Lecture 4: Infectious disease pt 4

Question 1

1) The most common parasitic infection in the world is what?
2) What else is it the most common of?
3) Describe the pathophysiology
4) Describe its life cycle
5) Is it reportable?

Answer 1

1) Giardia Lamblia
2) Most common waterborne illness in the US; 15,000-20,000 per year in the US
3) Pear-shaped Flagellated protozoan; transmitted Fecal-oral.
4) Life cycle: Cyst ingested; Trophozoites in colon
5) Yes

Question 2

Giardia Lamblia:
1) Risk factors
2) Signs/ Sx
3) Labs you need to order?
4) Tx?

Answer 2

1) Poor sanitation or poor hygiene, daycare outbreaks, oral-anal sex, water supply from shallow well, wilderness travel with ingestion of contaminated water
“Beaver Fever”
2) Diarrhea 1-3 weeks, fatty greasy stools, foul smelling
3) Stool Giardia Antigen PCR
4) Tinidazole 2 gm orally x 1

Question 3

Malaria:
1) Etiology? (incl. species)
2) Epidemiology?

Answer 3

1) Plasmodium parasite inside the Anopheles mosquito.
-Species: P. falciparum (most virulent), P. malaria, P. ovale, P. knowlesi, P. vivax
2) Epidemiology: Africa, Asia, Latin America. endemic in most tropics, ~229 million cases & ~409K deaths worldwide in 2019, >94% in Africa

Question 4

Malaria:
1) Describe its signs/ Sx.
2) Describe 2 stages
3) What labs would be abnormal? (3)

Answer 4

1) Fever, sweats, headache, periodic chills every 3 days (paroxysms). Hepatosplenomegaly
2) Liver stage: asymptomatic, then
-Erythrocyte stage: symptomatic
2) Atypical lymphocytes, decreased platelet count, elevated lactate dehydrogenase level

Question 5

Malaria:
1) How is it diagnosed?
2) Tx?
3) Prevention?
4) Is it reportable?

Answer 5

1) Gimesa stain peripheral smear; thick and thin blood smears
2) Chloroquine/Hydroxychloroquine
3) Antimalarial drugs before, during and after travel Personal mosquito protection (barrier nets)
4) Yes

Question 6

Amebiasis: Entamoeba Histolytica-
1) Epidemiology?
2) Risk factors?
3) What are its two forms? Describe each

Answer 6

1) 10% world wide
Asymptomatic cyst carrier 90% of cases
Fatalities per year 100,000
2) Mental health institutions, crowded living conditions, poor sanitation, travel to endemic areas: Asia, Africa and Latin America
3) Cyst: Can survive weeks in moist environment
Trophoziote: Moves toward colon (results in enterocolitis)

Question 7

Amebiasis: Entamoeba Histolytica-
1) S/Sx?
2) Labs?
3) Tx?

Answer 7

1) Bloody profuse Diarrhea, fever, dehydration, weight loss, LIVER ABSCESS
-Can also go to the lung or brain
2) Stool PCR: Sensitivity 87%, Specificty >90%
-Liver function tests
-Alkaline phosphatase increased in 75% of cases
3) Asymptomatic: Paromomycin x 7 days
-Mild diarrhea: Metronidazole oral 7-10 days
-Severe Disease: Metronidazole IV x 10 days

Question 8

Helminths: Define it and its classifications

Answer 8

1) Infections caused by worm-like parasites; defined by shape & host organ inhabited
2) Classified by external & internal morphology of egg, larval, & adult stages

Question 9

Helminths:
1) Flukes (trematodes)
2) Tapeworms (cestodes)
3) Roundworms (nematodes)

Answer 9

1) Leaf-shaped flatworms (ie, schistomomiasis, fascioliasis)
2) Adult flatworms that inhabit intestinal lumen (larvae inhabit extraintestinal tissues (ie, beef, pork, fish, dwarf, cysticercosis).
3) Roundworms inhabiting intestinal & extraintestinal sites (ie, ascariasis)

Question 10

Describe the pathologic stages of flukes, tapeworms, and roundworms

Answer 10

1) Flukes: Egg+, larva+, adult+
2) Tapeworms: Egg-, larva+, adult+
3) Roundworms: Egg-, larva+, adult+

Question 11

Schistosomiasis:
1) Also called what?
2) Epidemiology?
3) Sx?
4) Complications?

Answer 11

1) “Snail Fever”
2) 252 million cases per year
3) Abdominal pain, diarrhea, bloody stool, blood in the urine
4) Liver damage, kidney failure, infertility, bladder cancer

Question 12

Schistosomiasis:
1) How is it Dx’d?
2) Tx?
3) Prevention?

Answer 12

1) Finding eggs in the urine or stool, antibodies in the blood
2) Praziquantel (4-6 weeks after exposure)
3) Access to clean water

Question 13

Where do you contract tapeworms?

Answer 13

From pig/ cow muscle (undercooked)

Question 14

Cysticercosis:
1) Etiology?
2) Epidemiology?

Answer 14

1) Taenia Solium
2) Immigrants from Central America and South America. US natives 15% of deaths.
-Most common cause of acquired epilepsy.
-Endemic to Asia, India, Sub-Saharan Africa, Central and South America.

Question 15

Cysticercosis: Describe the signs/ Sx

Answer 15

-Can be asymptomatic for years.
-Neurocysticercosis (90% of cases).
-Seizures.
-Headache, parkinsonism, encephalopathy, hydrocephalus, papilledema, chronic meningitis, cranial nerve palsy, eye lesions

Question 16

Cysticercosis:
1) Describe how it’s Dx’d
2) How’s it treated?

Answer 16

1) -MRI brain. Single <2 cm lesion, no midline shift. Larval sucking parts may be visible (pathognomonic).
-Cysticercal Antibody: Sensitivity>65%, Specificity >67%. Biopsy of infected tissue.
2) Consult! Might need surgical excision. Albendazole with Dexamethasone. Seizure prophylaxis

Question 17

Describe roundworm infections

Answer 17

-Found in soil
-Human stool as fertilizer
-Famous for migrating to lungs

Question 18

Ascariasis (type of round worm):
1) Etiology
2) Epidemiology?

Answer 18

1) Ascariasis Lumbricoides
2) Epidemiology: Asia (75%), Africa (10%), Latin America (10%)

Question 19

Ascariasis (type of round worm): Signs/ Sx?

Answer 19

-Eggs hatch in the intestines and migrate to the lungs.
-Often asymptomatic at first. Lower abdominal pain for days. Might see worms in stool.
-SOB, fever, diarrhea, malnutrition. Intestinal blockage.
-Allergies. Eosinophilia.

Question 20

Ascariasis:
1) How’s it diagnosed?
2) Tx?
3) Prevention?

Answer 20

1) Identifying the appearance of the worm in eggs or feces. Fecal smears.
2) Albendazole
3) Improved sanitation.

Question 21

Pinworms (enterobiasis):
1) Definition
2) Etiology
3) Epidemiology
4) Clinical features

Answer 21

1) Definition: most common helminthic infection in U.S. & Western Europe
2) Person-person via ingestion of Enterobius vermicularis (roundworm) eggs (hands, perianal region, food, fomites, bedding, clothing) or autoinfection
3) School-aged children, ~40 million in U.S.
4) Most asymptomatic
m/c symptom: nocturnal perianal pruritis
Insomnia, restlessness, enuresis

Question 22

What are 3 ways to Dx pinworms (enterobiasis)?

Answer 22

1) Worms or eggs on perianal skin
Eggs usually not found in stool
2) Clear cellophane tape to perianal skin (ideal in early am), then micro exam for eggs
3) Nocturnal exam of perianal or gross exam of stools (adult worms)

Question 23

How are pinworms (enterobiasis) treated?

Answer 23

1) Single PO mebendazole (alt. albendazole, pyrantel pamoate)
-Repeat Tx in 2 wks due to frequent re-infection
2) Concurrent Tx of infected (& uninfected) close contacts
3) Wash clothes & bedding (kills eggs)

Question 24

Toxoplasmosis:
1) Etiology?
2) Epidemiology?

Answer 24

1) Intracellular protozoan parasite, Toxoplasma gondii
Infects HIV patients with CDV<50. Pregnant women exposed to cat feces.
2) Worldwide, in U.S. infects ~1.1 million annually (chorioretinitis ~21K & vision loss ~4,800)

Question 25

1) What are general signs/ Sx of toxoplasmosis? 2) CNS Sx?

Answer 25

1) Acute infection > Asymptomatic but may have lymphadenopathy. 2) Headache, neurological defects, nausea, seizures, AMS, fevers, chills.

Question 26

Toxoplasmosis: 1) Describe congenital Sx 2) Describe ocular Sx

Answer 26

1) Psychomotor retardation, hydrocephalus, cerebral calcifications, retinochoroiditis, and/or microcephaly. 2) Ocular pain, blurred vision, blindness due to focal necrotizing retinitis.

Question 27

Toxoplasmosis: 1) How's it diagnosed? 2) Tx?

Answer 27

1) CT or MRI (best) brain  Multiple ring enhancing lesions. Serology for T. gondii antibodies (IgG). Fundoscopy white-yellow cotton-like lesions in a nonvascular distribution 2) Pyrimethamine, sulfadiazine, and Leucovorin (need all three) 2-4 weeks

Question 28

Trichomoniasis 1) Definition 2) Etiology: Trichomonas vaginalis 3) Epidemiology: worldwide, F>M 4) List 2 clinical Fx

Answer 28

1) GU infection, most common non-viral STI worldwide 2) Trichomonas vaginalis 3) Vaginitis and Non-Gonococcal Urethritis (NGU):

Question 29

1) Describe Sx of vaginitis 2) Describe the Sx of Non-Gonococcal Urethritis (NGU)

Answer 29

1) Copious, frothy, yellow/green, discharge, vulvovaginal discomfort, pruritis, dysuria, dyspareunia, vaginal wall inflammation, cervix with punctate hemorrhages 2) Usually asymptomatic, discharge more scant (compared to urethritis from GC or chlamydia)

Question 30

Trichomoniasis 1) How's it diagnosed? 2) How's it treated? What's an alternate?

Answer 30

1) Vaginal or urethral secretions, wet mount shows motile organisms 1) TOC: Tinidazole (or metronidazole) as 2G single oral dose -Alternate: metronidazole 500 mg PO BID x 7 days

Question 31

Name a non-reportable STI

Answer 31

Trichomoniasis

Question 32

Polio: 1) Who is it most common in? 2) How many cases in the 50s? What abt the 60s?

Answer 32

1) Most often in children <15 years 2) 1950s: 15,000 cases per year 1960s: <100 cases per year

Question 33

Polio epidemiology: 1) How many cases a year in the 1970s? 2) What happened in 1973? 3) What abt 1993?

Answer 33

1) <10 cases per year 2) No wild-type cases onset in US at this time 3) Last internationally imported case of polio in the US

Question 34

Polio: 1) Risk factors 2) Pathophysiology (hint: 2 routes)

Answer 34

1) Risk factors: Developing world, poor hygienic lignin conditions, under-immunized populations 2) Enterovirus (Picornaviridae) -Fecal-oral route or respiratory route

Question 35

Polio: 1) What is the incubation period of non-paralytic polio? 2) What abt paralytic polio? 3) _____% progress to paralytic poliomyelitis

Answer 35

1) 3-6 days 2) 7-21 days from exposure to paralysis 3) 1%

Question 36

Polio: 1) Describe the S/Sx 2) When does paralysis occur? Describe its spread

Answer 36

1) Fever, pharyngitis, fatigue, headache, nausea, epigastric pain. 2) 5-10 days after prodrome. Meningeal irritation, asymmetric flaccid paralysis.q -Descending paralysis: Starts proximally in affected limb and progresses distally

Question 37

1) How is polio diagnosed? 2) How is it managed?

Answer 37

1) Poliovirus PCR: 2 of each source at least 24 hours apart -Stool Specimens, Throat swabs 2) Supportive care and isolation -Report to CDC within 4 hours.

Question 38

How fast do you need to report polio?

Answer 38

Within 4 hours

Question 39

HPV (Human Papilloma Virus): 1) Etiology (which are more virulent and which are warts?) 2) Epidemiology 3) S/Sx

Answer 39

1) HPV strains most virulent 16, 18,31, 33, 35, 45. Genital warts: 6,11 2) 60% of population 3) May be asymptomatic. Flat pedunculated or popular flesh-colored growths (condyloma acuminatum). Cauliflower-like lesions that can occur anywhere in the genital/anal/perineal area. Post-coital bleeding

Question 40

HPV: 1) How is it diagnosed? 2) How is it treated? 3) How is it prevented?

Answer 40

1) Clinical diagnosis > whitening with 4% acetic acid application. -Pap smears test for HPV 2) Trichloroacetic acid, podophyllin or imiquimod 3) Gardasil vaccine (6,11, 16, 18 ) or Gardasil 9 (covers many more)

Question 41

Most common HPV strain for cancer is ___________ and __________

Answer 41

16 and 18

Question 42

HPV 1) Mechanisms of ___________ transmission not well understood 2) What has been suggested? Why? 3) What does this suggest?

Answer 42

1) vertical 2) Prenatal transmission has been suggested Lesions on neonate at time of birth Found in amniotic fluid prior to ROM 3) Mechanisms of ascending infection rather than transplacental (HPV infection does not result in viremia)

Question 43

Cytomegalovirus (CMV): 1) Etiology 2) Epidemiology

Answer 43

1) Double stranded DNA HHV-5, lytic virus 2) Often co-infection with HIV. 1 in 200 babies born with CMV. Over 50% of adults will have it by the time they are 40 (asymptomatic or mild)

Question 44

Cytomegalovirus (CMV) signs and Sx: 1) General Sx 2) Pulmonary 3) GI 4) CNS 5) Hematology 6) Eye

Answer 44

1) Enlarged cells with viral inclusion bodies, commonly asymptomatic, fatigue 2) Pneumonia like symptoms 3) Abdominal pain, splenomegaly, colitis, transaminitis 4) Encephalitis 5) Cytopenia causes anemia/leukopenia 6) Retinitis

Question 45

Cytomegalovirus (CMV): 1) How do you Dx? 2) Tx?

Answer 45

1) PCR, culture, antigens in serology, elevated IgM (4-fold) 2) PO/IV ganciclovir

Question 46

Epstein-Barr Virus (EBV): 1) Etiology 2) Epidemiology; __________% of adults are seropositive

Answer 46

1) Double stranded, enveloped, linear, HHV-4 -Causes Mononucelosis; “kissing disease”: Shared by saliva 2) 90%

Question 47

Epstein-Barr Virus (EBV) (mono): 1) Signs and Sx? 2) How is it diagnosed? (2 ways) 3) Tx?

Answer 47

1) Posterior LAD, fever, malaise, splenomegaly, rash (esp: after ampicillin therapy) 2) Peripheral smear > atypical lymphocytes (Downey cells) -Monospot test > Heterophilic IgM antibodies 3) Supportive care and avoid contact sports.

Question 48

What is the EBV/ mono triad?

Answer 48

1) Fever 2) Lymphadenopathy 3) Pharyngitis

Question 49

Compare/ contrast CMV/ EBV

Answer 49

1) CMV: Encephalitis, meningitis, retinitis, pneumonia, transverse myelitis, prolonged cytopenia, exacerbation of the disease in ITP pts, death + colitis 2) EBV: Bilateral periorbital edema, pharyngitis, pneumonia, gastric carcinoma, febrile neutropenia, exacerbated AIHA, ^ risk of Reiter syndrome in CLL pts, development in HLH

Question 50

For CMV and EBV, describe their fever, cervical lymphadenopathy, generalized lymphadenopathy, exudative tonsillopharyngitis, & splenomegaly

Answer 50

1) CMV: more protracted fever, both lymphadenopathies less common (cervical <20%), exudative tonsillopharyngitis is rare, splenomegaly is less common. 2) EBV: fever common, both lymphadenopathies more common (generalized >80%), exudative tonsillopharyngitis common, splenomegaly more common

Question 51

Herpes Simplex: 1) Etiology (what are the 2 types) 2) Triggers? 3) Epidemiology?

Answer 51

1) Human herpesviruses type 1 (“oral”) and 2 (“genital”) -Transmission from close contact with a person who is shedding the virus 2) Sun, febrile illness, stress, immunosuppression 3) 90% of the population is seropositive

Question 52

Herpes Simplex: 1) S/Sx (include systemic) 2) How is it diagnosed? 3) Tx?

Answer 52

1) Primarily affects oral/genital areas. -Finger: Herpetic whitlow -Small grouped vesicles, accompanied by burning/stinging that crust when healing. -Systemic: Headache, lymphadenopathy, fever, dysuria 2) Clinical diagnosis, can do serology and PCR. Viral culture is definitive 3) Acyclovir. Can use valacyclovir or Famciclovir but dosing varies.

Question 53

List some Sx of neonatal herpes (vertical transmission). How is it treated?

Answer 53

1) Encephalitis 2) Blindness 3) Secondary infections 4) Hepatomegaly 5) Seizures -If positive test, needs admission, lumbar punctures, etc

Question 54

1) What is the most common cause of fatal encephalitis? 2) What is this cause also called?

Answer 54

1) Herpes simplex 2) Aseptic Meningitis

Question 55

1) What should you do if you suspect herpes has spread to the nervous system? What will this tell you? 2) What other test do you do? 3) What is the Tx?

Answer 55

1) Lumbar puncture for CSF: -WBC 10-100(75% lymphs) -Protein: Normal -Glucose: May be reduced -Culture: Negative 2) Have to send out special tests for herpes (PCR) 3) IV acyclovir x14- 21 days

Question 56

Herpes keratitis: 1) Define it 2) What can it cause? 3) When should you check for it?

Answer 56

1) Infection in the cornea 2) Scarring and blindness 3) With shingles (or with herpes with ocular Sx)

Question 57

Varicella-Zoster Virus: 1) Is also called what? Etiology? 2) Epidemiology?

Answer 57

1) Human Herpes Virus 3; reactivation in the posterior dorsal root ganglion. 2) Usually older population, decreasing due to vaccinations

Question 58

Varicella-Zoster Virus: 1) S/Sx? 2) How is it diagnosed? 3) How is it prevented?

Answer 58

1) Painful, lancing, dermatomal distribution followed by a rash within 2-3 days of pain. 2) Clinical evaluation. PCR can confirm. Used to use Tzanck smear to isolate multinucleated giant cells 3) Vaccine. (live)

Question 59

What syndrome can result from the Varicella-Zoster virus? Give its S/Sx

Answer 59

1) Ramsay Hunt Syndrome 2) Ear pain, facial paralysis, vertigo, vesicles on external auditory canal, loss of taste. -Ophthalmic: CN V1 distribution (around eye, forehead and tip of nose (Hutchinson sign) Postherpetic neuralgia.

Question 60

How is Varicella-Zoster Virus treated? (3 ways)

Answer 60

1) Symptomatic. Antivirals: Acyclovir, famciclovir, valacyclovir. 2) Ophthalmic: Emergent referral to ophthalmologist. 3) Postherpetic neuralgia: Gabapentin, TCAs, topical capsaicin/lidocaine

Question 61

Influenza: 1) Etiology 2) Epidemiology

Answer 61

1) Influenza type A, B or (less common) C. Hemagglutinin on the virus surface allows fusion to the host’s cell membrane 2) Antigenic drift > virus is able to mutate, creating new virulent strains > causes seasonal epidemics. -Antigenic shift > new combinations of antigens that create a reassortment of the viral genome >causes pandemics

Question 62

Influenza: 1) S/Sx 2) How is it Dx'd?

Answer 62

1) Sudden onset sore throat, rhinorrhea, non-productive cough, myalgias, GI s/s 2) Clinical, POC PCR tests via nasopharyngeal or pharyngeal sample

Question 63

Influenza: 1) Tx? 2) Is it reportable?

Answer 63

1) Supportive. Neuraminidase inhibitors (Oseltamivir) within 2 days of symptom onset; vaccination annually. 2) Yes

Question 64

Erythema Infectiosum: 1) Etiology 2) Epidemiology

Answer 64

1) Parvovirus B19 or HHV-5 “Slapped check rash” “Fifth disease” 2) 5-7 year old in the spring; incubation period 4-14 days.

Question 65

Describe the S/Sx of Erythema Infectiosum

Answer 65

1) Erythematous, maculopapular rash on cheeks Lacy reticular pattern on extremities or trunk. 2) Fever, coryza, sore throat, headache, abdominal pain. 3) Can suppress erythropoiesis.

Question 66

Erythema Infectiosum: 1) How is it diagnosed? 2) How is it treated?

Answer 66

1) Clinical. Maybe labs to rule out other diseases. 2) Tylenol for fevers, hydration

Question 67

Mumps: 1) Etiology? 2) Epidemiology?

Answer 67

1) Paramyxovirus 2) 500,000 cases world- wide, US cases went up in 2017-18

Question 68

Mumps: 1) Incubation period 2) S/Sx 3) What are less common Sx? 4) Is it reportable?

Answer 68

1) Incubation period: 12-24 days. (late winter) 2) Anorexia, malaise, low grade fever, otalgia. -Days 2-7 = glandular swelling, high fever, unilateral or bilateral parotitis > orchitis and oophoritis may also develop (can cause infertility) 3) Cranial nerve palsies, pancreatitis, myocarditis 4) Yes

Question 69

Mumps: 1) How is it diagnosed? 2) Treated? 3) Prevented?

Answer 69

1) Clinical diagnosis. Can use serology or culture PCR. Buccal swab, CSF, urine, seminal fluid as sources 2) Supportive care, Tylenol for fever, hydration 3) MMR Vaccination, live virus, Dose 1: 12-15 months and dose 2: 4-6 years.

Question 70

Measles/Rubeola: 1) Etiology 2) Epidemiology

Answer 70

1) Paramyxovirus (RNA virus) 2) Very contagious. 13 outbreaks in 2019. Before vaccines, 3-4 million.

Question 71

Measles/Rubeola: 1) S/Sx? 2) Dx?

Answer 71

1) Fever, coryza, cough, pink eye, Koplik spots, 1-2 weeks later rash on face then travels to trunk, palms and soles 2) Clinical. PCR if needed

Question 72

Measles/Rubeola: 1) Tx? 2) Prevention? 3) Is it reportable?

Answer 72

1) Supportive Care, +/- vitamin A 2) MMR vaccine; Dose 1: 12-15 months and Dose 2: 4-6 years 3) Yes

Question 73

Rubella/German Measles: 1) Etiology? 2) Epidemiology?

Answer 73

1) Etiology: Togavirus. Respiratory droplets. Can spread to fetus from mother 2) Children ages 6-9

Question 74

1) Describe some general S/Sx of Rubella/German Measles 2) What spots are a Sx? Describe them 3) What can measles-related congenital defects (especially with exposure during 1st trimester) lead to? Describe this

Answer 74

1) Days 12-23 incubation period = low-grade fever, sore throat, LAD. -Days 14-17 = Maculopapular rash that usually starts on the face. 2) Forchheimer spots: Tiny, erythematous petechiae on soft palate that precedes/accompanies the rash. 3) Congenital rubella syndrome: Fetal death, premature delivery, sensorineural hearing loss, congenital heart disease, cataracts

Question 75

Rubella/German Measles: 1) How is it diagnosed? 2) How is it treated?

Answer 75

1) Clinical diagnosis. -Labs/virology are done in pregnant woman, neonates or s/s of encephalitis. -Rubella IgM Ab or detection of viral RNA via PCR of throat/urine/nose 2) Supportive care. Hydration

Question 76

Rubella/ German measles: 1) How is it prevented? 2) Is it reportable?

Answer 76

1) MMR Vaccination: Live virus; dose 1: 12-15 months and dose 2: 4-6 years 2) Yes

Question 77

Roseola: 1) Etiology 2) Epidemiology

Answer 77

1) Human herpes virus type 6. “sixth disease” 2) Very common in children 9-24 months. 90% younger than 2 years

Question 78

Roseola: 1) Signs/ Sx 2) How is it diagnosed? 3) How is it treated?

Answer 78

1) Pink maculopapular rash that is blanchable and lasts two days. Starts on trunk and then spreads to the face. 3 days of high fever. 2) Clinical. Virology usually only if meningitis suspected 3) Tylenol for fever, hydration. If immunocompromised, Foscarnet and Ganciclovir

Question 79

Rabies: 1) Etiology 2) Epidemiology

Answer 79

1) Rhabdoviridae 2) Canines (dogs, foxes, coyotes) cats, bats, skunks and racoons

Question 80

Describe rabies signs and Sx

Answer 80

Fatal once symptoms begin; Incubation period:20-90 days 1) Nonspecific: fever, headache malaise. 2) Tingling/burning at bite site. 3) Prodromal period (2-10 days)N/V/D, sore/swollen thrat, fatigue/malaise, excessive salivation. 4) Acute neurologic period (2-7 days)Muscle fasciculations, convulsions. 5) Coma (usually within 10 days of neuro symptoms)

Question 81

Rabies: 1) How is it diagnosed? 2) How is it treated?

Answer 81

1) Diagnosis: Imaging usually normal. Skin biopsy direct fluorescent Ab testing. PCR of fluid tissue. CSF80% monocytosis. Brain tissue postmortem autopsy reveals Negri bodies. 2) Contact with a bat in any capacity is an absolute indication for postexposure prophylaxis. Postexposure ASAP (100% effective if administered before onset of symptoms) -4 doses of vaccine IM on days 0,3,7,14 extra dose on day 28 if immunocompromised

Question 82

COVID-19: 1) Etiology 2) Epidemiology 3) Risk factors

Answer 82

1) (Originated in bats), enveloped, single-stranded RNA novel coronavirus 2) Originally acquired at seafood and live animal market in Wuhan, China in late 2019. Multiple variants. (Alpha, delta, iota, omicron). 500 million confirmed cases. 6 million deaths 3) BMI>35, CKD, DM, Immunocompromised, Pregnancy, age>65, cerebral palsy,

Question 83

List the Sx of COVID-19 throughout the course of the illness (give the worst case scenario)

Answer 83

Incubation 4-7 days. Day 0: First symptoms Day 5: Dyspnea Day 7: Hospital Admission Day 8: Acute respiratory distress syndrome (ARDS) Day 12-18: Death

Question 84

Give some S/Sx of COVID-19

Answer 84

1) Asymptomatic in 18-33% 2) Fever, chills, myalgias, fatigue, anorexia 3) Pharyngitis, rhinorrhea, conjunctivitis, cough 4) SOB, hypoxia, chest pain, palpiatations 5) Decreased appetite, diarrhea, nausea and vomiting, 6) Headache, encephalopathy, dizziness, 7) Loss of smell (anosmia), altered taste (dysgenusia), rash 8) Pernio-like reactions “covid toes”,

Question 85

How is COVID-19 diagnosed?

Answer 85

-PCR testing. -No need to re-test after positive test (may remain positive for weeks). -Do not need to retest if exposed within the first 3 months.

Question 86

Describe the sensitivity and specificity of COVID-19 PCR tests

Answer 86

Test Sensitivity: Day 0: 0% Day 4: 33% **Day 5: 63%** Day 8-9: 80% Day 21: 34% Test specificity: >98%

Question 87

List additional labs that might be abnormal for COVID-19 pts

Answer 87

1) CBC: Leukopenia. Thrombocytopenia. 2) AST/ALT: mildly increased 3) CRP: elevated 4) Procalcitonin: Increased may suggested additional bacterial infection 5) D-Dimer: >1.5mcg/ml

Question 88

What does COVID-19 look like on imaging?

Answer 88

1) CXR may be normal in early disease -When not normal: Typical bilateral & peripheral predominate ground glass opacities (also consolidation, lower lobes/posterior distribution) 2) Lung US

Question 89

List potential complications of COVID-19

Answer 89

Pulmonary embolism CHF Myocarditis ARDS Acute coronary Syndrome CVA Renal Failure

Question 90

Describe COVID-19 management

Answer 90

1) Symptomatic and quarantine for most people 2) Prone positioning 3) High Risk patients -Monoclonal antibodies -Dexamethasone 6mg up to 10 days -Albuterol HFA inhaler as needed -Remdesivir (inhibits RNA synthesis)

Question 91

1) What are two ways to prevent COVID-19? 2) Is it a reportable disease?

Answer 91

1) Vaccination, quarantine 2) Yes