Infectious Disease Final

Front 1

major risk factors for HIV in American females

Back 1

unprotected sex
IV drugs
multiple partners

Front 2

AIDS leads to _________; must register w/ CDC

Back 2

Kaposi's Sarcoma

Front 3

AIDS pt w/ mx wasting TX =

Back 3

testosterone

Front 4

PCP, AIDS have ________ on CXR

Back 4

atypical infiltrates (patchy)

Front 5

pt with altered mental status w/ HIV can get

Back 5

MAC (Mycobacterium avium complex)

Front 6

________ is caused by direct infection of the renal cells with the HIV-1 virus and leads to renal damage through the viral gene products.

Back 6

HIVAN

Front 7

_________ shows as multiple lesions on MRI

Back 7

Toxoplasmosis

Front 8

Tx Peripheral neuropathy (sensory) in HIV-infected persons

Back 8

amitriptyline

Front 9

___________ 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

Back 9

Hairy leukoplakia

Front 10

Hairy leukoplakia is caused by the ___________ and tx is __________

Back 10

Epstein-Barr virus

oral acyclovir

Front 11

CD4 < 500
<200
<100

Back 11

start retrovirals
tx PCP prophylaxis
TX MAC

Front 12

_________are nucleoside reverse transcriptase inhibitors with activity against human Immunodeficiency virus
(HIV).

TX 4-6 WKS

Back 12

lamivudine
zidovudine
Indinavir- protease inhibitor

Front 13

odds of converting from needle stick ________
tx dec. odds by _____

Back 13

1/300

80%

Front 14

__________was also approved for primary prophylaxis of CMV retinitis in HIV-positive patients

Back 14

ganciclovir

Front 15

HIV TESTS

Back 15

ELISA with Western blot confirmation

Front 16

PEOPLE TRAVELING TO AFRICA NEED ________ VAC.

Back 16

YELLOW FEVER
(+ MALARIA)

Front 17

SE:
INDINAVIR
DIDANOSINE (DDI)
DELAVIRDINE
NELFINAVIR
STAUVIDINE

Back 17

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

Front 18

CD4 < 500: tx with nucleosidase analogues

Back 18

DDI and indinavir

Front 19

G6PD _______ is CI b/c of hemolytic anemia

Back 19

dapsone

Front 20

adults have more persistant _________ than children

Back 20

diarrhea

Front 21

most common opportunistic infection

Back 21

PCP

Front 22

newborn w/ HIV+ mom; test of choice = ____________

___% chance of mother passing HIV to infant

Back 22

HIV DNA PCR

8%

Front 23

<1 yo start anteretroviral b/c dz progresses _________ than in adults

Back 23

faster

Front 24

_______ is a live vaccine CI in children < _________

Back 24

varicella

<12 mo

Front 25

_________ is not infectious unless contains gross blood

Back 25

saliva

Front 26

_____% convert to HIV
_____% convert to HBV

Back 26

0.3-0.5%
6-30%

Front 27

_____ has inc risk of complications with pregnancy

Back 27

HIV

Front 28

Chorionic villi sampling 12-16 wks b/c < ______ wks there is no chance of verrtical transmission to fetus

Back 28

<20 wks

Front 29

Only ________ vaccination may be required by law for international travel

Back 29

yellow fever

Front 30

Yellow Fever
This live, attenuated virus vaccine is highly effective and recommended for those traveling to areas in _________ where yellow fever is endemic.

Back 30

South America and Africa

Front 31

_________ is endemic in parts of Asia and Africa, and has returned to South and Central America, where it is a major concern to travelers

Back 31

Cholera

Front 32

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 ________

Back 32

measles

Front 33

_________ is a ubiquitous problem and is most prevalent in tropical countries. A booster within the past 5 years is recommended

Back 33

Tetanus

Front 34

________ 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

Back 34

Polio

Front 35

_________ is the most frequent and important vaccine-preventable infection for travelers due to poor sanitation

Back 35

hepatitis A

Front 36

____________ 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

Back 36

Meningococcal meningitis

Front 37

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

Back 37

typhoid

Front 38

Special considerations for some should be given to immunization with __________, Japanese B encephalitis, ________, and ________ vaccines

Back 38

hepatitis B
plague
rabies

Front 39

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.

Back 39

India
Africa

low-grade

Front 40

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

Back 40

Bactrim
Shigella and Salmonella
Prophylactic

Front 41

activities overseas include exposure to _______(rabies), swimming in _______ water (schistosomiasis or leptospirosis), ________ (hookworm or strongyloidiasis), and insect bites

Back 41

dogs and cats
fresh
walking barefoot

Front 42

Live virus vaccines are contraindicated in pregnant women, which greatly complicates pretravel preparations. _________ probably can be used safely

Back 42

Chloroquine

Front 43

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 _______

Back 43

fever and diarrhea
eosinophilia
P. falciparum malaria

giardiasis

Front 44

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

Back 44

persistent, nonbloody diarrhea
Latin America

Front 45

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

Back 45

Entamoeba histolytica

Front 46

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

Back 46

leishmaniasis

Front 47

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.

Back 47

African Trypanosomiasis

insect bite

Front 48

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

Back 48

Chagas' Disease (American Trypanosomiasis)

cardiomegaly

nitrofuran

Front 49

___________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: _______

Back 49

Pinworm
Enterobiasis

Perianal

fecal-oral

mebendazole

Front 50

_________(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

Back 50

Ascaris
Ancylostoma duodenale
Necator americanus
Trichuris

Front 51

_____________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

Back 51

Strongyloides stercoralis

Front 52

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

Back 52

hepatosplenic enlargement

Front 53

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.

Back 53

elephantiasis

ivermectin

Front 54

_________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 _________.

Back 54

Loa Loa
Eyeworm

Eosinophilia

diethylcarbamazine

Front 55

____________
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

Back 55

River Blindness
Onchocerca volvulus

eye

pruritic dermatitis

Ivermectin

Front 56

______________
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

Back 56

Clonorchiasis
Asian
cholangiocarcinoma
Praziquantel

Front 57

______________
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.

Back 57

Cysticercosis
seizures
ring-enhancing
Praziquantel
albendazole

Front 58

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 __________.

Back 58

beef
pork
fish

cysticercosis
vitamin B12
praziquantel

Front 59

___________
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

Back 59

Hydatid Disease
sand