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Independent Duty Corpsman > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

What is a person or animal that harbors an infectious agent/disease and can transmit it to others but does not demonstrate signs of the disease?

A

carrier

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2
Q

What is the exposure to a source of an infection?

A

contact
- contact does imply infection it implies the possibility of infection

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3
Q

What is the capability of being transmitted from person to person by contact or proximity?
Does not need or utilize a vector?

A

Contagious

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4
Q

What is an organisim that harbors a parasitic, mutualistic, or commensalism guest?

A

host

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5
Q

What is an organism that lives on or in host organism and gets food from or at the exposure of its host?

A

parasite

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6
Q

What are the 3 main classes of human parasite?

A
  • protozoa
  • helminths
  • ectoparasites
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7
Q

What is an infectious agent or organism that can produce disease?

A

pathogen

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8
Q

What is the invasion of the body tissue of a host by an infectious agent, regardless if it is a disease or not?

A

infection

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9
Q

What is the pathway into the host that gives an agent access to tissue that will allow it to multiply or act?

A

portal of entry

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10
Q

What is a population of organisms or the specific environment in which an infectious pathogen naturally lives and reproduces; usually living host of a certain species?

A

reservior

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11
Q

What is an increase, often sudden, in the number of cases of a disease above what is normally expected in the population and area?

A

epidemic

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12
Q

What is a pathogen that is transmissible from non-human (typically vertebrates) animals to human?

A

zoonosis

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13
Q

What carries the same definition of epidemic but is often used for a more limited geographic are?

A

outbreak

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14
Q

What is the constant presence of an agent or health condition within a given geographic are or population?

A

endemic

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15
Q

What is an epidemic occurring over a widespread area (multiple countries or continents) and usually affecting a substantial proportion of the population?

A

pandemic

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16
Q

What is any group of viruses that are transmitted between hosts by mosquitoes, ticks, and arthropods?

A

arbovirus (arthropod-borne virus)

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17
Q

What is resistance developed in response to an antigen (pathogen or vaccines) characterized by the presence of antibody produced by the host?

A

active immunity

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18
Q

What kind of immunity occurs when a majority of a group is resistant/immune to a pathogen? This confers confers protection to unvaccinated or susceptible individual/group by reducing the likelihood of infection or spread?

A

herd immunity

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19
Q

What is the transfer of active humoral immunity of ready-made antibodies produced by another host or synthesized?

A

passive immunity

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20
Q

What is used when there is a high risk of infection and insufficient time for the body to develop its own immune response?

A

passive immunization
- SHORT TERM!

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21
Q

What describes an illness, impairment, degradation of health, chronic, or age-related disease?

A

morbidity
- increased morbidity = decreased lifespan and increased mortality

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22
Q

What is the time interval from a person being infected to the onset of symptoms of an infectious disease?

A

incubation period

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23
Q

What is the tie interval from a person being infected to the time of infectiousness of and infectious disease?

A

latency period

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24
Q

What is an infection that is nearly or completely asymptomatic.

A

subclinical infection

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25
Q

What is an asymptomatic carrier of an infection?

A

subclinically infected person

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26
Q

What is a combination of symptoms, characteristics of a disease, or health condition; somtimes refers to a health condition without a clear cause?

A

syndrome
- Greek for “concurrence”

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27
Q

What is the measure of death defined population during a specified time interval, from an defined scale?

A

mortality rate

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28
Q

What transmission occurs between an infected person and a susceptible person via physical contact with blood or body fluids?

A

direct contact

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29
Q

What transmission occurs when there is no direct human-to-human contact?

A

indirect contact

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30
Q

What are the two forms of indirect contacts?

A
  • vehicle borne
  • vector borne
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31
Q

What is the person to contaminated surface/object to person contact?

A

vehicle borne

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32
Q

What is the person to vector (mosquitoes, flies, mites, fleas, ticks, rodents, dogs) to person contact?

A

vector borne

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33
Q

What is the onset of a disease before more diagnostically specific signs and symptoms develop?

A

prodrome
- prodromal symptoms

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34
Q

What is a one-celled organism that is free-living or harbor on a host?

A

protozoa - parasite

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35
Q

What class of parasites are capable of multiplying in humans, contributing to its survival and permitting further infections to develop?

A

protozoa

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36
Q

What are the 4 further classifications of protozoa based of mode of movement?

A
  • sarcodina
  • mastigophora
  • ciliophora
  • sporozoa
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37
Q

What is ameba group of protozoa?

A

sarcodina

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38
Q

What is the flagellates class of protozoa?

A

mastigophora

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39
Q

What is the cilates class of protozoa?

A

ciliophora

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40
Q

What is the non motile adult stage organism class of protozoa?

A

sporozoa

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41
Q

What is the leading cause of water borne disease in the US?

A

cryptosporidium (sporozoa protozoa parasite)

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42
Q

What class of parasite is a large multicellular organism visible to the naked eye in adult stage, that are free-living or harbors on a host?

A

helminths

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43
Q

What parasites invade the GI tract, but are unable to multiply in humans?

A

helminths

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44
Q

What class of parasite’s name is derived from the Greek word for worms and categorized into three main groups of soil transmitted human parasite infections?

A

helminths

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45
Q

What are the 3 main groups of soil-transmitted helminths human parasite infection?

A
  • flatworms (platyhelminths)
  • thorny-headed worms (acanthocephalins)
  • round worms (nematodes)
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46
Q

What helminth reside in the GI tract, blood, lymph or subcutaneous tissue?

A

roundworms

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47
Q

Ticks, fleas, lice, and mites that burrow into the skin and remain there for weeks to months falls under what category of parasite that broadly includes bloodsucking arthropods such as mosquitoes?

A

ectoparasites

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48
Q

What causes various disease, and more importantly functions as vectors or transmitters of many different pathogens that causes morbidity and mortality?

A

ectoparasites

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49
Q

What is ordered to find protozoan or hemlinths parasites in patients presenting with GI symptoms indicative of parasite infection?

A

fecal exam

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50
Q

What is used when stool exam findings are unremarkable, but patients continue to have symptoms indicative of GI parasitic infections?

A

endoscopy/colonoscopy

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51
Q

What bloods test looks for antibodies or parasites antigens produce by the body’s immune response to a parasitic disease?

A

serology

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52
Q

What blood test identifies parasitic species in the blood under a microscope?

A

blood smear

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53
Q

What can help identify parasitic diseases affecting certain organs?

A
  • x ray
  • MRI
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54
Q

What is a single stranded RNA virus of the family Flavivirdae?

A

west nile virus

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55
Q

What is the leading cause of domestically acquired arboviral disease in the US?

A

west nile virus

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56
Q

How is the west nile virus transmitted?

A
  • culex mosquito
  • blood transfusion/organ donation; mother to child
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57
Q

What is the incubation period for west nile virus?

A

2-6 days but can range from 2-14 days

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58
Q

is west nile virus lethal?

A

non-neuroinvasive (no)
neuroinvasive (yes)

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59
Q

What are some predisposing factors of west nile virus?

A
  • outdoor activities during spring and summer
  • mosquito bites
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60
Q

West nile virus outbreaks tend to occcur when?

A

between mid- July and early September
- elevated temperature, rainfall, blood transfusion, and organ transmission correlate with increased WNV transmission

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61
Q

What is the most prevalent mosquito borne disease in the US?

A

WNV

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62
Q

Mosquitos become infected with WNV when they feed on what? Before spreading virus to human and other animals?

A

infected birds

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63
Q

What are considered dead end host for WNV?

A
  • horses
  • humans
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64
Q

What percentage of human WNV infections are subclinical or sysmptomatic?

A

70-80%

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65
Q

What presents clinically indistinguishable from viral meningitis due to other etiologies and typically presents with fever, HA, and nuchal rigidity?

A

WNV meningitis

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66
Q

What is a more severe clinical syndrome that usually manifest with fever and altered mental status, seizures, focal neurologic deficits, or movement disorders such as tremor or Parkinson’s?

A

WNV encephalitis

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67
Q

What often presents as an isolated limb paresis or paralysis and can occur without fever or apparent viral prodrome?

A

WNV acute flaccid paralysis
- WNV poliomyelitis

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68
Q

What labs are used to diagnose WNV?

A

IgM in serum or CSF

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69
Q

What is used to detect IgM antibodies?

A

ELISA

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70
Q

If CNS symptoms are present in regards to WNV what lab should be ordered?

A

lumbar puncture with CSF analysis
- CBC is not reliable

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71
Q

What is the first line management protocol for WNV?

A

vigorous supportive measures
- no antiviral treatment available

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72
Q

WNV warrants MEDEVAC when what signs are present?

A
  • encephalitis
  • menigitis
  • paralysis
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73
Q

What is the protozoan parasite of the genus plasmodium?

A

malaria

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74
Q

What are the 4 subtypes of subtypes?

A
  • P. falciparum
  • P. vivax
  • P. ovale
  • P. malarae
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75
Q

What are some predisposing factors of malaria?

A
  • mosquito exposure
  • operating in endemic area
  • lack of PPE
  • lack of chemoprophylaxis
  • lack of bed nets
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76
Q

How is malaria transmitted?

A

female anopheles mosquito
- vector borne illness
- no vaccines available

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77
Q

What is the incubation period for malaria?

A

7 to 30 days

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78
Q

Is malaria lethal?

A
  • P. falciparum (yes)
  • P. vivax (maybe)
  • P. ovale (maybe)
  • P. malaraeb (maybe)
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79
Q

What are the three phases of malaria lifecycle?

A
  • sporogony phase
  • exoerythrocytic phase
  • erythrocytic phase
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80
Q

What phase of malaria is the sexual cycle in female anopheles mosquitos?

A

sporogony phase

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81
Q

What phase of malaria is the asexual cycle in human liver?

A

exoerythrocytic phase

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82
Q

What phase of malaria is the asexual reproduction in RBCs?

A

erythrocytic phase

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83
Q

The presentation of malaria can be broken down into what 2 broad categories?

A
  • uncomplicated
  • severe
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84
Q

What category of malaria is characterized by paroxysmal (cyclical) fever, influenza-like symptoms including chills, HA, myalgias, malaise, jaundice and anemia secondary to hemolysis?

A

uncomplicate malaria

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85
Q

What category of malaria is characterized by small blood vessels infarction, capillary leakage, organ dysfunction, altered consciousness, hepatic failure, renal failure, acute respiratory distress syndrome, and severe anemia?

A

severe malaria

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86
Q

What is considered a clinical hallmark of malaria infection?

A

paroxysmal fever

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87
Q

What are the stages of paroxysmal fevers in regards to malaria?

A

cold stage - lasts 1 hour
febrile stage - lasts 2-6 hours
diaphretic stage - lasts 2-4 hours, fever drops
- patient then return to normal and cycle repeats itself every 48-72 hours

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88
Q

What is the lifecycle ranges for malaria?

A

48-72 hours

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89
Q

What is the diagnosing testing for malaria?

A

rapid malaria testing via blood smear
- givers qualitive results
- results must be confirmed with microscopy

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90
Q

Malaria treatment options are based on what?

A
  • species
  • severity of infection
  • likelihood of drug resistance
  • patients age and pregnancy status
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91
Q

What are 2 reliable supply treatment regimens available in the US for malaria?

A
  • atovaquone-proguanil (malarone)
  • artemether-lumefantrine (coartem)
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92
Q

What is the treatment of uncomplicated malaria?

A
  • chloroquine phosphate 1g (600mg base) PO
  • 0.5 g in 6 hours
  • 0.5 g daily for 2 days
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93
Q

What is the treatment of malaria with chloroquine resistance?

A

malarone (atovaquone 250mg/proguanil 100mg) 4 tabs PO QD for 3 days

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94
Q

What is the treatment of severe malaria?

A
  • Artesuate 2.4mgkg IV at 0, 12, 48 hours
  • Doxycycline 100mg BID x 7 days after parenteral therapy
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95
Q

What is the treatment for malaria P. ovale?

A
  • ADD primaquine 52.6mg (30mg base=2 tabs) PO QD x 14 days
  • added to regiment for hypnozoites
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96
Q

What is the most important protective measure for of malaria prevention?

A

proper clothing and awareness

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97
Q

What is the administration of chloroquine and mefloquine for prophylaxis against malaria?

A
  • start 1-2 weeks prior embark
  • continued for 4 weeks after leaving endemic area
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98
Q

What is the administration of malarone, primaquine, and doxycycline for prophylactic medications?

A
  • start 2 days prior to embark
  • continued 7 days after departing
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99
Q

What is the disposition for malaria?

A

MEDEVAC

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100
Q

What is a single strand RNA virus of the genus Flavivirus?

A

dengue fever

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101
Q

Dengue fever has how many subtypes?

A

4 serotypes

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102
Q

What is the common name for dengue fever?

A

breakbone fever

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103
Q

What are the predisposing factors of dengue virus?

A
  • urban environment
  • outdoor activities during spring and summer
  • mosquito bites
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104
Q

How is dengue fever transmitted?

A
  • aedes aegypti mosquito
  • blood transfusion/organ donation
  • vector borne
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105
Q

What are the 3 phases of dengue fever?

A
  • febrile
  • critical
  • convalescent
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106
Q

The febrile phase of dengue fever typically last how long?

A

2-7 days
- biphasic

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107
Q

What are some signs and symptom during the febrile phase of dengue?

A
  • severe HA
  • retroorbital pain
  • muscle, joint, and bone pain
  • transient maculopapular rash
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108
Q

What are the minor hemorrhagic manifestations of the febrile phase of dengue?

A
  • petechia
  • ecchymosis
  • purpura
  • epistaxis
  • bleeding gums
  • hematuria
  • positive tourniquet test
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109
Q

How long does the critical phase of dengue last?

A

begins at defervescence and typically lasts 24-48 hours

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110
Q

What is a cardinal feature of dengue hemorrhagic fever?

A

plasma leakage

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111
Q

Patient’s with severe plasma leakage from dengue fever will present with what?

A
  • pleural effusion or ascites
  • hypoproteinemia
  • hemoconcentration
    patient will appear well despite early signs of shock
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112
Q

In regards to the critical phase of dengue fever once hypotension develops, systolic blood pressure rapidly declines, and irreversible shock and death may ensue despite resuscitation efforts. This is known as?

A

dengue shock syndrome

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113
Q

In regards to the critical phase of dengue fever can develop severe hemorrhagic manifestations such as?

A
  • bloody stool
  • melena
  • menorrhagia
    especially in prolonged shock
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114
Q

What phase of dengue fever can present with a rash that may be desquamate and pruritic?

A

convalescent phase

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115
Q

What are the two hallmarks of severe dengue?

A
  • capillary permeability
  • disordered/diminished blood clotting
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116
Q

What is a relatively accurate way to get a general determination of a patients capillary fragility or hemorrhagic tendency in dengue fever?

A

tourniquet test

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117
Q

How do you perform tourniquet test?

A
  • obtain baseline BP
  • Attach and inflate BP cuff midway between systolic and diastolic
  • keep inflated for 5 min
  • deflate and wait 2 min
  • count petechia below AC fossa
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118
Q

What is a positive tourniquet test?

A

10 or more petechia per 1 square inch

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119
Q

What are the diagnostics for dengue fever?

A
  • clinically if patient was in endemic are within 2 weeks of symptoms onset
  • single acute phase serum specimen of viral components obtained early (<7 days after onset)
  • IgM against dengue virus can be detected with ELISA later in illness (>4 days after fever onset)
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120
Q

What rugs should be avoided in the treatment of dengue fever?

A

aspirin, aspirin containing drugs, and NSAIDs because of there anticoagulant properties

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121
Q

What is a gram-negative, intercellular, coccobacillus bacterium?

A

rocky mountain spotted fever (RMSF)
- vector borne

122
Q

What is the scientific name for RMSF?

A

R.rickettsia

123
Q

Where is RMSF prevalent?

A

endemic in central and south America. occurs throughout the US
- North Carolina
- Tennessee
- Missouri
- Arkansas
- Oklahoma

124
Q

What are some predisposing factors of RMSF?

A
  • hiking
  • camping
  • high tick population
  • spring and summer months
  • not performing tick checks
  • lack of PPE
125
Q

How is RMSF transmitted?

A

American dog tick - east of Rockies and pacific coast
Rocky mountain wood tick - rocky mountain region
Brown dog tick - worldwide

126
Q

What is the incubation period for RMSF?

A

2-14 days

127
Q

What is the lethality of RMSF?

A

not lethal unless untreated

128
Q

Spotted fever rickettsiosis is reported in all lower 48 states with over 50% of cases reported where?

A
  • North Carolina
  • Arizona
  • Montana
  • Tennessee
  • Virginia
129
Q

When does peak transmission of SFR occur?

A

may-august

130
Q

Wht two states are characterized by unusually high incidence and case fatality rates, particularly among children?

A
  • Arizona
  • North Mexico
131
Q

RMSF is a rapidly progressive disease and without early administration of what drug can be fatal within day?

A

doxycycline

132
Q

What/When are the early ilness signs and symptoms?

A
  • day 1-4
  • fever
  • HA
  • GI symptoms
  • myalgias
  • edema around the eyes and back of hands
  • rash
133
Q

When and how does the rash for RMSF present?

A
  • begins with small flat pink macules on wrist, forearms and ankles that spread to the trunk
  • can also involve palms of hands and feet
134
Q

What ID infects endothelial cells that line blood vessels, causing vasculitis and bleeding or clotting in the brain or other organs?

A

RMSF (late ilness day 5 or later)

135
Q

Severe RMSF may cause permanent complications from?

A
  • neurological deficets
  • damage to internal organs (respiratory compromise, renal failure)
  • vascular damage requiring amputation
136
Q

Is there any evidence that R. rickettsii causes any persistent or chronic disease?

A

No

137
Q

What presents as a sign of severe late sign of RMSF?

A

petechial rash
- presents 5-6 days after illness

138
Q

What RMSF DDX present with lesions on hands and feet?

A
  • syphilis
  • hand, foot and mouth disease (HFMD)
  • dyshidrosis treatment
139
Q

What is the treatment an disposition for suspected RMSF?

A
  • empiric treatment with doxy
  • MEDEVAC for further monitoring and lab studies
140
Q

When should you perform tick checks?

A

12- hour intervals
- never let you personnel go more that 24 hours without a check

141
Q

What disease has an organism type of spirochetes belonginging to the borrelia burgdorferi complex?

A

Lyme disease

142
Q

What is the scientific name for lyme disease?

A

B. burgdorfi

143
Q

What are the three subtypes of Lyme disease?

A
  • B. afzelii
  • B. burgdorfi
  • B. garinii
144
Q

Where is Lyme disease prevalent?

A
  • Europe (central and eastern)
  • Asia (western Russia, Mongolia, northeastern China, Japan
  • United States (northern and north-central)
145
Q

What are some predisposing factors of Lyme disease?

A
  • hiking
  • camping
  • high tick population
  • spring and summer months
  • not performing tick checks
  • lack of PPE
146
Q

How is Lyme disease transmitted?

A

bite of a Lyme infected Ixodes (blacklegged) ticks
- vector borne, ticks

147
Q

What is the lethallity of Lyme disease?

A

typically not lethal

148
Q

What is the causative bacteria in Lyme disease, transmitted to a host (most often a mammal) via ticks when taking a blood meal?

A

B. burgdoferi

149
Q

What is the main reservoir for Lyme disease?

A

Rodents
- white foot deer mice
- chipmunks
- squirrels

150
Q

When do most transmissions and infections of Lyme disease occur?

A

May-August
when ticks and mammals are active

151
Q

Ticks attach to any part of the host but often prefer where?

A
  • groin
  • axilla
  • scalp
152
Q

In most cases, the tick must be attached for how long for b. burgdorferi can be transmitted?

A

36-48 hours
- however, transmission has occurred in as little as 24 hours

153
Q

Many people do not know a tick is attached for days due to what?

A

anesthetic chemical in saliva

154
Q

What are the early localized stage symptoms of Lyme disease?

A

flu-like symptoms
- malaise
- HA
- fever
- myalgia
- arthralgia
- lymphadenopathy

155
Q

What is a red ring-like or homogenous rash expanding that appears about 1 week after initial infection of lime disease, begins as a slightly raised red lesions at the site of the tick bite, and after several days the rash expands out from the central lesion sometimes appearing as a “bulls-eye/target” lesion, but more often as a muddled circular rash?

A

Erythema migrans (EM)

156
Q

What are the constitutional symptoms of the acute/early disseminated stage of Lyme disease?

A
  • multiple secondary annular rashes
  • flu-like symptoms
  • lymphadenopathy
157
Q

What are the cardiac manifestations of the acute/early disseminated stage of Lyme disease?

A
  • conduction abnormalities (atrioventricular node block)
  • myocarditis
  • pericarditis
158
Q

What are the neurologic manifestations of the acute/early disseminated stage of Lyme disease?

A
  • bell’s palsy
  • meningitis
  • encephalitis
159
Q

What are the manifestations of the late disseminated stage of Lyme disease?

A

Rheumatologic manifestations
- transient, migratory arthritis and effusion in multiple joints
- migratory pain in tendons, bursae, muscle, and bones

160
Q

In regard to Lyme disease when should you NOT perform serologic testing?

A
  • asymptomatic patients in endemic areas
  • asymptomatic patient after an ixodes tick bite
  • patients with non-specific symptoms (subacute myalgias, arthralgias, or fatigue)
161
Q

What is used for the acute/early phase of Lyme disease?

A

2 ELIZA tests

162
Q

What is used for late disseminated stage of Lyme disease?

A

@ ELIZA test or 1 western blot

163
Q

What test can show specific antigens of B. burgdorferi are reacting with serum antibodies?

A

western blot

164
Q

For patients with Lyme disease illness duration of more than 1 month what test should be used?

A

IgG or combined IgG/IgM testing can detect the disease

165
Q

What is the treatment for ALL stages of Lyme disease? As well as post exposure prophylaxis

A

doxycycline

166
Q

What can be used for chemoprophylaxis to reduce risk of acquiring Lyme disease after the bite of a high-risk tick?

A

single dose of 200mg of doxycycline

167
Q

What is the disposition for suspected Lyme disease?

A

MED ADVICE

168
Q

A vast majority of patients treated with ABx in early stage of Lyme disease recover rapidly and completely without complications. However a small percentage of cases have lingering fatigue, myalgia, and arthritis that can persist for months to years, this is known as?

A

post-treatment Lyme disease syndrome (PTLDS), or chronic Lyme disease

169
Q

What ID is an obligate intracellular protozoan parasite?

A

leishmaniasis

170
Q

What is the scientific name for leishmaniasis?

A

leishmania (species) AKA L. tropica

171
Q

What are the subtypes of leishmaniasis?

A
  • old world leishmaniasis (eastern hemisphere)
  • new world leishmaniasis (western hemisphere)
172
Q

What is the prevelance of leishmaniasis?

A

700,000 to 1.2 millions cases each year
- on every continent except Australia and Antarctica

173
Q

What are the predisposing factors for leishmaniasis?

A
  • chronic san fly exposure
  • poverty
  • proximity to dogs/cats/rodents
174
Q

How is leishmaniasis transmitted?

A
  • sand fly
  • sand flea
    vector borne
175
Q

What is the incubation time for leishmaniasis?

A

2 weeks to several months and in some cases up to 3 years; some >20 years

176
Q

What is the lethality of leishmaniasis?

A
  • cutaneous leishmaniasis (maybe)
  • mucocutaneous leishmaniasis (yes)
  • visceral leishmaniasis (yes)
177
Q

What is the most common manifestation of leishmaniasis?

A

cutaneous leishmaniasis

178
Q

What is the primary vector for the protozoa of leishmaniasis?

A

sand flies

179
Q

Where do the lifecycle for the leishmaniasis protozoa take place?

A

one stage in the sand fly and, one stage in the mammalian host

180
Q

What is a normal sand fly bite reaction?

A

pruritic but do not enlarge and resolve after several weeks

181
Q

How does infection form CL differ from normal sand fly bites?

A
  • begin as pink colored papule that enlarges to a nodule or plaqu-like lesion
  • lesion ulcerates with indurate border and may have thick white-yellow fibrous material
  • lesion are often painless
  • multiple lesions may be present
  • lesions gradually heal over months to years with noticeable scarring at site
182
Q

Clinicians should maintain a high suspicion for CL in any patients with what?

A
  • chronic non healing skin lesions
  • endemic area
  • sand fly bites
183
Q

CL is diagnosis through lab confirmation by what means?

A
  • microscopic examination for leishmaniasis parasite or DNA of tissue.
  • culture techniques
  • molecular methods
184
Q

CL is diagnosis through lab confirmation by what means?

A
  • microscopic examination for leishmaniasis parasite or DNA of tissue.
  • culture techniques
  • molecular methods
185
Q

Tissue collected from the base and margins of CL ulcers should be submitted for what tests?

A
  • histology
  • cuture
  • PCR
186
Q

What is the treatment for visceral leishmaniasis?

A

Amphotericin B deoxycholate

187
Q

What is the treatment for CL?

A
  • oral azoles
  • topical formulations of paromomycin
188
Q

What is the most commonly used drug to treat leishmaniasis?

A

pentavalent antimonials

189
Q

What is the FDA approved treatment for CL, MCL and VL caused by leishmaniasis species?

A

miltefosine

190
Q

What is the foundation of leishmaniasis prevention?

A

avoidance by sand flies in endemic area
- sand flies are less active during the hottest hours of the day
- fans or ventilators might inhibit the movement of sand flies

191
Q

What is the gram-positive genetically distinct strain of staphylococcus aureus?

A

Methicillin-resistant Staphylococcus Aureus (MRSA)

192
Q

What is the scientific name for MRSA?

A

staphylococcus aureus

193
Q

What are the subtypes of MRSA?

A
  • community associated (CA-MRSA)
  • healthcare associated (HA-MRSA)
194
Q

What is the prevalence of MRSA?

A

worldwide and increasing

195
Q

What are predisposing factors of MRSA?

A
  • hospitals
  • prisons
  • nursing homes
  • close living quaters
  • military
  • athletes
  • weaked immune system
196
Q

How is MRSA transmitted?

A
  • direct contact
  • sharing peronal/hygiene items
  • surfaces or items contaminated with MRSA
  • 5% of patients in U.S. hospitals carry MRSA in their nose or on their skin
  • NOT vector borne
197
Q

What is the incubation period of MRSA?

A

high variable
4-10 days , but asymptomatic years

198
Q

What is the lethality of MRSA?

A

20,000 deaths in the US in 2019

199
Q

What is any strain of S.aureus that has developed multiple dri=ug resitance to beta-lactam antibiotics?

A

MRSA

200
Q

What is any strain of S. aureus susceptible beta-lactam antibodies?

A

MSSA

201
Q

What is the most frequently reported clinical manifestation of MRSA?

A

SSTIs specifically…
- furuncles
- carbuncles
- abscesses

202
Q

Patients with c/c of what kind of bites should raise suspicion for S. arues infection?

A

spider bite
- areas of fluctuance and purulent drainage are commonly present

203
Q

What is the mainstay therapy for any fluctuant lesion secondary to MRSA?

A

I & D

204
Q

What antibiotics can be used to treat MRSA infection?

A
  • TMP-MX
  • clindamycin
  • doxycycline
205
Q

What is the disposition for MRSA infection?

A

uncomplicated MRSA ROB

206
Q

An MO should be consulted for what complications of MRSA?

A
  • SSTI on face, neck, or head that may require I&D
  • orbital cellulits
  • SSTI unresponsive for 48 hours after ABx
  • osteomyelitis
  • any signs of NECFASC
  • patients with reoccurent infection
  • may require Derm
207
Q

An MO should be consulted for what complications of MRSA?

A
  • SSTI on face, neck, or head that may require I&D
  • orbital cellulits
  • SSTI unresponsive for 48 hours after ABx
  • osteomyelitis
  • any signs of NECFASC
  • patients with recurrent infection
  • may require Derm
207
Q

An MO should be consulted for what complications of MRSA?

A
  • SSTI on face, neck, or head that may require I&D
  • orbital cellulits
  • SSTI unresponsive for 48 hours after ABx
  • osteomyelitis
  • any signs of NECFASC
  • patients with recurrent infection
  • may require Derm
208
Q

What is the 3rd most common bite wound after dogs and cats?

A

human

209
Q

What are the two basic categories of human bites?

A
  • occlusive; teeth closing over and breaking skin
  • clenched fist “fight bite”
210
Q

Typical human oral and skin flora cause what infections?

A
  • eikenelle
  • group A streptococcus
  • fusobacterium
  • staphylococcus
  • prevotella
211
Q

What are the typical locations for fight bites?

A

3rd, 4th, or 5th MCP joint
- most common in adolescent boys and adult men

212
Q

What ABx do you NOT use on human bites?

A
  • cephalexin (keflex)
  • penicillinase-resistant penicillin PRPs (dicloxacillin)
  • macrolides (erythromycin & azithromycin)
213
Q

What is the early antibiotic for an uninfected human bite?

A

amoxicillin clavulanate

214
Q

What labs should be ordered for concerns of osteomylitis?

A
  • CBC
  • ESR
  • CRP
215
Q

What is an acute or chronic inflammatory process involving bone and structures secondary to infection with pyogenic organisms, including bacteria, fungi, and mycobacteria?

A

osteomyelitis

216
Q

Among younger adults OM occurs most commonly in what settings?

A
  • trauma, and related surgery
217
Q

Among older adults, OM occurs most commonly as a result of?

A

contagious spread of infection to bone from adjacent soft tissue and joints

218
Q

In adults OM most often affects what bones?

A

vertebrae or hips
- extremities are frequently involved due to skin wounds, trauma and surgies

219
Q

What are risk factors of OM?

A
  • bacteremia
  • endocarditis
  • IV drug use
  • trauma
  • open fractures
220
Q

What are some local findings of OM?

A
  • tenderness
  • warmth
  • erythema
  • swelling
221
Q

What are some systemic symptoms of OM?

A
  • fever
  • rigors
222
Q

What is an essential component in evalutating suspected OM?

A

radiographs

223
Q

What are the most useful studies for OM?

A
  • MRI
  • technetium-99 bone scintigraphy
224
Q

What is the most common cause of scute OM in adults and children?

A
  • MSSA
  • MRSA
225
Q

What are the 2 pillars of OM treatment?

A
  • surgical containment
  • prolonged ABx therapy
226
Q

What is the prolonged ABx therapy medication of choice for OM?

A
  • IV vancomycin
  • IV ceftriaxone
227
Q

What is the disposition for OM?

A

MEDEVAC for defenitive treatments
- radigraphs
- long term ABx
- MO should be contacted to determine in empiric oral antibiotics should be started before transport

228
Q

What is a spore-forming, anaerobic, gram-positive bacterium?

A

tetnus

229
Q

What is the scientific name for tetanus? what is the common name?

A
  • clostsridium tetani
  • lockjaw
230
Q

What are the predisposing factors of tetanus?

A
  • inadequate TD immunization
  • no TD booster in last 10 years
  • puncture wound
  • penetrating injury with retained foriegn body
  • untreated necrotic tissue
  • crushing injury
231
Q

How is tetanus transmitted?

A

direct contact of open wound and non-contact skin
- NOT vector borne

232
Q

What is the incubation period for tetanus?

A

3 to 21 days, usually 8 days
- the further the inoculation site is from the CNS the longer the incubation period

233
Q

Is tetanus lethal?

A

yes

234
Q

What is an acute, often fatal, exotoxin-mediated disease produced by gram positive, spore-forming anaerobic rod, clostridium?

A

tetanus

235
Q

What causes the symptoms of tetanus and is one of the most potent toxins known?

A

tetanus toxin

236
Q

What are the first commonly presented symptoms of tetanus?

A
  • lockjaw
  • nuchal rigidity
  • dyshphagia
  • rigidity of abdominal muscles
  • frequents muscles spasms
  • hyperthermia
  • diaphoresis
  • hypertension
  • episodic tachycardia
237
Q

What are the common late symptoms of tetanus

A
  • periods of apnea due to contraction of thoracic muscles or pharyngeal muscle contraction
  • fracture from muscles spasms
  • nosococmial infections
  • aspiration pneumonia
  • death typically occurs secondary to respiratory arrest
238
Q

What re the two classifications of wound cleanliness?

A
  • clean vs. contaminated/dirty
  • superficial vs. deep/penetrating
239
Q

What antibiotic do you prescribe for prophylaxis against tetanus?

A

None, there is no benefit unless other SSTIs from organisms other than tetanus is present

240
Q

What is the treatment if you suspect tetanus in a patient?

A
  • urgent MEDEVAC
  • clean/debride wound
  • supportive therapy and airway protection
241
Q

What antibiotic is used to treat antibiotics?

A
  • metronidazole or pen G 2-2
  • Tetanus Immune Globulin (TIG,HTIG)
242
Q

How long is the recovery from tetanus?

A

months to years

243
Q

What are the bacterial etiologies of meningitis and encephalitis?

A
  • streptococcus pneumonia
  • group B streptococcus
  • N. echoviruses
  • H. influenza
  • E.coli
  • listeria monocytogenes
244
Q

What are the viral etiologies of meningitis and encephalitis?

A
  • enteroviruses
  • coxsackieviruses
  • echoviruses
  • WNV
  • influenza
  • HSV
  • VZV
  • EBV
  • arbovirus
245
Q

What is the most common viral etiology of meningitis and encephalitis?

A

enteroviruses

246
Q

What are some risk factors that should increase clinical suspicion for meningitis?

A
  • close contact exposures (military barracks, college dorms)
  • incomplete vaccinations
  • immunosuppression
  • > 65 y/o and <6 y/o
  • alcohol use disorder
247
Q

Meningitis typically occurs through what two routes of inoculation?

A
  • hematogenous seeding
  • direct contagious spread
248
Q

When bacteria colonize in nasopharynx and enter bloodstream. Upon making their way to the subarachnoid space, the bacteria cross the blood-brain barrier, causing a direct inflammatory and immune-mediated reaction is known as?

A

hematogenous seeding

249
Q

When organisms enter CSF via neighboring anatomic structures (otitis media, sinusitis) or foreign objects (medical devices, penetrating trauma) is known as?

A

direct contiguous spread

250
Q

What is the classic meningeal tetrad?

A
  • fever
  • nuchal rigidity
  • altered mental status
  • severe HA
251
Q

What lab is used to distinguish between bacterial and septic meningitis?

A

lumbar puncture with CSF analysis

252
Q

What is the preferred imaging modality for meningitis?

A

CT

253
Q

What ABx are used for meningitis?

A
  • ceftriaxone IV
  • pen- G IV
254
Q

What steroid is used because of its association with reduction in rate of healing loss, neurologic complications, and decreased mortality for meningitis?

A

dexamethasone

255
Q

What are signs of ICP?

A
  • altered mental status
  • neurological deficits
  • non-reactive pupils
  • bradycardia
256
Q

What should be done for patients with ICP?

A
  • elevate the head of the bed 30 degrees
  • induce mild hyperventilation in the intubated patient
  • osmotic diuretics (25% mannitol, 3% saline)
257
Q

What is the chemoprophylaxis regime for meningitis?

A
  • ceftriaxone 250mg IM one time
  • Ciprofloxacin 500mg PO one time
258
Q

What is the scientific name for mono?

A

eptien-barr virus

259
Q

What are the common names for mono?

A
  • kissing disease
  • glandular fever
260
Q

How is mono transmitted?

A
  • saliva
  • bodily fluids
261
Q

What is the incubation period of mono?

A

4-6 weeks

262
Q

What is the lethality of mono?

A

not lethal but high risk of splenic rupture

263
Q

IM presents consistent with what other diseases making it often misdiagnosed by clinicians?

A

erythematous or exudative pharyngitis or tonsilitis

264
Q

What are some common findings of mono?

A
  • malaise
  • fever
  • cervical lymphadenopathy (typically posterior)
  • splenomegaly
  • maculopapular rash if patient is treated with cillin-class antibiotic
265
Q

What labs are used for mono?

A
  • mono spot (positive 4 weeks after onset)
  • CBC
  • LFT
266
Q

What is the treatment for IM?

A

treat symptomatically
- avoid antivirals

267
Q

What is the disposition of IM?

A
  • SIQ
  • light duty with no physical contact sports for 3-4 weeks due to risk of splenomegaly and splenic rupture
268
Q

What is the scientific name for rabies?

A

lyssavirus

269
Q

What are some predisposing factors for rabies?

A
  • veterinarians
  • wild life researcher
  • exposure to bat colonies
  • feral/unvaccinated dog and cats in developing countries
270
Q

How is rabies transmitted?

A

spreads through infected saliva through a break in the skin
- dogs account for 99% of all rabies transmission

271
Q

What is the incubation period for rabies?

A

1-3 months depending on site of inoculation

272
Q

What is the lethality of rabies?

A

once the rabies virus reach the CNS is has a 99% fatality rate

273
Q

What is a fatal acute, progressive encephalitis caused by neurotropic viruses in the family rhabdoviridae, genus lyssaavirus?

A

rabies

274
Q

What are the major rabies reservoirs?

A
  • terrestrial carnivores
  • bats
275
Q

Clinical rabies typically manifests as 1 of 2 forms. What are they?

A
  • encephalitis “furious”
  • paralytic “dumb”
276
Q

Fever, hydrophobia, pharyngeal spasms, hyperactivity subsiding to paralysis, coma, ANS instability, hypersalivation, lacrimation, diaphoretic, “goose flesh”, and dilated pupils are all part of what major manifestation form of rabies?

A

encephalitic “fuirious”

277
Q

Ascending paralysis that is similar to guilliain-barre, lost of DTR and plantar reflex are all part of what major manifestation form of rabies?

A

paralytic “dumb”

278
Q

What is the most characteristic feature of rabies, when patient becomes afraid of water due to involuntary pharyngeal muscle spasms when they attempt to drink?

A

hydrophobia

279
Q

What is a pathognomonic pharyngeal muscle spasm triggered by feeling a draft of air, leading to spiration, couching, choking, asphyxiation and respiratory arrest?

A

aerophobia

280
Q

Fever and chills with paresthesia surrounding animal nite site is suggestive of what?

A

rabies

281
Q

What is the definition of diarrhea?

A
  • 3 or more loose stools within 24-hrs
  • caused by increase water content of the stool, due to either impaired water absorption, or active secretion by the bowel, or both.
282
Q

Time frame for acute diarrhea?

A

< 14 days

283
Q

Timeframe for persistent diarrheas?

A

more than 14-30 days

284
Q

time frame for chronic diarrhea?

A

> 30 days

285
Q

What classification of diarrhea presents with blood in loose-watery stool, and fever, secondary to tissue damage to lining of the colon from certain bacteria, and/or toxins?

A

inflammatory diarrhea

286
Q

What classification of watery stool presents with watery stool, NO blood and absence of fever?

A

non-inflammatory diarrhea

287
Q

What are some common viral etiologies for diarrhea?

A
  • norovirus
  • rotavirus (primary children)
288
Q

What are some bacterial etiologies of diarrhea?

A
  • enterotoxigenic escherichia coli (ETEC)
  • campylobacter jejuni
  • shigella spp.
  • salmonella spp.
  • bacterial toxin-releasing
289
Q

What are some protozoal etiologies of diarrhea?

A
  • giardia
  • entamoeba histolytica
290
Q

What is the scientific and common names of viral infectious diarrhea?

A
  • nonenveloped, single-stranded RNA viruses genus norovirus
  • stomach flu/bug, Norwalk virus
291
Q

What are some predisposing factors of viral ID?

A
  • ready to eat cold foods
  • raw selfish (especially oysters)
  • contaminated ice
  • close quarters living
292
Q

How is viral ID transmitted?

A

primarily fecal-oral route
- direct person to person contact
- indirect through food and water
- spread through aerosols of vomits and contaminated environmental surfaces/objects

293
Q

What is the incubation period for infectious ID?

A

12-48 hours

294
Q

What presents with acute onset of abdominal cramps, nausea, vomiting, body aches, HA, non-bloody diarrhea and sometimes a low grade fever?

A

norovirus

295
Q

What is an RNA virus of the orthomyxovirus genus?

A

influenza

296
Q

What is the scientific name for influenza?

A

orthomyxovirus

297
Q

What are the 4 subtypes of influenza?

A

A/B/C/D
- only A and B commonly cause illness in humans

298
Q

What is the incubation period for influenza?

A

24-96 hours

299
Q

What are the 2 distinct virion structures that surround the viral membrane which is necessary for viruses to enter cells and are also how influenza undergoes periodic changes?

A

glycoproteins

300
Q

How are influenza virus strains identified?

A

by the way the glycoproteins mix

Independent Duty Corpsman (4 decks)

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