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INFECTIOUS DISEASE > MDT > Flashcards

MDT Flashcards

1
Q

Person or animal that harbors the 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

Exposure to a source of an infection; a person who has been exposed.

Does not imply infection; it implies possibility of infection

A

Contact

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3
Q

Capable 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

An organism that harbors a parasitic, mutualistic, or commensalism guest

A

Host

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5
Q

An organism that lives on or in a host organism and gets its food from or at the expense of its host

A

Parasite

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6
Q

Three main classes of human parasites

A

Protozoa

Helminths

Ectoparasites

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7
Q

An infectious agent or organism that can produce disease

A

Pathogen

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8
Q

Invasion of the body tissues of a host by an infectious agent, regardless if it causes disease or not

A

Infection

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9
Q

A 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

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

A

Reservoir

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11
Q

A pathogen that is transmissible from non-human animals (typically vertebrates) to humans

A

Zoonosis

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12
Q

An increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area

A

Epidemic

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13
Q

Carries the same definition of epidemic but is often used for a more limited geographic area

A

Outbreak

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14
Q

The constant presence of an agent or health condition within a given geographic area or population

A

Endemic

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15
Q

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

Any of a group of viruses that are transmitted between hosts by mosquitoes, ticks, and other arthropods

A

Arbovirus (arthropod-borne virus)

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17
Q

Resistance developed in response to an antigen (pathogen or vaccine) characterized by the presence of antibody produced by the host

A

Active Immunity

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18
Q

When a majority of a given group is resistant/immune to a pathogen. This confers protection to unvaccinated or susceptible individuals/group by reducing the likelihood of infection or spread

A

Herd Immunity

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19
Q

Transfer of active humoral immunity of ready-made antibodies produced by another host or synthesized.

Used when there is a high risk of infection and insufficient time for the body to develop its own immune response. Short term.

A

Passive Immunity

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20
Q

Describes any illness, impairment, degradation of health, chronic, or age-related disease

A

Morbidity

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21
Q

Time interval from a person being infected to the onset of symptoms of an infectious disease

A

Incubation period

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22
Q

Time interval from a person being infected to the time of infectiousness of an infectious disease

A

Latency period

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23
Q

An infection that is nearly or completely asymptomatic.

A subclinical infected person is an asymptomatic carrier of the infection

A

Subclinical infection

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24
Q

A combination of symptoms characteristic of a disease or health condition; sometimes refers to a health condition without a clear cause

A

Syndrome

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25
Q

Measure of death in a defined in a defined population during a specified time interval, from a defined cause

A

Mortality rate

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26
Q

Transmission occurs between an infected person and a susceptible person via direct physical contact with blood or body fluids

A

Direct contact

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27
Q

Transmission occurs when there is no direct human-to-human contact

A

Indirect contact

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28
Q

Often indicate the onset of a disease before more diagnostically specific signs and symptoms

A

Prodrome

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29
Q

Leading cause of domestically acquired arboviral disease in the U.S.

A

West Nile Virus

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30
Q

Organism that transports West Nile Virus

A

Culex Mosquito

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31
Q

Incubation period of West Nile Virus

A

2-6 days, can range 2-4

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32
Q

WNV

Mosquitoes become infected when they feed on infected _____; then spread the virus to humans

A

Birds

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33
Q

Considered ‘dead-end’ hosts for West Nile Virus

A

Horses and Humans

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34
Q

Should be considered in any febrile patient or acute neurologic illness with recent exposure to mosquitoes during the summer months in endemic areas

A

West Nile Virus

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35
Q

Acute systemic febrile illness accompanied by:

  • Headache, weakness, myalgia, or arthralgia
  • Gastrointestinal symptoms
  • Transient maculopapular rash
A

West Nile Virus

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36
Q

West Nile Virus lab diagnosis

A

IgM in serum or CSF

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37
Q

West Nile Virus Treatment

A

Pain control for headaches, antiemetic therapy and rehydration for
associated nausea & vomiting

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38
Q

Most patients with non-neuroinvasive WNV disease recover completely; however, fatigue, malaise, and weakness can linger for how long?

A

Weeks to months

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39
Q

Subtypes of Malaria

A

Falciparum

Vivax

Ovale

Malariae

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40
Q

Malaria is transmitted via:

A

Female anopheles mosquito

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41
Q

Incubation period of Malaria

A

7-30 days

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42
Q

Malaria Phase

SEXUAL CYCLE in a female Anopheles Mosquito

Begins when a female anopheles mosquito takes a blood meal from an infected human

Ends when the mosquito salivary glands are filled malaria parasites

A

Sporogony Phase

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43
Q

Malaria Phase

Asexual cycle in the human liver

A

Exoerythrocytic Phase

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44
Q

Malaria phase

Asexual reproduction in RBCs

Patient is SYMPTOMATIC at this stage

A

Erythrocytic Phase

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45
Q

Presentation of Malaria can be broken into what 2 broad categories?

A

Uncomplicated & Severe

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46
Q

Paroxysmal (cyclical) fever

Influenza-like symptoms including chills, headache, myalgias, and malaise

Jaundice & mild anemia secondary to hemolysis

A

Uncomplicated Malaria

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47
Q

Malaria with the following symptoms:

  • Small blood vessels infarction, capillary leakage and organ dysfunction
  • Altered consciousness
  • Hepatic failure and renal failure
  • Acute respiratory distress syndrome
  • Severe Anemia
A

Severe Malaria

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48
Q

Hallmark of Malaria

A

Paroxysmal fevers

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49
Q

Life cycle of malaria

A

48-72 hours

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50
Q

Both positive and negative Rapid Malaria Testing must always be confirmed by:

A

Microscopy

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51
Q

Two reliable-supply treatments for Malaria

A

Atovaquone-proguanil (Malarone)

Artemether-lumefantrine (Coartem)

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52
Q

Treatment of uncomplicated Malaria

A

Chloroquine phosphate 1g (600mg base) PO

THEN 0.5g in 6 hours

THEN 0.5g daily for 2 days

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53
Q

Treatment of malaria in areas with chloroquine resistance

A

Malarone (Atovaquone 250mg/Proguanil 100mg) 4 tabs PO QD for 3 days

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54
Q

Treatment for severe Malaria

A

Artesunate 2.4mg/kg IV at 0, 12, 24, 48 hours

Followed by doxycycline 100mg BID x 7 days after parenteral therapy

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55
Q

Treatment of P. ovale

A

Artesunate 2.4mg/kg IV at 0, 12, 24, 48 hours

Followed by Doxycycline 100mg BID x 7 days after parenteral therapy

Add Primaquine 52.6mg PO QD x 14 days

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56
Q

Malaria Prevention

The most important protective measures are:

A

Proper clothing and awareness

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57
Q

How many subtypes of dengue are there?

A

Four

DENV-1, DENV-2, DENV-3, DENV-4

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58
Q

Dengue is transmitted by which mosquito?

A

Aedes aegypti mosquito

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59
Q

Three phases of Dengue Fever

A

Febrile

Critical

Convalescent

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60
Q

Dengue Fever

Febrile stage typically lasts __ days and can be biphasic

A

2-7 days

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61
Q

Headache; retroorbital pain; muscle, joint, and bone pain; macular or maculopapular rash

Minor hemorrhagic manifestations

A

Dengue Fever

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62
Q

Mild Dengue Fever

Critical phase of dengue typically lasts ___ hours

A

24-48 hours

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63
Q

Mild Dengue Fever

Most patients clinically improve during the phase and move on to recovery and convalescence stage

A

Critical Stage

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64
Q

Mild Dengue Fever - ______ Stage

Plasma leakage subsides

Pt begins to reabsorb extravasated intravenous fluids, pleural, and abdominal effusions

Patient continues to improve, hemodynamic status stabilizes and diuresis ensues

A

Recovery

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65
Q

Dengue Fever

Hypotension develops, systolic blood pressure rapidly declines, and irreversible shock and death may ensue despite resuscitation efforts

A

Dengue Shock Syndrome

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66
Q

Dengue

Relatively accurate way to get a general determination a patients’ capillary fragility or hemorrhagic tendency.

A

Tourniquet Test

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67
Q

Dengue - Tourniquet

A positive test is ___ or more petechiae per square inch

A

10

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68
Q

Treatment for mild Dengue Fever

A

Hydration and Acetaminophen

Avoid skin injections and NSAIDs due to bleeding risk

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69
Q

Treatment for severe Dengue Fever

A

ICU-level monitoring and blood products

Maintenance of the patient’s body fluid volume is CRITICAL

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70
Q

Scientific name of Rocky Mountain Spotted Fever

A

R. rickettsia

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71
Q

Rocky Mountain Spotted Fever is transmitted by:

A

American dog tick (east of Rockies & Pacific Coast)

Rocky Mountain wood tick (Rocky Mountain region)

Brown tick (worldwide)

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72
Q

Incubation period for Rocky Mountain Spotted Fever

A

2-14 days

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73
Q

Rocky Mountain Spotted Fever is a rapidly progressive disease and without early administration of _______ can be fatal within days

A

Doxycycline

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74
Q

Fever, HA, GI symptoms, myalgias and rash

Rash usually presents 3-5 days after fever onset
-small flat pink macules on wrist, forearms, ankles and spreads to trunk

A

Rocky Mountain Spotted Fever

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75
Q

Rocky Mountain Spotted Fever late disease

R. rickettsia infects:

A

Endothelial cells that line blood vessels, causing vasculitis and bleeding or clotting in the brain or other vital organs

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76
Q

Rocky Mountain Spotted Fever

__% people have some type of rash

A

90%

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77
Q

Rocky Mountain Spotted Fever

Sign of severe disease

A

Petechiae

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78
Q

Treatment of choice for all tickborne rickettsia disease (Rocky Mountain Spotted Fever)

A

Doxycycline

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79
Q

Perform tick checks at __-hour intervals when training or operating in RMSF endemic areas

A

12 hour

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80
Q

Never let your personnel go >___ hours without a tick check

A

> 24 hours

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81
Q

Lyme Disease is transmitted via:

A

Blacklegged ticks

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82
Q

Incubation period for Lyme Disease

A

3-30 days

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83
Q

Reservoirs for Lyme Disease

A

Rodents (white foot deer mice, chipmunks, squirrels)

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84
Q

Vectors for Lyme Disease

A

Blacklegged ticks

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85
Q

Most cases, the tick must be attached for ___ hours or more before B. burgdorferi (Lyme) can be transmitted to the host

A

36-48 hours

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86
Q

Erythema migrans (red ring like rash)

Malaise, headache, fever, myalgia, arthralgia, lymphadenopathy

A

Lyme Disease

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87
Q

Cardiac manifestation of Lyme Disease

A

Conduction abnormalities, AV node block

Myocarditis pericarditis

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88
Q

Neurologic Manifestations of Lyme Disease

A

Bell’s palsy or other cranial neuropathy

Meningitis

Encephalitis

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89
Q

Late disseminated stage of Lyme Disease symptoms:

A

Same as acute disseminated stage with:

-Rheumatologic Manifestations

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90
Q

Treatment for EARLY Lyme Disease (Erythema migrans)

A

Doxycycline 100mg PO BID x 14 days

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91
Q

Treatment for early disseminated Lyme Disease (Bell’s Palsy)

A

Doxycycline 100mg PO BID x 14 days

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92
Q

Treatment for disseminated Lyme disease (Arthritis)

A

Doxycycline 100mg PO BID x 28 days

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93
Q

Lyme disease prevention medication post-exposure prophylaxis

A

Doxycycline 200mg PO 1 dose

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94
Q

Leishmaniasis organism type

A

Obligate intracellular protozoan PARASITE

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95
Q

Scientific name of Leishmaniasis

A

Leishmania tropica

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96
Q

Leishmaniasis is on every continent except:

A

AUS & Antarctic

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97
Q

Leishmaniasis is transmitted by:

A

Female phlebotomine sand flies

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98
Q

Incubation period of Leishmaniasis

A

2 weeks to several months and cases up to 3 years

Some >20 years

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99
Q

Most common manifestation of Leishmaniasis

A

Cutaneous Leishmaniasis

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100
Q

Begins as a pink colored papule that enlarges to a nodule or plaque-like lesion

Lesion ulcerates with indurated border and may have thick white-yellow fibrous material

Lesions are often painless

A

Cutaneous Leishmaniasis

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101
Q

Leishmaniasis lesions healing takes how long?

A

Months to years with noticeable scarring

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102
Q

Cutaneous Leishmaniasis Treatment

A

Ulcer debrided and cleaned

Anti-fungal

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103
Q

Incubation period of MRSA

A

Highly variable; typically 4-10 days but asymptomatic (years)

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104
Q

The highest risk of being bit by sand flies occurs at what time of day?

A

Dusk to dawn (typically bite at night and during twilight hours)

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105
Q

Any strain of S. aureus that has developed multiple drug resistance(s) to beta-lactam antibiotics

A

MRSA

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106
Q

CA-MRSA

A

Community Acquired

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107
Q

HA-MRSA

A

Hospital Acquired

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108
Q

Any strain of S. aureus susceptible (able to be killed by) beta-lactam antibiotics

A

MSSA

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109
Q

Most commonly manifestations of MRSA

A

Furuncles, carbuncles, and abscesses

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110
Q

Abscess with purulent drainage & fluctuance is a high suspicion for:

A

MRSA

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111
Q

MRSA treatment

A

I&D, packing, daily dressing changes

  • Bactrim
  • Clindamycin
  • Doxycycline
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112
Q

An acute or chronic inflammatory process involving bone & structures secondary to infection with pyogenic organisms, including, bacteria fungi, and mycobacteria

A

Osteomyelitis

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113
Q

Among younger adults osteomyelitis, occurs most commonly in:

A

Trauma (Penetrating injury) and related surgery

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114
Q

Among older adults, osteomyelitis occurs most commonly as a result of:

A

Contagious spread of infection from adjacent soft tissues and joints

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115
Q

Patients present with dull pain at the involved joint, with or without movement

Tenderness, warmth, erythema, and swelling

Fevers

A

Osteomyelitis

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116
Q

Treatment for Osteomyelitis

A

Surgical Containment

IV Vancomycin & IV Ceftriaxone

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117
Q

Human bites occur in two basic categories

A

Occlusive wounds (teeth closing over and breaking the skin)

Clenched-fist or “fight bites” (skin surface strikes a tooth)

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118
Q

Human Bites

Typical human oral and skin flora cause infection

A

Eikenella

Group A Strep

Fusobacterium

Staphylococci

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119
Q

Antibiotic prophylaxis for Human bites

A

Amoxicillin-clavulanate 875/125mg PO BID x 5 days

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120
Q

Hand wounds are examined in what positions?

A

Fingers extended & in the clenched-fist position

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121
Q

Scientific name for Tetanus

A

Clostridium tentani

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122
Q

Tetanus booster should be within ___ years

A

10 years

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123
Q

Incubation period for tetanus

A

3-21 days, usually about 8 days

Further the inoculation the site is from CNS the longer the incubation period

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124
Q

An acute, often fatal, exotoxin-mediated disease

Widely distributed in soil, and the intestines & feces of farm animals

A

Tetanus

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125
Q

C. tetani spores can survive autoclaving at _____ degrees Fahrenheit for 10-15 minutes

A

249.8 F

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126
Q

Tetanus

Passive immunization was first used for treatment & prophylaxis of allied forces during:

A

WWI

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127
Q

Inactivated tetanus toxin was developed in the 1920’s and first widely used for allied forces during:

A

WW2

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128
Q

What conditions allow germination of spores and production of two exotoxins, collectively called ‘tetanus toxin’

A

Anaerobic conditions

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129
Q

Minimum lethal dose in humans for tetanus toxin

A

2.5 ng per kg

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130
Q

Tetanus

Muscle rigidity and spasms occur secondary to the disinhibition of:

A

Lower motor neurons

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131
Q

Typically the first sign is trismus or lockjaw, followed by nuchal rigidity, dysphagia, and rigidity of abdominal muscles

Hyperthermia, diaphoresis, hypertension, episodic tachycardia

A

Tetanus

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132
Q

Tetanus

Death typically occurs secondary to:

A

Respiratory arrest

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133
Q

Treatment for Tetanus

A

Clean/deride wounds

Supportive therapy and airway protection

Antibiotics:

  • Metronidazole
  • Pen G
  • Tetanus Immune Globulin (500 units IM at different sites from the TDAP; part of the dose should be infiltrated around the wound)
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134
Q

When would patients with a completed 3-dose primary tetanus vaccination require a booster of TDAP?

A

Last documented dose of TDAP was > 5 years ago

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135
Q

Inflammation of the meninges that line the vertebral canal/skull enclosing spinal cord/brain

A

Meningitis

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136
Q

Inflammation of the brain itself

A

Encephalitis

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137
Q

Meningitis

Risk factors that increase clinical suspicion

A

Close contact exposure (barracks, dorms)

Incomplete vaccinations

Immunocompromised

> 65 y/o & < 5 y/o

Alcohol use disorder

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138
Q

Meningitis

Typically occurs through what two routes of inoculation?

A

Hematogenous seeding

Direct contagious spread

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139
Q

Febrile, HA, Nuchal rigidity, altered mental status

A

Meningitis

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140
Q

Labs/Rads for Meningitis

A

Lumbar puncture

CT

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141
Q

Treatment for Meningitis

A

Ceftriaxone 2g IV
OR
Pen-G 4 million units IV

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142
Q

Osteomyelitis

Antibiotics without activity against _______ should be avoided

A

E. corrodens

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143
Q

Meningitis

Chemoprophylaxis is indicated for close contacts of patients diagnosed with which types of meningitis?

A

N. meningitidis

H. influenzae type B meningitis

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144
Q

Chemoprophylaxis regimen for meningitis

A

Ceftriaxone 250mg IM one time
(or)
Ciprofloxacin 500mg PO one time

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145
Q

Mononucleosis organism type

A

Virus, one of 9 known human herpesviruses

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146
Q

Mononucleosis scientific name

A

Epstein-Barr virus

147
Q

Mononucleosis is transmitted via:

A

Bodily fluids, primarily saliva

148
Q

Mononucleosis

Has a high risk for __________ which can be fatal

A

Splenic rupture

149
Q

Presents consistent with erythematous or exudative pharyngitis or tonsillitis

Malaise, Fever, Cervical lymphadenopathy, Splenomegaly

Rash

A

Mononucleosis

150
Q

Mononucleosis

Diagnosis can be made clinically and confirmed with:

A

Monospot test (positive within 4 weeks after symptoms)

151
Q

Mononucleosis treatment

A

Bed rest, Acetaminophen or NSAIDs

Saline gargles 3-4 times

Treat symptomatically

152
Q

What drug class do you want to avoid when treated Mononucleosis?

A

Antivirals

153
Q

Mononucleosis

Fever resolves within ___ days

Lymphadenopathy and splenomegaly may persist upwards of ____ weeks

A

10 days

3-4 weeks

154
Q

Disposition due to risk of splenomegaly and splenic rupture

A

Light duty with no physical contact sports for 3-4 weeks

155
Q

Rabies scientific name

A

Lyssavirus

156
Q

How many lyssavirus genus’ cause rabies in the mammals?

A

All 14

157
Q

Incubation for Rabies

A

1-3 months, depends on site of inoculation

158
Q

Lethality of rabies

One the rabies virus reaches the CNS it has a __% fatality rate

A

99.9%

159
Q

Fatal, acute, progressive encephalomyelitis caused by neurotropic viruses in the family Rhabdoviridae, genus Lyssavirus

A

Rabies

160
Q

The only U.S. state that has never had a lab-confirmed case of rabies is:

A

Hawaii

161
Q

All mammals are believed to susceptible to infection, but major rabies reservoirs are:

A

Terrestrial carnivores and bats

162
Q

Clinical illness in humans begins following invasion of the peripheral nervous system; and then central nervous system; culminating in acute fatal encephalitis

A

Rabies

163
Q

First symptoms of Rabies

A

Pain and paresthesia at the site of exposure

164
Q

Anxiety, paresis, paralysis, and other signs of encephalitis; spasms of swallowing muscles can be stimulated by the sight, sound, or perception of water (hydrophobia); and delirium and convulsions can develop, followed rapidly by coma and death

A

Rabies

165
Q

Clinical rabies typically manifests as what two major forms?

A

Encephalitic “Furious”
-Fever, hydrophobia, pharyngeal spasms, hyperactivity subsiding to paralysis

Paralytic “Dumb”
-Ascending paralysis that is similar to Guillain-Barre

166
Q

Most characteristic feature of Rabies; patient becomes afraid of water due to involuntary pharyngeal muscle spasms when they attempt to drink

A

Hydrophobia

167
Q

Rabies

Pathognomonic pharyngeal muscle spasms triggered by feeling draft of air

Leads to aspiration, coughing, choking, and if severe asphyxiation and respiratory arrest

A

Aerophobia

168
Q

Diagnostic confirmation of rabies

A

Post-mortem brain tissue samples

169
Q

Rabies

Offending animals that appear well will be placed in isolation for ___ days for observation

A

10-14 days

170
Q

Diarrhea is defined as ___ or more loose or water stools within a 24 hour period

A

3 or more

171
Q

Acute Diarrhea = ___ days

Persistent = ___ days

Chronic = ___ days

A

Acute = < 14 days

Persistent = 14-30 days

Chronic = > 30 days

172
Q

Presents with blood in loose-water stools and fever

Secondary tissue damage to lining of the colon from certain bacteria, and/or toxins

A

Inflammatory Diarrhea

173
Q

Water stools with no blood & absence of fever

A

Non-inflammatory Diarrhea

174
Q

Community outbreaks of infectious Diarrhea are highly suggestive of:

A

Common food source, or viral etiology

175
Q

Bacterial Etiologies of infectious Diarrhea

A

Enterotoxigenic Escherichia coli

Campylobacter jejuni

Shigella spp.

Salmonella spp.

Bacterial toxin-releasing

176
Q

Viral Etiologies of Infectious Diarrhea

A

Norovirus

Rotavirus (primarily children)

177
Q

Protozoal etiologies of infectious Diarrhea

A

Giardia

Entamoeba histolytica

178
Q

Viral infectious Diarrhea

A

Norovirus

179
Q

Norovirus activity peaks during what season

A

Winter

180
Q

Predisposing factors for Viral infectious Diarrhea

A

Ready-to-eat cold foods (sandwiches and salads)

Raw shellfish especially oysters, contaminated ice

Close quarters living with high population density

181
Q

Viral infectious Diarrhea is transmitted via:

A

Fecal-oral route

Aerosols of vomitus

Contaminated environmental surfaces/objects

182
Q

Incubation period for Viral infectious Diarrhea

A

12-48 hours

183
Q

Acute onset of nausea, vomiting, and non-bloody diarrhea

Abdominal cramps, and sometimes a low-grade fever

Illness is generally self-limited, and full recovery can be expected in 1-3 days for most patients

A

Viral infectious Diarrhea

184
Q

E. coli

AKA Traveler’s diarrhea or Montezuma’s revenge

A

Enterotoxigenic E. coli (ETEC)

185
Q

E. coli

Also called Shigatoxigenic Escherichia Coli or STEC

A

Enterohemorrhagic E. coli (EHEC)

186
Q

E. coli Inflammatory Diarrhea is transmitted via:

A

Fecal-oral route

187
Q

Salmonella

Most common clinical presentation of infection

A

Gastroenteritis

188
Q

Symptoms typically consist of acute diarrhea, abdominal pain, fever, and vomiting for 4–7 days. Patients typically recover without treatment

A

Salmonella

189
Q

Salmonella Inflammatory Diarrhea

Treatment for patients with severe diarrhea, high fever, or manifestations of extraintestinal infection

A

Fluoroquinolones

190
Q

Transmission routes for Campylobacter infectious Diarrhea

A

Eating contaminated foods (undercooked chicken/raw chicken)

Contaminated water or unpasteurized milk

191
Q

Characterized by diarrhea (frequently bloody), abdominal pain, fever, and occasionally nausea and vomiting.

Severe infections can include dehydration, bloodstream infection, and mimic acute appendicitis or ulcerative colitis.

Generally self-limiting & lasting < 1 week

A

Campylobacter

192
Q

Diarrhea of the _______ tend to be more frequent, smaller volume and are often more painful.

Fever, bloody stools, or mucus tends to be more common

A

Large bowel

193
Q

Diarrhea of the _______ origin tend to be larger volume and watery and will tend to have more abdominal cramping, bloating and gas

A

Small bowel

194
Q

Diarrhea within 6 hours of food consumption is suggestive of toxin possible from:

A

S. aureus

B. cereus

195
Q

Diarrhea between 8-16 hours after eating suggests

A

C. perfringens

196
Q

Diarrhea >16 hours after eating suggests

A

Viral or other Bacterial etiology

197
Q

Reptiles have ______ on skin

A

salmonella

198
Q

Diarrhea

Hiking or outdoor recreation where patient may have drunk stream water would indicate:

A

Giardia

199
Q

Diarrhea

Being on a ship where others have had recent illness would indicate:

A

Norovirus

200
Q

Protozoal Parasitic infectious Diarrhea is caused by:

A

Giardia

201
Q

Most common intestinal parasitic disease affecting humans

A

Giardia

202
Q

Incubation period for Giardiasis

A

1-14 days; mean of 7

203
Q

Giardia life cycle

  • Infectious form of the parasite
  • Excreted in stool and can survive in wet environments
  • After ingestion excystation occurs in the proximal small bowel releasing trophozoites
A

Cyst Form

204
Q

Giardia life cycle

  • Flagellated parasites adhere to proximal small bowel
  • Trophozoites that pass to large intestine revert to cysts and excreted into the environment
A

Trophozoite Form

205
Q

Acute Giardiasis

Symptoms typically develop in __ weeks after exposure and resolve within ___ weeks afterwards

A

1-2 weeks

2-4 weeks

206
Q

Symptoms

  • Diarrhea (foul-smelling & greasy)
  • Abdominal cramps, bloating, flatulence, fatigue, anorexia, and nausea

Gradual onset of 2-5 loose stools per day and gradually increasing fatigue. Weight loss may occur over time.

Fever and vomiting are uncommon.

A

Giardiasis

207
Q

Giardiasis lab diagnostic tests

A

Antigen detection assays

Stool microscopy

208
Q

Giardiasis Stool microscopy

Diagnostic sensitivity increased by examining up to __ stool specimens over several days

A

3

209
Q

Giardiasis treatment

A

Tinidazole

Metronidazole

210
Q

Giardia

Patients need to be excluded from going into water until asymptomatic for ___ hours

A

48 hours

211
Q

General treatment guidelines for infectious diarrhea

A

Rule out more serious pathologies

Rehydration

BRAT (bananas, rice, applesauce, toast) diet

Patient education regarding hygiene

212
Q

Infectious Diarrhea

Symptomatic therapy/conservative treatment for mild-moderate in the absence of fever & bloody stools.

A

Loperamide

Bismuth subsalicylate

213
Q

Severe fluid loss from infectious diarrhea should be treated with:

A

1-2 liters of LR

214
Q

Severe fluid loss from infectious diarrhea

What tests should be utilized as a metric for improvement?

A

Orthostatic hypotension tests

215
Q

When to consider antibiotics for infectious diarrhea?

A

Severe disease (Fever, >6 stools/day, signs dehydration)

Blood or mucoid stools with no clinical suspicion of E. coli

216
Q

Infectious diarrhea

E.coli 0157:H7: specific strain of E.coli associated with

A

Undercooked fast-food hamburger meat

217
Q

Infectious Diarrhea

Antibiotic treatment has no clinical benefit in a patient with
0157:H7, and can significantly worsen outcomes by causing:

A

Hemolytic Uremic Syndrome (HUS)

218
Q

Most cases of non-inflammatory diarrhea are self-limiting and resolve within:

A

48-72 hours

219
Q

Any patient suspected of having infectious diarrhea shall be removed from food handling & food preparation duties until symptom free for:

A

24 hours

220
Q

When to consider MEDADVICE or MEDEVAC for a patient with infectious diarrhea

A

Fever >101.3

Blood in stool

Severe Dehydration (with inability to rehydrate)

Multiple patients presenting at once with similar symptoms

Inability to control symptoms with medication

221
Q

Influenza scientific name

A

Orthomyxovirus

222
Q

Subtypes of influenza

A

A/B/C/D

223
Q

Influenza subtypes that cause illness in humans

A

A & B

224
Q

Influenza viruses spread from person to person primarily through:

A

Respiratory droplet transmission

225
Q

Incubation period for influenza

A

24-96 hours

226
Q

Influenza can cause severe illness and death typically at what ages?

A

> 65 or <2

227
Q

Epidemics of influenza usually occur during which months?

A

Fall and winter months

228
Q

Influenza

Adults are infectious from 1 day prior to symptom onset to __ days after symptom onset

A

5-7 days

229
Q

Flu

Infectiousness is highest within __ days of onset and correlated with fever

A

3 days

230
Q

Children and immunocompromised/severely ill may shed the flu virus for ___ days after onset of symptoms

A

> 10 days

231
Q

Two distinct glycoproteins which are necessary for viruses to enter cells and are also how influenza undergoes periodic changes

A

Hemagglutinin (H1, H2, H3)

Neuraminidase (N1 and N2)

232
Q

Avian influenza glycoproteins

A

A(H5N1)

A(H7N9)

233
Q

Swine-origin glycoproteins

A

A(H1N1)

A(H1N2)

A(H3N2)

234
Q

Fever/chills (> 100.8 F), myalgias, headache, malaise,
occasional nausea, sometimes vomiting

Nonproductive cough, sore throat, rhinitis, substernal
soreness, nasal congestion

Predominantly localized to the respiratory tract; include
nasal discharge, pharyngeal inflammation without
exudates, and occasionally rales on chest auscultation

A

Influenza

235
Q

Influenza typically resolves within __ days

A

1-7 days

236
Q

Treatment goal for influenza

A

Alleviate and control symptoms while preventing spread to others

237
Q

Antiviral medication for Influenza that can shorten the duration of fever and other symptoms and reduce the risk of complications

A

Oseltamivir 75mg PO BID

238
Q
  • Transmitted through consumption of contaminated water or food and certain sex practices.
  • Infections are typically mild, with most making a full recovery & gaining lifelong immunity.
  • Most people in areas of the world with poor sanitation have been infected with this virus.
  • Safe and effective vaccines are available
A

Hepatitis A Virus (HAV)

239
Q

-Transmitted through exposure to infective blood, semen,
body fluids, contaminated blood products, and IV drug use.

  • Poses risk to healthcare workers (needle stick injuries).
  • Safe and effective vaccines are available
A

Hepatitis B Virus (HBV)

240
Q

Transmitted through exposure to infective blood, contaminated blood & blood products, and IV drug use.

Sexual transmission is possible but less common.

There is no vaccine

A

Hepatitis C Virus (HCV)

241
Q

Infections occur only with Hepatitis B infection

Dual infection, results in a more serious disease and worse outcome

Hepatitis B vaccines provide protection

A

Hepatitis D Virus (HDV)

242
Q

Transmitted through consumption of contaminated water or
food.

Common cause of hepatitis outbreaks in developing nations.

Vaccines exist but are not widely available.

A

Hepatitis E Virus (HEV)

243
Q

No vaccination for Hepatitis C but can be cured with:

A

Antiviral Treatment

244
Q

Hepatitis

Can both remain dormant in the liver and cause chronic hepatitis & hepatocellular carcinoma

A

Hep B & Hep C

245
Q

Fatigue, fever, muscle/joint pains, runny nose, pharyngitis,
nausea, vomiting, anorexia

  • Low grade fever
  • Hepatomegaly with liver tenderness
  • Jaundice and scleral icterus
  • Right upper quadrant abdominal pain
A

Hepatitis

246
Q

Hepatitis

Within __ weeks, jaundice & RUQ pain develops

A

1-3 weeks

247
Q

Lab diagnostic test for Hepatitis

A

Hepatitis panel serologic testing

248
Q

Lab findings for Hepatitis

A

WBC = Normal or low

UA = Proteinuria and Dark urine (bilirubinuria)

LFT = Increased levels of AST and ALT

  • Viral: ALT>AST
  • Alcoholic: AST>ALT

CMP Elevated bilirubin and alkaline phosphates

249
Q

TB scientific name

A

Mycobacterium tuberculosis

250
Q

Subtypes of TB

A

Multi-drug resistant TB (MDR-TB)

Extensively drug-resistant TB (XDR-TB)

251
Q

TB is transmitted via:

A

Contagious patient coughs, spreading bacilli through the air

252
Q

Leading infectious cause of death worldwide

A

TB

253
Q

Characterized by local granulomatous inflammation in periphery of the lung (GHON focus) may be accompanied by ipsilateral lymph node involvement (GHON complex)

A

TB

254
Q

Vaccines against TB

A

Bacille Calmette-Guerin (BCG)

Interferon-Gamma Release Assays (IGRAs)

  • QuantiFERON – TB Gold In-Tube test (QFT–GIT)
  • SPOT TB test (T–Spot)
255
Q

TB vaccination may cause a false positive reaction to a TB skin test.

A

BCG

256
Q

Positive result on the following labs:

(a) Tuberculin skin test (TST)
(b) Purified protein derivative (PPD)
(c) Positive QuantiFERON Gold blood test
(d) Positive IGRA-TB blood test

Patient is infected with M. tuberculosis but does not have active TB disease

A

Latent TB

257
Q

Labs and Rads for Latent TB

A

(1) Positive TST/PPD or blood test
(2) Normal CXR
(3) Negative acid-fast sputum test

258
Q

TB

Document History on which form?

A

NAVMED 6224/7, Initial TB Exposure Risk Assessment

259
Q

Latent TB infection

Baseline LFTs are indicated in patients who have:

A

Elevated risk for liver disorder (heavy/regular ETOH use)

260
Q

LTBI regimens

A

Isoniazid & rifapentine (3HP) PO once a week x 12 weeks.

Rifampin PO QD x 16 weeks

Isoniazid PO QD for 6-9 months, plus Pyridoxine PO QD for
6-9 months to mitigate peripheral neuropath

261
Q

The provider must rule-out active TB before started the treatment for LTBI via:

A

Labs and Chest X-ray

262
Q

LTBI

Who should you consult for preferred treatment regimen and the likelihood of drug-resistant strains in the region?

A

Local NEPMU/MTF

263
Q

LTBI

Monthly follow up is required and will be documented on which form?

A

NAVMED 6224/9

264
Q

Where do you document successful completion of LTBI?

A

Medical Record

265
Q

Active TB is denoted from which three terms?

A

Post-primary TB

Reactivation TB

Active TB

266
Q

Prolonged & productive cough with or without hemoptysis, chest discomfort & pain, low-grade fever, decreased appetite & anorexia, unexplained weight loss, night sweats

A

Active TB infection (pulmonary)

267
Q

TB

Most common in adults (60%–80%). Can occur years to decades after primary infection after immunological impairment.

A

Post-primary Re-activation TB

268
Q

Lab test

Measures immune response to TB antigens

Does not differentiate LTBI & ATB

A

IGRA-TB

269
Q

TB

Screening and provisional testing, not confirmatory

Does not differentiate between active LTBI and ATB

A

Tuberculin Skin Test (TST)

270
Q

Gold standard for confirmatory TB diagnosis

Can differentiate between LTBI and ATB

A

Sputum Test - Acid-Fast Bascillus (AFB) with NAAT

271
Q

What might you find on a CXR for a patient with Post-primary Re-Activation TB:

A

Fibrosis/scarring, cavitations

Enlargement of hilar and mediastinal lymph nodes

272
Q

Patients with suspected/known active TB immediately get _______ to minimize aerosolization of respiratory secretions and spread

A

Surgical masks

273
Q

Active TB

Medical department must wear:

A

Particulate respirators (N95)

274
Q

TB

Medical event report must be submitted within:

A

24 hours

275
Q

Suspected or confirmed case of active TB, the SMDR notifies _______ as soon as possible

A

Cognizant NEPMU

276
Q

TB

Follow routine testing and screening guidelines from which instruction?

A

BUMEDINST 6224.8C

277
Q

TB Prevention

Ensured TST/PPD is conducted during which timeframes?

A

Pre-deployment and Post-deployment

278
Q

Anthrax scientific name

A

Bacillus anthracis

279
Q

Predisposing factors for Anthrax

A

Working with any unvaccinated animal that is a common reservoir

More common in ranchers, leather workers, veterinarians, wildlife researchers

280
Q

Incubation period for Anthrax

A

Cutaneous anthrax 1-7 days; 17 days in rare cases

281
Q

Zoonotic disease primarily affecting ruminant herbivores such as cattle, sheep, goats, antelope, and deer that become infected by ingesting contaminated vegetation, water, or soil

A

Anthrax

282
Q

Four main clinical presentations of Anthrax

A

Cutaneous

Ingestion

Injection

Inhalation

283
Q

Most common form of anthrax in humans (95-99%)

A

Cutaneous

284
Q

Hallmark of cutaneous anthrax

A

Eschar with extensive surrounding edema

285
Q

Small, painless, pruritic papules emerge anywhere from 1 – 12 days after exposure

Papules enlarge rapidly to vesicles or bulla (blisters)

Vesicle or bulla start to erode and leave painless black necrotic ulcer

A

Cutaneous Anthrax

286
Q

Treatment for Anthrax

A

Refer to an infectious disease specialist

Antibiotics

  • Ciprofloxacin
  • Levofloxacin
  • Doxycycline
287
Q

If untreated, cutaneous anthrax may result in:

A

Sepsis

Meningitis

288
Q

Scientific name for Chlamydia

A

Chlamydia trachomatis

289
Q

Most frequently reported bacterial STI in the U.S

A

Chlamydia

290
Q

Chlamydia transferred from mother to child can cause:

A

Infant blindness “trachoma”

291
Q

Known as a ‘silent’ infection because most infected people are asymptomatic & lack abnormal physical examination findings.

A

Chlamydia

292
Q

Male presentation for chlamydia

A

Urethritis

  • CLEAR WATERY discharge
  • Dysuria is most common complaint
  • Scant discharge on underwear usually presents in the morning
293
Q

Female presentation for chlamydia

A

Urethritis

  • Dysuria
  • Pyuria
  • Increased urinary frequency

Cervicitis

  • Increased vaginal discharge
  • Intermenstrual vaginal bleeding
  • Dyspareunia
294
Q

___% of chlamydia and gonorrhoeae co-infections

A

> 50%

295
Q

Gold standard for laboratory diagnosis for Chlamydia

A

Nucleic Acid Amplification Testing (NAAT)

-UA or discharge swab

296
Q

Preferred treatment for Chlamydia

A

Doxycycline 100mg PO BID for 7 days

297
Q

Antibiotic of choice for chlamydia if concerned for coinfection with gonorrhea

A

Ceftriaxone

298
Q

Untreated chlamydia can cause:

A
  • Pelvic Inflammatory Disease
  • Pre-term delivery in women who are pregnant
  • Reactive Arthritis
299
Q

Gonorrhea scientific name

A

Neisseria gonorrhoeae

300
Q

Incubation period for Gonorrhea

A

1-14 days, can be as short as 2-4

301
Q

Male presentation for gonorrhea

A

Dysuria

-White/yellow/green urethral discharge

302
Q

Female presentation for gonorrhea

A
  • Dysuria, increased vaginal discharge, or vaginal bleeding
  • Lower abdominal discomfort
  • Dyspareunia
303
Q

Diagnostic lab tests for Gonorrhea

A

GC/NAAT

Culture (important due to antibiotic resistant strains)

304
Q

__% of gonorrhea infections are resistant to at least one antibiotic

A

50%

305
Q

Emergence of fluoroquinolone-resistant N. gonorrhoeae left _________ as the sole remaining class available for treatment of gonorrhea in the U.S.

A

Cephalosporins

306
Q

Treatment for Gonorrhea

A

Ceftriaxone 500mg IM single dose

AND

Doxycycline 100mg PO BID x 7 days

307
Q

STI screening includes:

A

Gonorrhea

Chlamydia

HIV

RPR for syphilis

HPV vaccination counseling

308
Q

Scientific name for syphilis

A

Treponema pallidum

309
Q

Incubation period for Syphilis

A

10-90 days; average is 21 days

310
Q

Stages of Syphilis

A

Primary Syphilis

Secondary Syphilis

Latent Stage

Tertiary Syphilis

311
Q

Begins as a painless papule that proceeds to ulcerate. Ends as a to 1-2cm painless ulcer with raised margins. This is called a chancre.

Lymphadenopathy is typically in the inguinal lymph nodes.

Chancre lasts 3 to 6 weeks and heals.

A

Primary Syphilis

312
Q

Skin rashes and/or mucous membrane lesions (sores in the mouth, vagina, or anus)

Syphilitic rash is characterized by diffuse non-pruritic maculopapular eruption on the trunk and extremities that includes the palms and soles.

Additional symptoms may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue.

A

Secondary Syphilis

313
Q

Stage is a period of no visible signs or symptoms of syphilis.

Without treatment, the patient will continue to be infected but will not realize it.

A

Latent Stage

314
Q

Rare and develops in a subset of untreated syphilis infections that appear 10–30 years after infection and can be fatal.

Cardiovascular syphilis

Neurosyphilis

  • General paresis
  • Tabes dorsalis

Gummatous syphilis

A

Tertiary syphilis

315
Q

Diagnostic tests for Syphilis

A

Serologic test (the standard)

Nontreponemal tests (RPR)

Treponemal test (FTA-ABS) (confirmatory test)

316
Q

Nonspecific Syphilis test, not definitive

Can be falsely positive (Lupus, mononucleosis, pregnancy)

Need to be confirmed with treponemal test

A

RPR

317
Q

Standard treatment for all stages of syphilis

A

Penicillin G

318
Q

Treatment for Primary Syphilis

A

Penicillin G 2.4 million units IM once

PCN allergy: Doxycycline 100mg PO BID x 14 days

319
Q

Treatment for secondary syphilis

A

Penicillin G 2.4 million units IM once weekly for 3 weeks

Doxycycline 100mg PO BID x 4 weeks

320
Q

An acute febrile reaction frequently accompanied by headache, myalgia, fever, that can occur within 24 hours after initiation of therapy for syphilis.

Reaction occurs most frequently among persons who have early syphilis, presumably because bacterial burdens are higher during these stages.

A

Jarisch-Herxheimer reaction

321
Q

Trichomoniasis organism type

A

Anaerobic, flagellated protozoan PARASITE

322
Q

Trichomoniasis scientific name

A

Trichomoniasis vaginalis

323
Q

Incubation period for Trichomoniasis

A

5-28 days

324
Q

T. vaginalis principally infects ______ epithelium in the urogenital tract

A

Squamous epithelium

325
Q

Purulent, malodorous discharge, burning, pruritis, dysuria, dyspareunia

Physical exam: erythematous vulva, green-yellow malodorous discharge

A

Trichomonas

326
Q

Trichomonas lab diagnostic tests

A

Wet mount prep

NAAT

327
Q

Treatment for trichomonas

A

Metronidazole 2g PO single dose or 500mg BID x 7 days

No alcohol consumption during treatment and 24 hours after completion

328
Q

Trichomonas

Abstain from sex until they have been treated and asymptomatic for __ days

A

7 days

329
Q

HSV scientific name

A

Human alphaherpesvirus 1 & 2

330
Q

Incubation period of HSV

A

2-12 days; average is 4 days

331
Q

Severe. painful genital ulcers

Dysuria

Fever

Local inguinal lymphadenopathy

A

Primary infection HSV

332
Q

Unilateral small vesicular lesions on erythematous base or ulcerative lesions “dew drops on a rose petal”

May have mild tingling or shooting pains in buttocks and legs prior to recurrent episode

A

Recurrent HSV infection

333
Q

Acute treatment for Primary HSV infection

A

Acyclovir

Valacyclovir

Famciclovir

334
Q

Reactivation of HSV can be triggered by:

A

Stress, menstruation, anxiety

335
Q

Scientific name of HPV

A

Human papilloma virus

336
Q

Most common strains of HPV causing anogenital warts

A

Types 6 & 11

337
Q

HPV strains that are high-risk subtypes for developing a malignancy

A

16 & 18

338
Q

Most common STD in the world

A

HPV

339
Q

Incubation period for HPV

A

2 weeks to 1 year

340
Q

Anogenital lesions may be found on the penis, vulva, vagina, cervix, perineum, and the anal region.

-Usually appear as raised, skin-colored, fleshy papules that
range in size from 1-5 mm.

-They can be broad and flat, pedicled, or occasionally have a cauliflower-like appearance

A

HPV

341
Q

HPV Treatment

A

Topical therapies

Cryotherapy

Surgical excision

342
Q

HPV treatment should be pursued if:

A

Lesions that persist for more than two years if the lesions are symptomatic, or for cosmetic purposes.

343
Q

HPV topical therapies

A

Imiquimod cream

Podophyllotoxin Solution

344
Q

HPV treatment

Inexpensive, minimally painful, and safe during pregnancy

Weekly treatment for 6-10 weeks.

A

Cryotherapy

345
Q

HPV therapy that has a clearance rate near 100%

A

Surgical excision

346
Q

HPV

Infection is preventable with:

A

Vaccination (Gardasil)

347
Q

Who should get vaccinated against HPV?

A

All females and males 11-26 years of age

348
Q

9 of every 10 cases of cervical cancer are caused by:

A

HPV

349
Q

HPV can cause what types of cancer?

A

Female: Cervix, Vagina, Vulva

Male: Penis

350
Q

Scientific name for HIV

A

Human immunodeficiency virus

351
Q

Subtypes of HIV

A

HIV-1 & HIV-2

352
Q

Incubation period for HIV

A

2-4 weeks

353
Q

Untreated survival timeframe for HIV

A

9 to 11 years

354
Q

Sex workers have a __x higher infection rate of HIV than the general population

A

12x

355
Q

The acute phase of HIV infection is called:

A

Acute Retroviral Syndrome (ARS)

356
Q

Fever, maculopapular rash, arthralgia, myalgia, malaise, lymphadenopathy, oral ulcers, pharyngitis, and weight loss.

The presence of fever and rash have the best positive predictive value

A

Acute Retroviral Syndrome (acute phase of HIV)

357
Q

HIV laboratory testing

A

Screening test: OraQuick ADVANCE Rapid HIV-1/2 Antibody test

Confirmatory test: 4th Gen HIV immunoassay

358
Q

HIV PrEP

A

Pre-exposure prophylaxis

359
Q

HIV PrEP Guidelines

A

DHA IPM 18-020: Guidance for HIV (PrEP) for Persons at High Risk

360
Q

Initiation of PrEP requires:

A

Negative 4th gen HIV test within 7 days if infection is not suspected

Negative 4th gen HIV test & Nucleic Acid Test within 7 days if infection is suspected

361
Q

HIV PEP

A

Post-exposure Prophylaxis

362
Q

Medication type that has improved life expectancy for HIV patients

A

ART

363
Q

HIV in Military Service Members instruction

A

DoDI 6485.01

364
Q

DoDI member with HIV

Clinical evaluations required by military infectious disease physicians at least every ____ months after diagnosis

A

6-12 months

INFECTIOUS DISEASE (7 decks)

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