DJ Sunday Review Flashcards
Person or animal that harbors the infectious agent/disease and can transmit it to others but does not demonstrate signs of the disease
Carrier
Exposure to a source of an infection, a person who has been exposed. Does not imply infection, it implies possibility of infection
Contact
An increase, often sudden, in number of cases of a disease above what is normally expected in that population and area
Epidemic
Constant presence of an agent or health condition within a given geographic area or population
Endemic
Epidemic occurring over a widespread area (multiple countries or continents) and usually affecting a substantial proportion of the population
Pandemic
Describes any illness, impairment, degradation of health, chronic or age-related disease
Morbidity
Measure of death in a defined population during a specific time interval, from a defined cause
Morbidity rate
What is the leading cause of domestically acquired arboviral disease in the US?
WNV
What spreads WNV?
Culex mosquito
What time of year do WNV outbreaks occur?
Between mid-July and Early September
Presentation:
- Acute systemic febrile illness
- HA, weakness, myalgia or athralgia
- GI sx
- Transient maculopapular rash
WNV
Labs for WNV
- IgM in serum or CSF
- ELISA
Treatment of WNV
Supportive measures
Prevention of WNV
- Mosquito repellant
- Wearing long sleeves/pants
- Limit outdoors exposure
- Using air condition, windows and screens to prevent mosquitos
What condition do protozoan parasites of genus Plasmodium cause?
Malaria
Sub types of malaria
- P. Valciparum/Vivax/Ovale/Malariae
What transmits malaria
Female anopheles mosquito
Presentation:
- Paroxsymal fevers
- Influenza-like sx
- Jaundice and mild anemia
Uncomplicated malaria
Paroxysmal fevers are a hall mark of what infection?
Malaria
Lab for dx of malaria
Blood smear
Treatment of Malaria
- Atovaquone-proguanil (Malarone)
- Artemether-lumefantrine (Coartem)
Treatment of Uncomplicated Malaria
- Chloroquine Phosphate 1g (600mg) base PO
- THEN 0.5g in 6 hours
- THEN 0.5 daily for 2 days
Treatment of malaria with chloroquine resistance
Malarone (Atovaquone 250mg/Proguanil 100mg) 4 tabs PO QD for 3 days
Treatment of severe malaria
- Artesunate 2.4mg/kg IV at 0, 12, 24, 48 hours
- Followed by Doxycycline 100mg BID x 7 days after parenteral therapy
Treatment of P. Ovale
- ADD primaquine 52.6mg (30mg=2 Tabs) PO QD x 14 days
- Added regiment for hypnozoites
How do you prevent malaria
- Long clothes
- Stop mosquitos
What transmits Dengue Fever
Aeges Aegypti
3 Phases of Dengue Fever
- Febrile Fever
- Critical Phase
- Convalescent Phase
Which phase of Dengue Fever:
(1) Typically lasts 2–7 days and can be biphasic.
(2) Signs and symptoms may include severe headache; retroorbital pain; muscle, joint, and bone pain; & transient maculopapular rash.
(3) Minor hemorrhagic manifestations, including petechiae, ecchymosis, purpura, epistaxis, bleeding gums, hematuria, or a positive tourniquet
test result.
Febrile Phase
WHich phase of dengue fever:
typically lasts
24–48 hours.
(2) Most patients clinically improve during this phase and move on to recovery & convalescence phase.
Critical Phase
Which phase of dengue fever:
(2) Patient begins to reabsorb extravasated intravenous fluids, pleural, &
abdominal effusions.
(3) As a patient continues to improve, hemodynamic status stabilizes and
diuresis ensues.
(4) The patient’s hematocrit stabilizes or may fall because of the dilutional
effect of the reabsorbed fluid, and the white cell count usually starts to
rise, followed by a recovery of platelet count.
(5) The convalescent-phase rash may desquamate and be pruritic.
Convalescent Phase
What is the TQ test?
- For dengue fever
- Pump BP cuff
- Deflate and wait
- Reinflate at midway
- Keep cuff inflated for 5 minutes
- Count petechiae below AC fossa
What is a positive TQ test
10 or more petechiae per 1 square inch
Treatment of Dengue Fever
- Hydration
- Avoid NSAIDS
- Tylenol to control fever
Prevention of Dengue
Avoid mosquitos
What condition does R. rickettsia cause
RMSF
What transmits RMSF
- Americsn Dog Tick
- Rocky Mountain Wood tick
- Brown dog tick
Hallmark of RMSF
Small pink macules on wrists, forearms and ankles that spread to trunk
Crucial history to r/i or r/o RMSF
- recent tick bite
- area where ticks are common
Treatment of RMSF
Doxycycine 100mg PO BID for 5-7 days
What does Borrelia burgdorferi cause
Lyme disease
What transmits lyme disease
Ixodes (Black legged) ticks
How long must tick be attached to transmit lyme
- 36-48 hours
- Has occured in as little as 24 hours
Hallmark for lyme disease
Erythema migrans (EM)- red ring-like homogenous expanding rash
Treatment of lyme disease
Early lyme/Early disseminated lyme
- Doxycyline 100mg PO BID x 14 days
Late disseminated
- Doxycycline 100mg PO BID x 28 days
Medication post exposure to lyme disease
Doxycyline 200mg PO once
Disposition of lyme
MED ADVICE
What can cause leishmaniasis
Sand fly exposure
Presentation:
- Pink colored papule that enlarges to a nodule or plaque like lesion
- Lesion ulcerates with indurated border and may have thick white-yellow fibrous materialk
- Lesions are painless
Leishmaniasis
IDC treatment of lyme disease
- Ulcer should be debrided and kept clean
- Bandaged and wrapped
Leishmaniasis disposition
- Sent to MO or ID
Prevention of leishmaniasis
Stay away from sand flies
What is an acute or chronic inflammatory process involving bone and structures secondary to infection with pyogenic organisms including bacteria, fungi and mycobacteria
Osteomyelitis
Treatment of osteomyelitis
- Surgical debridement
- IV vancomycin and IV ceftriaxone
What does the spore forming, anaerobic, gram positive bacterium, clostidrum tetani cause?
Tetanus
Presentation:
- Lock jaw, nuchal rigidity, dysphagia, rigid abdominal muscles
- Muscle spams
- Apnea due to thoracic contraction or pharyngeal muscle contraction
- Fracture of long bones/vertebrae during muscle spasms
- Death due to respiratory arrest
Tetanus
Disposition of tetanus
MEDEVAC
Treatment of tetanus
- Metronidazole 500mg IV q6-8hrs for 7-10 days
- Pen G 2-4 mile IV
- HTIG
Inflammation of meninges
Meningitis
Inflamation of the brain
Encephalitis
Viral causes of meningitis
Enterovirus (most common), coxsackie viruses, echoviruses, WNV, influenza, HSV, VZV, EBV, arboviruses
Bacterial causes of meningitis
Strep, penumonia, influenza, e coli
Classic meningeal tetrad
fever, nuchal rigidity, altered mental status, severe HA
Imaging for meningitis
CT
Treatment of meningitis
- Ceftriaxone 2g IV q12h x 7 days
- Pen G 4 million units IV q4h x 7 days
- Dexamethasone 4mg IV
EBV causes what
Mononucleosis
Does mono have a vector
NO
Presentation:
- Erythematous, exudative pharyngitis or tonsillitis
- Malaise
- Fever
- Cervical lymphadenopathy
- Splenomegaly
Mononucleosis
Labs for mono
- Monospot
- CBC: leukocytosis
- LFT
Treatment of mono
Treat symptomaticallt
Disposition of mono
- SIQ
- No contact sports due to spleen pop
How is rabies spread
Infected salvia innoculated through a break in skin
What is the most characteristic feature of rabies
Hydrophobia
- Afraid of water due to involuntary pharyngeak soasns when they attempt to drink
Aerophobia in rabies
Pharygneal muscle spasms triggered by feel draft of air leading to aspiration, coughing, choking, respiratory arrest
Disposition of raabies
MEDEVAC
Difference between inflammatory and non-inflammatory diarrhea
- Inflammatory= Blood
- Non-inflammatory= no blood
Viral causes of diarrhea
- Noro
- Rota
Bacterial causes of diarrhea
- ETEC
- Campylobacter jejuni
- Shigella
- Salmonella
Protozoa causes of diarrhea
- Giardia
- Entamoeba
Acute onset of abdominal cramps, nausea, vomitting and non bloody diarrhea
Norovirus
Treatment of diarrhea
- Rehydrate
- Antimotility/antiemetics
- Cipro
Treatment of travelers diarrhea
Azithromycin 500mg PO daily x 3 days
Common name for giardia
Beaver fever
What can cause giardia
Contaminated lake water/streams
Presentation:
- Foul smelling/greasy diarrhea
- 2-5 loose stools per dau with increasing fatigue
Giardia
Treatment of Giardia
Metronidazole (Flagyl) 250mg PO TID x 5-7days
When to consider antibiotics for diarrhea
- Fever
- > 10 stools per day w/ dehydration
- significant operational or complete loss of effectiveness
Transmitted through consumption of contaminated water or food and fecal-oral route to include certain sex practices
HEP A
Transmitted through exposure to infective blood, semen, body fluids, contaminated blood products and IV drug use
HEP B
Transmitted through exposure to infective blood, IV drug use. Can be transmitted sexually but less common.
Hep C
Infections only occur with Hep B
Hep D
Transmitted through consumption of contaminated water or food. Vaccine exists but are not widely available
Hep E
Presentation:
- Jaundice
- RUQ pain
- Low grade fever
- Hepatomegaly
- Dark or brown urine
- Gray poop
Hepatitis
Treatment of Hepatitis
- IDC supportive care
- MEDEVAC
Myobacterium Tuberculosis
TB
How is TB transmitted
Through the air
What vaccine may cause a positive TST
BCG
Preferred method of testing for TB for patients who have had BCG
QFT
LTBI instruction
BUMEDINST 6224.8C
LTBI treatment regiment
Isoniazid and Rifampin 1 PO daily x 12 weeks (3 months)
Presentatioin:
- Prolonged and productive cough w or w/o hemoptysis
- Chest discomfort
- low grade fever
- decreased appetite
- anorexia
- unexplained weight loss
- Night sweats
TB
Procedures for suspected or confirmed TB
- Masks
- Isolation of patient
- MER submitted within 24 hours
- Notify NEPMU
Bacillus anthracis
Anthrax
What increases your chance of getting anthrax
Working with unvaccinated animals. Common in ranchers, leather workers, vets, wildlife researchers
Hallmark for anthrax
Eschar with extensive surrounding edema
Antibiotics for anthrax
- Ciprofloxacin 500mg PO BID 7-10 days
- Levofloxacin 750mg PO QD 7-10 days
- Doxycyline 100mg PO BID x 7-10 days
Prevention of anthrax
- Vaccine
Chlamydia trachomatis
Chlamydia
Most frequently reported bacterial STI
Chlamydia
Why is chalmydia known as the “Silent Killer”
Most are asymptomatic
Labs for chlamydia
- NAAT
- UA
Treatment of chlamydia
- Doxycyline 100mg PO BID x 7 days
- ALT= Azithromycin 1g
- Can treat with ceftriaxone if concerned for coinfection
Neisseria gonnorhoeae
Gonorrhea
Who is asymptomatic and symptomatic in terms of gonorrhea
- Males= symptomatic
- Females= asymptomatic
Presentation:
- Dysuria
- White/yellow/green urethral discharge
- epididymitis
- discharge, anal itching, bleeding, painful bowel movements
- sore throat
Gonorrhea
Labs for gonorrhea
GC/NAAT
Treatment of gonorrhea
Ceftriaxone 500mg
Doxycycline 100mg po bid x 7 days
ALT= Azithromycin 1g po
Treponema pallidum
Syphilis
Syphilis is also called
Great pretender as it can look like many diseases
Presentation:
- Painless papule called chancre
Syphilis
Describe Secondary Syphilis
- Skin rashes/mucous membrane lesions
- Syphilitc rash on trunk and extremities that includes palms and soles
S/s of latent syphilis
no visible signs and sx
Untreated syphilis that appear 10-30 years after infection and can be fatal
Tertiary syphilis
Labs for syphilis
Treponemal test (FTA_ABS)
Treatment of syphilis
PCN G
PCN allergy: Doxycycline
Differentials for syphilis
- Atopic dermatitis
- Psoriasis
-Tinea versicolor - RMSF
Trichomonas vaginalis
Trichomniasis
Presentation:
- Purulent, malodorous d/c, burning, pruritis, dysuria, dyspareunia
- Strawberry cervix
Trichomonas
Labs for Trichomonas
NAAT
Treatment of trichomonas
Metronidazole 2g orally
- Avoid alcohol
Which HPV types cause anogenital warts (condyloma acuminata)
6 and 11
Which HPV types cause malignancy
16 and 18
Presentation:
- Lesions are generally found in multiples and can coalesce
Condyloma acuminata
Topical treatment of HPV
Podophyllotoxin solution
Clinician applied therapy for HPV
- Cryo
- Surgical excision
Vaccine for HPV
Gardasil
Gardasil protects against which types of HPV
6 and 11
16 and 18
Who should get gardasil
Everyone from 11-26
>26 can request
Acute (symptomatic) phase of HIV
Acute Retroviral syndrome (ARS)
Can present similarly to mono and the flu
Acute Retroviral syndrome
HIV Testing
Rapid 1/2 antibody test
4th gen HIV
Do we initiate PrEP in an operational environment?
No
Initiation of PrEp requires what?
- Negative 4th gen HIV within 7 days if infection is not suspected
- Negative 4th gen and docuemented negative NAAT within 7 days if infection is suspected
Initiation of PrEp requires what?
- Negative 4th gen HIV within 7 days if infection is not suspected
- Negative 4th gen and docuemented negative NAAT within 7 days if infection is suspected
When is nPEP relevant
- Sexual assault
- Unprotected sex with high risk contact
When is PEP relevant
- Needle stick
- Healthcare related exposure to high risk substances
When are clinical evaluations required for DoD member with HIV?
q 6-12 months
