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Tropical Medicine > Travel Med > Flashcards

Travel Med Flashcards

1
Q

2500 m = _____ ft

A

8000

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2
Q

Acute Mtn Sickness- alttude

A

2500 m (8000 ft)

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3
Q

Aedes vector for 5 virus CRuDZY

A

DEN, CHIK, YF, RVF, Zika

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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

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5
Q

after drop effect

A

Core temp drop if blood flow to extremities first -> repurfusion acidosis

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6
Q

airline and cruise EGA restrictions

A

32-36 air, 28 boat

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7
Q

altitude and pregnancy (2)

A

try to sleep below 3600 m NO acetazolamide

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8
Q

Anopheles vector for

A

malaria, ONY

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9
Q

Arterial gas embolism- cause, timing

A

lung barotrauma causing CVA and MI with 10 min of surfacing; cause 3% dive deaths

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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

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11
Q

BCG side effects

A

ulcer or abscess weeks later

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12
Q

Bismuth reduces travelers diarrhea by

A

55% take QID

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13
Q

black fly vector for (3)

A

onchocerciasis, M. Ozzardi, dirofilariasis

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14
Q

Cholera vaccine- indication

A

epidemics 2 doses 1-6 weeks apart (depending on type age down to 1 or 2)

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15
Q

Chrysops deerfly vector for (2)

A

Loa, Francisella tularensis

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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

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17
Q

Contraindication to DTaP

A

Encephalopathy within 1 week of previous DTaP/DTP

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18
Q

Contraindication to Hep A

A

Anaphylactic reaction to 2-pheooxyethanol or alum

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19
Q

Contraindication to IPV

A

Anaphylactic reaction to neomycin, streptomycin or polymyxin B

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20
Q

contraindications to MMR

A

reaction to prior MMR, Immunosuppression, Thrombocytopenia, Gelatin or neomycin allergy, Pregnancy

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21
Q

Contraindications to nasal flu (4)

A

< 2 YO, egg allergy, lung disease, pregnant

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22
Q

Culex vector for

A

LF, JE, WNV, VEE, WEE, EEE

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23
Q

DDx subconjunctival hemorrhage (4)

A

Leptospirosis, scrub typhus, hantavirus renal, dengue, measles

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24
Q

decompression illness

A

Inadequate elimination of nitrogen from tissues during ascent, causing muscle aches and pains

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25
Q

Decompression sickness

A

nitrogen bubbles forming in tissues on resurfacing- cause 2% dive deaths

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26
Q

DEET can also inhibit (2)

A

schisto, tick (typhus)

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27
Q

elderly less likely to get (3)

A

motion sickness, diarrrea, AMS

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28
Q

Flea is vector for (6)

A

Bacteria: B. henslae, R. felis, R. typhi, Y. pestis Parasite: Dipylidium caninum, tungiasis

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29
Q

frequency of post-infectious IBS

A

25%

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30
Q

frostbite- def, Tx, good prognosis

A

ice crystals in tissue rapid rewarm, avoid refreeze early clear blebs and edema

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31
Q

Glossina Tsetse fly vector for

A

Trypansomsoma brucei

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32
Q

Hajj- attendees, illnesses (lung, blood, nasal)

A

3 million from > 180 countries 75% get Hajj cough- environmental, TB, flu, pneumonia, MERS HIV and hepatitis from shaving by barbers PAM- nasal abolution

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33
Q

health contraindications to fight

A

10 days after chest or abdominal surgery 14 days from MI or CABG Uncontrolled CHF, Sz, HTN, DM, psych

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34
Q

health precautions to flying (4)

A

Anemia Cerebrovascular disease SS Pulmonary- dry cabin air

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35
Q

heat exhaustion vs heat stroke

A

weak, confusion vs collapse, uncontrolled fever, organ damage

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36
Q

Hep A vaccine use in endemic?

A

No. Kids usually mild and Asx.

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37
Q

Hepatitis B vaccine contraindications (2)

A

previous allergy, yeast allergy

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38
Q

High altitude cerebral edema (HACE)- Sx, Tx

A

Sx: ataxia, confusion Tx: immediate descent. Dexamethasone may buy time

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39
Q

High altitude contraindications

A

Uncontrolled CHF, pulm HTN, SS, mod-severe COPD (not asthma); Hx HAPE, HACE

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40
Q

High Altitude Pulmonary Edema (HAPE)- fame, Tx

A

most common cause of altitude death descent, O2, EPAP, nifedipine (steroid NO help)

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41
Q

high eosinophlilia related to

A

trichinosis, visceral larva migrans, microfilaria, onchocerciasis, ascariasis, hookworm, schistosomiasis, or liver or lung flukes

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42
Q

HIV malaria prophylaxis interaction

A

mefloquine and ART

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43
Q

how effective is 1st dose of measles

A

97%

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44
Q

how long for meningitis, YF and polio to be effective

A

10 d, 10 d, 4 wks

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45
Q

how long until YF vaccine effective

A

10 d

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46
Q

how often are diarrhea studies positive- what percentages

A

1/3 pos 70% bacterial, 15% viral

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47
Q

HPV strains related to CA, related to warts, in vaccine

A

16, 18, 31. 33 6, 11 (6, 11,) 16. 18

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48
Q

Huntington’s response

A

cold induced vasodilation in intermittent 5-10 min cycle at 10 degrees C

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49
Q

hyperthermia

50
Q

hypothermia

51
Q

hypothermia levels

A

< 35 mild (passive rewarming), < 33 moderate (active rewarming), < 28 severe (stop resuscitation at 32 if no response)

52
Q

immersion injury

A

non-freeze cold injury like trench foot

53
Q

Immunization contraindicated in pregnancy

A

MMR, VZV, other live

54
Q

Immunization in immunocompromised (3)

A

no BCG regardless no YF IF symptomatic HIV maybe no roto IF symptomatic HIV

55
Q

Infections from animal bites (5)

A

rabies, tetanus, pasteurellosis, bartonella, herpes B virus…

56
Q

jellyfish stinger removal and Tx

A

credit card, sea water, Windex, vinegar (anemone and coral also have neumatocysts); box jelly antivenom (AUS)

57
Q

live typhoid coverage vs IM

A

Paratyphoid B but not A

58
Q

Live vaccines- 9

A

MMR, OPV, Yellow fever, Vaccinia, Varicella, Nasal influenza, BCG, Cholera, Oral typhoid

59
Q

Louse vector for (3)

A

Epidemic typhus (R. prowazekii) Trench fever (B. quintana) Relapsing fever (Borrelia recurrentis)

60
Q

lower age limits on sunscreen, DEET

A

6 mo, 2 mo

61
Q

Malaria emergency Tx

A

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
Q

malaria prophylaxis and breast feeding

63
Q

Measles vaccine contraindications

A

pregnancy, severe immunocompromised neomycin or gelatin allergy (OK egg allergy) thrmobocytopenia

64
Q

measles vaccine side effects

A

10% get rash week later 1/3000 have Sz

65
Q

mefloquine black box warning

A

dizzy may be permanent, psych may persist yrs

66
Q

Menactra and Menveo cover which strains

A

A, C, Y, W135

67
Q

midge/culicoides vector for

A

mansonella

68
Q

MMR timing for travelling infant

A

6 mos, repeat in 1 month if still travelling

69
Q

mosquito day biter infections (2)

A

dengue, chik

70
Q

mosquito night biter infections (3)

A

malaria, WNV, JE

71
Q

Most common malaria in travellers

72
Q

myiasis vs tungiasis

A

African tumbu/botfly Sand flea

73
Q

nasal flu contraindications

A

< 2 YO asthma/COPD pregnancy/immunocompromised (NO egg issue)

74
Q

Neurotoxic shellfish poisoning- source, Sx

A

Red tide dinoflagellate concentrating in shellfish, ingest or inhaled wave GI, paraesthesia, ataxia

75
Q

Nitrogen narcosis/ depth, Tx

A

depths greater than 70 ft or 100 ft clears on resurfacing.

76
Q

Norovirus- incubation, duration, spread

A

1-2 d < 4 d FO, P2P, fomites

77
Q

number traffic deaths annually

A

1.3 million

78
Q

only required vaccines

A

YF for certain countries in AF and SAM Meningitis for Mecca polio before leaving a few endemic areas (Cameroon, Pakistan, Syria)

79
Q

OPV risk

A

1/250K get paralytic polio use IPV in low endemic areas

80
Q

osborne J wave

A

on EKG, notched R wave wider than RBBB

81
Q

Paralytic shellfish poisoning- agent, source, onset, Tx

A

Dinoflagellate- concentrated in mollusk so Shellfish, seafood Potent toxin

82
Q

percent sulfa allergy getting rash with acetazolamide

83
Q

permethrine can also inhibit (2)

A

tick (typhus), triatomine (Chagas)

84
Q

Pigbel vaccine- target, geo, schedule

A

to Clostridium perfringens toxin type 3 used in Papua New Guinea 2, 4, 6 mo

85
Q

pregnancy stand by malaria Tx

A

malarone x 3 d

86
Q

pregnancy travel contraindications

A

multiple, malpresentation, hyperemesis, FGR, abruption, active labor, cervical incompetence, PTL, PROM, ectopic, toxemia

87
Q

preventing malaria in first pregnancy in Africa

A

sulfadoxine/pyrimethamine at prenatal visits

88
Q

Resistant to alcohol

A

Cryptosporidium, norovirus, anthrax

89
Q

Sand fly/phlebotmus vector for (3)

A

leishmania sand fly fever Bartonella bacilliformis

90
Q

scombroid poisoning- Sx, source, signs

A

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
Q

sea urchin spine removal and Tx

A

surgical, hot water (heat labile toxin)

92
Q

stool studies for chronic diarrhea

A

O+P AF for cryptosporidia, cyclospora, isospora Giardia Ag C. dif toxin

93
Q

tetrodotoxin

A

neurotoxin from puffer/fugu

94
Q

Tick vector for

A

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
Q

Transplant pts and vaccines

A

avoid live for 2 yrs and other for 3-6 mo

96
Q

travel health risks per 100K

A

1 death 300 hospital 8000 see doc 50% some health issue

97
Q

travel mortality- top 2, bottom

A

45% CV 25% accident 1% ID

98
Q

Travelers diarrhea- geo

A

Latin Americia- EAEC Asia- Campylo, Plesiomonas, Aeromonas Africa- Aeromonas

99
Q

Travelers diarrhea- incidence, peaks, duration, incubation

A

Incidence 35% per 2 weeks Peak days 2-4 and 10-12 d Duration 2-5 d bacterial or viral Incubation , 4 d

100
Q

Triatomine bug vector for

A

Trypanosoma cruzi/Chagas

101
Q

Tropical sprue- geo, cause, Tx

A

Asia, SAM ? doxy 6 wks with folate

102
Q

Tropical Sprue- geo, Sx, Tx

A

chronic diarrhea from Asia, South America Malabs, B12 and folate def, steatorrhea No causative agent found Responds to 6 weeks TTC and folate

103
Q

Tularemia- 5 presentations

A

Ulceroglandular, Glandular, Oculoglandular, Oropharyngeal, Pneumonic

104
Q

typhoid vaccine re-booster

A

oral- 5 yrs IM- 2 yrs

105
Q

typhoid vaccines lower age limit (2)

A

IM 2 YO, PO 6 YO

106
Q

Vaccine best for wild type polio

A

Oral Sabin vaccine

107
Q

vaccines safe to give at birth (2)

A

Hep B, OPV

108
Q

vaccines to avoid with 2-pheooxyethanol or alum allergy

109
Q

vaccines to avoid with egg allergy (3)

A

JE, flu, YF

110
Q

vaccines to avoid with gelatin allergy (2)

111
Q

vaccines to avoid with neomycin allergy (3)

A

IPV, MMR, Hep A, some Hep B, some flu, smallpox

112
Q

vaccines to avoid with streptomycin or polymyxin B allergy

113
Q

vaccines to avoid with yeast allergy

114
Q

Venomous fish- examples, Tx

A

includes Scorpionfish, Stonefish, Lionfish, weeverfish, stingray, catfish (Indo-Pacific) Tx hot water, stonefish antivenom (AUS)

115
Q

What insect is attracted to bright blue colors

A

Tsetse, Glossina

116
Q

what percent people on malaria prophylaxis still get malaria?

117
Q

WHO rabies PEP Categories and Tx

A

I- touch,lick; none II- scratch with no bleeding; vaccine III- bites, mucous mems, bats; RIG and vaccine

118
Q

Yellow fever contraindications and precautions

A

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
Q

Yellow fever lower age limit

A

6 mo with precaution, 9 mo without

120
Q

Yellow fever vaccine complications

A

YEL-AND (neuro)- about 1/100K but higher in elderly YEL-AVD (viscerotropic)- 0.4/100K, higher in elederly, 60% mortality

121
Q

YF vaccine in HIV

A

CD4 < 200 contraindicated < 500 precaution

Tropical Medicine (7 decks)

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