Bioterrorism

Question 1

CBRNE mnemomic

Answer 1

chemical, biological, radiological, nuclear, energetic (explosives and incendiary)

Question 2

chemical has __ onset of sx

Answer 2

rapid

Question 3

biological agents create __ onset of sx

Answer 3

gradual

Question 4

describe anthrax bacteria

Answer 4

bacillus anthracis 
encapsulated 
aerobi 
gram + 
spore former 
Rod shaped

Question 5

what are the two toxins anthrax creates?

Answer 5

edema toxin ET and lethal toxin LT

Question 6

sx of cutaneous anthrax exposure

Answer 6

painless skin lesions over 1-7 days
papules to vesicle to depressed black eschar with local edema

80% recover w/o tx

Question 7

onset of inhalation anthrax exposure

Answer 7

onset 1 wk but up to 2 mo

Prodrome - viral resp illness
hypoxia, dyspnea with mediastinal widening, or pleural effusion on CXR

88% fatal event even with aggressive tx

Question 8

sx inhalation anthrax exposure

Answer 8

fever, chills, chest discomfort, SOB, cough, N/V, dizzy, HA sweats, myalgias

Question 9

signs of anthrax meningitis from inhalation exposure

Answer 9

AMS, fever, HA, N/V, sz, nuchal rigidity

krnig/brudzinski sign

Question 10

gastrointestinal sx

Answer 10

severe abdominal distress s/s of septicemia

fever, chills, cervical lymphadenopathy, pharyngitis, dysphagia, hoarseness, N/V/D, hematemesis, HA, flushing, red eyes, abdominal pain/swelling etc

Question 11

anthrax abx tx

Answer 11

1 bacteriocidal agent
(Cipro, levo, moxi, meropenem, impipenem, doripenem, vancomycin)

AND 1 protein synthesis inhibitor: clindamycin, linezolid, doxy, rifampin

Question 12

anthrax tx if PCN susceptible

Answer 12

for bacteriocidal agent use one of following: Pen G or ampicillin

Question 13

anthrax additional tx with abx

Answer 13

need good CNS penetration for anthrax meningitis: fluoro + b lactam + protein synthesis inhibitor

Question 14

anthrax PEP

Answer 14

doxy and Cipro are first line

Sensitive: amoxicillin, Pen VK, clndaymycin

Dose for 60 days

Question 15

what drug would you consider for anthrax exposure with pregnancy?

Answer 15

> .?

Question 16

describe plague bacteria

Answer 16

Yersinia pestis: bacterium gram - rod

Question 17

plague clinical sx

Answer 17

fever and leukocytosis plus 1 or more of the following:

bubonic, septicemic, pna, pharyngeal sx

Question 18

bubonic plague sx

Answer 18

regional lymphadenitits

Question 19

septicemic plague

Answer 19

septicemia without evident bubo

Question 20

pharyngeal plague

Answer 20

pharyngitis and cervical lymphadenitis

Question 21

plague pna sx

Answer 21

onset 1-6 days PE

fever, HA, weakness, hemoptysis, SOB, cough, CP

Question 22

first line plague tx

Answer 22

streptomycin
gentamicin
ciprofloxacin, levofloxacin
treat 10-14 days

Question 23

second line plague tx

Answer 23

moxifloxacin, doxycycline and chloramphenicol

Question 24

pediatrics plague tx

Answer 24

streptomycin, gentamicin
levofloxacin, ciprofloxacin
doxycycline
chloramphenicol for kids 2+

Question 25

pregnancy plague tx

Answer 25

gentamicin, doxycycline, ciprofloxacin

Question 26

smallpox caused by__

Answer 26

variola virus - no animal, environmental or vectors

Question 27

classic smallpox presentation

Answer 27

acute onset fever 101+, HA, myalgia small spot on mouth and tongue rash 1-4 days later (firm deep seated vesicles or pustules in same stage of development)