Travel Med Flashcards
1
Q
2500 m = _____ ft
A
8000
2
Q
Acute Mtn Sickness- alttude
A
2500 m (8000 ft)
3
Q
Aedes vector for 5 virus CRuDZY
A
DEN, CHIK, YF, RVF, Zika
4
Q
After dive, avoid flying for:
A
>12 h after no-compression dive >18 h after repetitive or after decompression diving >24 h after altitude diving
5
Q
after drop effect
A
Core temp drop if blood flow to extremities first -> repurfusion acidosis
6
Q
airline and cruise EGA restrictions
A
32-36 air, 28 boat
7
Q
altitude and pregnancy (2)
A
try to sleep below 3600 m NO acetazolamide
8
Q
Anopheles vector for
A
malaria, ONY
9
Q
Arterial gas embolism- cause, timing
A
lung barotrauma causing CVA and MI with 10 min of surfacing; cause 3% dive deaths
10
Q
Bartonella- 3 types, vectors, disease
A
B. bacilloformis – sand fly- bartonellosis B. henselae- flea- cat scratch, bacillary angiomatosis, endocarditis B. quintana- louse- trench fever, endocarditis, bacillary angiomatosis
11
Q
BCG side effects
A
ulcer or abscess weeks later
12
Q
Bismuth reduces travelers diarrhea by
A
55% take QID
13
Q
black fly vector for (3)
A
onchocerciasis, M. Ozzardi, dirofilariasis
14
Q
Cholera vaccine- indication
A
epidemics 2 doses 1-6 weeks apart (depending on type age down to 1 or 2)
15
Q
Chrysops deerfly vector for (2)
A
Loa, Francisella tularensis
16
Q
Ciguatera poisoning- agent, source, sx (2), Tx
A
Gambierdiscus toxicus (a flagellate) heat resistant
gastroenteritis/vomit 1-6 hours; paresthesias, pruritis and myalgia may persist months
hot/cold reversal
warm-water reef fish, oysters, clams
supportive Tx
17
Q
Contraindication to DTaP
A
Encephalopathy within 1 week of previous DTaP/DTP
18
Q
Contraindication to Hep A
A
Anaphylactic reaction to 2-pheooxyethanol or alum
19
Q
Contraindication to IPV
A
Anaphylactic reaction to neomycin, streptomycin or polymyxin B
20
Q
contraindications to MMR
A
reaction to prior MMR, Immunosuppression, Thrombocytopenia, Gelatin or neomycin allergy, Pregnancy
21
Q
Contraindications to nasal flu (4)
A
< 2 YO, egg allergy, lung disease, pregnant
22
Q
Culex vector for
A
LF, JE, WNV, VEE, WEE, EEE
23
Q
DDx subconjunctival hemorrhage (4)
A
Leptospirosis, scrub typhus, hantavirus renal, dengue, measles
24
Q
decompression illness
A
Inadequate elimination of nitrogen from tissues during ascent, causing muscle aches and pains
25
Decompression sickness
nitrogen bubbles forming in tissues on resurfacing- cause 2% dive deaths
26
DEET can also inhibit (2)
schisto, tick (typhus)
27
elderly less likely to get (3)
motion sickness, diarrrea, AMS
28
Flea is vector for (6)
Bacteria: B. henslae, R. felis, R. typhi, Y. pestis Parasite: Dipylidium caninum, tungiasis
29
frequency of post-infectious IBS
25%
30
frostbite- def, Tx, good prognosis
ice crystals in tissue rapid rewarm, avoid refreeze early clear blebs and edema
31
Glossina Tsetse fly vector for
Trypansomsoma brucei
32
Hajj- attendees, illnesses (lung, blood, nasal)
3 million from \> 180 countries 75% get Hajj cough- environmental, TB, flu, pneumonia, MERS HIV and hepatitis from shaving by barbers PAM- nasal abolution
33
health contraindications to fight
10 days after chest or abdominal surgery 14 days from MI or CABG Uncontrolled CHF, Sz, HTN, DM, psych
34
health precautions to flying (4)
Anemia Cerebrovascular disease SS Pulmonary- dry cabin air
35
heat exhaustion vs heat stroke
weak, confusion vs collapse, uncontrolled fever, organ damage
36
Hep A vaccine use in endemic?
No. Kids usually mild and Asx.
37
Hepatitis B vaccine contraindications (2)
previous allergy, yeast allergy
38
High altitude cerebral edema (HACE)- Sx, Tx
Sx: ataxia, confusion Tx: immediate descent. Dexamethasone may buy time
39
High altitude contraindications
Uncontrolled CHF, pulm HTN, SS, mod-severe COPD (not asthma); Hx HAPE, HACE
40
High Altitude Pulmonary Edema (HAPE)- fame, Tx
most common cause of altitude death descent, O2, EPAP, nifedipine (steroid NO help)
41
high eosinophlilia related to
trichinosis, visceral larva migrans, microfilaria, onchocerciasis, ascariasis, hookworm, schistosomiasis, or liver or lung flukes
42
HIV malaria prophylaxis interaction
mefloquine and ART
43
how effective is 1st dose of measles
97%
44
how long for meningitis, YF and polio to be effective
10 d, 10 d, 4 wks
45
how long until YF vaccine effective
10 d
46
how often are diarrhea studies positive- what percentages
1/3 pos 70% bacterial, 15% viral
47
HPV strains related to CA, related to warts, in vaccine
16, 18, 31. 33 6, 11 (6, 11,) 16. 18
48
Huntington's response
cold induced vasodilation in intermittent 5-10 min cycle at 10 degrees C
49
hyperthermia
\>40
50
hypothermia
\< 35
51
hypothermia levels
\< 35 mild (passive rewarming), \< 33 moderate (active rewarming), \< 28 severe (stop resuscitation at 32 if no response)
52
immersion injury
non-freeze cold injury like trench foot
53
Immunization contraindicated in pregnancy
MMR, VZV, other live
54
Immunization in immunocompromised (3)
no BCG regardless no YF IF symptomatic HIV maybe no roto IF symptomatic HIV
55
Infections from animal bites (5)
rabies, tetanus, pasteurellosis, bartonella, herpes B virus...
56
jellyfish stinger removal and Tx
credit card, sea water, Windex, vinegar (anemone and coral also have neumatocysts); box jelly antivenom (AUS)
57
live typhoid coverage vs IM
Paratyphoid B but not A
58
Live vaccines- 9
MMR, OPV, Yellow fever, Vaccinia, Varicella, Nasal influenza, BCG, Cholera, Oral typhoid
59
Louse vector for (3)
Epidemic typhus (R. prowazekii) Trench fever (B. quintana) Relapsing fever (Borrelia recurrentis)
60
lower age limits on sunscreen, DEET
6 mo, 2 mo
61
Malaria emergency Tx
Malarone 4 tabs x 3 d Artemether/lumefantine (Coartem) 4 tabs for 6 doses Mefloquine 250 mg- 3 tabs, then 2 tabs 6-12 h later
62
malaria prophylaxis and breast feeding
any
63
Measles vaccine contraindications
pregnancy, severe immunocompromised neomycin or gelatin allergy (OK egg allergy) thrmobocytopenia
64
measles vaccine side effects
10% get rash week later 1/3000 have Sz
65
mefloquine black box warning
dizzy may be permanent, psych may persist yrs
66
Menactra and Menveo cover which strains
A, C, Y, W135
67
midge/culicoides vector for
mansonella
68
MMR timing for travelling infant
6 mos, repeat in 1 month if still travelling
69
mosquito day biter infections (2)
dengue, chik
70
mosquito night biter infections (3)
malaria, WNV, JE
71
Most common malaria in travellers
vivax
72
myiasis vs tungiasis
African tumbu/botfly Sand flea
73
nasal flu contraindications
\< 2 YO asthma/COPD pregnancy/immunocompromised (NO egg issue)
74
Neurotoxic shellfish poisoning- source, Sx
Red tide dinoflagellate concentrating in shellfish, ingest or inhaled wave GI, paraesthesia, ataxia
75
Nitrogen narcosis/ depth, Tx
depths greater than 70 ft or 100 ft clears on resurfacing.
76
Norovirus- incubation, duration, spread
1-2 d \< 4 d FO, P2P, fomites
77
number traffic deaths annually
1.3 million
78
only required vaccines
YF for certain countries in AF and SAM Meningitis for Mecca polio before leaving a few endemic areas (Cameroon, Pakistan, Syria)
79
OPV risk
1/250K get paralytic polio use IPV in low endemic areas
80
osborne J wave
on EKG, notched R wave wider than RBBB
81
Paralytic shellfish poisoning- agent, source, onset, Tx
Dinoflagellate- concentrated in mollusk so Shellfish, seafood Potent toxin
82
percent sulfa allergy getting rash with acetazolamide
7%
83
permethrine can also inhibit (2)
tick (typhus), triatomine (Chagas)
84
Pigbel vaccine- target, geo, schedule
to Clostridium perfringens toxin type 3 used in Papua New Guinea 2, 4, 6 mo
85
pregnancy stand by malaria Tx
malarone x 3 d
86
pregnancy travel contraindications
multiple, malpresentation, hyperemesis, FGR, abruption, active labor, cervical incompetence, PTL, PROM, ectopic, toxemia
87
preventing malaria in first pregnancy in Africa
sulfadoxine/pyrimethamine at prenatal visits
88
Resistant to alcohol
Cryptosporidium, norovirus, anthrax
89
Sand fly/phlebotmus vector for (3)
leishmania sand fly fever Bartonella bacilliformis
90
scombroid poisoning- Sx, source, signs
histidine in fish causing allergic reaction heat resistant only prevention is to store fish properly tuna, mackerel, bonito, skipjack and canned fish may describe a peppery, salty, or spicy taste
91
sea urchin spine removal and Tx
surgical, hot water (heat labile toxin)
92
stool studies for chronic diarrhea
O+P AF for cryptosporidia, cyclospora, isospora Giardia Ag C. dif toxin
93
tetrodotoxin
neurotoxin from puffer/fugu
94
Tick vector for
viral: CCHF, TBE, KFD, OMSK, POW, CTF Bacterial: Lyme, Borrelia, Ricketsial (Spotted, Q fever), tularemia Dermacentor (RMSF, CTF, tularemia, Siberian tick typhus, tick paralysis) Ixodes (Lyme, babesia, human granulocytic ehrlichiosis,)
95
Transplant pts and vaccines
avoid live for 2 yrs and other for 3-6 mo
96
travel health risks per 100K
1 death 300 hospital 8000 see doc 50% some health issue
97
travel mortality- top 2, bottom
45% CV 25% accident 1% ID
98
Travelers diarrhea- geo
Latin Americia- EAEC Asia- Campylo, Plesiomonas, Aeromonas Africa- Aeromonas
99
Travelers diarrhea- incidence, peaks, duration, incubation
Incidence 35% per 2 weeks Peak days 2-4 and 10-12 d Duration 2-5 d bacterial or viral Incubation , 4 d
100
Triatomine bug vector for
Trypanosoma cruzi/Chagas
101
Tropical sprue- geo, cause, Tx
Asia, SAM ? doxy 6 wks with folate
102
Tropical Sprue- geo, Sx, Tx
chronic diarrhea from Asia, South America Malabs, B12 and folate def, steatorrhea No causative agent found Responds to 6 weeks TTC and folate
103
Tularemia- 5 presentations
Ulceroglandular, Glandular, Oculoglandular, Oropharyngeal, Pneumonic
104
typhoid vaccine re-booster
oral- 5 yrs IM- 2 yrs
105
typhoid vaccines lower age limit (2)
IM 2 YO, PO 6 YO
106
Vaccine best for wild type polio
Oral Sabin vaccine
107
vaccines safe to give at birth (2)
Hep B, OPV
108
vaccines to avoid with 2-pheooxyethanol or alum allergy
Hep A
109
vaccines to avoid with egg allergy (3)
JE, flu, YF
110
vaccines to avoid with gelatin allergy (2)
MMR, YF
111
vaccines to avoid with neomycin allergy (3)
IPV, MMR, Hep A, some Hep B, some flu, smallpox
112
vaccines to avoid with streptomycin or polymyxin B allergy
IPV
113
vaccines to avoid with yeast allergy
Hep B
114
Venomous fish- examples, Tx
includes Scorpionfish, Stonefish, Lionfish, weeverfish, stingray, catfish (Indo-Pacific) Tx hot water, stonefish antivenom (AUS)
115
What insect is attracted to bright blue colors
Tsetse, Glossina
116
what percent people on malaria prophylaxis still get malaria?
6%
117
WHO rabies PEP Categories and Tx
I- touch,lick; none II- scratch with no bleeding; vaccine III- bites, mucous mems, bats; RIG and vaccine
118
Yellow fever contraindications and precautions
YFV contraindications: \< 6 mos Immunodeficiency- CD4 \< 200, Thymus disorder, Cancer, Transplant Allergy to egg, gelatin, latex YFV Precautions: 6-9 mos, Age \> 60 YO ASx HIV with CD4 200-500 Pregnant BF
119
Yellow fever lower age limit
6 mo with precaution, 9 mo without
120
Yellow fever vaccine complications
YEL-AND (neuro)- about 1/100K but higher in elderly YEL-AVD (viscerotropic)- 0.4/100K, higher in elederly, 60% mortality
121
YF vaccine in HIV
CD4 \< 200 contraindicated \< 500 precaution
