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Clin Med II - Exam 4 > Schoenwald - Malaria and Tick Borne Illnesses > Flashcards

Schoenwald - Malaria and Tick Borne Illnesses Flashcards

1
Q

malaria symptoms are characterized as

A

cyclical

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2
Q

3 sx of malaria

A

f/c

ha

myalgia

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3
Q

most cases of malaria in US can be attributed to

A

returning travelers

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4
Q

85% of all malaria cases are from (2)

A

Africa

India

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5
Q

93% of malaria cases are from

A

sub Saharan Africa

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6
Q

severe malaria migrates to the

A

brain

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7
Q

sx of severe malaria

A

sx

confusion

renal failure

ARDS

coma → death

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8
Q

5 forms of malaria

A

falciparum

vivax

ovale

malariae

knowlesi

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9
Q

mc transmission of malaria

A

mosquito

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10
Q

besides mosquito, 4 other modes of transmission for malaria

A

transfusion

organ transplant

needle sharing

mother to fetus

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11
Q

malaria is a parasite of the

A

RBC

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12
Q

1st lifecycle of malaria affects the __,

if undetected, it moves to __

A

liver

RBC

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13
Q

__ hx is very important in suspected malaria

A

travel

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14
Q

gs (and most sensitive) test for malaria

A

blood smear → thick AND thin

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15
Q

blood smear for malaria determines (2)

A

species

%parasitemia

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16
Q

when is blood smear for malaria ideally done

A

during episode of fever

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17
Q

less sensitive test for malaria

A

rapid diagnostic tests

PCR (more sensitive than rapid)

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18
Q

rapid tests for malaria need confirmation via

A

microscopy

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19
Q

prevention for malaria (5)

A

insect repellent

caution at night

mosquito netting

permethrin containing clothes, tents etc

malaria chemoprophylaxis

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20
Q

what insecticide should be used for malaria prophylaxis

A

permethrin

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21
Q

what prophylaxis for malaria has resistance issues

A

chloroquine

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22
Q

chemoprophylaxis options for malaria (5)

A

atovaquone

doxycycline

mefloquine (lariam)

primaquine

tafenoquine (arkoda, krintafel)

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23
Q

mc used malaria prophylaxis

A

atovaquone/proguanil (malarone)

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24
Q

dosing for atovaquone/proguanil (malarone)

A

daily through 7 days after return

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25
Q

malaria prophylaxis causes sun sensitivity

A

doxycycline

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26
Q

dosing for doxycycline prophylaxis

A

through 30 days after return

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27
Q

which class of malaria prophylaxis should be avoided in pt’s w. g6pd deficiency

A

quines →

chloroquine

mefloquine (lariam)

primaquine

tafenoquine (arkoda, krintafel)

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28
Q

which malaria prophylaxis has a high rate of s.e

A

mefloquine (lariam)

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29
Q

s.e of mefloquine (lariam)

A

dpn

confusion

night terrors

hallucinations

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30
Q

dosing for mefloquine

A

weekly through 4 weeks post return

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31
Q

what malaria drug is used for prophylaxis AND antirelapse

A

primaquine

used in combo w. other prophylaxis

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32
Q

protozoa mc associated w. recurrent malaria

A

p vivax

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33
Q

dosing for primaquine

A

daily for 7 days after return

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34
Q

newest malaria prophylactic

A

tafenoquine (arkoda, krintafel)

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35
Q

dosing for tafenoquine (arkoda, krintafel)

A

3 days prior to travel

then weekly thru 1 week after return

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36
Q

benefit of tafenoquine (arkoda, krintafel)

A

shorter dosing duration

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37
Q

tx in US for malaria

A

atovaquone/proquanil 4 tablets po qd x 3 days

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38
Q

malaria infections are more severe in

A

pregnant

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39
Q

best malaria prophylaxis for pregnant pt

A

avoid travel to malaria regions

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40
Q

only fda approved prophylaxis for pregnant

A

chloroquine

mefloquine

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41
Q

what malaria prophylactic is contraindicated in pregnant

A

doxycycline

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42
Q

malaria and pregnancy is associated w. (3)

A

premature births

spontaneous abortions

stillbirth

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43
Q

dengue fever is also called

A

bone break fever

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44
Q

sx of dengue fever (3)

A

extreme muscle/body aches

fatigue

fever

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45
Q

what kind of virus is dengue fever

A

flavivirus

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46
Q

dengue fever is endemic to (3)

A

asia

central america

africa

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47
Q

reinfections w. the same strain of dengue are usually __,

reinfection w. different strain of dengue can be __

A

same strain: less severe

different strain: more severe

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48
Q

can we test for different strains of dengue

A

no!

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49
Q

tx for dengue

A

symptomatic

50
Q

__ is absolutely contraindicated in tx for dengue

bc it can cause __

A

NSAIDs

hemolytic anemia

51
Q

the __ mosquito causes west nile virus

A

culex

52
Q

is the culex mosquito found in US?

A

yes, it is prevalent in US

53
Q

west nile virus can be asymptomatic, or symptoms can include (6)

A

ha

ams

fever

body aches

rash

meningitis

54
Q

prevalence of rash in west nile virus

A

1 in 150

55
Q

symptom that is unique to wnv

A

flaccid paralysis

56
Q

flaccid paralysis in wnv can be __

or become __

A

self-limiting

permanent

57
Q

dx for wnv

A

IgG/IgM serologies in blood or spinal fluid

58
Q

tx for wnv

A

supportive

59
Q

tick borne illnesses (3)

A

lyme dz

rickettsial dz

babesia

60
Q

pathogen responsible for lyme dz

A

spirochete borrelia burgdorferi

61
Q

what type of tick causes lyme dz

A

ixodes ricinius (deer tick)

62
Q

lyme dz is endemic which parts of the US (3)

A

northeastern

north central

coastal regions

63
Q

incubation period for lyme dz

A

3-32 days

64
Q

4 types of sx associated w. lyme dz

A

dermatologic

rheumatologic

neurologic

cardiac

65
Q

dermatologic sx associated w. lyme dz

A

erythema migrans w.in 30 days of exposure

66
Q

stages of lyme dz

A
  1. early
  2. conduction abnormalities
  3. persistent
67
Q

sx of stage 1 of lyme dz (4)

A

erythema migrans in 75%

fever

myalgias

fatigue

68
Q

sx of stage 2 of lyme dz

A

AV block in 5%

+/- onset of bell’s palsy

+/- lymphocytic meningitis

69
Q

sx of stage 3 of lyme dz

A

arthritis type sx

70
Q

t/f chronic lyme dz is clinically validated

A

f!

71
Q

dx for lyme dz (2)

A

hx of exposure

ELISA followed by western blot

72
Q

problem w. serology for lyme dz

A

often negative in 1st few weeks

73
Q

adult tx for lyme dz

A

doxycycline 100 mg po bid x 21 days

74
Q

tx for lyme dz < 8 yo

A

amoxicilin 50 mg/kg/day divided into 3 doses (q 8 hr) x 14-21 days

75
Q

tx for lyme dz in pregnant pt

A

amoxicillin

76
Q

what do you think when you see maltese cross formation in RBC

A

babesia

77
Q

what type of tick causes babesia

A

ixodes scapulaaris

78
Q

sx of babesia (4)

A

hemolytic anemia

fatigue

body aches

+/- fever, hsm, hepatomegaly

79
Q

tx for babesia

A

atovaquone 750 mg po bid

PLUS

azithromycin 500-1,000 mg qd x 7-10 days

80
Q

what pathogen causes spotted fever/rocky mtn spotted fever

A

rickettsia

81
Q

occurrence of spotted fever

A

worldwide

southeastern US

82
Q

cardinal sx of spotted fever

A

maculopapular rash progressing to petechiae

83
Q

maculopapular rash associated w. spotted fever starts on __

and spreads to __

A

hands/feet

body

84
Q

other sx associated w. spotted fever

A

fever

ha

abd pain

85
Q

dx for spotted fever (2)

A

PCR

acute AND convalescent sera

86
Q

sera testing for spotted fever

A
87
Q

tx for spotted fever

A

doxycycline 100 mg po bid x 14 days

88
Q

tx for spotted fever in pregnancy

A

chloramphenicol

89
Q

what do you think when you see morulae

A

anaplasma and ehrlichia

90
Q

what are morulae

A

inclusions in wbc

91
Q

sx of anaplasma and ehrlicia (2)

A

fever

myalgia

92
Q

anaplasma and ehrlichia are __ borne

A

tick

93
Q

colorado tick fever is primarily found in colorado and

A

idaho

94
Q

what do you think when you see pain behind the eyes, fever, rash, ha

A

colorado tick fever

95
Q

lab findings of colorado tick fever

A

low platelet counts on CBC

96
Q

tx for colorado tick fever

A

supportive

platelets normalize in a few weeks

97
Q

what flavivirus has a cross rxn w. wnv

A

zika

98
Q

sx of zika (2)

A

f/n/v

body aches

99
Q

main risk of zika is in __ population

A

pregnant

100
Q

what congenital birth defect is associated w. zika

A

microcephaly

101
Q

dx for zika

A

PCR on serum and/or urine

IgM

102
Q

tx for zika

A

supportive

103
Q

pt ed for pt w. travel hx to zika zone

A

3 months of abstinence → can spread in seminal fluid

104
Q

what drug should be avoided in zika

A

nsaids

105
Q

stages of yellow fever

A

incubation

acute

relapse

106
Q

incubation period of yellow fever

A

3-6 days

107
Q

sx of acute yellow fever

A

fever

myalgias

ha

backache

n/v

followed by initial improvment

108
Q

what % of pt’s relapse after acute yellow fever

A

15%

109
Q

what do you think when you see, jaundice, hemorrhagic sx, shock, multiorgan failure

A

relapse of yellow fever

110
Q

__% of the 15% of pt’s w. relapsed yellow fever die

A

50%!

111
Q

yellow fever is a __virus

A

flavivirus

112
Q

dx for yellow fever is based on (3)

A

area of travel

clinical presentation

hx of immunization

113
Q

definitive dx for yellow fever

A

contact cdc for guidance

serology and nucleic acid available but not reliable

114
Q

is there a tx for yellow fever

A

no!

115
Q

what tx should be avoided in yellow fever (and all flaviviruses)

A

NSAIDs

116
Q

can anyone administer the yellow fever vaccine

A

no! need certification

117
Q

yellow fever vaccine is a __ vaccine

and should be avoided in __

A

live

pregnancy

118
Q

caution in yellow fever vaccine in pt’s > __

dt risk for __

A

60 yo

yellow fever vaccine associated viscerotropic dz (YFV-AVD)

119
Q

what are the flaviviruses we need to know (4)

A

yellow fever

dengue fever

west nile virus

zika virus

120
Q

pharm to avoid in flaviviruses dt risk of hemorrhagic dz

A

NSAIDs

121
Q

what are flaviviruses

A

RNA viruses w. arthropod vectors that cause serious human dz

Clin Med II - Exam 4 (20 decks)

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