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237 Cards in this Set

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define immunology
1. study of systems reponsible for recognition and disposal of foreign, non-self entities
2. a desirable - natural and acquired resistance to infectious disx
acquired immunity
2 types
cell mediated
humoral
cell mediated immunity
Tcell lymphocytes + phagocytic cells
- Tcells recognize Ag from APC macrophages
ex: cytokines, interluekins
humoral immunity - Active
formed by the host in response to exposure
1. natural - Ab formed due to infxn
2. artificial - vaccine - expansion of Bmemory cells
humoral immunity - passive
1. natural - transfer in-vivo or in colostrum (mom's milk)
2. artificial - serum or plasm infusion w/ incr. [c] of PRE_FORMED Ab
ex: Rhogam or needle stick
IgG
how much in serum? what are characteristics
70-75% in serum
diffuses to EXTRAVASCULAR spaces- neutralizes toxins or binds to orgs
- can X placenta
adult level by 16
subclasses differ
*can activate complement cascade
can IgM cross placent or bind to microorganisms?
nope
how do the subclasses of IgG differ?
in heavy chain, bio activities
IgM
10% in serum
pentamer - largest Ig
INTRAVSCULAR AREAS
see EARLY immune response
ACUTE disease
adult level b/t 8-15 y/o
IgA
15-20% serum
MAIN Ig in secretions
-tears, saliva, colostrum, milk
Secretory IgA protected from GI proteolytic enz
adult level by age 16
IgD
<1% in serum
- a cell membrane Ig
-see on surface of Bcells in association w/ IgM
IgE
trace in serum
elev in hypersens rxn = allergies, parasitic infx
-binds strongly to mast cell and basophil receptor
along w/ Ag meadiates release of histamine and heparin
Type I hypersensitivivty rxn
immediate
IgE mediated
RAST allergy panel - msrs total Ag specific IgE
Type II
Tcytotoxic mediated
free Ab rxn w/ Ag on cell surface
ex: ABO transfusion rxn
DAT
direct antiglobulin tests
- detects presence of Ab coating RBC post rxn
use LAVENDAR top
Indirect Coomb's Test
used in X-matching blood
tests for Ab in transfused blood
use RED top
type III
immune complex
uses up complement- decr in C3,4,CH50
Type IV
-delayed hypersens. rxn
-symptoms 24-48 hrs post exposure
-ex: contact derm, PPD (screen for TB)
DFA
direct immunofluorescence
-looking for Ag (known Ab vs Ag)
-Ab is tagged with FITC
ex: testing for chlamydia or Legionella
FITC
fuorescein isothiocyanate
IFA
indirect immunofluoresence
looking for Ab
ex: ANA, FTA-ABS
Radioimmunoassay
radioisotopes used to msr [c]
-very sensitive
-detects trace amts of analyte
ex: T4, T3, TSH, B-HCG
Latex agglutination
latex particles are coated w/ specific Ag for the Ab to be detected
ex: monospot, strep screen
Flocculation
clumping of particles to form visible masses similar to agglutination
ex: RPR
ANA
antinuclear Ab
-screening test for
1. collagen
2. rheumatic
3. CT disx
4. Primarily for SLE
[-] is normal result
less than screen dilution value 1:20
using ANA to test for SLE
ANA - negative result excludes SLE
order with reflex to titer
90% lupus pts are +
a NEG ANA is MORE important than + = means can r/o
ANA - fine speckled
mixed CT disx, Sjogren's , scleroderma
ANA discrete speckled
CREST, Raynaud's,
ANA nucleolar
assoc with Scleroderma and polymyositis
what is significant about Hydralazine and procainamide and ANA test?
both can cause lupus-like syndrome and show positive for lupus
-stop drug, rxn reversible
what tests are used for Lupus?
ANA
Anti-ds DNA
Anti-ds DNA
can be used to test
1. Lupus nephritis
2. active lupus (40-60%)
3. incr w/. recurrance of SLE
4. decr w/ successful Tx SLE
ENA
extractable nuclear Ag's
assoc. w. Rheumatic disx
ordered when have a + speckled ANA
what tests are used to detect Sjogren's?
anti-SSA (anti RO), anti-SSB (anti-LA)
anti-RNP, antiy-Sm, Anti-Sc170 - describe
anti -RNP = ribonucleoprotein
anti-Sm = anti-Smith
anit-Sc170,associated with scleroderma
ANCA
antineutrophilic cytoplasmic Ab
-WEGENER'S granulomatosus-vasculitis
-polyarteritis nodosa
-churg strauss syndrome
*can be perinuclear or cytoplasmic
explain Thyroid Ab's
autoantibodies - against the thyroid
10% pop has low titer and no symptoms of disease
what is high titer of TSH seen in?
Hashimoto disease
Grave's disx
Thyroid cancer
hypothyroidism
not enough T3, so body incr the TSH level
what is the most specific test for thyroid?
TSH,k T3 and T4 fluxuate daily
normal range = 0.5-5.0
ASMA
what is it
what is it associated with?
anti-smooth muscle antibody
-liver and bile duct autoimmune disx
-foundin in chronic active hepatitis, biliary cirrhosis
**may see in 20% of intrinsic asthma pts
tests used for liver or hepatic disease dx
LFT's
ASMA-anti-smooth muscle Ab
AMA-anti-mitochondrial Ab
AST, ALT, SGOT/SCPT
AFP-alpha fetal protein
CEA-carcinoembryonic Ag
CA19-9 for pancreatic and hepatobiliary cancers
AMA
anit-mitochondrial Ab
-liver and bile duct autom-immune disx
-Ab directed against the LIPOPROTEIN in the inner mitochondrial membrane
what is used to differentiate pernicious anemia form megaloblastic anemia?
APCA - anti-parietal cell Ab
let's say you get a + speckled ANA, what is the next most logical test?
ENA
what diseases can be tested using APCA?
the anti-parietal cell Ab test is used for:
-chronic gastric disx
- pernicious anemia
-gastric ulcer and cancer
-Diabetes Mellitus
what is the prevelance of false + for APCA?
10-20% in elderly, and 2% in normal children
what is RF and how does it relate to disease?
Rheumatoid factor
22S IgM (nl IgM is 19s)
correlation b/t presence of nodules and severity of disx
-RF is NOT specific for rheumatoid arthritis
-RF neg result does not r/0 RA
what is 22S IgM?
rheumatoid factor and associated with rheumatoid arthritis
what diseases can produce a + result with RF?
SLE, TB, syphillis carcoidosis, viral infx, sjogren's
[+] result is >30IU
false [+] seen in elderly, and liepmic specimens
ASO
dx for?
see in?
anti-stetolysin O
-prior,not acute infx
-glomerulonephritis, pyoderma, rheumatic fever
age dependent
<100 for age <5
<200 for ages >6
RPR
what does it detect?
how is it reported?
range of results?
rapid plasmin reagin
-secondary and latent syphillis
- false + in pregnancy,
once tx is successful, RPR will beomce non-reactive for syphillis
FTA-ABS
fluorescent treponemal antibody absorption
what does FTA-ABS confirm?
dx of syphilis
d-etects Ab to spirochette, treponema pallidum
nl = non-reactive
[+] graded 1+ wk, 4+ strong
what factors interfere with FTA-ABS results?
pts with SLE
-hypergammaglobulinemia
pregnant pts
*may yield low false reactive results - bcuz PRO sticks to substrates
**repeated or sent to lab for confirm
VDRL
veneral disease research lab
what is VDRL used to detect?
characteristics of too
detects reagin Ab in CSF to dx tertiary (neurosyphilis) syphillis
teritary dev in 3-10 years in plastic
false [+] from contamination
teriary syphillis
[+] reported as reactive and a titer is given
nl is nonreactive,
RBC contamination can give false +

any + is reported to the county and state authorities
borrelia-burgdorfer
lyme disease by spriochette
testing for Lyme disease
ELISA - reported
as [-],equivocal, or [+]
confirmed with Western blot
if serology is [-] and you have a high suspicion, retest in 4-6 wks
to test for Syphillis use these
FTA-ABS
Rheumatoid factgor RF
RPR
VDRL
how is the Lyme disx antibody titer run on
CSF,
what factors interfere with Lyme antibody titer
Rheumatoid factor,other spirochete infx,
tumor markers - problem with
not tumor specific, may be detected in non-neoplastic coditions
CEA
carcinoembryonic antigen
when is CEA seen?
colorectoal, stomachc, pancreatic, breast, lung, stomach and helpatobiliary cancers
INCREASED in SMOKERS and ulcerative colitis in diverticulitis
*not all colorectal ca produce CEA
AFP
alpha fetal protein, a protein normally produced by the fetal liver and yolk sac
what is AFP and what is it used for>
mainline use is testing for neural tube defects using mothers serum
2. other is testicular and hepatic cancers
a. found in >90% hepatomas
what is the correlation AFP and tumor growth?
incr AFP relates directly to incr tumor growth
AFP is NOT specific for hepatomas however
what is normal range for AFP?
<40IU (ng/dl)
when testing a pregnant pt, what timeframe is safe to do the AFP test?
b/t 16-18 weeks gestation when levels peak.
B-HCG
the beta version of human chorionic gonadotropin
when is it seen?
1. trophoblastic tumors
2. hydatidiform moles
3. breast and testicular cancer
PSA
used for?
range?
prostatic specific antigen
-BPH-benign prostatic hypertrophy
-normal is <4.0 ng.dl
if value >4 but< 10, order free PSA
what tests allow you to detect up to 90% of prostate cancers?
PSA and DRE - digital rectal exam
**levels can be elevated post procedure
ex: TURP
PAP
prostatic acid phosphatase - less specific than PSA
CA-125
increased in up to 80% pts with ovarian cancer
used ONLY as a SCREEN for pts at high risk with strong family history
non specific-may be incr with endometriosis
breast cancer staging tests
CA 15-3 and CA 27.29
pancreatic and hepatobiliary cancer screens
CA19-9
used to test for Wegener's granulomatosus vasculitis
ANCA - antineurtrophilic cytoplasmic Ab tests
EBV
etiology
incubation
s/s
labs
epstein-barr virus
HHV 4 - the kissing disease
found in saliva
s/s= pharyngitis, malaise, fever, (distate of cigs)
physE: enlarged erythematous tonsils w/ exudate, palatine petechia, cervical adenopathy , spenomegally
used to test for Hashimoto's and Graves disease
Thyroid Ab test
in what disease do smokers suddenly get a distate for cigarettes>
Epstein-Barr Virus
used to test for Chrug-Strauss
ANCA
incubation and phases of EBV
incubation = 4-8 wks
acute phase = 1-3 wks
recovery 6-8 wks
what labs are run to test for EBV?
AST/ALT - incr
blood- see WBC elevation-lymphocytosis (in reversed diff)
ATYPICAL lymphs
50% reduction of platelets
MONO spot - shows current infx
Treatment for EBV?
supportive, avoid strenuous exercise to prevent splenic rupture,
Ampicillin ( but can cx rash)
forms of EBV?
Africa - Burkitt's Lymphoma
China_nasopharyngeal carcinoma
status post infection>
lifelong carriers,
LATENT EBV carriers can reactivate and have CHRONIC FATIGUE SYNDROME
the vaccine is Recombivax the virus is?
Hep B, and vaccine is given in two doses 6 mo apart
these are both wataerborne viruses that hapve fecal/oral transmission
Giardia L. and Hepatitis E
this virus presentation does not cross the midline
varicella zoster
this is an RNA virus and can replicate only when _______ strain of __________ is present
B hepatitis
false + for these viruses/diseases may show up when donating blood
autoimmune diseases, anyone with incr gammaglobulin, Ab's to viral Hep C
what tests are used to confirm or r/o fasle + obtained from blood donation?
PCR and RIBA-2
symptoms include malaise, pharyngitis, fever and distaste for cigarettes in regular smokers
EBV
damage to respiratory ET from this virus predisposes pt to secondary bacterial infxn
influenza RNA virus
these viral strains can cx cirrhosis and hepatocellular carcinoma
hepatitis B and C
anti-HBc is detected in serum when s/s of _____ begin
hepatitis B
this form of hepatitis does not have a vaccine
hepatitis c
kissing disease
EBV mono
treatments include Rimantadine, Relenza or Tamiflu, but avoid use of ASA
influenza virus
dermatomal distribution is seen w/ this virus
varicella Zoster
this is associated with Burkitts lymphoma
EBV - African strain
this is a ds-DNA virus
CMV
this is an RNA virus that can be confused at first with a cold
influenza virus
labs show up with ATYPICAL lymphocytes
EBV - see reversed diff
transmission forms include respiratory droplets
influenza A
what viral family is CMV associated with?
human herpes virus
s/s include splenomegaly, enlarged erythematous tonsils with exudates, cervical adenopathy and palantine petechia
EBV in active stage
labs present with NL to decr WBCs, proteinuria; s/s of abrupts onset fever >102F, myalgia and HA
influenza RNA virus
EIA test can be used to detect Ab against __________virus components
EBV
symptoms are expansion glutitis, foot paresthesia, decreased peripheral circulation, incr adipose to posterior regions, inflammation of periorbital space, altered mental status including hallucinations of life beyond current status
prolonged studyosis due to PA school :-)
just checking to see if you are still awake! hang in there, keep going, rah rah rah!
this virus has recently been correlated with chronic fatigue syndrome
EBV
post recovery of this primary infxn confirs pt as life-long carrier that risk reactivation
EBV
this is a ds-DNA virus
CMV
this is an RNA virus that can be confused at first with a cold
influenza virus
labs show up with ATYPICAL lymphocytes
EBV - see reversed diff
transmission forms include respiratory droplets
influenza A
what viral family is CMV associated with?
human herpes virus
s/s include splenomegaly, enlarged erythematous tonsils with exudates, cervical adenopathy and palantine petechia
EBV in active stage
labs present with NL to decr WBCs, proteinuria; s/s of abrupts onset fever >102F, myalgia and HA
influenza RNA virus
EIA test can be used to detect Ab against __________virus components
EBV
symptoms are expansion glutitis, foot paresthesia, decreased peripheral circulation, incr adipose to posterior regions, inflammation of periorbital space, altered mental status including hallucinations of life beyond current status
prolonged studyosis due to PA school :-)
just checking to see if you are still awake! hang in there, keep going, rah rah rah!
this virus has recently been correlated with chronic fatigue syndrome
EBV
post recovery of this primary infxn confirs pt as life-long carrier that risk reactivation
EBV
this is a ds-DNA virus
CMV
this is an RNA virus that can be confused at first with a cold
influenza virus
labs show up with ATYPICAL lymphocytes
EBV - see reversed diff
transmission forms include respiratory droplets
influenza A
what viral family is CMV associated with?
human herpes virus
s/s include splenomegaly, enlarged erythematous tonsils with exudates, cervical adenopathy and palantine petechia
EBV in active stage
labs present with NL to decr WBCs, proteinuria; s/s of abrupts onset fever >102F, myalgia and HA
influenza RNA virus
EIA test can be used to detect Ab against __________virus components
EBV
symptoms are expansion glutitis, foot paresthesia, decreased peripheral circulation, incr adipose to posterior regions, inflammation of periorbital space, altered mental status including hallucinations of life beyond current status
prolonged studyosis due to PA school :-)
just checking to see if you are still awake! hang in there, keep going, rah rah rah!
this virus has recently been correlated with chronic fatigue syndrome
EBV
post recovery of this primary infxn confirs pt as life-long carrier that risk reactivation
EBV
presentation of anti-VCA, but NOT anti_____ equates recent______infection
EBNA, EBV
past infectin of EBV shows persence of both anti_____and anti______
VCA, EBNA
symptoms include esophagitis, colitits, retinitis, and seen in IMC pts
CMV, seen in HIV pts
definitive Ab test if german measles is suspected in a newborn
IgM
some s/s are non-productive cough, sore throa, coryza, abrupt onset fever >102F, myalgia
influenza RNA virus
this virus is the mc cx of blindness in HIV pts
CMV
amantadine is an effective tx against type A but not type B of this virus
viral influenza
microscopic view of this virus presents with large intranuclear inclusions with clear halos
CMV - you are seeing "owls eyes" inclusion bodies in tissue
Rimantadine is preferred over Amantadine inthese pts with viral influenza
Renal pts
side effects of Ganciclovir tx
toxicity to bone marrow
side effect of Foscarnet tx
Kidney/ hepatotoxicity
this virus is associated with nasopharyngeal carcinoma
EBV in China
treatment for CMV
ganciclovir and foscarnet
incubation and immunity time line for Hepatitis A vaccine
incubation >3wks, immunity is conferred 4 weeks post dose
will confer lifelong immunity
see lab values of CD4<100 in HIV pts and suspect this virus
CMV
what seroligcal test is good for detecting EBV antibodies
EIA
what congenital problems can arise if pregnant pt contracts german measles in 1st trimester?
heart vavle malformations / miscarriage
why is testing for IgM preferred over testing for IgG in newborn suspected of having german measles?
IgM will show active infection whereas IgG would show ONLY the maternal transfer of Ab
vaccine Havrix
for hepatitis A
Flumist
live attenuated vaccined against influenza A and B given ages 5-49
Relenza is a powder form tx for this virus
influenza
varicella zoster
chicken pox
appears as dewdrops on petals
red, erythematous base
this does not cross the midline, but will have dermatomal distribution
shingles of repeat varicella virus
T/F a positive test result of HIV means you have the virus and will get AIDS
FALSE, all it means is that yo are carrying the virus and that you can infect others - you may not develop AIDS, nor are you immune to it
the biggest cause of cervical dysplasia and cancer
Human papilloma virus
presents as slapped cheek, fever, doilie rash, arthralgia
Parvovirus-fifths disease
EBV and antibody titers
after recovery from virus anti-VCA and anti-EBNA are ALWAYS present but in lower levels, also sometimes anti-EA may be present
EBNA is persistent for the rest of the pts life
if recent infx what Ab do you see? if past infectin what do you see?
recent=anti-VCA but NOT anti-EBNA
past=anti-VCA AND anti-EBNA
what tests do you order to determine 5ths disease?
parvovirus Ab IgG, IgM, with a postive reslut post 3 days viremia
treatment for parvovirus?
supportive to symptoms
T/F a negative HIV test result means you do not have the virus
FALSE, it could be too early to test for it, there is a window period and you may have to come back and get rechecked
treatments include Valtrex, Famvir and help prevent complication of postherpatic neuralgia
shingles-varicella zoster
what is the window peiod from infection with virus to sero-conversion to HIV?
3-6 months , most pts,
three methods for testing HIV
ELISA
Western Blot
IFA
what is the preferred protocal for testing HIV?
use ELISA first, and if positive, go to Western blot or IFA.
*IFA can give results faster than western blot
hepatitis A
fecal/oral route or shellfish
vaccine = Havrix
hepatitis B + C
both implicated in cirrhosis and hepatocellular cancer
NO vaccine for hep C
Hep B,C,D
chronic disease
Hepatitis D
Delta RNA virus - replicated only if Hep B present
NO vaccine
Hepatitis E
-waterborne, fecal/oral route, under-developed countries
-NO vaccine
Twinrix vaccine
combo vaccine used for hepatitis A and B - but do NOT give pt who has recv'd seperate vaccines for hep A or B previously
Recombivax vaccine
used for hepatitis B two doses, give 6mo apart
defiinition of Hepatitis
inflammatory process in the liver
chronic = > 6 months symptoms
what strain of hepatitis is MC source of post-transfusion infxn?
Hepatitis C - 70% pts
what forms (not strains) of hepatitis are there?
1. viral
2. drug induced
3. autoimmune
4. ETOH related (see AST>ALT)
acute phase of this virus shows + for IgM and IgG anti-VCA
EBV
EA-D is commonly found in
nasopharyngeal cancer
Chronic EBV is denoted by serological lab results of ____titer
anti-EA, titer>80 post 2 yeras of infx
green fluorescent protein is seen on micrscopic eval
EBV viral cells
Xantham virus
Rubelle - German Measles
hepatitis A
fecal/oral route or shellfish
vaccine = Havrix
hepatitis B + C
both implicated in cirrhosis and hepatocellular cancer
NO vaccine for hep C
Hep B,C,D
chronic disease
Hepatitis D
Delta RNA virus - replicated only if Hep B present
NO vaccine
Hepatitis E
-waterborne, fecal/oral route, under-developed countries
-NO vaccine
Twinrix vaccine
combo vaccine used for hepatitis A and B - but do NOT give pt who has recv'd seperate vaccines for hep A or B previously
Recombivax vaccine
used for hepatitis B two doses, give 6mo apart
defiinition of Hepatitis
inflammatory process in the liver
chronic = > 6 months symptoms
what strain of hepatitis is MC source of post-transfusion infxn?
Hepatitis C - 70% pts
what forms (not strains) of hepatitis are there?
1. viral
2. drug induced
3. autoimmune
4. ETOH related (see AST>ALT)
acute phase of this virus shows + for IgM and IgG anti-VCA
EBV
EA-D is commonly found in
nasopharyngeal cancer
Chronic EBV is denoted by serological lab results of ____titer
anti-EA, titer>80 post 2 yeras of infx
green fluorescent protein is seen on micrscopic eval
EBV viral cells
Xantham virus
Rubelle - German Measles
when do you see HBs antigen?
first during incubation period of Hep B and then it disappears = core window
what about the "core window"? what is going on?
when IgM anti-HBc is at its peak as well as ALT is high
explain what is going in during the infective phase of Hepatitis B?
hepatitis surface Ag first appears, then a response by the body to make Hep B surface Ab,
if you NEVER make the Ab, you are a CARRIER,
most people will make the anitbody and it confirs the immunity to hep B
you are a carrier for Hep B when....?
when anti-HBs do not develop and HBs Ag persists = carrier
what is present during recovery phase of Hep B?
increase anti-HBs Ab which will last for life - confers life-long immunity
how do you know if a pt is a carrier?
order a quantitative Hep B serologic test
present around 1.5 months post Hep B infection?
begining of IgM anti-
HBc, it peaks at about 3 months post infx
when do you see a spike in ALT presence in Hep B?
start of 2-3 months post infx
when do you see a peak in IgM anti-HBc?
onset around 1.5 months post infx, peak around 3-3.5 months
when do you see a peak in anti-HBe?
starts around 3-4 mo post infx and peaks around 5-6 months post infx
when does anti HBs show up?
around 5-5.5 mo post infection and it peaks around 1 year
when is the core window for Hep B?
b/t 2-4 months post infection
when is anti-HBc detected?
in serum when symptoms FIRST begin
where is HBV core antigen found?
ONLY IN THE LIVER cells
what is the first Ig developed?
anti-HBc IgM develops first then followed by IgG which is present for LIFE
what do you order to check immunity status to Hep B vaccine?
quantitative HBs antibody screen
what does HBe antigen indicate?
active viral replication and infectivity- and pt is contagious
what does persistent presence of HBe Antigen predict?
development of CHRONIC HEPATITIS B - high levels of anti-HBe indicate a good prognosis
what do you use to tst for anti-HBcIgG?
nothing, there is NO test for that,
what is the antigen mc seen in the core window>
anti-HBcIgM
CMV
ds-DNA virus in herpes family
in HIV pts can cx esophagitis, colitis, retinitis, and is the MC cx of blindness in HIV pts with CD4<100
"owls eyes" enlargement of cells w/ lg intranuclear inclusions and clear halos
TX= ganciclovir
caution - toxic to bone marro
Tx= Foscarnet - toxic to kidneys
what are the cautions with gangiclovir and foscarnet as tx for CMV?
toxic to bone marrow and kidneys respectively
avoid ASA treatment with which diseases?
viral influenza,
preferred treatment for viral Flu?
amantadine for type A but not B
other treatments for viral influenza?
Rimantadine for pts with renal failure
Tamiflu for uncomplicated acute illness (s/s <2days)
Relenza-dry powder strains A/B w/ s/s <2days
what are the vaccines available for influenza?
yearly vaccine
partial immunity
-avoid if allergic to eggs
Flumist- ingtranasally
-live attenuated, confers partial, short term immunity

-for A/B, age 5-49 and healthy
varicella Zoster
chicken pox
lab= viral culture, serology
dew drop on a petal
mutiple stages of skin appearance
swab to culture
shingles
does not cross the midline
-a reactivation of varicella zoster
- dermatomal distribution
treat with VALTREX, FAMVIR
appears as a dewdrop on a petal ( as I see it, looks like a freakin leaf)
chicken pox
treatment of shingles
treat with Valtrex, Famvir
good for prevention of complication of herpetic neuralgia
ELISA is an intial test used for what diseases/illness? what are two confirmatory tests used?
HIV
Lyme disease
Giardia( dx with O and P)
confirmatory
1. Western Blot
2. IFA (immunofluoresce Assay - is faster than western blot and used for HIV testing)
GIEMSA stain is used to dx what?
malaria
MC cause of cervical dysplasia and cancer?
HPV - human papilloma virus
slapped cheek presentation and doile rash?
parvovirus -fifths disease
parvovirus
-slapped cheek and doile rash
-arthralgia
-Order parvovirus antibody IgG and IgM, Ig M may be positive 3 days post viremia
tx= supportive
German measles (Rubella ab)
viral Xantems
nl value IgG
congenital infx most severe if contrx during 1st trimester
-can cx heart valve defect, malformations, miscarriage
order IgM antibody if suspect in newborn