Lecture 8 (Travel med+military medicine)- Exam 4 Flashcards

Question 1

Q

Travel Medicine- Occupational Specialty
* Travel medicine is devoted to what?
* It is an interdisciplinary specialty concerned with what? (3)

Answer

A

Travel medicine is devoted to the health of travelers who visit foreign countries.

It is an interdisciplinary specialty concerned with:
* Prevention of infectious diseases during travel.
* Personal safety of travelers.
* Avoidance of environmental risks.

Question 2

Q

Travel Medicine- Occupational Specialty
* Where will patient present?

Answer

A

However, most patients will present to primary care pre-travel and emergency department post-travel.

Question 3

Q

Most common diseases in returning US Travelers
* Most common are what?
* What is the most potentially life threatening?

Answer

A

Most common are travelers’ diarrhea and respiratory infections.
Most potentially life-threatening is malaria.

Question 4

Q

Most common diseases in returning US Travelers
* What are 5 common diseases?

Answer

A

Diarrheal Disease
Malaria
Dengue/Zika/Chikungunya
Tuberculosis
Typhoid

Question 5

Q

What are the less common diseases? (4)

Answer

A

Yellow Fever
Japanese Encephalitis
Hepatitis A
Meningococcal Meningitis

Question 6

Q

Fever in the Returning Traveler
* According to the World Health Organization, the most common diseases in Ghana include those endemic to sub-Saharan African countries, are what?

Answer

A

particularlymalaria, cholera, typhoid, pulmonary tuberculosis, anthrax, pertussis, tetanus, chicken pox, yellow fever, measles, infectious hepatitis, trachoma, HIV and schistosomiasis

Question 7

Q

Fever in the Returning Traveler
* Returned travelers with fever should undergo at least the following investigations: (4)

Answer

A

CBC, Liver Enzymes, Electrolytes, Renal Function
Malaria Smears at least three times over 24-48 hours.
Blood cultures x 2
UA

Question 8

Q

Returned travelers with fever should undergo at least the following investigations:
* You need to cite what?
* The febrile traveler to a malaria-endemic area should be considered to have what?

Answer

A

Cite the travel history on the lab order.
The febrile traveler to a malaria-endemic area should be considered to have malaria until proven otherwise.

Question 9

Q

Where are the malaria endemic countries?

Question 10

Q

Malaria-
* what is the process of infection?

Answer

A

Parasite (Plasmodium) infects a mosquito that spreads to humans through mosquito saliva.
The parasite enters the liver cells and replicates.
The liver cell erupts, and the parasites enter red blood cells.
In the RBC, they hide from the immune system, continue to replicate, and become sticky.
The RBC bursts, releasing parasites.

Question 11

Q

Malaria-
* What is the type of mosquito?

Answer

A

Anopheles (Pregnant)

Question 12

Q

What are the 5 Type of Plasmodium Parasites cause Malaria?

Answer

A

Plasmodium falciparum (or P. falciparum)- The most prevalent and causes the majority of severe disease and deaths
Plasmodium vivax (or P. vivax)- the main cause of relapsing malaria; prevalent in SE Asia and Latin America
Plasmodium ovale (or P. ovale)
Plasmodium knowlesi (or P. knowlesi)
Plasmodium malariae (or P. malariae)

Question 13

Q

Malaria
* What are the areas of concern? (3)
* Who is at risk?(2)

Answer

A

Area of Concern: Africa, South/Central America, and Southeast Asia
At Risk (Epidemiology): In endemic countries, those at risk are young children and pregnant women.

Question 14

Q

Malaria
* Who is at high risk?
* For this reason, it is essential to consider malaria in who?
* Vaccine?

Answer

A

Travelers to malarious areas generally have had no previous exposure to malaria parasites or have lost their immunity if they left the endemic area; they are at high risk for severe disease if infected withPlasmodium falciparum.
For this reason, it is essential to consider malaria in all febrile patients with a history of travel to malarious areas.
No vaccine available

Question 15

Q

Malaria
* What are the sxs/presentation?

Answer

A

Fever. This is the most common symptom. The fever occurs in paroxysms/cyclical.
Chills.
Headache.
Sweats.
Fatigue.
Nausea and vomiting.
Body aches.
Generally feeling sick.
Jaundice +/-

Question 16

Q

Malaria
* how do you dx it? (3)

Answer

A

High Index of Suspicion
Blood smears and rapid tests available
Presumptive diagnosis

Question 17

Q

Malaria
* What is the treatment of uncomplicated disease with non-falciparum malaria?

Answer

A

Chloroquine (Mefloquine) (if not from an area that was Chloroquine resistant) or Artemisinin

Question 18

Q

Malaria
* What is the treatment of Severe Disease with P. Falciparum malaria or mild disease with P. Falciparum (in the United States)?

Answer

A

Administer oral antimalarial therapywhile obtaining IV artesunate. If oral therapy is not tolerated, consider administration via nasogastric tube or following an antiemetic.
Make a referral to infectious disease.

Question 19

Q

Malaria- Best Defense is Offense
* What is the prevention?
* Choice depends on what?

Answer

A

Options for chemoprophylaxis include atovaquone-proguanil, mefloquine, doxycycline, and tafenoquine; all four agents are highly efficacious for prevention of malaria.
Choice depends on where the traveler is going and local resistance rates.

Question 20

Q

Malaria- Best Defense is Offense
* Avoid outdoor exposure when?
* Wear what? (2)
* Sleep with what?
* Stay in what?

Answer

A

Avoiding outdoor exposure between dusk and dawn (when Anopheles mosquitoes feed)
Wearing clothing that reduces the amount of exposed skin
Wearing insect repellant (as described below)
Sleeping within bed nets treated with insecticide (eg,permethrin)
Staying in well-screened or air-conditioned rooms

Question 21

Q

What are the areas with zika?

Question 22

Q

Zika/Dengue/Chikungunya
* What type of virus?
* Transimitted how?
* What is the mosquito?
* The virus can live in what?

Answer

A

Flavavirus
All are RNA Viruses transmitted by a mosquito.
Mosquito: Aedes- feeds in the daytime.
The virus can live in the blood, urine, semen, CSF, saliva, breast milk, and amniotic fluid.

Question 23

Q

Question 24

Q

Zika/Dengue/Chikungunya
* Early phase is diagnose with what test? What happens if positive or negative?

Answer

A

Early phase- diagnose with PCR- if it’s positive- then that is positive but if it is negative- does not rule it out because the virus may have cleared because the body has created antibiodies- so then you have to do serology testing to look for IgM.

Question 25

Q

Zika/Dengue/Chikungunya
* What is the txt?
* Pregnancy?

Answer

A

Treatment- Supportive
* Tylenol- Not aspirin

DO NOT GET PREGNANT- FEMALE FOR AT LEAST 8 WEEKS AND MALES FOR AT LEAST SIX MONTHS

Question 26

Q

Yellow Fever- Hemorrhagic Fever
* What type of virus?
* Vaccine?
* Where are areas?
* Spread by what?

Answer

A

Flavavirus RNA Virus
Vaccine is good for life but not 100% effective.
Sub-Saharan Africa, South America
Spread by mosquitos (found in monkeys and humans are highly susceptible). Aedes Mosquito- feeds during the day.

Question 27

Q

Yellow Fever- Hemorrhagic Fever
* How is it spread?

Answer

A

Injected through mosquito saliva and replication begins at site of inoculation.
Spreads through lymphatics then reaches the bloodstream.
Large amounts of virus are then seeded in the liver, spleen and lymph nodes where is continues to replicate and release.

Question 28

Q

Yellow Fever- Hemorrhagic Fever
* What are mild symptoms?
* What are are the severe symptoms?

Answer

A

Mild symptoms:Fever, chills, headache, nausea, vomiting, muscle pain, and loss of appetite
Severe symptoms:Jaundice, bleeding, shock, organ failure, dark urine, stomach pain, and vomiting

Question 29

Q

Yellow Fever- Hemorrhagic Fever
* What are the fetal symptoms? (4)
* Dx with what?
* What is the treatment?
* Who is at risk of severe sxs?

Answer

A

Fatal symptoms:Delirium, seizures, coma, and death
Dx’s with PCR
Treatment- Supportive
At risk of severe symptoms: Older, white men

Question 30

Q

Japanese Encephalitis
* What are the areas of concern?
* What type of virus?
* How does it spread?
* Most at risk are what?

Answer

A

Area of Concern- Asia/Western Pacific
Flavavirus RNA Virus
Mosquito borne (pigs are infected). Humans are dead end hosts as they do not develop high levels of the virus.
Most at-risk are in rural areas for longer duration of travel.

Question 31

Q

Japanese Encephalitis
* the United States Advisory Committee on Immunization Practices (ACIP) which recommends what?

Answer

A

the United States Advisory Committee on Immunization Practices (ACIP) which recommends JE vaccine for individuals moving to a JE-endemic country to take up residence, longer-term (eg, ≥1 month) travelers to JE-endemic areas, and frequent travelers to JE-endemic areas

Question 32

Q

Japanese Encephalitis
* Most hunam JEV infections are what?
* Fewer than 1% of JEV infections result in what?
* However, when neurologic disease does occur, it is usually what/

Answer

A

Most human JEV infections are asymptomatic or cause a nonspecific febrile illness.
Fewer than 1 percent of JEV infections result in symptomatic neuroinvasive disease.
However, when neurologic disease does occur, it is usually very severe with a high case-fatality rate; among survivors, neurological sequelae are common.

Question 33

Q

Japanese Encephalitis
* What is the treatment?
* All travelers to JEV-endemic countries should be advised on what?

Answer

A

Treatment- supportive
All travelers to JEV-endemic countries should be advised on measures to prevent JE, and JE should be considered among the differential diagnoses for patients with suspected neurological infection who have returned from recent travel in a JEV-endemic country in Asia or the Western Pacific region.

Question 34

Q

Japanese Encephalitis
* Dx how?
* Should contact who?
* What is the txt?
* What is the mortality rate?

Answer

A

Diagnosed by antibodies.
Should contact the CDC and refer to ID
Treatment- Supportive care
Mortality in hospitalized patients is 20-30%.

Question 35

Q

Japanese Encephalitis
* When should you get a vaccine?

Answer

A

Longer duration of travel
* ●Travel during the JEV transmission season
* ●Spending time in rural areas
* ●Participating in extensive outdoor activities
* ●Staying in an accommodation without air conditioning, screens, or bed nets

Question 36

Q

Japanese Encephalitis
* However, if a person received the vaccine, but still came home with a fever, stiff neck, and headache, the next step

Answer

A

However, if a person received the vaccine, but still came home with a fever, stiff neck, and headache, the next step would be a lumbar puncture.

Question 37

Q

Typhoid Fever
* The organism classically responsible for the enteric fever syndrome is what?
* How do they infect the body?

Answer

A

The organism classically responsible for the enteric fever syndrome is Salmonella enterica serotype Typhi
These organisms are ingested and survive exposure to gastric acid before gaining access to the small bowel, where they penetrate the epithelium, enter the lymphoid tissue, and disseminate via the lymphatic or hematogenous route.

Question 38

Q

Typhoid Fever
* What is the only organism that can disease in humans?
* Vaccine?

Answer

A

S.enterica serotype Typhi causes disease only in humans; it has no known animal reservoir. Infection therefore implies direct contact with an infected individual or indirect contact via contaminated food or water.
Vaccine is available but is not 100% effective.

Question 39

Q

Typhoid Fever
* When do the onset of sxs occur?
* Majority of patients present with what?
* What happens on the 2nd week of illness?

Answer

A

Onset of symptoms- 5-21 Days after exposure.
Majority of patients present with abdominal pain, fever, and chills. +/- Diarrhea or Constipation
2nd Week of illness: rose spots” (faint salmon-colored macules on the trunk and abdomen) may be seen. (salmon colored rash)

Question 40

Q

Typhoid Fever
* What are the sxs of 3rd week?
* What happens to the sxs?

Answer

A

3rd week of illness, hepatosplenomegaly, intestinal bleeding, and perforation due to ileocecal lymphatic hyperplasia of the Peyer’s patches may occur, together with secondary bacteremia and peritonitis.
In the absence of acute complications or death from overwhelming sepsis, symptoms gradually resolve over weeks to months.

Question 41

Q

Typhoid Fever
* How do you dx and tx it?

Answer

A

Diagnosed by stool culture
Treatment- Fluoroquinolone, Zithromax, or ceftriaxone

Question 42

Q

Typhoid Mary
* What does it mean to the a chronic carrier of salmonella?

Answer

A

Chronic Carriers of Salmonellacarriage is defined as excretion of the organism in stool or urine >12 months after acute infection.

Question 43

Q

Typhoid Mary
* Chronic carriers appear to reach an immunologic equilibrium in which what happens?
* Management of chronic carriage generally consists of what?

Answer

A

Chronic carriers appear to reach an immunologic equilibrium in which they are chronically colonized (usually in the biliary tract) and may excrete many organisms but do not develop clinical disease.
Management of chronic carriage generally consists of antimicrobial therapy. If eradication is not achieved with antimicrobial therapy, cholecystectomy may be warranted.

Question 44

Q

Hepatitis A
* Hep A is caused by what?
* HAV is usually transmitted by what?

Answer

A

Hepatitis A infection is caused by the hepatitis A virus (HAV) Humans are the only known reservoir.
HAV is usually transmitted by the fecal-oral route (either via person-to-person contact or consumption of contaminated food or water).

Question 45

Q

Hepatitis A
* HAV can remain infectious on hands for how long? food? surfaces?
* What has never been described?

Answer

A

HAV can remain infectious on hands for several hours, on foods for several days, and on frozen foods, surfaces, and in feces for several months.
Maternal-fetal transmission has not been described.

Question 46

Q

Hepatitis A
* Infected individuals are contagious when?
* HAV replicates where? Where is it sheed?

Answer

A

Infected individuals are contagious during the incubation period (28 days) and remain so for about a week after jaundice appears.
HAV replicates in the liver and is shed in the stool in high concentrations from two to three weeks before to one week after onset of clinical illness

Question 47

Q

Hepatitis A
* In the United States, since vaccination was recommended for who?

Answer

A

In the United States, since vaccination was recommended for individuals at increased risk for infection (in 1996), for children living in states with the highest incidence of HAV (in 1999), and for all infants (in 2006), the rate has declined…. Until now- on the rise again.

Question 48

Q

Hepatitis A
* What are the sxs?
* Within a few days to a week, what appears?
* These are followed by what sxs?

Answer

A

Symptoms and signs begin with abrupt onset of nausea, vomiting, anorexia, fever, malaise, and abdominal pain.
Within a few days to a week, dark urine (bilirubinuria) appears; pale stools (lacking bilirubin pigment) may also be observed.
These are followed by jaundice and pruritus (40 to 70 percent of cases). The early signs and symptoms usually diminish when jaundice appears, and jaundice typically peaks within two weeks.

Question 49

Q

Hepatitis A
* What is elevated?
* Dx by what?
* Acute HAV infection in adults is usually what?

Answer

A

Elevated liver enzymes.
Diagnosed by serology (IgM/IgG)
Acute HAV infection in adults is usually a self-limited illness; fulminant hepatic failure occurs in fewer than 1 percent of cases.

Question 50

Q

Causes of Traveler’s Diarrhea

Question 51

Q

Causes of Traveler’s Diarrhea

Question 52

Q

Causes of Traveler’s Diarrhea
* What is the most common?
* What is highly contagious?
* What is beaver fever?

Answer

A

Enterotoxic e coli- most common
Norovirus- highly contagious
Giardia- “Beaver fever”

Question 53

Q

Traveler’s Diarrhea
* Defined as what?
* Episodes of travelers’ diarrhea are nearly always what?

Answer

A

Defined as passage of three or more unformed stools in a 24-hour period, accompanied by at least one of these other symptoms: nausea, vomiting, abdominal pain or cramps, fever, or blood in the stool.
Episodes of travelers’ diarrhea are nearly always benign and self-limited, but dehydration may be severe.

Question 54

Q

Traveler’s Diarrhea
* The organisms that cause travelers’ diarrhea are most often transmitted by what?
* Also transmitted in what settings?
* Generally, what is the course? Txt?

Answer

A

The organisms that cause travelers’ diarrhea are most often transmitted by food and water; therefore, the risk of travelers’ diarrhea is the highest in regions where sanitation and hygienic practices are poor and there is limited access to safe drinking water. Also, settings with inadequate electricity resulting in poor refrigeration can result in unsafe food storage and increased risk for disease.
Generally self-limiting and can be treated with loperamide and hydration. Dicyclomine is good option for crampy pain.

Question 55

Q

Traveler’s Diarrhea
* C. Jejuni (campylobacter) and Shigella: the initial symptoms are generally similar to those seen with what? Sxs may progress to what?

Answer

A

C. Jejuni (campylobacter) and Shigella: the initial symptoms are generally similar to those seen with ETEC, however, infections with these organisms may progress to include symptoms of colitis, such as fever, tenesmus, urgency, cramping, and bloody diarrhea.

Question 56

Q

Traveler’s Diarrhea
* When do you treat with antibiotics?
* What are the examples of antibiotics?

Answer

A

When to treat with antibiotics:
* Bloody or mucoid stools- get a stool culture first
* Prescence of fever- get blood and stool culture first
* Recent antibiotic use- test for c. diff
* Persistent diarrhea- further workup

Antibiotic- Azithromycin- single 1 gram dose
* Fluoroquinolones had previously been the first choice of treatment for travelers’ diarrhea; drug resistance has limited their utility.

Question 57

Q

under notes

Traveler’s Diarrhea
* Antibiotic chemoprophylaxis may be appropriate in what?

Answer

A

Antibiotic chemoprophylaxis may be appropriate in short-term (eg, <2 weeks) travelers who have an underlying medical condition that would increase the risk of complications from diarrhea or would be severely exacerbated by dehydration from diarrhea such that the benefits of using antibiotic prophylaxis outweigh its risks [2,46]. Such situations include known severe inflammatory bowel disease that could be exacerbated by an episode of infectious diarrhea; severe vascular, cardiac, or renal disease that would be seriously compromised by dehydration; or a severe immunocompromised state.

Question 58

Q

Traveler’s Diarrhea
* If antibiotic chemoprophylaxis is used, what should be used?

Answer

A

If antibiotic chemoprophylaxis is used, we suggest rifaximin, a non-absorbed antibiotic with a favorable safety profile that has been effective at preventing travelers’ diarrhea in several trials.

Question 59

Q

For giardia:
* What do you give for individal? What are two other options?

Answer

A

Tinidazole
* other options: Nitazoxanide and metronidazole

Question 60

Q

Meningitis
* What causes meningococcal disease?
* What are the five major serogroups?

Answer

A

Meningococcal disease is caused by Neisseria meningitidis.
The five major serogroups most associated with invasive disease are A, B, C, Y and W135

Question 61

Q

Meningitis
* What are the vaccines?

Answer

A

Quadrivalent conjugate meningococcal vaccines (Men-C-ACYW)
* Menactra® (meningococcal groups A, C, Y, and W-135 polysaccharides conjugated to diphtheria toxoid protein)
* Menveo™ (meningococcal groups A, C, Y and W-135 oligosaccharides conjugated to CRM197 protein)

Question 62

Q

Meningitis
* When should better get the vaccine?

Answer

A

Is recommended for travellers to the African meningitis belt – Particularly during high transmission season (Dec to June)

Question 63

Q

Meningitis
* At least 22 states require what?
* All11- to 12-year-old adolescentsshould receive what?
* How long is the vaccine good for?

Answer

A

At least 22 states require the meningococcal vaccine for students
All11- to 12-year-old adolescentsshould receive a MenACWY vaccine. Since protection wanes, CDC recommends a MenACWY booster dose atage 16 years. The booster dose provides protection during the ages when adolescents are at highest risk.
Effective for about 5 years and then you need a booster.

Question 64

Q

Military Culture-

Answer

A

Culture- The values, traditions, and behaviors that characterize the U.S. Armed Forces and shape the experiences of military personnel and their families.

Answer 60

A

Branches of the U.S. Military:
* Army, Navy, Air Force, Marine Corps, Coast Guard, and Space Force.

Military Structure:
* Enlisted Personnel: Non-commissioned officers (NCOs) and other ranks.
* Officers: Commissioned leaders responsible for command and decision-making.

Answer 61

A

Respect for authority, chain of command, and formal titles (e.g., addressing individuals by rank) is important.
Values and Traditions:Honor, duty, loyalty, courage, self-sacrifice, discipline, teamwork, and camaraderie.

Answer 62

A

American Culture- individualistic culture- prioritizes self over group- values independence and autonomy
American Military- prioritize needs of group over self. Mission before anything- Team before Self.

Answer 63

A

Fear of career repercussions, distrust of civilian providers, and reluctance to seek mental health care due to perceived weakness.

Multiple Fucked up trials:
* Tuskegee Syphilis Experiment (1932-1972)
* MK-Ultra (1950s-1973)
* Operation Whitecoat (1954-1973)
* Project 112/Project SHAD (1960s)
* Burn Pits
* Agent Orange

Answer 64

A

Recruitment and Training:
* Introduction to military life, including physical and mental conditioning.

Deployment and Combat Exposure:
* High-stress environments, separation from family, and exposure to trauma.

Answer 65

A

Reintegration and Transition to Civilian Life:
* Challenges related to finding new roles, mental health concerns, and adjusting to civilian norms.

Military Family Life:
* Frequent relocations, spouse employment challenges, and the stress on military children.

Answer 66

A

Reserve and National Guard Members Signed Up to Serve Part-Time, But They’re Deploying More Than Ever Before
* are increasingly deployed more frequently and for longer durations. This surge is due to the growing reliance on these units to supplement active-duty military in global missions and domestic emergencies.

Answer 67

A

The increased deployment strains members, their families, and civilian employers, who must navigate the demands of frequent service.

Answer 68

A

Frequent relocations, deployment separations, and financial stresses.
Healthcare Needs of Military Spouses and Children:
Mental health support for children facing deployment stress, access to consistent medical care, and addressing spouse employment and health needs.

Answer 69

A

about their service-related experiences, deployments, exposures to hazardous materials, combat situations, physical injuries, mental health impacts, and specific military occupational specialties, in addition to standard medical history questions, to fully understand their health needs and potential risks associated with their military service.

Answer 70

A

Per the Health Insurance Portability and Accountability Act (HIPAA), medical information may be disclosed to military commands in a variety of circumstances necessary for safety, fitness for duty determinations and mission requirements.

Answer 71

A

I acknowledge I am responsible to report medical (including mental health) and health issues that may affect my readiness to deploy or fitness to continue serving in an active status in accordance with Department of Defense Instruction 6025.19, Individual Medical Readiness. As a condition of continued participation in military service, I must report significant health information to my chain of command. In addition, I will authorize and facilitate disclosures of all health information by any non-DoD health care provider(s) to the Military Health System (MHS) and/or to my respective Reserve

Answer 72

A

Harm to self; harm to others; harm to mission; special personnel; inpatient care; acute medical conditions interfering with duty; substance abuse treatment program; command-directed evaluation

Answer 73

A

C) Reassuring them about patient confidentiality while explaining any mandatory reporting requirements.

Answer 74

A

Stigma surrounding mental health

Answer 75

A

Combat injuries, musculoskeletal disorders, hearing loss, and exposure to hazardous environments.

Answer 76

A

Mental Health:
* PTSD, anxiety, depression, traumatic brain injury (TBI), and substance use disorders.

Healthcare System Engagement:
* Navigating the Veterans Affairs (VA) system or military health system (TRICARE).

Answer 77

A

Higher rates of military sexual trauma (MST), reproductive health concerns, and gender-specific health disparities.

Answer 78

A

Chronic obstructive pulmonary disease (COPD):A common chronic disease among veterans
Type 2 diabetes:A common chronic disease among veterans
Alzheimer’s:A common chronic disease among veterans
Cancers:Some types of cancer are more common among veterans than non-veterans
Chronic kidney disease (CKD):Veterans are more likely to have CKD than non-veterans

Answer 79

A

Arthritis:A common condition among veterans, especially female veterans
Hypertension:A common condition among veterans, especially female veterans
PTSD:Affects 10–13% of veterans from the Vietnam, Gulf, Afghanistan, and Iraq Wars
Depression:A common mental health disorder among veterans

Answer 80

A

Number one killer of veterans: Heart disease and cancer.
The most common disability is tinnitus.

Answer 81

A

PTSD is the most common mental health disorder for male veterans, and depression is the most common for female veterans.

Answer 82

A

Diagnosis:
* Based on criteria from the DSM-5, including the presence of intrusive thoughts, avoidance, and altered cognition and arousal for over a month.

Treatment:
* Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), medications like SSRIs, and group therapy.

Answer 83

A

PTSD in veterans may be linked to combat experiences, leading to higher rates of co-morbidities like substance abuse.
The Primary Care PTSD Screen for DSM-5, or PC-PTSD-5, is a 5-item questionnaire with yes/no response options specifically designed for administration by primary care providers.

Answer 84

A

Burn Pits-an open-air area used by the military to burn solid waste, such as trash, chemicals, and medical waste.Burn pits are used when there is no equipment for burning solid waste or when there are more than 100 personnel at a location for more than 90 days. (PACT Act)

Answer 85

A

Asthma/COPD
Sinusitis/Rhinitis
Cancers
Sarcoidosis
Pleuritis

Answer 86

A

Gulf War Syndrome- widely used term to refer to the unexplained illnesses occurring in veterans of the 1991 Gulf War.

Symptoms
* Fatigue
* Musculoskeletal pain
* Cognitive problèm
* Skin rashes
* Diarrhea

Answer 87

A

Incubation Period
Rabies incubation typically lasts 1-3 months but can range from a few days to years. The closer the bite is to the brain, the shorter the incubation. This patient’s symptoms two weeks post-exposure are consistent with rabies’ timeline.
Early vs. Late Signs
Early signs: fever, malaise, tingling at the bite site.
Late signs: hydrophobia, encephalitis, paralysis. This patient shows both early (fever, tingling) and late signs (dysphagia, hyperactivity).
Immediate Management
Since rabies is almost universally fatal once symptoms start, palliative care is typically the focus. However, the Milwaukee Protocol (experimental) could be considered.

Answer 88

A

Effect of No PEP
Without PEP, rabies infection is almost inevitable after exposure to a rabid animal. PEP is most effective when administered immediately after exposure.

Prevention Policies
Military personnel should have pre-exposure rabies vaccines in high-risk areas. Additionally, post-exposure protocols should be easily accessible in deployment zones, and rapid medical evacuation for treatment is crucial.
Rabies vaccine– It is reasonable to administer rabies vaccine if the patient has not received a complete course of post-exposure prophylaxis (see”Rabies immune globulin and vaccine”). Viral clearance in rabies is associated with the development of an immune response, and an important hallmark of this response is the presence of neutralizing anti-rabies virus antibodies in the serum and cerebrospinal fluid [44].

Rabies Immune Globulin– As much of the RIG dose as is anatomically feasible should be infiltrated in the area around and in the wound at the same depth as the wound. Any remaining dose should be given intramuscularly and at a different intramuscular site than the vaccine (such as the opposite deltoid).

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Lecture 8 (Travel med+military medicine)- Exam 4 Flashcards

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