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186 Cards in this Set
- Front
- Back
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Definition of Toxic Shock Syndrome requires what (6)?
|
1. Fever, 2. Rash, 3. Desquamation, 4. HoTn, 5. Multisystem involvement (GI, MSK, Mucous Membrane, Renal, Hepatic, Heme, CNS) 6. Lab- Neg results on bld, throat, CSF
pg 1000 |
|
|
What bacterial are most menstrual cases of toxic shock caused by?
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Staph aureus
pg 1000 |
|
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What is the most impressive aspect of the pathophysiology of toxic shock syndrome?
|
massive vasodilation and rapid movement of serum proteins and fluids from intra to extravascular space
pg 1000 |
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Consider toxic shock syndrome in pt w/ any unexplained ___ illness associated w/ erythroderma, HoTn, and diffuse organ pathology.
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febrile
pg 1000 |
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What is the difference btwn mild and severe toxic shock syndrome?
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hypotension
pg 1000 |
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Tender, edematous ext genitalia, ____cervix, d/c, and bilat adnexal tenderness is seen in 25-35% of menstral toxic shock pts.
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strawberry cervix
pg 1001 |
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The most important management for toxic shock syndrome is ___?
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circulatory shock
pg 1002 |
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Although abx don't affect the outcome of TSS, why are they given?
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to eradicate the toxin-producing staphylococci
pg 1002 |
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Pts who are not treated with _______ abx are at risk for reoccurance of TSS.
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Beta Lactamase-stable (Augmentin, Unysn, Zosyn)
pg 1002 |
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What type of TSS is associated with invasive soft tissue infxns?
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Group A Strep (strep pyogenes) / necrotizing fasciitis
pg 1002 |
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What do you expect to see on CBC w/ diff in a TSS pt?
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elevated WBCs (>13K) with bandemia (40-50%)
pg 1003 |
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Although abx therapy is important, what is needed if suspected deep-seated S. pyogenes infx?
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aggressive exploration and debridement
pg 1003 |
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What is the most commonly affected valve by infective endocarditis?
|
Mitral Valve
pg 1042 |
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What is the most likely cause of infective endocarditis in the developed and undeveloped world?
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Developed - mitral valve prolapse
Undeveloped - rheumatic dz pg 1042 |
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When endocarditis occurs in IV drug users what valve is typically affected?
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Tricuspid
pg 1042 |
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What is the single most common bacterial cause of infective endocarditis?
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Stap aureus
pg 1043 |
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What are the 3 most common causes of native valve infective endocarditis?
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staph, strep, and enterococci
pg 1043 |
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Fever is present in >90% overall and >98% in IV drug users in infective endocarditis. What population may it be absent in (4)?
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Elderly, severe CHF, renal failure, or immunosuppression
pg 1043 |
|
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What are your cutaneous findings with infective endocarditis?
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subungal hemorrhage, Osler nodes (tender subq nodes), and Janeway lesions (hemorrhage on palms/soles)
pg 1044 |
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Suspicion for endocarditis requires ___ ____.
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hospital admission
pg 1044 |
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What are the Duke's criteria in relation to infective endocarditis?
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Major: + Bld Cx x 2 12hrs apart, +echo (valve, mass, regurge)
Minor: IV drugs, Fever, Vascular issues, Immunologic, +bld cx, echo pg 1044 |
|
|
How many Modified Duke criteria are required for IE dx?
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Two major, or One major and three minor, or five minor
pg 1044 |
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What infective endocarditis pt's require a TEE?
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prosethic valves, poor TTE results, or those w/ high probability of endocarditis
pg 1045 |
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Empiric therapy of suspected bacterial endocarditis, uncomplicated hx?
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Ceftriaxone 1-2g IV, or Vanc + Gentamicin 1-3mg/kg IV
pg 1045 |
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Empiric therapy of suspected bacterial endocarditis; IV drug use, hospital aquired, or on oral abx?
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Naficillin 2g IV + Gentamicin 1-3mg/kg IV + Vanc
pg 1045 |
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Empiric therapy of suspected bacterial endocarditis; prosthetic heart valve?
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Vanc + Gent 1-3mg/kg + Rifampin 300mg PO
pg 1045 |
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How long do you give abx to tx infectious endocarditis?
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4-6 weeks
pg 1046 |
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T/F: Infx Endocarditis prophylaxis is indicated for MVP, pacemakers, HCM, murmurs, CABG, or septal repairs.
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False: reanalysis of evidence shows NOT routinely indicated for any of those cases
pg 1046 |
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Name some high risk conditions that require prophylaxis abx txmt for Infective Endocarditis.
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any cardiac prosthetics, hx of previous IE, unrepaired congenital hrt dz, cardiac transplant
pg 1046 |
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In the US, what type of pt is most at risk for contracting tetnus?
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Diabetics and Injection drug users
pg 1047 |
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T/F: Clostridium tenani is a gram + rod found in soil and animal feces and extremely susecptable to destruction.
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False: extremely resistant to destruction
pg 1047 |
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What 4 factors favor growth of the vegetative, toxin-producing C. tetani?
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crushed, devitalized tissue, foreign body, or development of infx
pg 1047 |
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C. tetani produces two exotoxins once in the vegetative form, which is responsible for clinical manifestations?
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Tetanospasmin
pg 10477 |
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No wound is idenitified in __% of patients with tetanus.
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10%
pg 1047 |
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The incubation period for tetnus ranges from ___hrs to more than ___ month(s).
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<24hrs to > 1 month
pg 1047 |
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____ tetanus follows inuries to the head, occasionally otitis media and results in dysfxn of the cranial nerves, most commonly CN ___.
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Cephalic, 7th CN
pg 1048 |
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___ tetnus is manifested by rigidity of muslces in proximity to the site of injury and resolves after weeks to months.
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Local tetnus
pg 1048 |
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How is tetnus diagnosed?
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Clinically (quest immuniz hx, lock jaw, descending msc progression, nml mental status)
pg 1048 |
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___ tetnus is the most common form of the dz and accounts for about __ % of the cases.
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Generalized, 80%
pg 1047 |
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___ tetnus, a form of generalized tetnus, develops in infants born to inadequately immunz mothers, after unsterile txmt of umbilical cord.
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Neonatal
pg 1047 |
|
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What poisoning most closely mimics generalized tetnus?
|
Strychnine
pg 1048 |
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T/F: Human Tetnus Immunoglob (TIG) neurtalizes circulating tetanospasmin and toxin in the wound but not toxin already fixed in the nervous system.
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True
pg 1048 |
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When should TIG be given when tetnus is suspected in a puncture wound?
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before debridement, b/c toxin may be released during wound manipulation
pg 1048 |
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What is the abx of choice for txmt of tetnus and which is contraindicated?
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Metronidazole (abx of choice), PCN (contra) - centrally acting GABA antagonist potentiates toxin effects, pg 1048
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|
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What can be given to tentus pt's to counteract the catecholamine excess release?
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Magnesium sulfate (inhibits release of norepi and epi)
pg 1048 |
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T/F: Pts who recover from tetnus no longer require immunization b/c dz confers immunity.
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False: does not confer immunity
pg 1048 |
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What is in the Tdap booster?
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Tetnus toxoid, reduced diptheria toxoid, and acellular pertussis vaccine, pg 1049
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What % of pt's appropriately receive tetnus wound prophylaxis after acute injury?
|
60%
pg 1049 |
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How do you acutely tx tetnus infxn?
|
1) TIG 3000-6000units IM (opposite of vaccine), 2) Tetnus toxoid (Tdap or DTaP) at 0 wk, 6 wks, and 6 mon, 3) Metronidazole 500mg IV q 6, 4) Magnesium 40mg/kg load
pg 1049 |
|
|
Worldwide, what is the most common source of rabies bites?
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Dogs >90%
pg 1049 |
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What is the most common source of rabies in human in the US?
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Bats - 80% of infx
pg 1050 |
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What animals almost never require rabies postexposure prophylaxis?
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squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, mice, rabbits
pg 1050 |
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Where is rabies not found in the world?
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some islands (Britian, Hawaii, Austrailia, and Antartica)
pg 1050 |
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The risk of developing rabies following an exposure to a rabid animal depends on what (4)?
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1) scratch vs bite
2) number of bites 3) depth of bites 4) location of wound(s) (face) pg 1050 |
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How does preexposure prophylaxis change rabies exposure txmt?
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eliminates the need for human rabies immune globulin (HRIG) and decreases # of doses of vaccine required, pg 1050
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For the purposes of rabies postex prophylaxis, how is a bite defined?
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any penetration of the skin by the teeth of the animal
pg 1052 |
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Nonbite exposure from animals ___ cause rabies.
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very rarely
pg 1052 |
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32yo M coach noticed stray dog acting strangely (aggresive, foaming mouth) around baseball park. Dog attacked a player and coach killed dog with bat. Reports blood exposure. What is the txmt course?
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Medal of honor for bravery, otherwise nothing. contact w/ blood, urine, feces of rabid animal is not indication for txmt. pg 1052
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What is recommended for txmt, where bat was found in the room where 6yo F was sleeping?
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ACIP (Adv Comm on Immun Pract) recommends consideration of postexp prophylaxis, pg 1052
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What does the CDC recommend after a bite from an animal that is acting normally?
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Quarintine for 10days, signs of rabies put animal down and send head to qualified lab
pg 1053 |
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Health care workers w/ nonintact skin or mucous membrane exposure to infected ___ from pt w/ rabies should be treated.
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Saliva
pg 1053 |
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What is the postexp rabies treat regimen?
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HRIG x 1 and Rabies vaccine x 1 ASAP, then rabies vaccines at day 3, 7, & 14
pg 1054 |
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Where must the rabies vaccine be administered (anatomically)?
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deltoid
pg 1053 |
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What is a contraindication to the rabies vaccine, purified chick embryo cell culture vaccine (PCECCV)?
|
severe egg allergy
pg 1053 |
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T/F: Rabies vaccination prophylaxis should be discontinued due to local or mild systemic adverse rxn to vaccine.
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False: should NOT
pg 1053 |
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Why is HRIG administered for rabies postex prophylaxis w/ 24hrs?
|
provides immediate antibodies until pt responds to vaccination
pg 1053 |
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Failure to administer ___ has led to rabies despite appropriate postex prophylaxis w/ vaccinations.
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HRIG
pg 1053 |
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What should be avoided when administering HRIG and vaccine at day 0?
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never in the same syringe or deltoid
pg 1053 |
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What type of pt should received the 5 dose vaccination schedule for rabies?
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immunocompromised
pg 1054 |
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T/F: Rabies vaccination doses must be lowered in immunocompromised pts.
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False: vaccine is inactivated virus and does not pose threat to immnunocompromised
pg 1054 |
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What medication may interfere with the antibody response to the rabies Human Diploid Cell Vaccine (HDCV)?
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antimalarials
pg 1054 |
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Pts bitten or scratched by animal in endemic area SHOULD or SHOULD NOT receive postex prophylaxis?
|
Should
pg 1054 |
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Is pregnancy considered a contraindication to rabies postexposure prophylaxis or HRIG?
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No
pg 1055 |
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What is the dose for the rabies vaccine and HRIG based on for adults and children?
|
Vaccine - same dose in kids / adults
HRIG - dose based on weight pg 1055 |
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What are the two forms of acute neurological disorders of rabies and which is more common?
|
Furious (80%) and paralytic (20%)
pg 1055 |
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What is the difference in CFS and presentation btwn tetnus and rabies?
|
Tetnus - mental status and CSF are normal
pg 1055 |
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What are the most useful labs for rabies diagnosis, since routine labs are of limited value?
|
serum, CSF, salvia, and tissue (nuchal skin biopsy)
pg 1055 |
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What is the result of steroids in the txmt of rabies?
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shortens incubation and increases mortality
pg 1056 |
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What is the vector that spreads malaria and what is the latin name?
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Female Mosquito - Anopheles
pg 1056 |
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What is the genus and how many types of that protozoan infects humans with malaria?
|
Plasmodium - 5 types
P. vivax, P. ovale, P. malariae, P. falciparum, P. knowlesi pg 1056 |
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What is the most deadly subspecies of the malaria causing protazoan Plasmodium?
|
P. falciparum - >1 million deaths /yr
pg 1056 |
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In regards to malaria, where do the Plasmodial sporozoites travel to reproduce daughter merozoites in the human?
|
the liver (asexual reprod), then back to blood stream to RBCs
pg 1057 |
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What clinical sign of malaria occurs when there is hemolysis of infx'd erythrocytes and release of antigenic products w/ activation of macrophages and production of proinflammatory cytokines?
|
recurring febrile paroxysms
pg 1057 |
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What is the clinical hallmark of malaria?
|
periodic low grade fevers w/ chills, malaise, myalgia, and HA
pg 1058 |
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What changes in the clinical hallmark of malaria w/ P. falciparum or in persons who received chemoprophylaxis?
|
classic signs are often lacking
pg 1058 |
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What are a couple complications from malaria?
|
hemolysis, splenomegaly, splenic rupture, glomerulonephritis, ceberal malaria
pg 1058 |
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What does the CSF show with ceberal malaria?
|
essentially normal, possible elevated opening pressure, mild pleocytosis
pg 1058 |
|
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Which organ(s) is/are susceptible to the effects of severe tissue hypoxia from the cytoadherence of the parasitized erythrocyte to the vascular endothelium of hte host.
|
Any target organ
pg 1058 |
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Who is at greatest risk for complications due to P. falciparum?
|
very young, elderly, and pregnant women
pg 1058 |
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What type of lab is the definitive diagnositic lab of choice for malaria?
|
Thick blood smear, long and careful search for parasites is necessary
pg 1058 |
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33yo SOF soldier returns from 3mon deployment to the Congo. Pt has had 2 weeks of fevers, chills, aches and fatigue. Meds -chloroquine qd, No PMSHx. Thin bld smear is negative for parasites. What is next step?
|
Use Thick Blood Smear, treat as uncomplicated infx w/ chloroquine resist falciparum, Quinine + Doxycycline
pg 1059 |
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T/F: Withhold antimalarial therapy in highly suspicious cases with failure to detect parasitemia.
|
False
pg 1060 |
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What is the accuracy of the thick smear on first attempt?
|
>90%
pg 1060 |
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What are the two major goals of the thick blood smear in the malaria workup?
|
1) degree of parestemia
2) if P. falciparum if present pg 1060 |
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Where are the different Plasodium malaria causing protozoan common to?
|
P. vivax- India, Cent Amer
P. falciparum- Africa, Haiti, New Guin. P. knowlesi- Malaysia, Thailand, Phillipines, Singapor pg 1056 |
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Any patient coming from Asia with a high parasite burden on thick smear resembling P. malariae should be assumed to be haboring ___ as well.
|
P. knowlesi
pg 1060 |
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____ therapy is the standard for malaria txmt.
|
combination
pg 1060 |
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If malaria is suspected and labs are pending, when should you start therapy?
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ASAP. Do not delay txmt while awaiting labs.
pg 1060 |
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What is the drug of choice for P falciparum txmt in the US?
|
Quinidine IV has enhanced activity against P. falciparum compared to Quinine
pg 1060 |
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When treating severe malaria what is the drug of choice and how do you obtain it?
|
Artesunate - must enroll pt in CDC txmt protocol and contact CDC Malaria hotline
pg 1060 |
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What must be used in combination with Artesunate therapy for severe malaria?
|
any long half-life antimalarial due to artesunate's short half life
pg 1061 |
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|
What drugs should be initiated for P. falciparum txmt?
|
Quinine and doxycycline or atovaquone-proguanil
pg 1061 |
|
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What is the drug of choice for P. vivax, P. ovale, and P. malariae?
|
Chloroquine
pg 1062 |
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____ are of no benefit for cerebral malaria and should not be used.
|
Glucocorticoids
pg 1062 |
|
|
Quinine and Quinidine are potent inducers of ___ and may cause severe ___.
|
insulin and hypoglycemia
pg 1062 |
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What is a signifcant risk factor for fatal malarial infxn's?
|
not taking appropriate chemoprophylaxis
pg 1062 |
|
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Which vector transmits the most zoonotic dz worldwide?
|
ticks
pg 1071 |
|
|
What is the best method to remove a tick?
|
viscous lidocaine, fine-tipped tweezers, grasp head and pull gently
pg 1071 |
|
|
34yo M was hiking in the Blue Ridge mountains for the last week. C/o fever, HA, myalgia, N/V, and lymphadenopathy, and rash on hands and feet. What is the concern and txmt?
|
Concern is for tick bite, Rocky Mountain Spotted Fever and treat w/ Doxycycline
pg 1072 |
|
|
Of all the tickborne illness, which is the most likely to be fatal?
|
Rocky Mountain Spotted Fever
pg 1071 |
|
|
Which vector transmits the most zoonotic dz worldwide?
|
ticks
pg 1071 |
|
|
There is almost no risk of infx if the tick is attached for < __ hrs, and 25% risk if attached for > __hrs.
|
72hrs and 72hrs
pg 1072 |
|
|
What is the best method to remove a tick?
|
viscous lidocaine, fine-tipped tweezers, grasp head and pull gently
pg 1071 |
|
|
34yo M was hicking in the Blue Ridge mountains for the last week. C/o fever, HA, myalgia, N/V, and lymphadenopathy, and rash on hands and feet. What is the concern and txmt?
|
Concern is for tick bite, Rocky Mountain Spotted Fever and treat w/ Doxycycline
pg 1072 |
|
|
Of all the tickborne illness, which is the most likely to be fatal?
|
Rocky Mountain Spotted Fever
pg 1071 |
|
|
There is almost no risk of infx if the tick is attached for < __ hrs, and 25% risk if attached for > __hrs.
|
72hrs and 72hrs
pg 1072 |
|
|
What is the most common neurologic sx in the secondary stage of Lyme's Dz and how does it present?
|
Cranial Neuritis - unilateral or bilateral facial nerve palsy
pg 1073 |
|
|
How is Lyme's Dz diagnosed and treated?
|
Clinical w/ PCR or Western Blot
Txmt- doxy, amox, ceftriaxone or erythro pg 1073 |
|
|
When is prophalyxis txmt of tick bite appropriate?
|
high endemic Lyme's Dz, id nymphal deer tick engorged w/ blood, tick attached >72hrs
pg 1073 |
|
|
A single dose of Doxy __mg can be given within __hrs of a deer tick bite to prevent Lyme's Dz.
|
200mg and 72hrs
pg 1073 |
|
|
A single dose of Doxy __mg can be given within __hrs of a deer tick bite to prevent Lyme's Dz.
|
200mg and 72hrs
pg 1073 |
|
|
What is the txmt for the tick borne illnesses Ehrlichosis and Anaplasmosis and what are the ticks involved?
|
Ehrlichosis -Lone Star tick
Anaplasmosis - Black Legged tick Txmt: Doxycycline pg 1074 |
|
|
What is the difference in txmt btwn Tickborne Relapsing Fever and Colorado Tick Fever?
|
Tickborne Relapsing Fever - doxy, erythro vs Colorado - supportive
pg 1074 |
|
|
What tickborne illness mimics malaria?
|
Babesiosis
pg 1074 |
|
|
25yo W returns to ED for continued sore throat despite completing PCN regimen. Oropharynx if erythematous and exudative. WBC is 19K. What important questions do you need to ask to r/o atypical exudative pharyngitis?
|
Ask about pets!
Dogs- Strep, Corynebacterium, Yersinia Birds- Chlamydophilia pg 1075 |
|
|
What is most often aquired from handling unsterilized imported animal hides or raw wool?
|
Inhalation Anthrax
pg 1075 |
|
|
Working in a slaughter house or consuming unpasteurized milk leads to this URI. What is it and txmt?
|
Brucellosis - Doxy + Rifampin x 6 weeks
pg 1075 |
|
|
Exposure dried bird feces, feather dust, or avian resp secretions results in abrupt fever, chills, myalgias w/ PNA. What is the concern and txmt?
|
Psittacosis - Doxy 100mg
pg 1075 |
|
|
Inhaled endospores from animal contaminated soil, cat afterbirth, ticks results in pulm infil, pericarditis, myocarditis, hepatits. Concern and txmt?
|
Q Fever - Doxy 100mg
pg 1076 |
|
|
Exposure to oral flora of dogs and cats results in bronchopneumonia and pleural effusion. Concern and txmt?
|
Pasteurella - Augmentin, Doxy, or 3rd Gen Ceph
pg 1076 |
|
|
Potentially serious illness caused by gram -, saprophytic bacterium results in PNA, abscess. Concern and txmt?
|
Melioidosis - Doxy or Bactrum
pg 1076 |
|
|
This can result in a pulmonary capillary vasculitis w/ bronchiolitis, nonproduct cough, bacterial PNA. Concern and txmt?
|
Rocky Mountain Spotted Fever- Doxy
pg 1076 |
|
|
This is endemic to the US, found in rock squirrels and rodents. Fleas are the vector. Eschar found at bites sites, bubo (large lymph node), sepsis and PNA. Highly contagious. Concern and txmt?
|
Pulmonic Plague - Doxy or Cipro
pg 1076 |
|
|
The deer mouse is the primary vector in the southwest US. Inhalation of feces, urine, or bite results in ARF, flu-like sx, ocular abnorm, pulm edema, hypoxia, HoTn, tachycard. Concern and txmt?
|
Hantavirus - supportive, possible inhaled Ribavirin.
pg 1077 |
|
|
Pt w/ jaundice, dark urine, liver enlargement, elevated LFTs, ab pain, N/V and fever. Pt is a pig farmer. What is the concern for?
|
Hepatits E
pg 1077 |
|
|
This is also known as woolsorters dz and accounts for 95% of all of these types of infxns. Hands and fingers most commonly affected. Macules and vesicles evolve. Concern is?
|
Cutaneous anthrax
pg 1077 |
|
|
This infx up to 50% of all dogs and 15% of dogs actively excrete these. Steroids and albendazole, mebendazole work for txmt. What is this infx?
|
toxocara canis (intestinal parasite)
pg 1078 |
|
|
Cats are the host of the intracellular protozoan. Pregnant women should avoid cat feces. Concern and txmt?
|
Toxoplasmosis - pyrimethamine 25-100mg/d 3-4 weeks
pg 1079 |
|
|
Puppy or kitten with diarrheal illness in the house. Major cause of infectious diarrhea in humans. Concern and txmt?
|
Campylobacteriosis - Self limiting, or Erythromycin in protracted cases
pg 1079 |
|
|
What the five Travel-Specific Aspects of the Medical Hx?
|
1) Pretravel Info, 2) Exact Itinerary, 3) Purpose of Travel, 4) Adverse Incidents, 5) Status and Health of Fellow Travelers, pg 1081
|
|
|
What is the absolute eosinophil count > usually with parasitic infxns?
|
>500/mm3
pg 1082 |
|
|
Pts with fever after travel to a tropical location is __ until proven otherwise.
|
malaria
pg 1082 |
|
|
What is the classic triad of malaria?
|
fever, splenomegaly, and thrombocytopenia
pg 1082 |
|
|
Classically presents after a 4-7 days w./ sudden high fever, HA, N/V and rash. It is the second most serious tropical febrile illness after malaria?
|
Dengue fever
pg 1082 |
|
|
__ can cause petechial hemorrhages indistinguishable from meningococcemia.
|
Dengue fever
pg 1082 |
|
|
This fever typically lasts >10 days in recent travelers to the tropics (Mexico, Peru, Indonesia), caused by Salmonella. High fevers, HA, cough, ab distension, pale red rash ("rose spots"). concern and txmt?
|
Typhoid Fever - ceftriaxone 2g IV, cipro 400mg IV, add dexamethasone if severe
pg 1084 |
|
|
Bradycardia relative to fever is classic and after several days of fever, a pale red macular rash on the trunk is ?
|
Typhoid Fever
pg 1082 |
|
|
Also known as Weil Dz, it is associated w/ mucous membrane or percutaneous exposure to contaminated freshwater usually by infected animals urine. What is the cause and txmt?
|
Leptospirosis
Amoxicillin, Doxy or IV PCN (severe) pg 1085 |
|
|
Notable in this dz is conjunctival injection w/o purulent d/c, commonly after flooding, and/or seen in ecotourist after intense water exposure.
|
Leptospirosis
pg 1085 |
|
|
This fever is reoccuring up to 11 times and Borrelia spirochetes are identified on Romanowsky stained thick smear.
|
Relapsing Fever
pg 1085 |
|
|
___ is the most common cause of acute hemorrhagic fever in temperate climates.
|
Neisseria meningitidis
pg 1085 |
|
|
This flavivirus has a jungle monkey reservoir and the A. aegypyti mosquito transmits it. Fatal hemorrhagic fever, HA, myalgias, conjuntival inj., and bleeding. Concern is?
|
Yellow Fever
1086 |
|
|
The classic presentation is a triad of jaundice, black emesis, and albuminuria with renewed fevers.
|
Yellow Fever
pg 1086 |
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|
CNS involvement with fever in travelers returning from tropical regions require emergency presumptive txmt for both ___ and ___.
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malaria and bacterial meningitis
pg 1086 |
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Lavaral form of porktape worm, Taenia solium, causes systemic infxn and is the leading cause of adult-onset seizures worldwide.
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Cysticercosis
pg 1086 |
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This is transmitted by the Tsetse fly, bite forms painless chancre, intermittent fever, encephalitis, and coma.
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African Sleeping Sickness (Human African Trypanosomiasis)
pg 1087 |
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This protozoan, T. cruzi, is spread by the reduviid "kissing" or "assassin" bug. Romana sign (unilateral periobital edema). Leading cause of CHF in much of Latin America. Cause and txmt?
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American Trypanosomiasis (Chagas Dz)
Nifurtimox 10mg/kg/d pg 1087 |
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This dz is transmitted by the Lutzomyia or Phlebotomus sandflies. Stained smears show Donovan bodies.
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Leishmaniasis
pg 1087 |
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Travel related skin dz is generally causesd by one of the following (3)?
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1) previous condition
2) enviromental conditions 3) infx organism pg 1091 |
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The top 10 tropical travel dermatoses requiring specific therapy are?
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1) cutaneous larva migrans, 2) pyoderma due to stap/ strep, 3) arthropod, 4) myiasis, 5) tungiasis, 6) urticaria, 7) fever w/ rash, 8) cutaneous leishmaniasis, 9) scabies, 10) fungal infxn, pg 1091
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This filarial nematode inhabits the subcutaneous tissues, moves about freely, and can live up to 18yrs. Spread by Chrysops fly. Pt's complain about something in their eye. Concern is for?
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Loa Loa (Eye Worm)
pg 1091 |
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What are the 4 portals of exposure in regards to occupational exposures?
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1) Percutaneous, 2) Mucous Membranes, 3) Respiratory, 4) Dermal
pg 1093 |
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What is the greatest source of risk for contraction of bloodborne dz of the 4 portals of exposure?
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Percutaneous
pg 1093 |
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What does the risk of infection in an exposed health care provider depend on (5)?
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1) Route, 2) concentration of pathogen, 3) virility, 4) volume, and 5) immunocompetence of the exposed
pg 1093 |
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Infx control practices include (6):
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1) hand washing, 2) use of PPE, 3) cleaning/disinf/sterilizing equip and surfaces, 4) decon clothing/linens, 5) dispose of sharps, 6) pt location, pg 1093
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What are administrative controls regarding occupational exposures?
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organize, define, and direct infxn control activities
pg 1094 |
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__ ___ serve to reduce employee exposure by removing the hazard or isolating the provider from exposure.
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Equipment engineering
pg 1094 |
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___ is specialized clothing or equipment which does not permit blood or infx to pass through or reach worker clothing, skin, eyes, mouth or other mucous membranes.
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PPE
pg 1094 |
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T/F: After a needle stick exposure to a HIV + pt expedited triage, irrigation, blood samples, and direct viral assays are recommended.
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False: Direct viral assays are NOT recommended; rapid HIV antibody are
pg 1096 |
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How do you tx a HBV exposure in a unvaccinated, vaccinated (repsonder and nonresponder) pt?
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Unvaccinated - initiate Hep B vaccine series
Vac, respond- no txmt Vac, nonresp- Initiate Hep B vaccine series pg 1096 |
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What is the difference in Postexp Prophylaxis (PEP) for HIV + class 1 and class 2 txmt for less severe exposure?
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Less severe - Class 1 - 2 drug PEP
Class 2 - 3 drug PEP pg 1097 |
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What is the difference in Postexp Prophylaxis for HIV + class 1 and class 2 txmt for more severe exposure?
|
More Severe- Class 1- 3 drug
Class 2 - 3 drug pg 1097 |
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What is the diffference btwn less and more severe HIV + exposure?
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Less- solid needle, superficial injury
More - hollow, large bore needle; deep puncture, needle from artery or vein of HIV+ pt pg 1097 |
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What are some of your 2 and 3 drug combinations for HIV + PEP?
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2 drug: zidovudine + lamivudine, zidovudine + emtricitabine
3 drug: 2 drug reg + lopinavir/ritonvir pg 1098 |
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What are some of the airborne-spread dz < 5 micrometers?
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Rubeola (measles), Varicella, Tuberculosis
pg 1099 |
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What are some of the airborne-spread dz > 5 micrometers?
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HIB, N. meningitidis, Diphtheris, Mycoplasma, Pertussis, Influenza
pg 1099 |
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Airborne infection isolation room requires what 3 things?
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1) monitored neg pressure, 2) 6-12 air changes per hours, 3) d/c of the room air to the outdoors or filtration
pg 1099 |
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Where are the four major areas of actions that abx work?
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Cell Wall agents, Protein synthesis inhibitors, Nucleic acid inhibitors, and Enzyme inhibitors
pg 1103 |
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What type of MOA does PCN, Vanco, Cephalosporins have?
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Cell wall activity
pg 1099 |
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What type of MOA does aminoglycocides, macrolides, linezolid, clinda, and tetracyclines have?
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Protein synthesis
pg 1099 |
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What type of MOA does fluoroquinolones, rifampin, and nitrofurantoin have?
|
Nucleic acid inhibitors
pg 1099 |
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The crusted black "tache noire" eschar found at the papule bite site from a tick is commonly seen in what dz?
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Typhus
pg 1085 |
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Epidemics of this dz occurs after flooding or population displacement with water-sanitation system disruption. Profuse, watery diarrhea (rice water stool).
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Cholera (Vibrio cholerae)
pg 1089 |
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33yo M c/o painless, watery diarrhea x 4 days. Recently returned from trip to Madri Gras. Has "dishwater hands", vomiting, and leg cramps. Ate a lot of seafood on the trip. Cause and txmt?
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Cholera (infected seafood) and tetracycline 500mg QID
pg 1089 |
|
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This nematode is transmitted by the black fly, found near fast moving rivers in Central/South America. Skin changes like "leopard skin" and "hanging groin". Blindness results b/c of migrate to the eye. Cause and txmt?
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Onchocerciasis (River Blindness)
Ivermectin 150mcg/mg PO pg 1091 |
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Diagnosis is by skin biopsy and Giemsa stain. Small papule slowly enlarging and forming a painless shallow skin ucler. Volcano like chronic ulcerations.
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Cutaneous Leishamnaiasis
pg 1092 |
