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cdc yellowbook > Environmental Hazards & Risks 3 > Flashcards

Environmental Hazards & Risks 3 Flashcards

1
Q

which vaccines available to protect against 3 vectorborne diseases?

A

Japanese encephalitis, tick-borne encephalitis, and yellow fever

Dengvaxia to prevent dengue in children aged 9–16 years who had laboratory-confirmed previous dengue virus infection and who live in dengue-endemic areas.

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2
Q

what are EPA-registered ingredients that safely and effectively prevent insect bites?

A

DEET
Picaridin
Oil of lemon eucaplyptus or PMD
IR3535
2-Undecanone

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3
Q

what is the age limit of oil of lemon eucalyptus?

A

3 years and younger should not use due to potential allergic skin reactions

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4
Q

what is permethrin effective for?

A

insecticide
acaricide (pesticide that kills ticks and mites)
repellent

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5
Q

which insect repellent can be used without age limit?

A

DEEP, picaridin, IR3535, 2-undecanone

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6
Q

when is the peak biting activity of Aedes aegypti (chikungunya,, dengue, Mayaro, yellow fever, Zika)?

A

after sunrise (dawn) and at sunset (dusk) - during the day

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7
Q

when is the peak biting activity of Culex quinquefasciatus (filariasis, JE, St. Louis, West Nile encephalitis, Usutu)?

A

after sunset - 10-11 pm

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8
Q

when is the biting activity of Anopheles mosquitoes (malaria)?

A

varies with species -
gambiae (primary vector in Africa) - 3-6 am;
albimanus (central and south America) - 10-11pm

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9
Q

when do you need to see the doctor after removing a tick?

A

if they develop rash or fever within several weeks of removing a tick

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10
Q

where do fleas bite?

A

lower legs or feet - protect by wearing long socks and pants

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11
Q

which bacterial species with bat reservoir can be transmitted through inhalation and ingestion?

A

Leptospira spp
Pasteurella spp
Salmonellosis
Yersinosis

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12
Q

which viral species with bat reservoir can be transmitted through inhalation and ingestion?

A

Hemorrhagic fever viruses;
Paramyxoviruses (parainfluenza type 2 virus, Mapuera, Menangle, Nipah, Hendra);
Coronaviruses (SARS-CoV-1, SARS-Cov-2, MERS);
>200 bat associated viruses (almost all RNA)

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13
Q

which bacterial species with bird reservoir can be transmitted through inhalation and ingestion?

A

Avian mycobacteriosis;
Psittacosis;
Salmonellosis

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14
Q

which bacterial species with bird reservoir can be transmitted through bites and scratches?

A

Psittacosis

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15
Q

which bacterial species with cats/dogs reservoir can be transmitted through bites and scratches?

A

Capnocytophaga canimorsus;
Plague;
Tularemia

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16
Q

which bacterial species with cats/dogs reservoir can be transmitted through inhalation and ingestion?

A

Bartonella spp;
Brucella spp;
Campylobacter spp;
Leptospira spp;
Pastuerella spp

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17
Q

which bacterial species with monkeys reservoir can be transmitted through inhalation and ingestion?

A

Campylobacter spp;
Salmonellosis;
Shigellosis

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18
Q

which viral species with monkeys reservoir can be transmitted through bites and scratches?

A

B virus;
Rabies;
Simian retroviruses

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19
Q

which bacterial species with rodents reservoir can be transmitted through inhalation and ingestion?

A

Leptospira spp;
Salmonellosis

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20
Q

which viral species with rodents reservoir can be transmitted through bites and scratches?

A

Lymphocytic choriomeningitis virus;
Monkeypox;
Rat-bite fever;
Viral hemorrhagic fevers

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21
Q

which bacterial species with rodent fleas,ticks, mites reservoir can be transmitted through bites and scratches?

A

Bartonella spp;
Lyme disease;
Plague;
Rickettsial infections;
Tularemia

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22
Q

which viral species with rodent fleas,ticks, mites reservoir can be transmitted through bites and scratches?

A

Tick-borne encephalitis

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23
Q

if you are biten by a monkey, what do you need to do immediately and what to be evaluated for?

A

wash properly after bitten - 20 min running water and soap;

B virus postexposure prophylaxis (acyclovir or ganclovir)

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24
Q

if you visit Python Cave in western Uganda, what is the risk?

A

Marburg virus

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25
Q

what is the One Health approach?

A

recognizes that the health of people is closely connected to the health of animals and our shared environment.

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26
Q

To reduce the risk of introducing severe acute respiratory syndrome (SARS) coronavirus, the United States does not allow importation of civets and related animals in the family ….

A

Viverridae

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27
Q

The requirements to bring a dog into the United States depend on 3 things -

A

when the dog will arrive in the United States

where the dog has been in the 6 months before arriving in the United States

where the dog received its rabies vaccination (if required)

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28
Q

Nonhuman primates can transmit a variety of serious diseases to humans, including – and –.

A

Nonhuman primates can transmit a variety of serious diseases to humans, including Ebola virus disease and tuberculosis.

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29
Q

which are a known source of communicable diseases (e.g., monkeypox) that can be transferred to humans?

A

African rodents

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30
Q

Turtles often are kept as pets but can transmit which to humans.

A

Turtles often are kept as pets but can transmit Salmonella to humans.

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31
Q

Travelers wanting to import animal skins, hunting trophies, or other items made from animals when returning from a trip, what should they do?

A

import permit, or must be rendered noninfectious

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32
Q

CDC restricts bringing souvenirs made from goat hide (e.g., goatskin drums) into the United States because …

A

they have been associated with cases of anthrax in humans

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33
Q

how does Ciguatera fish poisoning occur?

A

eating reef fish contaminated with toxins like ciguatoxin or maitotoxin

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34
Q

what is the origin of reef fish toxins?

A

Gambierdiscus toxicus - small marine organism (dinoflagellate) that grows on and around coral reefs

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35
Q

where are Ciguatoxins concentrated in?

A

fish liver, intestine, roe, and heads

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36
Q

Approximately how many cases of ciguatera poisoning are reported worldwide annually?

A

50000;

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37
Q

Ciguatera is widespread in tropical and subtropical waters, usually between the latitudes of 35°N and 35°S, and is particularly common in…?

A

the Pacific and Indian Oceans and the Caribbean Sea

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38
Q

what are large carnivorous reef fish that likely cause ciguatera poisoning?

A

amberjack, barracuda, grouper, moray eel, sea bass, sturgeon

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39
Q

Ciguatera poisoning can cause what type of illnesses?

A

cardiovascular, gastrointestinal, neurologic, and neuropsychiatric illness

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40
Q

when is the first symptom of ciguatera poisoning develop?

A

within 3-6 hours after eating, but can be delayed upto 30 hours

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41
Q

what are General signs and symptoms of ciguatera poisoning?

cardiovascular signs and symptoms?

GI symptoms?

Neurologic and nueropsychiatric signs?

A

fatigue, general malaise, and insomnia;

bradycardia, heart block, or hypotension;

diarrhea, nausea, vomiting, and abdominal pain;

paresthesia, weakness, pain in the teeth or a sensation that the teeth are loose, a burning or metallic taste in the mouth, generalized itching, sweating, and blurred vision. Cold allodynia (abnormal sensation when touching cold water or objects)

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42
Q

The overall death rate from ciguatera poisoning is ?

A

<0.1%

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43
Q

how to prevent ciguatera fish poisoning?

A

avoid or limit consumption of reef fish, particularly fish that weigh >5 pounds; counsel travelers to never eat high-risk fish (e.g., barracuda, moray eel) and to avoid eating the parts of the fish (e.g., the head, intestines, liver, roe) that concentrate ciguatera toxin.

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44
Q

what is the symptomatic treatment for ciguatoxin or maitotoxin poisoning?

A

amitriptyline for chronic paresthesias, depression, or pruritus;

fluoxetine for chronic fatigue; gabapentin or pregabalin for neuropathic symptoms;

nifedipine or acetaminophen for headaches;

Intravenous mannitol - reduce the severity and duration of neurologic symptoms, particularly if given ≤48 hours of symptom onset

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45
Q

what is to avoid after ciguatoxin or maitotoxin poisoning?

A

avoid consuming alcohol, caffeine, fish, and nuts for ≥6 months

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46
Q

waht is scombroid caused by ?

A

eating fish that contain high levels of histamine

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47
Q

how are histamine level increased in fish?

A

when fish are improperly stored after capture, bacterial overgrowth can occur, facilitating and accelerating histamine production (coversion of histidine to histamine by bacteria).

48
Q

what is the one of the most common fish poisonings?

A

scombroid

49
Q

which fish has naturally high level of histidine?

A

amberjack, anchovies, bluefish, herring, mackerel, mahi mahi (dolphin fish), marlin, sardines, and tuna

50
Q

what are the symptoms of scombroid poisoning?

A

resembles an acute allergic reaction and usually appears 10–60 minutes after a person eats contaminated fish.

Signs and symptoms include abdominal cramps and diarrhea, blurred vision, flushing of the face and upper body resembling sunburn, severe headaches, itching, and palpitations.

Left untreated, symptoms usually resolve within 12 hours but can last ≤48 hours.

Rarely, respiratory compromise, malignant arrhythmias, and hypotension requiring hospitalization can occur. Scombroid poisoning has no long-term sequelae and usually is diagnosed from clinical signs and symptoms. Clustering of cases helps exclude the possibility of true fish allergy.

51
Q

how to prevent scombroid poisoning?

A

avoid fish which has peppery, sharp, salty taste or a ‘bubbly feel;
properly iced or refrigerated at temperatures <3.3 celcius or immediately frozen after being caught

52
Q

how to treat scomboid poisoning?

A

antihistamines - typically H1-receptor antagonists, although H2-receptor antagonists also might provide some benefit.

53
Q

what are shellfish?

A

crustaceans (Dungeness crab, lobster, and shrimp),

filter-feeding bivalve mollusks (clams, cockles, mussels, oysters, and scallops), and

gastropod mollusks (abalone, moon snails, and whelks)

54
Q

what are symptoms of shellfish poisoning?
onset?

A

gastrointestinal and neurologic illness;
30–60 minutes after a person ingests toxic shellfish

55
Q

Amnesic shellfish poisoning (ASP), what is the toxin called and which spp of diatoms produce this?

A

domoic acid;
Pseudonitzchia spp

56
Q

Outbreaks of ASP Amnesic shellfish poisoning have been reported in which countries?

A

the Americas (Canada, Chile), Europe (Belgium, France, Ireland, Portugal, Scotland, Spain), and the Pacific (Australia, New Zealand)

57
Q

In most cases of Amnesic Shellfish Poisoning, gastrointestinal symptoms (e.g., abdominal pain, diarrhea, vomiting) develop within 24 hours of eating toxic shellfish, followed by which symptoms?

A

headache, cognitive impairment, and memory loss

58
Q

what is the example of toxins that cause Diarrheic shellfish poisoning (DSP)?

most cases result from eating what type of shellfish?

A

okadaic acid;

bivalve mollusks (mussels, scallops)

59
Q

what are toxins causing Neurotoxic shellfish poisoning (NSP)?

A

brevetoxins produced by dinoflagellate K. brevis

60
Q

Neurotoxic Shellfish Poisoning is predominately an illness of the … Hemisphere, but the disease also has been reported from New Zealand.

A

Western Hemisphere (the Caribbean, Gulf of Mexico, southeastern coast of the United States)

61
Q

what is the most common and most severe form of shellfish poisoning?

A

Paralytic shellfish poisoning (PSP)

62
Q

which toxin causes paralytic shellfish poisoning?

A

saxitoxins - from clams or mussels

63
Q

what are the symptoms of paralytic shellfish poisoning?

A

Symptoms usually appear 30–60 minutes after a person eats toxic shellfish and include numbness and tingling of the face, lips, tongue, arms, and legs. Patients also might have diarrhea and vomiting, headache, and nausea. Severe cases are associated with ingestion of large doses of toxin and clinical features such as ataxia, dysphagia, flaccid paralysis, mental status changes, and respiratory failure.

64
Q

what are some strategies to avoid becoming a crime victim ?

A

Avoid accommodations on the ground floor or immediately next to the stairs, and lock all windows and doors.

Do not wear expensive clothing or accessories.

If confronted in a robbery, give up all valuables and do not resist attackers. Resistance can escalate to violence and result in injury or death.
Limit travel at night; travel with a companion, and vary routine travel habits.

Take only recommended, safe modes of local transportation.

65
Q

which countries have the highest number of homicide deaths among US citizens abroad?

A

Mexico, the Philippines, Haiti, and Jamaica

66
Q

how to prevent fire-related injuries?

A

To prevent fire-related injuries, travelers should select accommodations no higher than the 6th floor (fire ladders generally cannot reach higher than the 6th floor)

confirm that hotels have smoke alarms and, preferably, sprinkler systems.

bring their own smoke alarms with them, and that they should always identify ≥2 escape routes from buildings.

Crawling low under smoke and covering one’s mouth with a wet cloth are helpful for escaping a fire. Families should agree on a meeting place outside the building in case of a fire.

67
Q

when in the aircraft the person can be presumed dead and resuscitation efforts halted?

A

If CPR is performed in an aircraft cabin for ≥30 minutes with no signs of life, and no shocks advised by an AED

68
Q

Cruise ships are equipped with which items for death in the ship?

A

morgues and body bags

69
Q

what do you need to bring human remains abroad?

A

death certificate stating the cause of death;

OR instead, copy of the Consular Mortuary Certificate and the Affidavit of Foreign Funeral Director and Transit Permit

70
Q

which courier is the only courier legally allowed to ship cremated remains?

A

US Postal Service

71
Q

which two hallucinogenic substances are most promoted to travelers?

what are other ones?

A

Ayahuasca & Mand honey;

ibogaine, peyote cactus, psilocybin-containing mushrooms, and Salvia divinorum (“sage of the diviners”)

72
Q

what is Ayahuasca?

A

Used in religious rituals in the Amazon region of South America (Machu Picchu and the Sacred Valley);

this beverage has been marketed to travelers as a cultural experience (e.g., ethnotourism) and treatment for depression;

Made from the vine Banisteriopsis caapi and other plants;

N-N-dimenthyltryptamine and beta-carboline alkaloids such as harmine and harmaline are active substances

73
Q

what drug interactions can Ayahuasca cause?

A

inhibit the enzyme monoamine oxidase and lead to potentially dangerous interactions with certain medications

74
Q

what is mad honey?

A

a folk medicine in many areas around the world (e.g., Nepal, the Black Sea region of Turkey)

honey contaminated with grayanotoxin, a chemical produced by Rhododendron plants.

Used to treat diabetes, digestive problems, hypertension, and other medical conditions, it has also been promoted as a sexual enhancement.

Mad honey poisoning has been widely reported, with symptoms including ataxia, blurred or double vision, dizziness, drooling, headache, sweating, vomiting, and weakness. Grayanotoxin can cause bradycardia and other potentially dangerous arrythmias.

75
Q

what are environmental toxins?

A

carbon monoxide;
chemical irritants;
herbicides, pesticides, rodenticides

76
Q

what does Carbon monoxide (CO) do in the body?

A

CO inhibits the molecular transport of oxygen from the blood to the tissues of the body.

77
Q

what are the most common chemical irritants?

A

chloroacetophenone, chlorobenzylidenemalonitrile, and
oleoresin capsicum - “pepper spray.”

78
Q

what to advise travelers exposed to chemical irritants?

A

leave the area immediately and to flush their eyes with copious amounts of clean water or saline solution, if available

Contact lens wearers should remove and not reuse their lenses, even if they are not disposable.

Contaminated clothing should be removed but not pulled over the head, an action that may require cutting off the clothing.

Exposed individuals should avoid touching contaminated areas of clothing, place all clothing in a sealed plastic bag to avoid further spread of the chemical irritant, and wash affected skin with soap and water.

Contaminated clothing should be discarded, if possible, ideally sealed in two plastic bags.

Clothing that cannot be discarded should be washed thoroughly with detergent, separate from other laundry. Chemical irritants can be difficult to remove from clothing and may persist despite multiple washings.

79
Q

what is a toxic byproduct of ethanol production which can lead to dizziness, headache, nausea, permanent visual loss, organ failure, and death?

A

methanol

80
Q

what is botulism? symptoms?

A

a potentially deadly disease caused by a toxin produced by the bacterium Clostridium botulinum.

blurred vision, difficulty speaking, and weakness, but can progress to paralysis.

81
Q

how is Infant botulism caused by?

A

ingestion of bacteria spores by infants, often associated with consumption of contaminated honey or corn syrup.

82
Q

what are 3 botulisms?

A

foodborne botulism
would botulism
infant botulism

83
Q

waht food pose a risk of foodborn botulism?

A

Preserved foods, including smoked fishes and other cured meats, can pose a risk if not stored at proper temperatures. Pickled or preserved foods also pose a risk if they do not contain the proper amounts of salt or acidity.

84
Q

what are sedative drugs and incapacitating agents?

A

GHB (gamma-hydroxybutyric acid) - party drug;
Ketamine - anesthetic/recreationally used;
Rohypnol (flunitrazepam)

85
Q

which marine animals use venom?

A

cnidarians - include corals, hydroids (fire coral, Portuguese man o’war), jellyfish and sea anemones

86
Q

waht is stinging structures of cnidarians called?

A

nematocysts

87
Q

what does cnidarian sting cause?

A

painful and itching rashes - not severe

88
Q

which cnidarian can cause life-threatening effects in humans?

A

Australian box jellyfish - Chironex fleckeri;
found in SW Pacific Ocean along the northern coast of Australia as well as Malaysia and New Guinea;

89
Q

what can the sting of an Australian box jellyfish cause?

A

abnormal heart rhythms and cardiac arrest leading to death

90
Q

what is Irukandji syndrome?

A

a serious condition that can develop following the sting of the Irukandji jellyfish, Carukia barnesi

91
Q

where is Irukandji syndrome causing jellyfish found?

A

northern coast of Australia

92
Q

what are the symptoms of Irukandji syndrome?

A

mild pain at first but can later develop a wide range of symptoms, including goosebumps, headache, waves of muscle spasms, restlessness, sweating, tachycardia, tachypnea, and a sense of doom.

Many victims develop dangerously high hypertension, which can be followed by hypotension, reduced cardiac function, and pulmonary edema. Patients with Irukandji syndrome typically require urgent hospital treatment to control pain and blood pressure.

93
Q

which hydrozoan can cause an Irukandji-like syndrome?

A

Physalia physalis, commonly known as the Portuguese man o’ war

94
Q

if tentacles remain adhered to the skin following a sting, what should you do?

A

remove ASAP and washing with copious amt of seawater (not fresh water!)

vinegar - prevent further nematocyst firing (in tropical waters of the Indo-Pacific regions - not for temperate waters around the US)

Ice packs

95
Q

if bit by Jellyfish venoms (Australian box jellyfish), what should you do?

A

hot water immersion - 45 degree water for 20 min

96
Q

where is cone snail found?

A

tropical waters of Indo-Pacific region

97
Q

what venom from cone snails can rapidly cause paralysis, coma, and death?

A

conotoxins (proteins)

98
Q

what types of fish possess sharp venomous spines that can injure humans?

A

lionfish, stingrays, stonefish

99
Q

if you are bit by spiny fish, what do you need to do?

A

hot water immersion

100
Q

how do stingrays cause sting?

A

using its tails

101
Q

where is stonefish found?

A

shallow tropical waters of the western Pacific Ocean, Indian ocena, and off the coast of East Africa

102
Q

what does stonefish stings cause?

A

severe pain, and a dark bluish discoloration of the wound and swelling that spread rapidly up the injured limb.

Wounds can take months to heal.

In addition, victims have experienced other effects of toxicity including abdominal pain and vomiting; cardiac arrhythmias, unstable blood pressure and heart failure; and confusion, headache, and life-threatening seizures. Because stonefish stings can cause life-threatening illness, advise travelers to seek immediate medical attention.

103
Q

where is the blue-ringed octopus, Hapalochlaena lunulata, can be found?

A

waters around Australia and the Indo-Pacific regions, hidden in crevices

104
Q

what toxin does the blue-ringed octopus have?

A

tetrodotoxin - cause paralysis and death if not treated

105
Q

what can sea urchins cause?

A

severe puncture wounds, especially when stepped on. The venom on their spines can cause intense burning pain, redness, and swelling of the injured areas.

106
Q

which starfish is harmful?

A

the crown-of-thorns starfish - long, sharp spines that contain toxins, cause severe pain, nausea, vomiting, muscle paralysis, hemolysis, and coagulopathies

107
Q

where is the crown-of-thorns starfish found?

A

in tropical coral reefs throughout the Pacific and Indian Oceans, from the Red Sea and East African coast to the Pacific coast of Central America, and are especially common near Australia.

108
Q

what to do when sting by sea urchin and starfish venoms?

A

Hot-water immersion can help limit the effects;

Travelers not up to date with tetanus vaccines may require a booster and, in some cases, antibiotics to prevent bacterial infections associated with puncture wounds in the marine environment.

109
Q

what do Scorpion stings often cause?

A

intense pain and redness;
some species cause severe illness, affecting the heart, nervous system, and other organs

110
Q

In 2019, an estimated how many deaths worldwide were attributed to snakebites?

A

63400

111
Q

how to prevent snakebites?

A

wear long pants, socks, and high boots when hiking in areas inhabited by venomous snakes and to inspect the ground before sitting down, especially at the base of a tree.

use a flashlight when walking outdoors at night and to not reach blindly into brush, tree branches, rocky ledges, holes, or even bags before checking visually for snakes and other venomous animals.

Wearing heavy protective gloves when gathering firewood, not sleeping on the ground, and carefully shaking out bedding material, shoes, and clothing before use

112
Q

what are some first aid recommendation for snakebite?

A

immobilization of a bitten arm or leg in an elevated and extended position with a splint;

pressure immobilization bandages to limit lymphatic drainage may be considered for neurotoxic venom

113
Q

what are some snakes that have venoms?

A

Elapidae family (cobras, mambas, coral snakes);

Viperidae (vipers or viperids);

sea snakes

114
Q

what kind of spiders have venom?

A

Australian funnel web spiders - family Atracidae;

Latrodectus species - widow spiders (genus Latrodectus)

Loxosceles species - recluse spiders (genus Loxoceles)

Phoneutria species - armed, banana, or wandering spiders, Phoneutria, are found in Brazil and other parts of South America

Tarantulas - not cause serious illness

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cdc yellowbook (26 decks)

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