Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Module 7: Mali: ID > ID CM > Flashcards

ID CM Flashcards

1
Q

definition of epidemiology

A

study of distribution of disease and the distribution of determinants (RF, exposures) of disease (or health related states) in disease specific populations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the 3 goals of epidemiology?

A

describe patterns

identify causes of disease

provide data for the management, evaluation and planning of services

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the 5 goals of surveillance?

A

detect outbreaks

quantify magnitude of the problem

evaluate prevention measures

detect changes in the health care practice

facilitate planning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the 5 categories of reportable conditions?

A

STDs

gastrointestinal (cholera)

biologic threat agents

Vector Borne

zoonotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are there reportable disease

category 1

category 2

A

Category 1: immediate notification

Category 2: Notification within 48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how long can it take for H1N1 to become a pandemic?

A

48 hours

she wrote this down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the 4 goals of influenza surveillance?

what is this accomplished by?

A

identify circulating strains

assist in controlling outbreaks

provide information to policy makers

build rapid response

accomplished by syndromic surveillance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

who is exempt from HIPPA privacy rule?

A

public health investigators

they have the right to acess the information on reportable disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

if someone has a reportable condition…what is provided to the public health official?

(4)

A

condition diagnosed or suspected

unusual or sudden increase

Name, date, phone number

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

who are specifically vulnerable to disease?

A

elderly living alone

those with chronic diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what number in the country are we for elderly living at home?

why do we care?

A

3rd!

especially living at home is an issue if there is a flu outbreak or also a heat wave!! think about this!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what number are we in the country of peope living outside of an urban area?

A

2nd for % living outside of urban area!

need to consider this if there was epidemic or anything because they would be more vulnerable and have less access to care!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

does the federal authority have the right to quarentine or isolate someone?

who is responsible for public health?

A

yes, federal authority has the right to quarentine someone TO PROTECT THE PUBLICAND IF EMERENCY HEALTH RISK

**states are responsible for public health within their own borders**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are 4 RECENT conditions that the federal authority can DETAIN somoene for having?

A

XDR-TB: air traffic

Bushmeat: possible ebola

measles: europe

H1N1 pandemic (young people)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

who did H1N1 pandemic effect?

A

young healthy people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are 7 isolateable diseases?

A

cholera

diphtheria

plague

TB

smallpox

yellow fever

hemorrhagic fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is it always important to do in a patient presenting with a illness

A

ask about travel hx!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is important to remeber when doffing PPE?

A

important to remove most contaminated PPE first to prevent self-contamination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

have they started vaccination trials for ebola?

A

YES!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

explain the source of peoples confusion surrounding vaccine and autism?

A

MEASLES MUMPS REBULA VACCINE IN LANCET PUBLISHED IT CAUSED AUTISM,

12 YEARS LATER IN 2010 THE ARTICLE AS REMOVED AND REATRACTED. THE ONLY TIME THAT THE JOURNAL MOVED ARTICLE BECAUSE ITS A PRETIGIOUS JOURNAL

THE RESERACHER FALSIFIED DATA AND LOST OFF OF HIS FUNDING, MULTIPLE STUDIES SINCE SHOWING NO RELATIONSHIP!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how many americans get ill with food borne illness?

A

1 in 4 Americans ill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are 3 long term sequelae of food born illness and what are they caused by?

A

1. Hemolytic uremic syndrome (HUS)

E. coli

long term kidney dysfunction in 33%

2. Guillain Barre Syndrome (GBS)

campylobacter jejuni

40% ventilated

85% with residual deficits

3. Reactive arthropathy

salmonella, campylobacter, yersinia, enterocolitia, shigella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is the 1 foodborne illness that has increased in influnence for infection?

A

vibrio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

how much has ecoli food born illness decreased over the last 4 years?

A

25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are the 7 most influential food born illnesses?

A
  1. listeria
  2. E. coli
  3. toxoplasmosis
  4. salmonella
  5. campylobacter
  6. norovirus
  7. vibro (increasing in prevalance)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

vibrio

2 things that cause this?

what does it come from?

what is the control strategy?

A

v. parahaemolyticus, v. vulnificus

underling liver disease, immunocomprimised

WARM WATERS, RAW SHELLFISH

Control strategy: educate the consumer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

focal outbreak

what is this characterized by?

who detects it?

what happens?

likely cause?

is there a fix?

A
  1. large number of cases in one jurisdiction
  2. detected by the infected group themselves
  3. local investigation
  4. local food handling error
  5. local solution
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

dispersed outbreak

where does this occur?

who detects it?

who investigates?

likely cause?

implications?

A
  1. small number in many jurisdictions
  2. detected by lab-based subtype surveillance
  3. multi-state investigation
  4. industrial contamination event
  5. broad implications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

why do we see more dispersed outbreaks?

A
  1. better surveillance
  2. centralized production of foods means when there is a problem it occurs everywhere
  3. more imported foods/ingredients

4.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

when you think of ground beef

what bacteria should you think of? (2)

A

shigella producing E. coli

MDR salmonella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

sprouts

why are these bad?

what is it difficult to prevent?

what are two intitiates put in place?

A

REALLY BAD DIRTY THING!!

grow in warm moist environment that harbors bacteria

Why difficult to prevent:

  1. difficult to detect the bacteria once in the plant
  2. rarely cooked by consumer
  3. scarification, bacteria enters the seed so hard to find

Prevention:

  1. NACMCF spout guidance white paper!
  2. sprout guidance by the FDA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what are the two common pathogens that infect sprouts?

A

E.coli

salmonella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what are the steps to following an outbreak?

(4)

A

determine whether there is an outbreak

describe the outbreak

measure the outbreak

stop further outbreaks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

case definition

what is this?

A

in epidemiology it is:

what is is required to be included in the outbreak and be considered positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what is descriptive epidemiology?

A

the summary of health-related characteristics according to the person place and time, tells you “who, what, when, where, why”

used to determine the cause of the outbreak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

yellow fever vaccine

where geographic locations do you need this?

can it be required?

living/dead?

A

central/south america and Africa

*1 of 2 required vaccines for travel*

required every 10 years to travel to infect areas with endemic levels

attenuated live vaccine

1 vaccine last 10 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what are the two vaccines that are the only two LEGALLY required for international travel?

A
  1. yellow fever
  2. cholera
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

is there polio in the americas?

A

NOPE! americas are polio free now!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

cholera vaccine

are travelers at high risk?

helpful vaccine?

how many shots?

booster?

what is there no vaccine to?

A

most travelers low risk

vaccine of limited use now

no vaccine to vibrio cholera 0139 strain

full 3 shot series

booster in 6 months might be needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what should you know about the parentral cholera vaccine?

A

poorly protective in 50% for only a few months

uncomfortable and rarely reccomended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what are some vaccines that may be indicated depending where you are traveling to?

(8 of them)

A
  1. typhoid
  2. plaque
  3. measles
  4. polio
  5. rabies
  6. Hep A
  7. Hep B
  8. Tetnus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

measles vaccine

MMR

live/dead?

of doses?

A

LIVE

two doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

polio vaccine

options for admin?

what 3 geographic locations?

A

single booster needed for india, pakistan, afghanistan

inactivated: parentral (18+ never vaccinated)

attenuated live oral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

where is the only known transmission for polio?

A

pakistan and afghanistan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

rabies vaccine

who gets it?

of doses?

A

people who are staying in a endemic region or remote area with close animal contact

4 vaccine doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Hep A vaccine

who should get this?

who are there new reccomendations for?

when should first dose be given?

when do they get booster?

A

nearly all international travelers

new pediatric recommendations

first dose >4 weeks prior

booster: 6-12/18 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

hepatitis B vaccine

who should get this?

how many series?

A

endemic in South America, Africa, SE Asia, South Pacific

close contact with locals

extended stay

0, 1, 6 month series

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Tetnus

who should get this?

when is the booster indicated?

what is the nickname for this?

what age group qualifies?

A

EVERYONE SHOULD HAVE A PRIMARY SERIES

TETNUS-DIPHTHERIA TOXOID BOOSTER IS INDICATED every 10 years

greater than 5 years old

“Tdap”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

when are the time frames for influenza in the different hemispheres?

A

November to March northern hemisphere

april to september in southern hemisphere

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

what are four unavaliable or uncommon vaccines?

if uncommon, where are they used?

A

small pox: ex: millitary

typhus-off the market

anthrax-CDC

BCG-_overseas_ use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what are 4 important hygiene considerations when traveling abroad?

(what to avoid as well)

A

1. water acquisition…bottled!

2. other beverages

3. food precautions

a. only well cooked meat
b. AVOID
- salad/raw veggies
- unpasteurized dairy products
- street vendors
- ice

4. restaurant evaluation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

travels diareahh

what does this come from?

who is it common in?

what is the 4 most common causes?

what is the most common?

what are 3 symptoms?

what are 4 tx considerations?

A

fecally contaminated water and food

more common in younger people

MOST COMON BACTERIA, then parasites

MOST COMMON: E.coli, shigella/salmonella, campylobacter, viral

symptoms:

  1. abrupt onset of loose stools
  2. abdominal cramping
  3. rectal urgency

tx:

  1. typically self limited
  2. REHYDRATION
  3. fluoroquinolones, short 3 day course
    - rifaximin
    - azithromycin
  4. immodium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

is prophylaxsis reccomended for travelers diarreah?

A

nope it is not…

but you can consider prophylaxsis in special situations with

fluorquinolones/refaxamin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what are 5 preventative measures you can take to prevent travelers diarreah?

A
  1. avoid street vendors
  2. buffets
  3. raw or undercooked meats/seafoods
  4. avoid raw fruits, vegetables
  5. avoid tap water, ice and dairy products
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

what type of mosquitos bite humans?

explain the life cycle?

what do they need for their life cycle?

what do you find larvae?

A

only the female take blood meals

eggs to larvae to pupae to adult

mosquitos need to be in WATER for most of their lifecycle

mosquito larvae are found in stanidng water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

what are some ways you can prevent arboviral illnesses?

5 ways

A
  1. repellants like DEET, oil of lemon
  2. protective premetherin treated clothing
  3. limit outdoor activity in high-risk area
  4. screens on windowns and doors
  5. use bed nets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what are the two arboviruses that maine is most concerned with?

A

eastern equine encephalitis

west nile virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

explain how they test for rabies on the specimen you bring in?

A

euthanasia and decapitation

cold (not frozen shipment)

harvest braine and prepare slides

cerebellum, hippocampus, and brain step

fluorescent antibody staining

monoclonal typing of positive specimens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

what are the 4 conditions transmitted by the ixodes scapularis (deer tick)?

A
  1. borrelia burdoferi: aka LYME DISEASE

2. babesia microti: HUMAN BABESIOSIS

3. anaplasma phagocytophilia: human granulocytic anaplasmosis

4. powassan virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

lyme disease is caused by

A

borrelia burdoferi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

human babesiosis is caused by

A

babesia microti

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

human granulocytic anaplasmosis aka human anaplasmosis is caused by

A

anaplasma phagocytophilia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

what is the scientific name for deer tick?

A

ioxodes scapularis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

what are the most common sxs seen with tickborne disease?

(3)

A
  1. fever/chills

  1. myalgias/pains
  2. rash
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

what is the stage of ioxodes scapularis tick that bites humans to cause lyme?

A

THE NYMPH!!!!!!

not the adult!!…these prefer white tailed deer!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

what is STARI? what is it transmitted by?

A

southern tick associated rash illness (STARI)

cause unknown

rash appeares like lyme disease

transmitted by lone star tick

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

what are relapsing fevers characterized by?

A

group of acute infections caused by arthropod born spirochetes of the genus BORRELIA

characterized by reccurent cycles of febrile episodes, separated by asymptomatic intervals of apparent recovery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

what are the 3 types of body lice?

A

1. head lice: pediculous humanus capitus

2. body lice: pediculus humanus humanus

3. pubic lice: phthirus pubis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

of the 3 types of body lice, which does spread disease and which ones do not?

A

body lice: SPREAD BACTERIAL DISEASE

head and public lice do NOT spread disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

borrelia reccurentis

what does this cause?

what causes this in africa?

what is this characterized by?

how often can it occur?

3 tx options?

A

louse born relapsing fever

Borrelia croicudare causes replapsing fever in africa

***portal of entry when infected lice are crushed into abraded skin***

gets into the skin from lice being crushed into abraded skin

CLEARING OF CICULATING STRAIN BORRELIA IN 3-5 days then NEW ANTIGENIC VARIANTS APPEARE

*** up to 3-5 relapses may occur***

TX:

penicillin

tetracycline

erythromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

how do people get bitten by a tick?

A

ticks don’t fly or jump!!!

they grab onto persons clothes as they walk by and crawl to a feeding spot on the person’s skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

where are some specific places you should look for hiding ticks on your body?

8 places

A
  1. head
  2. hairline
  3. nape of the neck
  4. armpits
  5. waist
  6. between legs
  7. thighs
  8. behind knees

***basically everywhere**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

what is the best way to remove a tick?

A
  1. promptly
  2. with tweezers
  3. pull gently and slowly till tick lets go
  4. apply antiseptic to bite
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Do not be alarmed if the tick’s mouthparts remain in the skin. Once the mouthparts are removed from the rest of the tick, it can no longer transmit the Lyme disease bacteria.

A

potentially a Dr. Sears mythbuster!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

what are the requirements for HIV test in maine?

(3)

A
  1. A patient must be informed that an HIV test will be performed
  2. Information must include an explanation of what an HIV infection involves
  3. If a test is positive, post-test counseling must be provided
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

what are the two reccomendations for pregnant women with regards to HIV?

2

A
  1. testing included in routine panel of prenatal screening in ALL pregnant women
  2. repeat screen in 3rd trimester in areas with elevated HIV among pregnant women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

who is screen reccomended in for HIV/AIDS? (3)

what is not required?

what must be obtained to test?

A
  1. routine screening in all health care settings for all patients 13-64

(annual tests for at risk populations)

  1. tests all pts with signs and sxs or with opportunist infection associated with AIDS
  2. prevention cousleing and written consent forms are not required
    - testing must be voluntary with verbal consent informaed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

what is the risk of HIV with needle stick?

what about risk after expsure from eye, nose, mouth to HIV infected blood?

A

.3% with needle stick

.09% from eye, nose, mouth to HIV infected blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

why is there resistance to HIV drugs?

(3)

A
  1. High replication rate
  2. High mutation rate
  3. Selective pressure of drugs favors mutant strains over wild type
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

what can be a down side of using antivirals to tx HIV?

when does this ocurr?

how long does it last?

sxs?

A

reconstitution syndromes

Inflammatory reactions that occur after initiation of effective antiretroviral therapy

Usually occur few weeks to several months after initiation of therapy

Usually self-limited, but manifestations may be severe

is a condition seen in some cases of AIDS orimmunosuppression, in which the immune system begins to recover, but then responds to a previously acquired opportunistic infection with an overwhelming inflammatoryresponse that paradoxically makes the symptoms of infection worse.[2]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

what must you continue to monitor for when txing a patient with HIV?

(4)

A
  1. new STDs annually
  2. new onset Hep C annually
  3. TB
  4. metabolic disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

what vaccines are particullary important to make sure HIV pt has?

(5)

A

Annual influenza

pneumococcal

tetanus

hepatitis A and B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

what is the structure of influenza? what family? what types?

A
  • single stranded RNA
  • orthomyxovirdae family
  • A, B, C types
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

what is the composition of influenza A? of these two, how many are there in humans?

A

hemagglutinin (HA)

neuramidase (NA)

3 HA types in humans

2 NA types in humans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

what does drift and shift mean in terms of influenza?

A

shift: pandemics, have NEW HA or NA

drift: epidemics, development of new strains, but not whole new component

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

what are 3 challenges of containment of influenza?

A
  1. short incubation time (1-7 days)
  2. ability for person with asymptomatic infection to transmit virus (can be contagious 1 day before symptoms)
  3. early symptoms of illness are likely to be non-specific, delaying recognition (need to get antivirals on board within 48 hours of onset)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Avian flu (H5N1)

who does this infect? how was this introduced into N. america? why are we so scared of this?

A
  • usually only infects birds
  • effects younger patients
  • longer duration of infection
  • introduced to N. america by bird migration, infected people migrating, transportation of infcted poultry

***hasn’t transferred from person to person but if it does, we will basically all die because no one has immunity and 1918 will happen all over again, working on vaccines now but super scary, race agains time***

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

influenza

what are the three types and which one is most pathogenic? what is the season for this disease, how is it spread and how long can it survive on a surface? how long does it incubate? how long do symptoms last? when is a person contagious? when is peak shedding and what does it correlate with? what is the definition? what is the best choice for diagnosis?

A

3 types; A (most pathogenic), B, C; neuramidase and hemmaglutinin make up the subtypes

Fall/winter outbreaks (october-november)

spread through aerosolized droplets, can live on surfaces 2-8 hours

  1. incubates 1-7 days, avg 3
  2. symptoms last 3-7 days, but up to 14

3. contagious 1 day before symptoms, 5-7 days after

4. peak shedding 3 days of illness, correlates with fever

fever >100 or 37.8C AND cough or sore throat in absence of know cause, ABRUPT onset, can have myalgia in legs and lumbosacral area. Emergency if CNS symptoms.

PCR is best choice for diagnosis, can do rapid from throat or nose, but not as good

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

what is the best way to prevent influenza?

what are the two mechanisms of this? which age groups should be considereded for these two methods? what form is the virus in? which patients should you NOT use this in???

A

IMMUNIZATION!!

  1. inactive intradermal vaccine: innactive, trivalent, quadrivalent, recombinant, higher antigen, contains 3-4 viruses, 70-90% effective everyone older than 6 months

2. intranasal: live attentuated, 2-49 year old, caution in >50 or pregnant

***don’t use if allergic to eggs or gelatin***

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

what are the treatment options for influenza?

how are they used?

when do they need to be started?

who don’t you use these in?

A

neuriamidase inhibitors

  • oseltamivir
  • zanamirvir

used for treatment and prophylaxis

need to be started within 48 hours

don’t use in

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

what do you worry about when a child has influenza and are given asprin? what is the fatality rate?

A

REYE SYNDROME

(fatty liver and encephalopathy)

happens when pt has viral infection and given asprin, occurs 2-3 weeks after with a 30% fatality rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

what do you worry about as a complication in elderly and chronically ill who have influenza? (2 things)

A
  1. necrosis of the respiratory epithelium that leads to secondary bacterial infection by staph, strep, or haemoph
  2. pneumonia development, significantly contributes to fatality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

How many people are infected with TB? how many of those go on to develope the disease?

A

2 billion people are infected

9 million people develop the disease

Infected does not mean you will develop the disease!! Two completely different things!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

what bacteria cause the most TB in the US? what are 4 other bacteria that can cause it?

A

mycobacterium tuberculosis

mycobacterium bovis

mycobacterium africanum

mycobacterium microti

mycobacterium canetti

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

what are the two populations of people that TB can be divided by?

A

hight risk for becoming INFECTED with TB

high risk for DEVELOPING TB DISEASE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

what are 7 things that can put someone at high risk for TB INFECTION (not disease)

A
  1. close contact
  2. foreign born
  3. low income and homeless
  4. health care workers in high risk groups
  5. racial and ethnic minorities
  6. infants, children and adolescents
  7. IV drug users
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

name five areas of the world where TB is common?

A
  1. asia
  2. africa
  3. russia
  4. eastern europe
  5. latin america
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

what groups of people are at risk for developing TB disease!? (7)

A
  1. people with HIV (thats why prevalence increased in the 80s)
  2. infection of TB within last two years (5% risk, and 10% lifetime)
  3. infants and children

4. prolonged therapy with corticosteroids

  1. IV drug use
  2. diabetes
  3. silicosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

what is the greatest risk factor for devloping TB?

A

HIV!!! 7-10% risk for devloping TB disease each year when infected with both TB and HIV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

are people with LTBI infectious? what percent of these people will go on to develope the disease?

A

no they aren’t infectious!!

10% will go on to develope disease!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Explain the pathogenisis steps for TB (5 steps)

A
  1. tubercle bacilli are inhaled and travel to alveoli
  2. multiple in alveoli, infection begins
  3. small number of tubercle bacilli enter bloodstream and spread throughout body
  4. within 2-4 weeks macrophages survive bacilli, form a barrier shell that keeps the bacilli contained and under control know as LBTI
  5. if the immune system can’t keep tubercle bacilli under control, they multiple rapidly and cause TB DISEASE *it can occur in other places in the body too*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

In TB, explain the differences between LTBI and TB disease in these characteristic:

  1. active/inactive bacilli
  2. chest xray findings
  3. sputum smears
  4. symptoms
  5. infectivity
  6. a case of TB or not
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Is LTBI treated with medication?

A

YES IT IS

you want to prevent these patients from getting it in the future!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

who is high priority treatment for LTBI with a TST >5 mm or postitive IGRA? (5 things)

A
  1. close contacts of those with infectious TB disease
  2. HIV
  3. chest xrays indicating previous TB
  4. organ donor transplants
  5. immunocomprimised patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

who is high priority for LTBI treatment >10 mm or positive IGRA test? (5 things)

A
  1. people who came to US within last 5 years where TB is common
  2. IV drug users
  3. live or work in high risk facilities
  4. micro labatories
  5. children
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

what are the two ways HIV can influence the path of TB?

A
  1. person with LTBI becomes infected with HIV and then developes TB disease as the immune system is weakened
  2. a person with HIV becomes infected with TB and rapidly developes the disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

what is primary resistance?

A

cause by person to person transmission of drug resistant organisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

secondary resistance

A

develops during TB treatment

  1. patients were not given appropriate treatment regimen
  2. patients didn’t follow the medication as it was prescribed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

multi-drug resistant TB is resistant to which drugs?

A

isoniazid and rifampin (2 first line drugs avaliable)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

extensively drug resistant (XDR-TB), what drugs are they resistant to?

A

isoniazid and rifampin, PLUS fluoroquinolones and at least 1 of the 3 second line drugs

**this is a major issue around the world**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

how long should a patient be treated for TB?

what if this person has pos sputum after 2 months of treatment?

A

at least 6 months

if cavities on chest xray and postitive sputum cultures at 2 motnhs then treatment should be extended for 9 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

what are the three phases of TB infection treatment?

A

1.initial phase: first 8 weeks of treatment, four drugs are used

isoniazid, rifampin, pyrazinamide, ethambutol

2. continuation phase: after first 8 weeks of treatment, bacilli remaining after initial phase are treated with at least two drugs

3. relapse phase: occurs when treatment is not continued for long enough, surviving bacilli may cause TB disease at a later time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

in order to prevent drug resistance, TB disease must be treated with at least how many drugs?

A

2 ones the organism is suseptible to

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Tuberculosis

what are the classic symptoms assosicated with TB (clinical and xray)?

A

clinical symptoms:

coughing >3 weeks

pleuritic chest pain

hemoptysis

positive rales

infiltrates (collection of fluid and cells in lung tissues)

cavities (hollow spaces within lung usually in the upper lobe)

caseating granuloms on biopsy (necrotizing granulomas)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

what tests do you use to diagnose TB?

A
  1. tuberculin skin test (TST)

2. interferon gamma assays (IGRAS)-measures immune response to m. tuberculosis, less likely to be incorrect compared to TST

3. culture with AFB staining

-need 3 specimens, 8-24 hour collection intervals, can induce with inhaling saline mist spray

4. chest x-ray (infiltrates and cavities)

5. nucleic acid amplification test

6. bronchoscopy or gastric wash if having hard time getting sample

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

explain the tuberculin skin test? what can’t this test do? what are positive test results for the three groups of people?

A

in lastent infection positive 2-4 weeks after infection

-injected with inactive tubercle bacilli, read within 48-72 hours

**this test can’t differentiate between latent and active TB, just that a person has been infected at some point**

Positive test results:

15 mm in normal patients

10 mm in immigrants, children

5 mm in HIV, immunsuppressed, positive chest xray, primary TB exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

explain the difference on chest xray between primary and reactivated TB?

A

primary: homogeous infiltrates, hilar/paratracheal lymph node englargement, middle/lower lobe consolidation

reactivation: fibrocavity apical disease, nodules, infiltrates **TB reactivation presents at the top of the lungs instead of wher eit happened originally**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

what should you connect Ghon complexes and Ranke complexes? what are they?

A

TB

ghon complexes: calcified primary focus

ranke complexes: calcified primary focus and hilar lymph nodes

**these represent healed primary infection**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

what does milliary TB look like?

A

millet seed like nodule lesions (2-4 mm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

what is the gold standard for TB testing?

A

acid fast bacilli tests

3 negative tests are considered negative!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

how long should a person be isolated and on treatment before being allowed in public when they have TB?

A

need to be isolated for a minimum of 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

what are the four drugs you use during the initial treatment phase for TB? what are their side effects? how do you treat someone if they have been exposed to someone with active TB? what is the treatment regiment for LBTI?

A

“RIPE acronym

  1. rifampin (hepatitis, flu, orange body secretions)
  2. isoniazid (hepatitis, periphreal neuropathy, give B6 to prevent risk)
  3. Pyrazinamide
  4. ethambutol (optic neuritis)

**for LBTI: treat with isoniazid and pyrazinamide for 9 months, or 12 months if HIV pos or granulomas present on CXR**

**if someone is exposed to patient with active TB, then treat them emipircally for 12 weeks until negative TB can be obtained**

126
Q

what are the three main classifications of candidal infections based on location?

A
  1. cutaneous (diaper dermatitis and candidal intertrigo)

2. mucosal candida of the mouth and pharynx

3. vulvovaginal

127
Q

what is the most common species of candida?

A

candida albicans

128
Q

Cutaneous candidal infection

  1. candidal intertrigo
  2. diaper dermatitis

what is the characterists of these? where are the places you would find these? what are the two TX options?

A

patches and pustules on a ERYTHEM MATOUS BASE beefy red the erode and confluent with “SATELITE LESIONS“ painful with puritis

Candidal intertrigo: axillae, groin, intergluteal, cleft

diaper dermatitis: irrritabiltiy with urination, defication, changing diapers, genital region, inner aspect of thights and butt

TX: keep dry, antifungals nystatin, imidazole powder

129
Q

oropharyngeal candidiasis

what does this look like and what in what population can this look completely different? what is the key characteristic of this? what are the 2 treatment options?

A

thrush, white curd like plaques that can be scraped off

what to find the percipitating cause and treat that, then treat with oral antifungals

*****KEEP IN MIND, PEOPLE IN DENTURES CAN APPEARE BIRGHT RED INSTEAD OF WHITE CURD LIKE****

Tx: nystatin oral fluconazole or itraconazole suspension, swish and spit or swallow

132
Q

vulvovaginal candidiasis

what percent of females can get this and what can it come from? what are 5 RF for this? what does it look like and what is an important symptoms? what are two treatment options?

A

75% of females get this at least once, >20% are colonized with C.albicans normally, so this is a overgrowth of normal biota

RF: age extremes, pregnancy, DM, corticosteroids, HIV

white cottage cheese like discharge/plaques, burning while peeing, and puritis

TX: topical/intravaginal azoles or oral fluconazole

133
Q

what can vulvovaginal candidiasis be closely related to?

A

some women just get it right befor their period because of the pH change that allows microbiota to grow better

134
Q

balanitis candidiasis

who is this common in? who must you treat? treatment?

A

common in uncircumsized men

erosions with white plaques under foreskin

treat sexual partner

TX: topical nystatin, warm soaks to alievate itching/burning

135
Q

what are 6 RF for candidiasis?

A
  1. diabetes
  2. pregancy
  3. obesity
  4. HIV/AIDS
  5. moisture
  6. IUD
136
Q

what do you use to diagnose candidiasis? what do you see?

A

KOH

***see pseudohyphae and budding yeast***

137
Q

varicella-zoster virus

explain the differences seen between the primary and secondary eroptios of this virus? how are they descirbed? what sign do you watch out for? what is the order of the lesion developement? where does it begin and where does it spread to?

A

VARICELLA-ZOSTER virus

varicella (chicken pox): 1st exsposure vesicles on a erythematous base “DEW DROPS ON A ROSE PETAL” describe the different stages

macules->papules->vesicles “dew drops on a rose petal”->pustules->crusts **appeare in crops!**

BEGIN ON FACE AND TRUNK AND SPREADS TO EXTREMITIES

Herpes zoster (shingles): VZV reactivation along a Dermatone in THORACIC OR LUMBAR REGIONS, reactivation from ganglionic satelite cells!

-Hutchinson’s sign:lesions on the nose mean lesions in the eye sincetrigeminal nerve involvement CN #5

138
Q

what are the two complications you worry about with herpes zoster virus reactivation (shingles)?

A
  1. eye involement herpes zoster opthalmicus: look for hutchinson’s sign which is lesions at the end of the nose, if seen here likely it is already in the eye since it follows along the trigeminal nerve or CN 5
  2. ear involvement herpes zoster oticus: look for ramsay hunt syndrome if lesions are seen on the ear, likely in the canal since it follows facial nerve or CN 7
141
Q

how long can the post herpetic neuraligia with shingles last? what is a thing you worry about if eldery?

A

>3 months…so give these people some pain meds

occurence likelyhood is greater if over 60!

142
Q

what is the treatment options for varicella zoster virus? (4)

A
  1. acyclovir, valacyclovir
  2. pain management for post therapeutic neuralgia
  3. tricyclate antidepressants
  4. corticosteroids
143
Q

what can you do to prevent varicella-zoster virus? (2 options)

A

VACCINATION!!

child: vaccinated 1-2 years old for varicella

adult: Zostavax single dose >60yrs…basically literally a booster of varicella, becuase it is the same virus, just marketed differently to apeal to elder adults!

**can’t give if allergic to gellatin, neomycin, pregnant, or immunocomprimised!**

144
Q

acute rheumatic fever/RHEUMATIC VALVITIS

what fraction occur in developign countries? what organism is this caused by? what does this attack and cause? what is the main tx? (what about for other two symptoms?)

A

2/3 of all cases in developing countries

group A streptococcus that cause oropharyngreal infection, the antigens to this attack the heart

PERICARDITIS INVOLVING THE VALVES, CAUSING FIBROUS THICKENING/STENOSIS AND REGURG

Dx:

Jones criteria two major, 1 minor

plus evidence of B-hemolytic streptococci

Tx: penicillin 10 day course

salicyclates for arthritis in involvement

glucocorticoids if severe carditis

145
Q

what are the complications of AFR?

(3)

A
  1. CHF
  2. rheumatic pneumonitis
  3. rheumatic heart disease ***most common and causes valvular disease***
146
Q

who is and who isn’t reccomended to get prophyllactic abx before invasive procedures to prevent endocarditis?

A

prophylaxsis no longer reccomended in patients with hx of RHD

EXCEPTIONS!!!

  1. PROSTETIC CARDIAC VALVE
  2. PREVIOUS ENDOCARDITIS
  3. CONGENITAL HEART DISEASE
147
Q

what are the four main characteristis you should consider when dxing someone with strep that could lead to AFR?

A
  1. tonsillar exudates
  2. absence of a cough
  3. tender anterior lymphadenopathy
  4. hx of fever

only need 3/4 for dx

148
Q

brucella

where does this localized?

what do we worry about with this condition?

how do you dx it? (2)

can you treat it?

A

gram -

highly contagious zoonosis

localizes to bone marrow and liver

can be a bioterrorism agent

DX:

  1. PCR

2. elisa

TX:

treatable but serious

***must treat patient and those exposed***

149
Q

what are the 5 ways you can prevent the spread of brucella?

A
  1. vaccination domesticated herds
  2. serologic testing of animals
  3. slaughter infected animals
  4. protection of slaughter house workers
  5. pasteurize milk
150
Q

crytococcous

what organism causes this?

what does this most commonly cause?

what does it grow?

where do you find this bacteria?

how is it transmitted?

what are the sxs? (3)

what CD4 count do you worry about

A

crytococcus neoformans

***most common cause of fungal meningitis***

grows mucoid colonies

budding yeast that is found in SOIL CONTAMINED WITH DREID PIGEON dung

transmission: inhalalation

SXS:

fever, cough, dyspnea

CNS in lose with less with CD4 less than 50

  1. headache
  2. meningeal sights
  3. RARE CRYTOCOMA with intracerebral mass that can cause obstructive hydrocephalus
151
Q

crytococcus

what are the 3 things you use to DX this?

what are the tx regiments between those with HIV and those without HIV?

A

CXR:

nodules

pneumonitis

CSF:

india ink stain with latex agglutination

crytococcal antigen assay

tx:

HIV patient:

  1. oral fluconazole 10 weeks
  2. severe: amphotericin B 2weeks then fluconazole

non-HIV pt:

amphotericin

152
Q

what people do you specifically worry about getting crytococcus?

(4)

A

immunodeficiency

HIV

cancer,

corticosteroids

153
Q

histoplasmosis

what fungus causes this?

what does it come from?

who do you worry about it in?

transmission?

what are the 3 classifications?

1

2 things to rememeber

3 who is it commom in, what do you see?

A

histoplasma capsulatum

dimorphic fungus foung in soild infected with bird and bat droppings

transmission: inhalation

especially risking in late stage HIV CD4 <100

*** can see pancytopenia and anemia***

  1. acute

febrile, few pulmonary complaints

  1. progressive disseminated
    a. fatal within 6 weeks

b. ulvers in the mouth, pharynx, liver, spleen, and adrenals

  1. chronic progressive pulmonary histoplasmosis

**older patients esp with COPD**

a. cavitary lung disease

b. progressive pulmonary dx with calcified nodules

c. pericarditis

154
Q

histoplasmosis

3 tests?

1 tx?

A
  1. CXR: milliary infiltrates
  2. urine antigen assay
  3. increased alkaline phosphatase lactatate dehydrogenase (LDH)

tx:

itracnazole for weeks to months

155
Q

what is the most common opportunistic infection see in HIV/AIDS patients?

A

pneumocysistis

156
Q

pneumocystis

what fungus causes this?

what should you know about this!***

how is it transmitted?

what are the SXS and 1 uncommon one?

what are the two dx tests? findings?

what do you treat with?

A

pneumocystic jiroveci pneumonia

most commmon opportunistic infeciton in HIV/AIDS

transmission: airborne, lies latent in the lung

HIV concern: CD4 count less than 200 in HIV/AIDS

SXS:

fever, fatigue, weight loss, SOB

uncommon: pneumothorax

DX:

1. CXR with interstital infiltrates

  • heterogenous
  • miliary
  • patchy

2. blood gas

  • hypoxia
  • hypocapnia

Tx:

tx empirically

TMP-SMX

157
Q

do you prophylax HIV patients against pneumocystis has been treated?

A

um…yeah! its the most common opportunistic infection in HIV/AIDS pts

give TMP-SMX if CD4 count below 200 ater suscessful treatment

158
Q

botulism

what organism causes this?

where dos it come from?

what is it generalized transmitted through? (3)

what is the differences between inital presentation (2)and late progression (4)?

A

clostridium botulium

spore forming bacillius found in soil, produces toxin

canned food, vaccum packed, smoked food allows the toxin to be produced until it is ingested!!

SXS:

1. initial-12-36 hours after ingestion

  • diplopia
  • loss of accomodation

2. later

  1. ptosis

2. impaired extraoccular movements

3. fixed dilated pupils

4.flaccid paralysis

**needs ventilation and lead to death**

159
Q

what does the botulism toxin inhibit?

A

inhibits the release of acetylcholine at the neuromuscular junction

160
Q

botulism

how do you dx?

tx?

2 things pt will likely need

A

Dx:

check for toxin using mouse inoculation with serum

TX:

antitoxin available through CDC

***will need ventilation when respiratory failutre occures and IV nuitritional support during progression***

161
Q

why don’t you give a baby honey? what can it cause?

A

dont’ give them honey for fear of botulism, can cause “floppy baby syndrome”

162
Q

cholera

what is the bacterial that causes this?

what does it cause in the body?

what does the pt present with?

transmission?

what are the 2 tx options?

A

vibrio cholera

toxin activates adenylyl cylase in the intestinal epithelial cells in the small intesting causes hyper secretion of water and chloride ions with massive diarreah

“rice water stool” grey turbid diarreah and causes hypovolemia

transmission: fecal-oral

Dx:

  1. stool culture for vibrio cholerae

TX:

`1. replace fluids and electrolytes sugar/salt water, severe use IV replacement

  1. abx in severe cases
163
Q

what are the 3 things you can do to prevent cholera?

A
  1. clean water and food
  2. proper waste disposal
  3. vaccine but protection is temporary and booster is needed every 6 months
164
Q

yellow fever

what spreads this (2)?

what type of virus is this?

where does it effect?

what are the sxs? (4)

Dx?

tx?

A

spread by

aedes aeypti mosquito or infected monkey

flavavirus infects endothelium and liver

SXS:

  1. fever, heaaches, muscular aches
  2. liver failure
  3. prostration and shock
  4. hemmorahgia into the intestine showing melena
  5. renal damage/tubular necrosis

DX:

CLINICAL with IgM after 1 week

tx: no treatment!!!!

165
Q

how to do prevent yellow fever?

A

live attenuated 17D yellow fever vaccine to anyone who has been exposed

lasts 10 years

required to travel to endemic areas

166
Q

E. coli structure?

what are 3 virulence factors?

2 antigens?

gram?

A

gram -

somatic or O antigen LPS

flagellar or H antigen

serotype O:H

virluence factors:

  1. hemolysin
  2. intimin
  3. shigatoxin
167
Q

whare are the 4 ways E.coli is transmitted?

A
  1. Food: cattle products, food contaminated with cattle or human feces

  1. water: contaminated drinking water
  2. animal contact: contact with farm animals ie petting zoo, farm
  3. person: feces or infected people
168
Q

what is the most common E.coli for what we think of as e. coli?

A

shigella toxin-producing (STEC) also called “enterohemmorrhagic”

E. COLI0157 is the one that we usually think of when taking about e.coli outbreak!!

169
Q

what is the reservoir for e.coli?

A

ruminant bovine

so common with GROUND BEEF INGESTION!!!

170
Q

what is the seasonal peak and trough for e. coli infection?

A

summer peak

winter nadir

171
Q

what is the most common cause of travelers diarreah?

3 sxs? and duration?

tx?

A

e.coli

diarreah is:

  1. purlulent
  2. bloody
  3. assocaited with abdominal cramping
  4. 5-10 duration

tx:

supportive unless severe

172
Q

diptheria

what is the bacteria that causes this?

where does it LIKE TO BE?

transmission?

what are the 3 types? which is most common and what is characterized by?

A

cornebacterium diptheriae

likes mucous membranes esp respiratory tract and spread by respiratory secretion, particullarily in children

  1. TYPES

1. laryngeal

a. upper airway/bronchial obstructions

2. pharyngeal

a. MOST COMMON FORM!!

b. GRAY MEMBRANE “pseudo membrane” COVERS TONSILS AND PHARYNX

c. BULL NECK from swelling of cervical nodes

3. myocarditis/neuropathy

this occurs when the bacterial gets into the blood and settles other places creating that membrane and preventing the organs from working

173
Q

diptheria

dx?

tx?

A

DX:

culture!!

Tx:

  1. horse serum antitoxin must be given in ALL cases and must be obtained from CDC
  2. penicillin/erythromycin

*****tx the contacts of infected with erythromycin to eradicate carrier state****

174
Q

what must you do for someone who has diptheria?

A

isolate the patient until 3 negative samples can be obtained

175
Q

how do you prevent diptheria?

A

diptheria-tetnus-pertussive

DTaP vaccine!!

vaccination to toxins!!

176
Q

salmonellosis

what is the main bacteria that causes this?

what is it most common in?

what does it break out across states?

what are the 3 types?

A

salmonella typhimurium MC

POULTRY MC!!! can also include leafy greens, beef, dairy, nuts

****MULTISTATE OUTBREAKS COMMON since found in animal flocks and herds***

  1. enteric fever, TYPHOID FEVER
  2. gastroenteritis
  3. bacteremia
177
Q

enteric fever salmonellosis

“enteric fever/typhoid fever”

where are the 3 places this replicates?

is there a prodrome?

what happens as fever develops? (5)

DX (what to keep in mind)?

Tx: 2 abx and for how long?

A

replicate in peyer patches, mesenteric lymph nodes, spleen

prodrome: malaise, headache, cough, sore throat

as fever developes: (peaks 7-10 days)

1. abdominal pain/distension

2. pea soup poop

3. splenomegaly

4. bradycardia

5. rash pink papules primarily on trunk during 2nd week

DX:

1. blood sample

+ during first week

- after first week

TX:

  1. ceftriazone
  2. fluoroquinolines

TWO WEEKS!!!!

178
Q

salmonellosis

“gastroenteritis”

what is the incubration?

what are the 5 sxs and msot important?

DX?

tx?

A

most common form of salmonella infection!!

incubation ​8-48 hours after ingestion of infected food or water

SXS:

fever

nausea

vomiting

bloody diarreah 3-5 days!!!!

DX:

STOOL CULTURE

Tx:

selflimited

symptomatic

179
Q

salmonellosis

“bacteremia”

who is this common in?

what is this?

2 tx

A

prologned or recurrent fevers with bacteremia and local infection of bone, joints, pleura, pericardia, lungs

***most common in immunosuppresion person***

Tx:

  1. ceftriaxone
  2. fluoroquinolones
  3. tx for 2 weeks and drain absecess
180
Q

shigellosis

what does this cause?

what are 5 sxs associated with this?

what are the 2 ways to dx this and what do you see?

what are 2 tx options?

A

dysentery

SXS:

  1. starts abruptly with diarrhea
  2. lower abdominal cramps
  3. tenesmus with fever chills
  4. loose stools with mixed blood and mucous
  5. tender abdomen

DX:

  1. stool
  2. sigmoidoscopy with punctate lesions, ulcers and inflammed mucose

TX:

  1. FLUIDS!!!!!!!
  2. TMP-SMX
181
Q

what can HLA-B27 peopel get from shigellosis?

A

reactive arthritis

182
Q

tetanus

what bacteria causes this?

where is it?

what does it produce that causes this?

what does it cause?

what types of wounds are most susceptible?

what are 5 symptoms?

A

clostridium tetani

*****present in all soiil*****

they germinate in the wounds and produce a neruotoxin tetanospasm that interferes with neurotransmission at spinal synpases

uncontrolled spasm and exaggerated reflexes

***puncture wounds most susceptible***

sxs:

  1. pain and tingling of stab site
  2. JAW TRISMUS/lockjaw
  3. hyperreflexes and muscle spasms
  4. tonic convulsions with muscle ridigity in descending fashion
  5. spasm of glottis and dysphagia
183
Q

what is the 3 tx for tetnus?

A
  1. tetanus immune globulin IM
  2. penicillin
  3. bedrest, sedation, and ventilation often needed
184
Q

what are the ways to prevent tetanus?

A
  1. active immunization in childhood
  2. 3-4 initial doses followed by a booster every 10 years
185
Q

relapsing fever

what two bacteria cause this?

what ist this characterized by and how does it accomplush this?

3 tx options?

A

borrelia recurrentis-louse

borrelia croicuidare-africa

characterized by recurrent cycles of febrile episodes, separated by asymptomatic intervals of apparent recovery

***ALTERS MEMBRANE SURFACE PROTEIN TO CAUSE RELAPSING FEVER!!!***

patients clear borrellia in 3-5 days, THEN NEW ANTIGENIC VARIANTS APPEARE

**this creates the relapsing fevers**

TX:

penicillin

teracylcine

erythromycin

186
Q

atypical mycobacterial disease

“nontuberculous mycobacteria”

WHAT ARE THE TWO MOST COMMON BACTERIA?

WHAT CD4 LEVELS DO YOU WORRY ABOUT?

WHAT ARE 3 DIFFERENT PRESETNATIONS?

  1. CAUSE, AGE, MOST COMMON, DX
  2. MOST COMMON,DX REQUIREMENT
  3. HX OF___, 3 BACTERIA, WHAT IS THE UNIQUE SYMPTOM ASSOCIATED WITH THE FIRST?
A

mycobacteria avium complex (40%)

mycobacteria gordgonae (25%)

effects immunocomprised esp HIV WITH CD4 LESS THAN 50

**doesn’t spread person to person…found in water, soil, animals***

  1. lymphadenopathy type

<5 years old

unilateral, submandibular most common

MAC MOST COMMON!!!

do need aspiration (seen in pic)

  1. chronic pulmonary disease

MAC MOST COMMON!!!

cough weight loss sputum production

must isolate 2+ sputum or bx site

  1. skin/soft tissue disease

hx of trauma or superficial laceration

  1. mycobacterium marnium

WATER, FISH

LAKE POOL AQUARIUM

1-2 MONTH IP TO GRANULMATOUS NODULAR TO ULCERATIVE LESIONS ON HANDS

“FISH TANK GRANULOMA!!!!!”

**person cleaning out their fishtank and they nick themselves and they don’t think about it!!! slowly progressive and without treatment becomes necrotic***

187
Q

hookworm

explain the lifestyle cylce of this helminth

A

humans are the only host!

penetrate the skin and migrate in bloodstream to the pulmonary capillaries when they destroy the alveoli and are carried to the mouth by cilia

once swallowed, they attach to the small bowel mucose and suck the blood

once they mature they release eggs and the cycle is repeated

188
Q

what is the difference between a light and moderate infection with hookworm?

A

light infection 1000 eggs per g feces

moderate infection 2,000-8,000 eggs per g feces

189
Q

what percent of the worlds population is infected with hookworm?

A

25%

190
Q

what are the sxs associated with hookworm?

(5)

A
  1. puritis at the site of penetration
  2. erythematous dermatitis and maculopapular or vesicular rash folllows
  3. pulmonary stages causes coughing with blood tinged sputum
  4. anemia, protein loss, malabsorption, ulcer like epigastric
  5. anorexia
191
Q

how do you dx hookworm? what is the tx? (4)

A

dx:

eggs in feces

tx:

  1. mebendazole BID 3 days
  2. high protein diet
  3. vitamins
  4. ferrous sulfate
192
Q

what is malaria spread by?

A

spread by anopheles mosquito

193
Q

what are the four parasites taht cause malaria?

what is the most dangerous?

what are some brief characteristics of each?

A
  1. plasmodium vivax: dormant in liver, requires more tx

  1. plasmodium ovale: dorman in liver, requires more tx
  2. plasmodium falciparum: MALIGNANT, MOST DANGEROUS
  3. plasmodium malariae: chronic
194
Q

what is the lifecyle of malaria?

A
  1. sporozoites in mosquito saliva
  2. go to liver develop in merozoites
  3. RBCS (this is when people get really sick)
195
Q

what are the sxs of malaria? (5)

what do you dx with?

A
  1. cyclical fevers

2. leukopenia

3. hemolytic anemia

4. thrombocytopenia

  1. fevers, childs, nausea blah blah

DX: thick and thin geimsa stain

196
Q

what are the two goals of txing malaria?

A

decrease parasite load

eradicate the parasite

197
Q

what are the DOCs for malaria? (3)

A
  1. DOC #1 chloroquine
  2. doxy in pregnant, children
  3. mfleoquine: heart/seizure conditions
198
Q

what are 3 complications of malaria?

A

DIC

splenic rupture

anemia

199
Q

what is the best prevention for malaria?

A

control the mosquitos!!!

200
Q

what are two conditions that provide protection against malaria?

A

sickle cell disease

thallesemia

201
Q

pinworms

what parasite causes this?

who does it effect the most?

where are the eggs?

how long can they survive outside of the body?

transmission?

when does this become infective?

A

enterobius vermicularis

***CHILDREN MORE THAN ADULTS***

gravid females pass through the anus to lay eggs on the perianal skin

***EGGS are viable outside of body 2-3 weeks***

Transmission: hands, food, drinks!!

infective within a few hours

202
Q

PINWORM

what are the sxs 3?

what are the 2 dx?

tx?

A

sxs:

1. perianal pruritis crawling sensation worse at night

2. examination at night may reveal worms in the anus or stool

3. scratching, excoriation, and secondary impetigo (staph) infection common

DX:

  1. capture egg on piece of tape over perianal skin
  2. 3 ries over 3 nights yield 90% success rate

tx:

**must tx all members of the household at same time**

albendazole, mebendazole given single dose and repeated 2-4 weeks later

203
Q

leprosy

A

type of non typical mycobacteria’

mycobacterium leprae

numbness and paralysis of the hands and feet, travels along the nerve, debilitating

effects skin, nerves, mucous membranes

204
Q

what is 2 important prevention methods for pinworms?

A
  1. wash hands before eating
  2. thorough linen washing
205
Q

toxoplasmosis

what is this caused by?

what are associated symptoms?

what test do you want to do?

tx?

A

toxoplasmosis gondii

*****reactivation of latent T. gondii****

COMMON OPPORTUNISTIC INFECTION WITH AIDS PATIENTS

SXS;

  1. headaches
  2. fevers
  3. neurologic dysfunction
    - confusion
    - lethargy
    - visual disturbances
    - seizures

TEST OF CHOICE: MRI IMMEDIATELY

tx: TMP SMX

206
Q

what is lyme disease cause by?

what is this spread by?

A

borrelia burgdoferi

SPIRIOCETE

spread by ioxodes scapularis

“deer tick/black legged tick”

207
Q

explain the lifestyle of the ioxodes scapularis that causes lyme? which one attacks humans?

A
  1. egg
  2. six legged larvae-august to september
  3. eight legged nymph-peaks may-july, agressive, bite humans
  4. adult- peak in spring and fall, prefer white tailed deer

*** prefer to feed on different hosts at each life stage***

208
Q

what do the ixodes secrete when they bite you?

A

anesthesia and anticoagulation

209
Q

in order for a tick to transmit lyme how long do they have to feed for?

A

at least 24 hours

210
Q

what are the symtoms associated with lyme disease?

(6)

A
  1. red rxn at the bite site when bit by a tick (different than bullseye)
  2. erythema migrans (buls eye rash)
    - 10-30 days after bite
    - only 80% get this
    - can disseminate
  3. muscle/joint pain
  4. fatigue
  5. fever/chills
  6. swollen lymph nodes
211
Q

explain the sxs of early disseminated lyme disease?

4

A
  1. erythema migrains rash 80-90%
  2. early presentation without the rash
    a. arthalgias, olioarticular and migrator
    b. post occipital headaches
    c. paresthesias on face/arm/leg
212
Q

early disseminated stage of lyme

6 sxs

how long?

A
  1. multiple erythema migrans
  2. sxs weeks to months
  3. lyme carditis with AV block
  4. neurological symptoms
    - 7th nerve palsy
    - lymphocytic meningitis
    - post occipital headaches
    - parenthesias on face, arms, legs
213
Q

late symptoms of lyme

4 sxs

length of time

A

greater than 6 months

  1. arthritis (migratory or monoarthritis)
  2. neurologic

peripheral axonal neuropathy, mild encephalopathy, encephalomyelitis

214
Q

what is chronic lyme?

A

patients with persistent sxs following tx of lyme disease but without relapsed infection

215
Q

what are the two tests ordered for lyme in the order you order them?

what 2 fluids can you test?

whats 1 thing to keep in mind?

A
  1. ELISA
  2. Western blot

**antibody tests**

use synovial fluid or CSF

***don’t order a lyme test unless you think that it is actually lyme because if not could give you false positives***

216
Q

what can early antibiotcsi prevent in lyme?

A

antibiotics in early disease can prevent seroconversion

217
Q

explain the testing time for lyme?

A

less than 4 weeks test IgM and IgG

greater than 4 weeks test IgG

218
Q

if you see the erythema migrans do you need to to the testing for lyme?

A

nope its made clinically dx

219
Q

is reinfection with lyme likely to occure?

A

unlikely to occur beyond erythema migrains

220
Q

what is the tx for lyme?

A
  1. doxycycline po 21 days

2. IV ceftriaxone for neuoborreliosis and some conditions like complete HB, meningoencephalitis

221
Q

is prophylaxsis reccomended for lyme? what are the rules?

what do you tx with?

monitor?

A

Prophylaxis, NOT recommended unless these four conditions are met:

  1. tick has been identified as engorged deer tick that has been attached for 36 hours
  2. occurred in area where there is high rate of infected ticks
  3. prophylaxis can be started within 72 hours
  4. doxycycline is not contraindicated

prophylax single dose doxy 200 mg

**monitor symptoms 30 days**

222
Q

what are 3 long term sequalae you worry about wiht lyme?

A
  1. persistent arthritis 5-10%, usually monoarticular (knee) for 4-5 years
  2. residual neurological impairment, gradual resolution

3. post-lyme syndrome: persistent fatigue, MSK pain, cognitive complaints for greater than 6 months

223
Q

rocky mountain spotted fever

what bacteria causes this?

what type carries it?

how does it occur?

what is it characterized by for rash?

A

bacteria rickettsia ricketsiae

dermacenter ticks dog ticks, nantucket

90% april-september, highest in CHILDREN

occur in CASE CLUSTERS in hyperendemic foci

characterized by: ring skin rash, high fever, headaches and muscle pain begins as 1-5 macules rash on ankles, wrists, forearms and spreds centripetaal to trunk includes palms/soles, petechial rash on or after day 6

224
Q

what are two long term sequelae of rocky mountain spotted fever?

A

CNS deficit

amputations

225
Q

rocky mountain spotted fever

dx?

tx?

A

dx

indirect immunofluorescence assay (IFA)

acute and convalescent sampes 2-4 weeks apart

Tx

tetracyclines DOC with respoinse 24-72 hours

226
Q

anaplasmosis

what is the name of the bacteria?

what is it spread by?

what does it infect?

what are sxs?

waht is this nickname?

A

anaplasmosis phagocytophilium

spread by

ioxodes scapularis black legged tick and infects granulocytes WBC

common: fever chils, headache, malasie, myalgia, arthalgia

less common: GI upset, stiff neck

nickname: summer flu

227
Q

anaplasmosis:

dx?

lab tests results? 4

tx?

A

dx: PCR assay for DNA

labs:

  1. mild anemia
  2. thrombocytopenia
  3. leukopenia with left shift
  4. mild elevation of LFTs

tx:

adults: doxy
children: bata lactam

228
Q

babesiosis

what causes this infection?

what type of infection is i?

what spreads it to humans?

where does it go?

what are the sxs and 4 unique things

what is common?

A

babesia microti protoazoan infection

*parasitic infection*

vector: ixodid tick

enters RBC and causes hemolysis

literally all the same SXS as other tick disease

splenomegaly, hepatomegaly, jaundice

severe: significant hemolysis

**asymptomatic disease common**

229
Q

in asymptmatic babeosis…do you tx?

A

maybe not

monitor 4-6 weeks and may clear on its own

**if no underlying disease watch**!!

230
Q

babeosis

dx?1

tx if symptomatic? 2 options

A

dx: PCR

tx if symptomatic

  1. clindmycin/quinine or azithromycin
  2. parasite levels more that 10% do abx PLUS transfusion till below 5%
231
Q

what is the bacteria that causes tularemia?

how many people does it kill a year?

A

Francisella tularensis

less than 50 people a year

232
Q

where can you find tularemia?

A

every state besides hawaii

233
Q

tularemia

What is the bacterial that causes this?

what toe keep in mind? how many bacteria?

2 geographic locations?

3 things that transmit it?

7 presentations?

A

francisella tularensis

HIGHLY INFECTIOUS..inhalation of 10 bacteria can cause disease

biting flies: Utah, Nevada, California

tick: east rocky mountains

infects small rodents like squirrels, rabbits, hares, voles, muskrats

spread by american dog tick, lone star tick, and rocky wood tick

SXS:

  1. ULCEROGLANDULAR
  2. oculoglandular
  3. typhoidal syndrome-greatest mortality if left untreated
  4. oropharyngeal
  5. gastrointestinal
  6. secondary pneumonia
  7. primary inhalational pneumonia
234
Q

how is tualeremia transmissed?

(6)

A

ingestion by food or water

inhalation

direct contact

arthropod intermediates

animal bites

no person to person spread

235
Q

tularemia

dx?

2 tx?

A

dx: PCR

tx:

  1. steptomycin
  2. gentamycin
236
Q

what are 3 conditions that are caused by body lice disease?

A
  1. louse-borne relapsing fever
  2. trench fever
  3. epidemic typhus
237
Q

syphillis

what causes this?

2 ways it is transmitted?

dx? for tertiary?

Tx considerations? 2

A

tremponema pallidum

transmisison:

  1. sexually transmitted
  2. congenital syphilis

DX:

fluorescent treponemal antibody absorption FTA-ABS

tertiary: lumbar puncture

TX:

benzathine penicillin G 2.4 million U IM

tertiary: 3 weekly injections

neurosyphilis: penicillin every 4 hours for 10-14 days

238
Q

early primary syphilis

2 characteristics of this

A
  1. chancre-painless ulcer with clean base and firm indurated margins most commonly in the genital region
  2. regional lymphadenopathy
239
Q

secondary syphilis

A

lesions on skin, mucous membrane, eye, bone, kidneys, CNS, liver

240
Q

late tertiary syphilis

6 sxs

A
  1. gummatous lesions involving skin, bone,viscera
  2. CVD
  3. ophthalmic lesions
  4. neurosyphilis

chronic meningitis

generalized paresthesia

  1. tabes dorsalis: chronic progressive degeneration of parenchyma

impaired proprioception

loss of vibratory sense

argyll robertson pupil (reacts to light but doesn’t accommodate)

241
Q

congenital syphilis

5 signs

A

if not txed can develope:

interstitial keratitis

hutchinson teeth

saddle nose

deafness

CNS abnormalities

242
Q

cytomegalovirus

what causes this?

who does it occur in?

what are the 3 types?

what might you see on dx?

1 tx?

A

human herpes virus type 5

occurs in immunocomprimised esp HIV and post transplant

3 types

  1. perinatal
  2. acute acquired CMV
  3. post transplant CMV

dx:

“owl eyes” on tissue biospy

antigen

tx:

  1. glanciclovir
243
Q

acute aquired CMV

3 ways this is transmitted?

what are the sxs and the key?

what do you diferentiate this from?

A

transmitted via:

  1. breast milk
  2. blood transfusion
  3. droplet

SXS:

fever

malaise

myalgias

arthralgias

splenomegaly

atypical lymphocytes

similar to EBV infection without pharyngitis, respiratory symptoms, or antibodies

244
Q

postransplant CMV

what are the 4 regions where sxs occure?

what is key preseentation buxx word?

A
  1. retinitis CD4 less than 50

“pizza pie” neovascularization and proliferative lesions

  1. GI
    a. esophagitis
    b. small bowel ulcers
    c. hematochezia
    d. abdominal pain
  2. pulmonary
  3. neuro
245
Q

how can you prevent the transmission of CMV? (3)

A
  1. limiting blood transfusions
  2. filtering to remove leukocytes
  3. restricting organ donor pool to seronegative donors
246
Q

what are the 3 conditions CMV plays a role in?

A

IBS

atherlosclerosis

breast cancer

247
Q

epstein barr virus

what is this caused by?

nickname for this?

what should they avoid?

5 symptoms?

2 dx? findings?

tx?

A

human herpes virus 4

“kissing disease” spread by saliva

**don’t participate in contact sports because of potential spleen rupture**

SXS:

  1. EXUDATIVE PHARYNGITIS

2. SOFT PALATE PETECHIAE

3. POSTERIOR CERVICAL NODE ENLARGEMENT

4. SPLENOMEGALY IN 50% OF PATIENTS

5. MACROPAPULAR/PETECHIAL RASH

DX:

  1. ATYPICAL LYMPHOCYTES THAT ARE LARGER AND STAIN DARKER AND VACULOATED
  2. MONOSPOT
    tx: supportive
248
Q

what should you not give to someone with mono?

A

ASA

249
Q

what can administration of amoxicillin cause in someone who has EBV?

A

a rash!!

250
Q

what test can give a false positive if the pt has EBV?

A

false positive syphilis test

251
Q

what are some complications that can come from from EBV?

5

A
  1. splenic rupture

pericarditis

myocarditis

encephalitis

aseptic meningitis

252
Q

norovirus

what is this?

what is this most common strain?

A

**most common cause of food poisoning”

Norovirus GII.4 new orleans most common circulating strain

253
Q

norovirus

where so you most likely see?

what transmission?

when contagious?

reinfection?

most common complication?

A

“cruise ship plague”

extremely contagious

fecal oral route

salads, sandwhichs, shellfish, oyster

**contagious from moment they feel ill to at least 2 days after, reinfection common**

strikes quick 1-2 days

DEHYDRATION IS MOST COMMON AND DANGEROUS COMPLICATION esp in elderly/infant

254
Q

what is the best way to prevent norovirus spread?

A
  1. handwashing
  2. environmental cleaning essential
255
Q

rabies

how is this transmitted and by what 6 animals? which is most common?

A

transmitted by animals by bite or scratch

doesn’t spread by petting rabid animal, blood, urine, or feces

reservoirs:

1.Bats-MOST COMMON *any physical contact should be considered possible rabies infection until negative tests can be obtained or patient is certain there is no bite, scratch, or mucous membrane exposure

2. raccoons

3. skunks

  1. foxes
  2. cats
  3. woodchuck
256
Q

explain the infectious path of rabies?

when are they symptomatic?

A
  1. raccoon bitten by rabid animal
  2. rabies enters the racoon through infectious saliva
  3. rabies virus spreads through the nerves to the spinal cord and brain
  4. when it reaches the brain the virus multiplies rapidly and passes to the salivary glands and the raccoon starts to show symptoms of the disease

**virus MUST replicate in the CNS before getting to salivary glands….they are symptomatic once at the salivary glands**

257
Q

how many people have ever survived rabies?

A

6

258
Q

explain the progression of rabies?

3 stages

2

4

3

A

incubation period: 4-12 weeks

prodrome:

2-10 days

paresthesia at the site of wound, with fever, headache, and anorexia

acute neurological hase:

2-7 days signs of encephalitis

mental status change

paralysis

hyperactivity

late stage:

coma

dysrhythmia,

DEATH

259
Q

is there tx for rabies?

A

no just PEP

260
Q

what is the 5 qualifications for PEP for rabies?

A
  1. suggested for anyone who was in the same room as a bat and might be unaware direct contact has occurred
  2. person bitten with known rabies
  3. person bitten with likely rabid animal
  4. those bitten with skunk, fox, bat, raccon
  5. certain non bite exposure
261
Q

explain the difference between the PEP for those who have been vaccinated and those haven’t for rabies?

A

1. with vaccination

-cleanse, irrigate wounds

0 and 3, only 2 doses

DONT GIVE human immunoglobulin

2. without previous vaccination

cleanse and irrgation

0, 3, 7, 14, total of 4 injections

give human rabies immunoglobulin

262
Q

what is the name of the post exposure protection options?

A

human diploid cell vaccine (HDCV)

MC reaction is skin reaction

human rabies immunoglobulin

passive and temporary, immediate

263
Q

what should you do if you are bit by a suspected rabbid animal?

A

try to capture it so it can be tested

264
Q

if you are concerned about pets having rabies, what to do?

A

can be monitored within 10 dayys because they will show symptoms within that time and

if reliable followup is avaliable can deferr vaccination if followup is avaliable

265
Q

ebola

what family does this come from?

name?

where MC (2)?

how is it transmitted? what can you get it from?

when do you msot likely come down with it?

incubation time?

6 sxs

A

filovidae, ebola virus

“ebola hemmoragic fever”

MC in sierra leone, liberia

Transmission: through direct contact of blood, body fluids (urine feces, vomit, saliva, semen)…*must be symptomatic to transfer ebola* you can get it from corpses

sxs

appeare sudenly

incubation 2-21 days

8-10 post expsure most common

SXS

sudden fever

muscle pain

headache

V/D

bruising and bleeding

impaired kidney/liver function

266
Q

what is the tx for ebola?

A

supportive!!

267
Q

what is the death rate from ebola?

A

50-90% of patients in developing countries

268
Q

what is the reccomended PPE for ebola?

A

gown (fluid impermeable)

goggles/face shield

facemask

double glove

disposable shoe covers

leg coverings

head covering

269
Q

what is it important to do everytime a patient present with illness no matter what?!

A

get a travelers history!!! every freaking time!!!

270
Q

how many people are living with HIV?

A

35 million

271
Q

**how many new cases of HIV are there a year?**

A

50,000 new cases a year

272
Q

**what is the highest risk group for HIV infection***

A

men having sex with men

273
Q

what are the two receptors HIV uses to get into the cell?

A

CCR5 and CXCR4

274
Q

what percent don’t know they are infected with HIV?

A

1/8

275
Q

explain the structure of the HIV virus? why does it mutate quickly?

A
  1. RNA virus
  2. glycoprotein 120 and stem gp14
  3. viral protein p24 core antigen
  4. CCR5 or CXCR4 receptors

****MUTATIONS OCCUR QUICKLY SINCE THE RNA POLYMERASE USED TO MAKE THE DNA TO INSERT INTO THE HUMAN DNA ISN’T GOOD AT ITS JOB AND OFTEN THERE ARE COPYING ERROS LEADING TO MUTATIONS***

276
Q

what are the two strains of HIV and where are they found?

A

HIV1: most common in the US “M strain”

HIV2: Africa, less aggressive

277
Q

what cells does HIV infection?

A

CD4 Helper T cells

also monocytes and macrophages because they have the CD4 receptor

278
Q

briefly explain the differences between HIV and AIDS?

A

HIV is in the infection

patient is usually asymptomatic or minimally symptomatic and the infection hasn’t yet effected the persons immune system yet

HAVING HIV DOESN”T MEAN YOU HAVE AIDS

AIDS

when the persons immune system has become compromised and the CD4 cells have become significantly diminished

279
Q

***Acquired immunodeficiency syndrome (AIDS)***

what are the 3 options the CDC defines this?

A
  1. clinically: opprtunistic infections effect patient that wouldn’t otherwise if the pt wasn’t immunocomprimised

  1. biomedically: CD4 count less than 200
  2. historically: at some potin in the past ever had opportunistic infections or a CD4 count lower than 200

**must have one of these qualifications but you don’ thave to have all of them***

280
Q

what is the percent chance of contracting HIV from a needle stick?

A

0.3%

281
Q

how is HIV transmitted?

(4)

A

sexual

vertical- mother to child

parenteral- injection drug users

transfusion

Body fluids

  1. blood
  2. seme
  3. vaginal fluids
282
Q

what racial group have the highest burden of HIV/AIDS?

A

african americans

283
Q

what are the four stages of HIV infection?

A

stage 1 primary

stage 2 asymptomatic

stage 3 symptomatic with viral replication

stage 4 AIDS

284
Q

stage 1 HIV

when does this occur?

length?

sxs?

A

short

flu-like illness

6 weeks after infection

infectious

285
Q

stage 2 asymptomatic

how llong does this last?

what might they have?

HIV levels?

antibodies?

A

lasts 10 years

free of symptoms

possible swollen glands

levels of HIV in blood drop to low levels

HIV antibodies are detectable in the blood

286
Q

stage 3 HIV

symptomatic with viral replication

when odes this occur?

what happens?

what are theu suspectible to?

at what CD4 level are HIV patients susceptible to opportunistic infection??

A

after 10 years viral replication is triggered at a high rate

CD4 cells destroyed in the process and the loss is significant

cause increase symptoms of HIV and increased susceptibility to opportunistic infections, disease and malignancy

**CD4 below 500 HIV infected pt is at risk for opportunistic infection**

287
Q

in stage 3 HIV what are 4 diseases that can suggest the patient may progress to AIDS?

A
  1. persistent herpes-zoster infection (shingles)

  1. oral candidiasis
  2. oral hairy leukoplakia
  3. kaposi sarcoma
288
Q

stage 4 HIV/AIDs

what is this characterzied by?

what 2 CD4 levels suggest progression to stage 4?

what are disease that a person can be susceptible for both?

7

5

A

immune system significantly weakened

1. CD4 less than 500

bacterial infection

TB

Herpes simplex

herpes zoster

vaginal candidiasis

karposi sarcoma

hairy leukoplakia

2. CD4 less than 200

toxoplasmosis

crytococcois

coccidiodomycosis

crytospooriosis

non-hodgkin’s lymphoma

289
Q

what is the order of tests you order if suspecting HIV in patient??

what do they tell us?

what test don’t we use anymore?

A
  1. TOC #1: 4th Gen

HIV-1 and HIV-2 IgG

and IgM plus HIV-1 p24 Antigen

**tests antigen so can be detected earlier, 2-3 weeks after infection**

*if postitive then move onto next!!!!

TOC #2 if previous postivie: Multispot Or RNA PCR

**distinguishes between presence of HIV1 or HIV2**

***this testing algorithm is more accurate, faster, and less expensive than previous so not longer use western blot**

290
Q

are there at home HIV tests?

A

yes!!!

oraquick (mouth)

or

HIV-1 test system

(prick finger, mail it in..wait a week)

291
Q

what should you do if someones at home screening test is positive?

A
  1. order 4th gen HIV1/2 IgG/IgM/p24Ag

if postivie…..

  1. multispot HIV1

if postiive…..

  1. order quantitative HIV-1 PCR to get viral load!!!
292
Q

what should you continue to monitor in HIV/Aids patients every 3-6 months?

A
  1. viral load
  2. CD4 levels
293
Q

Years ago, some patients and providers made the decision to delay initiation of HIV therapy with the thought that later treatment would reduce total medication exposure and decrease adverse effects.

Do we still follow these guidlines or suggestions?

A

NOPE!!!!!

data suggesting that earlier therapy improves long-term immune function

294
Q

what are the 5 tx options reccomended to HIV?

A

4 integrase strand transfer inhibitor (INSTI)-based regimens

1 ritonavir-boosted protease inhibitor-based regiment

295
Q

what are the goals of HIV treatment? (4)

A
  1. supress HIV viral load
  2. reconstitiute the immune system and get CD4 levels back
  3. prevent reistance
  4. prevent future infections
296
Q

what is the HAART tx for HIV?

4 drug classes

A

highly active anti-retroviral tx

  1. Fusion inhibitors
  2. nucleoside/nucleotide reverse transcriptase inhibitors
  3. non-nucleoside reverse transcriptase inhibitors
  4. protease inhibitors

*****combination of 3 active anti-retrovirals****

297
Q

what is the post-exposure DOC for HIV?

when do you give it?

goal?

A

truvada plus raltegravir

started ideally 1-2 hours after exposure but must be within a minimum of 72 hours for best results

tx for 28 days, but high risk groups can start up to 2 weeks post exposure

***goal: prevent initial infection with antivirals!!!***

298
Q

***pre-exposure HIV prophlaxsis***

who is this given in?

what does it do?

name of the drug?

how many times must you take it for it to be effective?

A

given to someone with partner who has HIV or someone who plans to participate in sexual activity with someone with HIV and wants to protec thtemself

PrEP is generally well-tolerated and can be dramatically successful

that early HIV treatment can reduce the risk of transmitting HIV to the uninfected partner by 96%.1

TRUVADA can prevent transmission!!!! must be take more than or equal to 4 times a week!!!!!

299
Q

***who does the CDC reccomend get tested for HIV***

A

CDC reccomends everyone age 13-64 to be tested at least once

and!!!…

1. everyone who presents with symptoms of STD should be tested at that visit

2. testing anyone that starts new relationship

300
Q

****what is the reccomendations for HIV testing in gay or bisexual testing for HIV?****

A

For individuals who identify as gay or bisexual testing every 3-6 months may be beneficial.

but AT LEAST ANNUALLY

301
Q

****There is evidence that referring patients elsewhere for testing, e.g. to an STD clinic from an ED, Urgent Care, or PCP office, results in lower testing rates and missed diagnoses *****

A

fun fact!!!

302
Q

*****what type of permission must be obtained before testing for HIV? 2 other considerations****

A

Maine state law requires that testing be voluntary undertaken that informed consent obtained either written or oral, and the patients must be informated of what a positive or negative test means

303
Q

what is the most common transmitted mutations for HIV?

A

makes emtricitabine not work and makes HIV susceptible to tenofovir

304
Q

***can people with HIV be infected with more than one strain?**

A

yes they can!!

305
Q

***explain the life expectancy of someone living with HIV?***

A

life expectancy for those living with HIV has increased to approximately the same as that for HIV negative individuals

306
Q

***what does HIV treatment regimen consist of?***

A

regimens must consist of 3 or more active agents from multiple medication classes

many pills have a combination of multiple drugs in them to increase compliance

307
Q

**what was on of the first and most common combination pills used to treat HIV? what does it contain?**

A

atripla is one of the first combination pills

contains efavirenz, emtricitabine, tenofovir

308
Q

**when should post exposure prophylaxsis be started***

A

within a minimum of 72 hours for best results!!!

309
Q

what are 5 notifiable diseases?

A

Infectious Diseases – Communicable

Infectious Diseases – Dangerous

Environmental Hazards

Bio-terrorism Agents

Public Health for Action

310
Q

where can you find the notifiable diseases for maine law?

A

22 M.R.S.A., sections 801-825

Chapter 258: Rules for the Control of Notifiable Diseases and Conditions

Module 7: Mali: ID (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions