarditis diagnosis **AND** Elevated cardiac enzymes New depressed left ventricular function Imaging (MRI) showing myocarditis
45
Causes of pericardidis and myopericarditis?
Viral Idiopathic Bacteria Fungi Autoimmune (Lupus) Neoplasm ESRD Post-cardiac injury (Dressler)
46
How do you treat uncomplicated myopericarditis?
ie normal EF and no arrhythmias? NSAIDS + Colchicine ---------------------------------------- Treat any identified underlying cause
47
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
48
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
49
What are potential triggers for microscopic colitis?
Smoking NSAIDs PPIs SSRIs Ranitidine
50
What is the treatment for microscopic colitis?
Stop possible triggers Anti-diarrheal agents Oral budesonide in persistant cases
51
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)
52
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)
53
Senile Purpura
Older adults due to vessel fragility from years of sun related damage Ecchymotic lesions with occasional hyperpigmentation due to hemosiderin deposition
54
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

2019 ABIM (5 decks)

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