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118 Cards in this Set
- Front
- Back
Two types of Yellow Fever
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Epidemic/urban AND Sylvatic/jungle
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Aedes aegypti mosquito is the vector for what type of Yellow Fever?
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epidemic/ urban
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Where did Yellow Fever originate?
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Africa
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Is there a vaccine for Yellow Fever?
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yes
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Pathophysiology of Yellow Fever
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female mosquito regurges the virus, the virus infects the vascular endothelial cell and is taken up by/replicates in the RES followed by secondary viremia and overwhelming of the immune system
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Why is there jaundice in Yellow Fever?
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replication occurs in the RES in the liver
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"Why is the vomit in Yellow Fever called ""Black Water"" Vomit? "
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because of mucosal and GI tract bleeding
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Yellow Fever has a __________ pattern with ___ stages.
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saddleback; 3
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How many stages does Yellow Fever have?
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3
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What may be the only findings in Acute phase of Yellow Fever?
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fewer/HA, nausea w/ bilious vomiting, and conjunctival injection
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Other nonspecific symptoms that may be present in Yellow Fever
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malaise, weakness, and myalgias
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How long does the acute phase of Yellow Fever last?
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usually 3 days
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What percentage of patients stop at the acute phase of Yellow Fever?
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85%
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What follows the acute phase of Yellow Fever?
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a 24 hour remission stage
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When will specific IgM be seen in Yellow Fever?
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7-10 days post infection
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Tx for Yellow Fever
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supportive therapy, may need central venous access, if actively bleeding--> FFP, isolation of patients, no effective antivirals, immunization and education, mosquito avoidance
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What will serologic studies in Yellow Fever show?
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4 fold increase in the acute and convalescent titers
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What are some of the S/S of toxic phase yellow fever?
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jaundice, oliguria, dark urine, tender hepatomegaly, petechiae, epistaxis, coffee ground emesis, hematemesis, melena, BRBPR, hematuria, relative bradycardia, myocardial depression, arrhythmias, and mental status changes
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What will the CBC show in Yellow Fever?
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leukopenia, thrombocytopenia, and HCT changes
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Disease found in humans and nonhuman primates.
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Ebola and Marburg
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How many subtypes of Ebola?
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4
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How many types of Marburg?
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1
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What is a possible natural reservoir for Ebola/ Marburg?
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maybe bats, but unknown
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What is the mode of transmission of Ebola?
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usually spread in healthcare/lab, but unknown
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S/S early in Ebola
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pharyngitis, severe constitutional changes, maculopapular rash, and bilateral conjunctival injection
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What are the S/S late in Ebola?
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expressionless hippocratic ghostlike facies, bleeding from mucous membranes, and tachypnea
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What are the physical findings early in Ebola/Marburg?
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severe HA, arthralgias/myalgias, fever with or without chills, anorexia, and asthenia
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What are the type of GI symptoms that follow the early phase of Ebola?
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abdominal pain, N/V, diarrhea, odynophagia, dysphagia
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Sites that patients with Ebola will bleed from
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GI tract, mucous membranes, puncture sites
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What will be seen in a terminally ill patient with Ebola?
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obtunded, anuric, tachypneic, normothermic, shock, hiccups, and tachypnea
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When are hiccups noted in Ebola?
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in fatal cases
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What will the CBC show in Ebola?
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thrombocytopenia, leukopenia, and pronounced lymphopenia
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What will the chem panel and LFTs show in Ebola?
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multiple organ failure, metabolic acidosis, and increase in BUN and Serum Creatinine
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What are the diagnostic test for Ebola?
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IgM and IgG ELISAs
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What is the tx for Ebola>
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no specific therapy- barrier isolation, fluid rehydration, nutrition; supportive care, Ribavirin, human convalescent plasma, Interferon alpha 2b
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How long is recovery for Ebola victims?
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requires months
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Mortality rate in Ebola/Marburg
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80% in Ebola, 25% in Marburg
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Complications in Ebola/Marburg
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ocular manifestations, tinnitus, unilateral orchitis, supportive parotitis, asymmetric and migratory arthralgia
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Where is Lassa endemic?
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West Africa
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How is Lassa transmitted?
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rodent to human transmission, secondary human to human transmission
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What type of Lassa outbreaks have a high case-fatality?
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nosocomial outbreaks
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Lassa is particularly dangerous in what trimester of pregnancy?
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third
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Are most infections of Lassa severe or mild/subclinical?
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mild or subclinical
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S/S of Lassa
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fever, weakness, joint/lumbar pain, cough, severe HA, prostration, abdominal pain, facial or neck edema, deafness
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MC sequela of Lassa
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deafness
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Is the onset of Lassa insidious or abrupt?
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insidious
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Major cause of Lassa Fever in children and infants
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pediatric hospitalizations
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What are the symptoms of Swollen Baby Syndrome?
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edema, anasarca, abdominal distention, bleeding
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What is the prognosis with Swollen Baby Syndrome?
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poor prognosis
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What will the LFTs in Lassa show?
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AST levels will be much higher than ALT levels
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What will the CBC in Lassa show?
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lymphopenia and thrombocytopenia
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What are the diagnostic tests for Lassa?
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ELISA for IgM and IgG and PCR (being researched)
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Tx for Lassa
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Ribavirin--best within first 6 days of illness, aggressive supportive therapy
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What is Hantavirus better known as?
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Hemorrhagic Fever with Renal Failure Syndrome or HFRS
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What geographic area does HFRS occur in?
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Far East
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Triad in HFRS
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fever, hemorrhage, and renal insufficiency
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What is the reservoir for Hantavirus?
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rodents
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In what age group is HFRS mild?
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in children under age 15
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What are the four phase of HFRS?
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febrile phase, hypotensive phase, oliguric phase, and diuretic stage
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S/S of febrile phase
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HA, chills, abdominal pain, malaise, flushing, petechiae, subconjunctival hemorrhage, absolute bradycardia
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S/S of hypotensive stage of HFRS
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tachycardia, acute abdomen in form of paralytic ileum, convulsions, purposeless movements
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Tachycardia in the hypotensive stage of HFRS indicates what?
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impending shock
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What are the S/S of oliguric stage of HFRS?
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oliguria, hypertension, bleeding tendency, edema, thrombocytopenia resolves
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What causes bleeding tendency in HFRS?
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caused by uremia
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What are S/S in diuretic stage of HFRS?
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other symptoms resolve rapid dehydration
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How long is the convalesce stage in HFRS?
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3-6 months
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What is the pathogenesis of HFRS?
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largely unknown
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What will the UA in HFRS show?
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hematuria, proteinuria that may last years
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What will the CBC in HFRS show?
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leukocytosis, elevated or normal hematocrit, thrombocytopenia
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What will be the electrolyte abnormalities in HFRS?
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hyponatremia and hyperkalemia
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What is diagnostic for HFRS?
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ELISA
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Tx for Hantavirus
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maintain fluid and electrolyte balance, supportive care, and Ribavirin may be efficacious
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Rare complications of Hantavirus
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pulmonary edema, metabolic dysfunctions like hypercalciuria, mortality up to 15%
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What is the vector for CCHF?
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ixodid ticks
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Areas where CCHF is found?
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Africa, Asia, Middle East, and Eastern Europe
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Other names for CCHF
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Central Asian Hemorrhagic Fever, Congo Fever
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S/S of CCHF
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flu like initially, hemorrhage after 3-5 days, massive ecchymosis, epistaxis, hepatomegaly, mucosal and GI bleeding, and erythema
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Where is erythema in CCHF seen?
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pharynx, conjunctiva, face, neck
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What will the CBC show in CCHF?
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leukopenia and thrombocytopenia
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Diagnostic tests for CCHF?
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ELISA and PCR
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Tx for CCHF?
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Ribavirin, supportive care
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Complications of CCHF
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rare encephalitis, mortality rate 13-50%
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How many closely related serotypes in Dengue?
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four- DEN 1,2, 3, and 4
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Which DEN is more virulent?
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DEN-2
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What geographic area is Dengue found in?
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tropics- between 35N ad 35S
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What is the vector for Dengue?
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domestic day biting Aedes aegypti mosquito that prefers to feed on humans
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What are the three types of Dengue?
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Dengue Fever (DF), Dengue Hemorrhagic Fever (DHF), and Dengue Shock Syndrome (DSS)
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Which type of Dengue is a symptom complex produced by the infection that may be asymptomatic or just a nonspecific febrile illness?
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DF
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S/S of Dengue Fever
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very high fever, HA, retroorbital pain, N/V, truncal scarlitinaform rash, severe myalgias and malaise, abdominal pain, and hemorrhagic manifestations
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What are the hemorrhagic manifestation in Dengue?
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small amounts of bleeding from nose or gums, melena or hematemesis
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What is a saddleback fever?
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abates for a day and then returns
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When is the risk for development of DHF and DSS highest?
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at approximately the time of defervescence
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Describe the rash in Dengue
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scarlatiniform or maculopapular
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Patients with DHF ill have what types of injections?
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pharyngeal (97%) and conjunctival (1/3)
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Physical findings in Dengue
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rash, petechiae/purpura, injections, generalized lymphadenopathy, hepatomegaly
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MC hemorrhagic finding in Dengue
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petechiae and bleeding at venipuncture site
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Describe Tourniquet test
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inflate BP cuff to midway between D and S; hold for 5 minutes--a positive test is 20 petechiae per sq. inch
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When will leukopenia be seen in Dengue?
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at the end of the febrile phase
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When will leukocytosis be seen in Dengue?
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before defervescence or shock
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What does a 20% rise in HCT precede in Dengue?
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shock
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How often should HCT be monitored in Dengue patient?
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every 3-4 hours
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What will the platelet count in Dengue show?
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thrombocytopenia
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What is the most common metabolic change in Dengue?
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hyponatremia
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What on the LFT is a sin of hemoconcentration in Dengue?
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low albumin
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What type of blood flow will there be when HCT is high by 20%?
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oozing
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What type of blood flow will there be when HCT is low by 10%?
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actually bleeding, not oozing
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How can diagnosis of Dengue be made>
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isolation of the virus; paired serum samples with a 4 fold increase in IgM or IgG (also RT-PCR, IH, ELISA)
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Describe Grade I Dengue
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fever w/ nonspecific constitutional symptoms w/ positive tourniquet test or scattered petechiae as the only hemorrhagic involvement
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Describe Grade II Dengue
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Grade I, but with spontaneous hemorrhagic manifestations
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Describe Grade III Dengue
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circulatory failure manifested by rapid, weak pulse, narrow pulse pressure, or hypotension
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Describe Grade IV Dengue
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profound shock with undetectable pulse and BP
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Tx for DF
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self limited; acetaminophen
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Tx for DHF/DSS
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IV fluid, admit, blood transfusions if there is pulm edema, fresh whole blood is drop of HCT of 10%
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What is the take on steroids with Dengue?
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not beneficial
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What does a drop of 10% in HCR indicate in DHF or DSS?
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significant hemorrhage
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Prevention of Dengue
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insect repellant with 30% DEET
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Who do you use caution with when using 30% DEET insect repellant?
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kids- b/c of side effects; do not put on their hands
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Complications of Dengue
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neurologic manifestations- encephalitis, G-B Syndrome, and transverse myelitis; liver failure in DHF/DSS, overhydration during tx
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