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59 Cards in this Set

  • Front
  • Back
major risk factors for HIV in American females
unprotected sex
IV drugs
multiple partners
AIDS leads to _________; must register w/ CDC
Kaposi's Sarcoma
AIDS pt w/ mx wasting TX =
testosterone
PCP, AIDS have ________ on CXR
atypical infiltrates (patchy)
pt with altered mental status w/ HIV can get
MAC (Mycobacterium avium complex)
________ is caused by direct infection of the renal cells with the HIV-1 virus and leads to renal damage through the viral gene products.
HIVAN
_________ shows as multiple lesions on MRI
Toxoplasmosis
Tx Peripheral neuropathy (sensory) in HIV-infected persons
amitriptyline
___________ is commonly seen as a white lesion on the lateral aspect of the tongue. It may be flat or slightly raised, is usually corrugated, and has vertical parallel lines with fine or thick ("hairy") projections
Hairy leukoplakia
Hairy leukoplakia is caused by the ___________ and tx is __________
Epstein-Barr virus

oral acyclovir
CD4 < 500
<200
<100
start retrovirals
tx PCP prophylaxis
TX MAC
_________are nucleoside reverse transcriptase inhibitors with activity against human Immunodeficiency virus
(HIV).

TX 4-6 WKS
lamivudine
zidovudine
Indinavir- protease inhibitor
odds of converting from needle stick ________
tx dec. odds by _____
1/300

80%
__________was also approved for primary prophylaxis of CMV retinitis in HIV-positive patients
ganciclovir
HIV TESTS
ELISA with Western blot confirmation
PEOPLE TRAVELING TO AFRICA NEED ________ VAC.
YELLOW FEVER
(+ MALARIA)
SE:
INDINAVIR
DIDANOSINE (DDI)
DELAVIRDINE
NELFINAVIR
STAUVIDINE
INDINAVIR - kidney stones
DIDANOSINE (DDI)- dry mouth, Hepatic failure; check CBC for anemia and thrompocytopenia, amylase, K+, TGL
DELAVIRDINE - rash
NELFINAVIR - diarrhea
STAUVIDINE - pancreatitis, peripheral neuropathy
CD4 < 500: tx with nucleosidase analogues
DDI and indinavir
G6PD _______ is CI b/c of hemolytic anemia
dapsone
adults have more persistant _________ than children
diarrhea
most common opportunistic infection
PCP
newborn w/ HIV+ mom; test of choice = ____________

___% chance of mother passing HIV to infant
HIV DNA PCR

8%
<1 yo start anteretroviral b/c dz progresses _________ than in adults
faster
_______ is a live vaccine CI in children < _________
varicella

<12 mo
_________ is not infectious unless contains gross blood
saliva
_____% convert to HIV
_____% convert to HBV
0.3-0.5%
6-30%
_____ has inc risk of complications with pregnancy
HIV
Chorionic villi sampling 12-16 wks b/c < ______ wks there is no chance of verrtical transmission to fetus
<20 wks
Only ________ vaccination may be required by law for international travel
yellow fever
Yellow Fever
This live, attenuated virus vaccine is highly effective and recommended for those traveling to areas in _________ where yellow fever is endemic.
South America and Africa
_________ is endemic in parts of Asia and Africa, and has returned to South and Central America, where it is a major concern to travelers
Cholera
Up to 20% of first-year college students have no serologic evidence of prior measles infection or immunization and must be presumed to be susceptible. Individuals born after 1956 with no physician-documented record of immunization are at greatest risk for ________
measles
_________ is a ubiquitous problem and is most prevalent in tropical countries. A booster within the past 5 years is recommended
Tetanus
________ remains endemic in some regions of Asia and Africa, and a small, geographically restricted, vaccine-associated outbreak recently occurred in the Dominican Republic and the adjacent area of Haiti. Most young adults have been immunized with at least four doses
Polio
_________ is the most frequent and important vaccine-preventable infection for travelers due to poor sanitation
hepatitis A
____________ is a worldwide disease, but cases in international travelers are infrequent except with prolonged contact with the local population.

Vaccination is recommended for travel to:
northern India, Nepal, and Saudi Arabia during the Moslem Hajj; certain parts of sub-Saharan Africa; and other locations where travel advisories have been issued
Meningococcal meningitis
Indian subcontinent,
Mexico,
western South America,
sub-Saharan Africa.

Vaccination is recommended for travel to endemic areas where exposure to contaminated food and water is likely.

Vaccination is also strongly indicated for travelers with achlorhydria, immunosuppression, or sickle cell anemia and for those taking broad-spectrum antibiotics
typhoid
Special considerations for some should be given to immunization with __________, Japanese B encephalitis, ________, and ________ vaccines
hepatitis B
plague
rabies
Traveler's Diarrhea
The risk is highest when traveling to _______, Latin America, _______, the Middle East, and South Asia.

The average duration of an episode of traveler's diarrhea is 3 to 6 days.

About 10% of episodes last longer than 1 week.

The diarrhea may be accompanied by abdominal cramping, nausea, headache, ______ fever, vomiting, or bloating.
India
Africa

low-grade
Traveler's Diarrhea TX
Bismuth subsalicylate (Pepto-Bismol) prophylactic or Diphenoxylate (Lomotil) loperamide (Imodium)

________, doxycycline, or one of the newer fluoroquinolones reduce the duration of symptoms and are effective against _______ species.

__________ antibiotics are not generally recommended
Bactrim
Shigella and Salmonella
Prophylactic
activities overseas include exposure to _______(rabies), swimming in _______ water (schistosomiasis or leptospirosis), ________ (hookworm or strongyloidiasis), and insect bites
dogs and cats
fresh
walking barefoot
Live virus vaccines are contraindicated in pregnant women, which greatly complicates pretravel preparations. _________ probably can be used safely
Chloroquine
The clinical problems that most often arise in travelers soon after return are _________, whereas ___________is the most common cause for later referral. Fever is most important because delay in the diagnosis of_________is often fatal

Traveler's diarrhea unresponsive to empirical antibiotics and persistent until the traveler returns home often represents _______
fever and diarrhea
eosinophilia
P. falciparum malaria

giardiasis
Giardiasis is a common cause of ____________in returning travelers. Giardia lamblia is prevalent throughout much of the developing world. _________, reflecting the relative frequency of American travelers, is the most common site of Giardia acquisition
persistent, nonbloody diarrhea
Latin America
Like Giardia, _______ is transmitted by the fecal-oral route; the vast majority of infected individuals are asymptomatic.

When causes acute illness, it is generally manifested by bloody diarrhea
Entamoeba histolytica
Cutaneous and mucocutaneous _________ (Table 109-1) should be considered in any traveler returning from the Middle East or endemic areas of Latin America who has a persistent skin or mucous membrane lesion.

Diagnosis is made by tissue biopsy.

Visceral leishmaniasis should be suspected in immigrants with fever and splenomegaly. Diagnosis is made by bone marrow biopsy and culture
leishmaniasis
This protozoal infection, endemic in Africa, causes sleeping sickness. Rarely imported into developed countries, it should be suspected in systemically ill patients from Africa presenting with fever, headache, and confusion (Table 109-1).

Many patients will remember a painful chancre at the site of an _______.

Diagnosis is made by direct examination of the blood, lymph aspirate, or cerebrospinal fluid.

Treatment should be supervised by an expert in the field.
African Trypanosomiasis

insect bite
most common cause of heart failure in Brazil. *Transmission:feces from infected reduviid bugs (kissing bugs)
*transfusion-associated in the United States
*Most cases are asymptomatic for decades and then manifest as _________, megaesophagus, or megacolon. *Diagnosis of acute disease is made by direct examination of the blood. *Early diagnosis is critical because patients may respond to- _______or nitroimidazole derivatives
Chagas' Disease (American Trypanosomiasis)

cardiomegaly

nitrofuran
___________is common in the United States (Table 109-2), particularly among children.

________ pruritus is the major clinical presentation.

Infection is maintained by _______ contamination.

Diagnosis is made by the application of cellophane tape to the anus and subsequent microscopic examination for ova.

Treatment: _______
Pinworm
Enterobiasis

Perianal

fecal-oral

mebendazole
_________(giant roundworm), __________and _________ (hookworm), and __________(whipworms), still endemic in the United States, are extremely common in immigrants and are ubiquitous in the developing world (Table 109-2). Most individuals are asymptomatic. Ascariasis and hookworm may cause transient pulmonary infiltrates with eosinophilia during the tissue migratory phase of infection. Heavy Ascaris infection may cause intestinal, biliary, or pancreatic obstruction. Hookworm infection can be associated with iron deficiency
Ascaris
Ancylostoma duodenale
Necator americanus
Trichuris
_____________is a common cause of eosinophilia in returning long-term travelers and immigrants, particularly those from Southeast Asia (Table 109-2). Infection can persist for years; many men who served in the Pacific theater during World War II or in Vietnam still harbor infections
Strongyloides stercoralis
Schistosoma mansoni (Africa, South America, and the Caribbean), S. japonicum (Philippines, China, and Indonesia), and S. mekongi (Cambodia, Laos, and Vietnam) are the most common causes of ________ in the world
hepatosplenic enlargement
Wuchereria bancrofti and Brugia malayi cause __________ throughout the tropics (Table 109-2). Patients may present with acute lymphadenitis or asymptomatic eosinophilia. Occasional patients have pulmonary symptoms, infiltrates, and marked eosinophilia (tropical pulmonary eosinophilia). The diagnosis is made by finding microfilariae in blood specimens obtained at midnight. Treatment currently consists of a single oral dose of _______, 100 to 400 μg/kg.
elephantiasis

ivermectin
_________is endemic in West and Central Africa (Table 109-2). Patients present with transient pruritic subcutaneous swellings. ________ is universal. In the United States, cases are often misdiagnosed for years as chronic urticaria. In rare patients, the adult worm can be visualized as it crosses the anterior chamber of the eye, giving this worm its common name. Diagnosis is generally suspected on clinical grounds and is confirmed by biopsy. Loasis can be treated with _________.
Loa Loa
Eyeworm

Eosinophilia

diethylcarbamazine
____________
Infection with ________ occurs in West and Central Africa as well as in South and Central America (Table 109-2). Although the most severe manifestations occur in the ___, the most common clinical presentation in the United States is recurrent ______. The diagnosis can be made by direct examination of skin snips for microfilariae; a specific serologic test is also available.
________ - treatment of choice. repeated after 6 months to suppress cutaneous and ocular microfilariae
River Blindness
Onchocerca volvulus

eye

pruritic dermatitis

Ivermectin
______________
The Chinese liver fluke, Clonorchis sinensis, is important to diagnose in ________immigrants.

Symptoms may be confused with those of biliary tract disease. If untreated, infection can lead to ___________.

___________ is curative
Clonorchiasis
Asian
cholangiocarcinoma
Praziquantel
______________
The invasive larval form of pork tapeworm is the most common cause of __________ throughout the world, as well as in young adults in Los Angeles, chiefly among immigrants from Mexico. Typically, patients present with new onset of seizures or severe headache. A single ______________ lesion is the characteristic finding on computed tomography. The diagnosis may be confirmed by an immunoblot assay using peripheral blood. ____________ or _________is curative but may precipitate focal cerebral edema and seizures by killing other cysticercariae within the CNS. An expert should be consulted before treatment.
Cysticercosis
seizures
ring-enhancing
Praziquantel
albendazole
Intestinal Tapeworms
Three intestinal tapeworms commonly infect humans: Taenia saginata from raw _______, Taenia solium from raw ______, and Diphyllobothrium latum from raw _______. Most individuals are asymptomatic, but T. solium can cause invasive disease (__________) if humans ingest ova of the adult worm. Diphyllobothrium latum is associated with ________ deficiency. All three are treated with __________.
beef
pork
fish

cysticercosis
vitamin B12
praziquantel
___________
Commonly manifests as a cystic liver mass in emigrants from sheep-raising parts of the world. Early diagnosis is important, because rupture of the cyst can lead to dissemination. Diagnosis is often suspected from the appearance of the cyst (calcified wall and dependent hydatid "______") on abdominal computed tomography. Serology can be helpful but is occasionally negative if the cyst has not leaked. Currently, primary therapy is the surgical removal of the cyst without spillage of its contents
Hydatid Disease
sand