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tropical medicine > Clinical cases, test prep > Flashcards

Clinical cases, test prep Flashcards

1
Q

Peruvian farmer, 2 days of non painful ulcer, dyspnea, HA, shock. CXR shows mediastinal widening.
Organism? Transmission? Diagnosis? Treatment?

A

Bacillus Anthracis
Inhalation of spores
Penicillin + Cipro + Meropenem + antitoxin (if you have it) The reason for these drugs is because he has CNS involvement

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2
Q

Peruvian farmer, two week history of painful lesions
Organism? Transmission? Diagnosis? Treatment?

A

Dx: Sporothrix Schenkii
Transmission: Cutaneous
Diagnosis: Daisy cells on pathology
Tx; Itraconazole

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3
Q

Patient with painful lesion (12cm) that developed over 12 months. Undermined lesion. Organism? Treatment?

A

Dx: Mycobacterium Ulcerans (Buruli Ulcer)
Tx: Clarithromycin + Rifampicin

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4
Q

Painless ulcer/lesion that developed over 1 week in a Brazilian Farmer
Organism? Treatment?

A

Dx: Leishmania Braziliensis
Tx: Pentavalent Antimonials

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5
Q

VERY painful lesion that developed over 2 days. Plaque like lesion with small vesicles and 3 colors. Red, white, blue. Organism? Tx?

A

Dx: Loxosceles spp (spider bite)
Tx: None

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6
Q

Bolivian patient with a 6 month h/o pleuritic chest pain, wound at the lateral chest wall, pleural effusion, grain.
Organism?Tx?

A

Empyema necesitans, actinomyces spp
Tx: Penicillin

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7
Q

Painless lesions with concomitant uveitis and hepatitis. NEver traveled out of Lima. Disseminated papular nodular rash on back, palms and soles. Organism? Tx?

A

Treponema Pallidum (syphilis)
Tx: Penicillin

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8
Q

A 50 year old woman returns from 2 weeks of medical mission trip to Honduras. She develops bloating, epigastric discomfort, diarrhea. The diarrhea is watery/foul smelling. What are the top 4 protozoans that cause this? Treatment for each?

A
  1. Giardia Lamblia -Metronidazole
  2. Cystoisospora Belli-TMP/SMX
  3. Cyclospora Cayatenensis -TMP/SMX
  4. Cryptosporidium Hominis-Nitazoxanide
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9
Q

12 year old girl with headache, seizures, tonic/clonic seizures, HA, photophobia. From Cusco, no known TB contacts.
Organism? Treatment?

A

Single CT lesion <20mm, no e/o ICP elevation, Can see the scolex:
Taenia Solium, Neurocystercircosis
Tx: Albendazole + steroids (both for short time) + Keppra (AEDs to be continued)
*DO NOT need prazi because only single cyst

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10
Q

24yoF with h/o developmental delay; Seizures at 8years old, continued to have seizures.
Identify what kind of cyst, what is the organism, what is the treatment

A

Cystic lesions with scolex present, calcifications: intraventricular AND subarachnoid
Org: T. Solium, neurocystercircosis
Tx: Concern for hydrocephalus with ventricular NCC, so need to consider neuroendoscopy removal if possible or a VP shunt to relieve hydrocephalus. Continue albendazole and praziquantel and steroids and anti epileptics

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11
Q

Patient has intermittent positional vertigo and headache. One day, develops left hemiparesis. ICP is increased. Has Hoffmans sign, UE Strength diminished. What do you see, what are you concerned about, what organism, what tx

A

You see CT scan with dilated lateral and third ventricle, concern for intraventricular but also maybe subarachnoid involvement. Lacunar strokes are concerning.
Organism: Taenia Solium, INtraventricular, subarachnoid
Tx: Steroids, Mannitol, Albendazole, Praziquantel, Acetazolamide, VP Shunt

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12
Q

45yo F 10-15 years PTA seizure. Began paresthesias in fingers, hands, arms, LOC, tonic clonic movements, somnolence. What do you see? What is the organism? What is the treatment

A

MRI shows ICP elevation, cerebral edema, collapsed ventricles.
Dx: Taenia Solium
Tx: DO NOT give antiparasitic drugs in ICP elevation; first give STEROIDS and other meds to control ICP. THEN give Albendazole and prazi. If you give antiparasitics immediately, you will cause the parasite to die and increase ICP even more

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13
Q

A 55 year old mexican male presented with fever, abdominal pain, RUQ tenderness with leukocytosis and left shift. Alk phosph 2x ULN. Single hypodense lesion in the right lobe of his liver. Organism? Treatment?

A

Organism : Entamoeba Histolytica
Treatment: Luminal agent-parmomycin, Tissular-Metronidazole

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14
Q

62yo Man presented with 3 days of fever, onset 4 weeks after safari to tanzania. INitial evaluation neg, fever resolved. Pt then devloped a urticarial rash, pruritis. Labs WBC 8100, Eos 12%. Pt went swimming in hotel pond. What causes this? How to diagnose? What treatment?

A

Organism: Schistosoma spp (Katayama Fever)
Diagnosis: Serology
Treatment: Steroids (for the katayama fever) + Praziquantel. Then repeat the prazi to kill the adult worms

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15
Q

Fresh water exposure in Africa, high grade eosinophilia. Fever, Rash, Urticaria. Oranism? Diagnosis? Treatment?

A

Organism: Acute schistosoma spp (Katayama Fever)
Diagnosis: Serology
Treatment: Praziquantel + Steroids, repeat Praziquantel

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16
Q

65yoF immigrant from cambodia 20years prior. Notes mild abdominal pain. Exam unremarkable. Abs eos 720. Stool O&P negative. H pylori negative. Colonoscopy neg. Organism? Diagnosis? Treatment?

A

Org: Strongyloides Stercoralis
Diagnosis: Serology
Tx: Ivermectin (2 doses) unless hyperinfection

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17
Q

Cough, nonspecific abdominal pain, rash , perianal itching

A

Org: Strongyloides Stercoralis
Diagnosis: Serology
Tx: Ivermectin (2 doses)

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18
Q

Soldiers with eosinophilia >10%, abdominal pain and diarrhea. In moist climate, exposed to soil

A

Organism: Hookworm spp. (Necator Americanus, Ancylostoma Duodenale)
Diagnosis: Stool examination
Treatment: Albendazole

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19
Q

What is the lifecycle of this?

A

organism: Hook worm
Life cycle: eggs in feces, rhabditiform larva hatches, development to filariform larva in the environment, filariform larva penetrates the skin, larva exit irculation in the lungs, coughed and swallowed

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20
Q

26year old man with 6 years of working in the rainforest in Madagascar, ROS MIld swelling in the forearms. Lives in rural areas. Has lived in Africa. +Eosinophilia. Migratory swelling . Organism? Vector? Symmptoms? Diagnosis? Treatment?

A

Organism: Loa Loa
Vector: Chrysops fly
Symptoms: calabar swelling, eye worm
Diagnose: centrifuge blood and examine microscopy
Treatment: Depending on #. Caution with ivermectin and DEC because of CNS side effects if microfilaria >2500 mf/mL. Look for co-infection with onchocerca (skin snips) -then definitely do not give DEC!

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21
Q

tropical pulmonary eosinophilia and calabar swelling

A

Loa Loa
Diagnose: Blood microscopy
Treatment: >2500, apharesis then DEC
<2500 DEC
Check onchocerca first
Caution with ivermectin for CNS side effects

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22
Q

23yoF traveled to SE Asia for 2 months. 3 weeks after return, onset fever, abdominal pain, diarrhea, urticarial rash. Lab shows 57% eos.

A

Toxocara Canis (Visceral larva migrans)
Diagnosis is usually clinical
Tx: Albendazole if symptomatic

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23
Q

What are the larva migrans syndromes? List at least 7

A

Toxocara
Baylisascaris
Angiostrongylus
Gnathostomiasis
Acute Ascaris
Paragonimus
Acute Fascioliasis

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24
Q

List the things that cause skin nodules with eosinophilia, migratory larvae

A

Gnathostomiasis, Paragonimiasis, Fascioliasis, Sparganosis

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25
Q

List what causes skin nodules, eos, fixed nodules

A

Cysticercosis, Onchocerciasis

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26
Q

Pulmonary infiltrates with eosinophilia causes, localized and diffuse and fleeting?

A

Localized: Paragonimus, Echinococcus
Diffuse: Tropical pulmonary eosinophilia due to filaria
Fleeting (i.e. loefflers): Larva migrans (Schisto, strongy, toxacara, ascaris, hookworm)

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27
Q

Abdominal pain in a patient with esosinophilia, fever.

A

Fasciola Hepatica
Tx: Triclabendazole
*Chronic phase can cause biliary involvement, cholangitis, pancreatitis

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28
Q

Immigrants from Africa with eosinophilia. What should you consider?

A

Strongyloides Stercoralis, Schistosoma Haematobium or Mansoni, Filaria

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29
Q

63 year old man presented with 3 days of fever, onset 4 week after Tanzania safari trip. Had a pruritic and urticarial rash on the trunk with eosinophilia. Had hotel pond exposure.
Organism? Infective stage? Transmission? Treatment?

A

Organism: Schistosoma Haematobium or Mansoni, Katayama Fever
Infective stage: Cercariae
Transmission: Through the skin, from fresh water snails
Diagnose: Direct smear, serology
Treatment: Praziquantel + Steroids and then Prazi again in the future ; can have co-infections with hepatitis, salmonella, HIV , malnutrition

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30
Q

48year old peruvian woman with colicky abdominal pain in RUQ quadrant. SHe previously worked as an agricultural worker raising cattle in Piura. The month prior, she noted pain that increased in intensity. The patient had 34% eos. CT scan shows liver hypodensities.
Organism? Diagnosis? Infective stage? Treatment?

A

Fasciola Hepatica
Diagnosed by ELISA
Infective stage metacercariae
1st int host; snails; definitive is sheep and cattle
Treatment: Triclabendazole

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31
Q

While working in Guatemala, a mother comes to you asking you to treat her 4 year old son for worms. When asked how she knows her son has worms , she says he vomits up round worms

A

Round worms: Ascaris Lumbricoides, Ancylostoma Duodenale, Necator Americanus, Trichuris trichuria, strongyloides stercoralis, enterobius vermicularis

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32
Q

An AIDS patient in Lima presents with diarrhea and rhabditiform larvae in his stool. How to manage?

A

Strongyloides Stercoralis, likely hyper infection (could be on steroids or have HTLV1)
Tx: Ivermectin daily until they clear the infection (cover for gram negatives at the same time)

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33
Q

A child in Cusco presents with cough and mild chest pain. CXR reveals large cannonball like lesions 8-10cm. What is the organism? What is the lifecycle? What is the treatment?

A

Org: Echinococcus Granulosum
Lifecycle: Echinococcus granulosus (sensu lato) (2—7 mm long) image resides in the small intestine of the definitive host. Gravid proglottids release eggs image that are passed in the feces, and are immediately infectious. After ingestion by a suitable intermediate host, eggs hatch in the small intestine and release six-hooked oncospheres image that penetrate the intestinal wall and migrate through the circulatory system into various organs, especially the liver and lungs. In these organs, the oncosphere develops into a thick-walled hydatid cyst image that enlarges gradually, producing protoscolices and daughter cysts that fill the cyst interior. The definitive host becomes infected by ingesting the cyst-containing organs of the infected intermediate host. After ingestion, the protoscolices image evaginate, attach to the intestinal mucosa image , and develop into adult stages image in 32 to 80 days.

Humans are aberrant intermediate hosts, and become infected by ingesting eggs image . Oncospheres are released in the intestine image , and hydatid cysts develop in a variety of organs image . If cysts rupture, the liberated protoscolices may create secondary cysts in other sites within the body (secondary echinococcosis).

Treatment for the lung: Lobectomy/Cystectomy followed by albendazole. Sometimes praziquantel as well for seeding prevention

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34
Q

15year old peruvian girl from Andes, 3 mo h/o HA, nausea, vomiting, visual and auditory lesions. Her MRI shows “swiss cheese” like appearance. How to treat?

A

Neurocysticercosis encephalitis; Taenia Solium with diffuse brain edema
-Give steroids (high dose)
-Antiepileptics
-Mannitol, bring down ICPs
-DO NOT give antiparasitics

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35
Q

Patient who comes in with vomicus, salty output, found to have a 4cm cyst in the lung. Organism? Treatment?

A

Echinococcus Granulosa
Tx: Albendaozle (because its <4cm)

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36
Q

Patient comes in a lung hytadid cyst with daughter cysts, what is your treatment? Why

A

Echinococcus Granulosa
Tx: Surgery, because when there is a cyst with daughter cysts, there is a higher risk of relapse

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37
Q

Patient has a ruptured hydatid cyst, now has “white cancer”. What is white cancer, what is the treatment

A

Echinococcus multiple abdominal cysts-white cancer because of the peritoneal spread-first peritoneal lavage/surgery, then give 1 year of therapy with prazi and albendazole after

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38
Q

28 year old male with no previous medical history , 9 months of progressive loss of visual acuity in the left eye. Dx? How to diagnose? Treatment?

A

Treponema Pallidum (Syphilis)
-VDRL or RPR (interchangeable); treponemal Ab
Tx: 2 weeks of penicillin + prednisone
(you want to see them have a 4 fold decline with treatment–>2 dilutions)

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39
Q

What are the most common infectious uveitis in tropical environments

A

Tuberculosis, Brucellosis, Bartonellosis, Histoplasmosis, Syphilis

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40
Q

20 year old male initially seen with a 15 day h/o bilateral inguinal swelling which was tender. No urethral discharge or ulcers.

A

LGV Serovar 1 2 or 3 of chlamydia trachomatis
Dx with culture
Tx with doxycycline

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41
Q

What are ddx for bubo formation

A

yerstinia pestis, tularemia, tuberculosis

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42
Q

57yoF with 10 day of history of pruritic rash and painful violaceous nodule in mid upper abdominal region without surrounding erythema and extreme warmth . She was tx with abx, and then the initial lesion resolved, second one started. No other systemic symptoms. From Lima, ate some fish in Mexico recently

A

Gnathostomiasis
Epi: Latin america, raw fish
Tx with albendazole or ivermectin, excise the papule

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43
Q

List causes of larva migrans

A

gnathostoma
Ancylostoma (well demarcated, thin red linear serpentine lesions)
Fasciola
Loa Loa
paragonimus
Toxocara, Bayliscaris

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44
Q

list things that cause subcutaneous nodules

A

onchocerciasis, cysticercosis, sparganosis
(do not present migratory)

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45
Q

Patient who comes in with urethritis, was treated for GC/Chlamydia. What other ddx could this be

A

Mycoplasma Genitalium
Tx: Doxycycline, then moxifloxacin

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46
Q

14yoM with 2 weeks of nausea, severe anorexia, fatigue, noticeable pallor. Afebrile for 5 days, then Tmax 40, vomiting, HA, dark urine. From the highlands off the Andes (3700m). HCT 16, 6.8% reticulocytes. Org? Vector? Treatment?

A

Bartonella Bacilliformis: Oroya fever
Blood film: pleomorphic coccobacilli intracellular which are diagnostic of acute bartonellosis
-Lutzomyia
-Treatment varies but chloramphenicol, cipro, azithro, have been used

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47
Q

If you have bartonella, what opportunistic infections are you at risk for?

A

S. typhi and non. typhi; toxoplasma; other OIs

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48
Q

What things can you diagnose in Blood smear?

A

Malaria
Babesia
Bartonella
Filaria
Histoplasma
Trypanasoma
Borrelia
Spirochetes

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49
Q

What is carried by the vector lutzomyia

A

Bartonella bacilloformis and Leishmaniasia

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50
Q

61 yo with 7 day history of fever, diffuse myalgia, dyspnea, jaundice, several episodes of hemoptysis. Conjunctival suffusion. patchy infiltrates on CXR. Tbili elevated

A

Leptospirosis, treatment is ceftriaxone
Not yellow fever because AST/ALT not elevated

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51
Q

51yoM with 8 month history of fever, cough, weight loss, painful oral lesion. Poor farmer, painful oral lesions and easy bleeding. CXR shows central lung involvement

A

paracoccioidomycosis

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52
Q

Most common manifestation of HIV NEGATIVE and crypto?

A

lung nodule

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53
Q

HIV with CD4 low, 2 month fever, dry cough, progressive dyspnea. High jungle. Wasted cervical adenopathy, diffuse rales. LDH is higih.

A

Histoplasmosis

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54
Q

pancytopenia and LDH elevation to 1000

A

Histoplasmosis

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55
Q

cutaneous, RES, oral cavity, lung involvement, organomegaly from the jungle

A

Histoplasmosis

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56
Q

42yoM 2 year h/o fever, dry cough, several episodes of hemoptysis. Started TB treatment 2 months ago. Born in highlands, eos 10%, negative TB. Failing treatment

A

Paragonimiasis (TB mimicker + eos)

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57
Q

what fungi causes eos

A

cocci (sometimes aspergillosis as well)

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58
Q

Pulmonary nodules Tropical DDx

A

dirofilariosis, TB, NTM, NOcardia, botryo, crypto, aspergillosis

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59
Q

bacterial TB mimickers

A

NTMs, Leptospira, Burkholderia, rhodococcus, nocardia

60
Q

Fungi TB mimickers

A

Crypto, histo, paracocci, PCP, blasto, cocci

61
Q

Parasite TB mimicker

A

paragoniums, dirofilaria

62
Q

32year old male, 2 day history of fever, cough dyspnea, pleuritic chest pain, hemoptysis, lives in the rural highlands, gram negative rod. in shock when presented. lobar consolidation

A

Yerstinia pestis (plague) -Pneumonic
Tx: Streptomycin or a fluoroquinolone

63
Q

acute pneumonia in a farmer from french guinea, has contact with animals. ALT is 250. Negative blood culture.

A

Coxiella Burnetii: Q fever

64
Q

Heavy smoker, lives in rural texas, 65 yo M. 15% eosinophilia. Negative for intestinal parasites

A

dirofilariasis immitis: coin like lesion on surgery-single nodule.

65
Q

Female patient with gram negative sepsis. 55yo with history of chills, HA, fever. Has had diarrhea x 2 years. +meningeal signs. No eos. CSF 1000 WBC, low glucose. E coli bacteremic and meningitis.

A

Strongyloidies with HTLV 1; ivermectin

66
Q

Chile, 2 day fever, hemoptysis, pulmonary hemorrhage

A

DDx: Influenza v. lepto v. hanta –>Hanta virus (Chile)

67
Q

Traveler to Spain with fever and went swimming with nodules int he chest. +eos

A

acute katayama fever

68
Q

1 week history of low grade fever, dry cough, dyspnea, e/o bronchospasm ; honduras ; eosinophilia

A

loefflers syndrome

69
Q

indian, shortness of breath, pna, did not get bettter with ceftriaxone

A

meliodosis

70
Q

List causes of eosinoiphilia

A

Filarial worms
Tapeworms
Strongyloidiasis
Hydatid disease
Hookworm
Fascioliasis
Toxocariasis (visceral larva migrans)
Schistosomiasis
Trichinella spiralis
Intestinal nematodes
Tropical pulmonary eosinophilia (usually results from hypersensitivity to microfilariae)

71
Q

How is Giardia acquired/ how do you kill it?

A

CYSTS in food/water. Kill via boiling x 10 minutes. Do not chlorinate

72
Q

List what diseases have mosquitos as vectors and name the vectors

A

Malaria-Anophales
Dengue-Aedes Aegypti
JEV-Culex
Yellow fever-aedes aegypti

73
Q

What can you get by eating raw fish

A

Clonorchis Sinensis
Gnathostoma
Hep A
V. Parahaemolyticus

74
Q

what vaccines to avoid in HIV

A

Oral typhoid
BCG
Yellow fever

75
Q

What is the risk with HIV+ children under efavirenz containing regimen and artesunate/amodiaquine for malaria?

A

High risk of hepatitis

76
Q

List malaria criteria

A
77
Q

List TB Mimickers

A
78
Q

Lutzomiya

A

Bacillary angiomatosis
Bartonella

79
Q

Severe anemia, jaundice, fever, salmonella co infection

A

Acute Oroya fever/bartonella
Tx with chloramphenicol and ceftriaxone. Give Bactrim as well for reactivación PCP

80
Q

Patient with chronic diarrhea, lower abd pain, rectal bleeding. Colonoscopy showed ulcer and necrosis

A

balantoides coli
Tetracycline

81
Q

Sacroiliac pain, fever

A

brucella with psoas abscess
Treat with doxycycline and gentamicin

82
Q

30 year old man presents with LAD, pustular rash on genitals, palms, and soles. Which of the below is NOT true about this infection?
A) Orthopoxvirus
B) Virus has a small RNA Genome
C) Monkeys are not the natural reservoir
D) Can be transmitted on Fomites
E) Pts with low CD4 coutns have worse outcomes

A

B–>IT IS A Large DNA Genome, minimal mutations

83
Q

27year old british soldier returned from Kenya, fainting, shivering , jaundice, hepatomegaly. Hgb 8, Plt 20, Cr 6, glu 66, Bili 8.2, Lactate 20

A

severe malaria: pt had >10% pf parasitemia with jaundice, gcs 11, Cr>3, Tbili elevated, lactate >20 (metabolic acidosis), ARDS

84
Q

who is susceptible to severe malaria

A

those who have never acquired immunity
those who lack innate protection
those who acquired immunity lapsed

85
Q

patient with >2 weeks fever, LFT derrangement, cough, travelled to Kazaksthan, comes in with atrial fibrillation.

A

Q fever-Coxiella Burnetii Endocarditis.
Endocarditis-treat for 18 months with Doxycycline and hydroxychloroquine

86
Q

What are common diseases that are considered bioterrorism agents

A

Plague, Anthrax, Meliodosis, Ebola, Lassa (VHFs), Tularemia

87
Q

nocardia triads

A

skin, lung, brain

88
Q

Cavitary PNA

A

Tuberculosis, Aspergillus, Nocardia, Klebsiella, Strep Pneumo, Staph Aureus, Crypto, Rhodococcus, Actinomycosis, Melioidosis/mucor, Paragonimus, Dimorphic fungi (TANKSS CRAMMP)

89
Q

Patient from Myanmar with T2DM, Cavitary lesions, fever, cough

A

Meliodosis: burkholderia pseudomallei
*Tx Ceftazidime and then bactrim

90
Q

Bipolar Gram Negative Rod

A

Burkholderia (intracellular)
Yersinia
Pasturella
tuleraemia

91
Q

Young men went to caves, ate fresh crab, has cavitary lesions (1 week ago, exposure)

A

1 week prior: histo
5 weeks prior: paragonimus

92
Q

List causes of eosinophilic meningitis

A

Angiostrongylus, Gnathostomiasis (no fever)
Amebiasis, African Trypanosomiasis (Fever)
Echinoccocus, onchocerciasis (Seizures)
Neurotrichinosis, Baylisarcariasis, Neuroschisto, Neurocysticer, paragonimiasis, Toxocara, Loa Loa, Toxo, Chagas

93
Q

How to differentiate angiostrong v. gnathostoma

A

Angiostrong: Acute severe HA, Focal Numness, Coconut Juice CSF, uncooked SNAILS

Gnathostom: Motor weakness, non-traumatic bloody CSF, Uncooked poultry and fish

94
Q

Eosinophilic meningitis: BAG (top 3)

A

Angiostrongylus cantonensis, Bayliscaris, Gnathostoma

95
Q

Dimoprhic fungi

A

Histoplasma Capsulatum, Blastomyces Dermatitids, Talaromyces, Cocci, Paracocci, Sporothrix

96
Q

RED PIGMENT around mold colony, Bamboo like septae

A

Talaromyces -Bamboo Rat

97
Q

skin lesions, HIV, Asia (look like molluscum); Treatment

A

Talaromyces Marnefeii
Amphotericin B, Itraconazole after (and if HIV + , then give itraconazole daily until CD4>100 for 6 months)

98
Q

Fever, diarrhea, AKI, Derranged LFTs, AKI, Very short incubation period coming back from Malaysia

A

Rickettsial disease-R. Typhi: Murine Typhus

99
Q

biggest cause of non-malarial febrile illnesses among returned travellers (high fever)

A

ricketsii -Give Tylenol

100
Q

Unilateral swelling in India, ascending, chicken farmer, sensation in tact–how to diagnose? What is highest on your ddx ?

A

Nocturnal blood film,Wucheria Bancrofti

101
Q

Day blood film

A

Loa Loa

102
Q

GNR in diabetic thai paddy field based farmer, fever, cough, rainy season

A

Burkholderia

103
Q

Thai teenager with 5 days of fever, HA, Myalgia, painless black scab in his grain

A

Orientia Tsustugamushi-PAINLESS

104
Q

skin scratch marks, jaundice, hypotension, tender abdomen

A

think of borrelia recurrentis (spirochetes)
Vector: Body, Clothes Louse -Pediculus H Humanus
Epi: Africa, South Sudan

105
Q

patient who is sleeping in tick-and-rodent-accommodating thatched, mud or log cabins, or infested domestic animals

A

tick borne relapsing fevers-borrelia duttonii

106
Q

Relapsing fevers ddx

A

P. Falciparum, Louse borne typhus, yellow fever, viral hepatitis, leptospirosis, typhoid, VHFs, tick borne fevers

107
Q

46yoM farmer, rainy season in India. 1 week fever, headache, myalgia, joint pains .GCS dropped, thrombocytopenia, high protein, mostly lymphocyte LP. +eschar Dx?

A

Scrub typhus (ELISA)-Orientia Tsutsugamushi
-Gram negative intracellular bacteria
-Mite Chigger (Leptotrombidium larva trombiculid mite)

108
Q

Most common cause of fever in South India/Asia

A

Dengue, Scrup typhus, malaria, leptospirosis, typhoid

109
Q

Acute undifferentiated fever in South Asia:

A

Malaria, Dengue, Leptospirosis, Scrub typhus, typhoid

110
Q

54yo Farmer T2DM, HTN, CKD with right eye visual issues x 2 weeks, frozen right globe, cannot move his eye. painful black necrotic ulceration into the hard palate

A

Mucor (Rhizopus) –>broad aseptate fungi, ribbon like

111
Q

DDx for paranasal infections

A

Pseudomonas, salmonella, staph
Aspergillus, Mucor
ANCA Wegners
Lymphoma

112
Q

Facial pain, soft tissue swelling, periorbital edema, pain, proptosis blurring, loss of vision. Treatment?

A

Rhino-orbito-Cerebral Mucormycosis. Liposomal Amphotericin B, Posaconazole

113
Q

Most common febrile illnesses in India

A

Q fever, CCHF, KFD, Nipah, Malaria, Histo, Visceral, Taylaromycosis

Dengue, Scrub Typhus, Typhoid, Lepto, TB, Melioidosis, Mucor, R conorii

114
Q

45year old back from Botswana, fever, multiple eschars, rash.

A

african tick fever: Ricketsisia africae (multiple eschars, tx doxy, serology for dx)

115
Q

30 year old from Guinea for 9 months (MSF) had a positive RDT Malaria, then went to Kindia and had fever, took cipro, had fever again. Eos 77%.

A

schisto (katayama fever) v. entameoba coli v. giardia -could have all 3 ; treat with praziquantel

116
Q

fever and eosinophilia causes from africa

A

larva migrans, strongy, fasciola

117
Q

fever and eosinophilia causes from africa

A

larva migrans, strongy, fasciola

118
Q

Apical complex parasites

A

Babesia, Plasmadoium, Cryptosporidium parvum, Cyclospora Cayetanensis, Cystoisospora Belli, Toxoplasmosis

119
Q

Which parasites are auto infection

A

enterobius vermicularis, strongyloides stercoralis, hymenolepsis nana, taenia solium, capillaria, cryptosporidium

120
Q

Which have a nodular lymphatic spread

A

nocardia, sporothrix schenkii, leishmaniasis, tuberculosis, tularemia, mycoacterium marinum

121
Q

What are the dimorphic fungi

A

blastomycosis, coccidiomycosis, histoplasma, paracocci, sporothrix

122
Q

Paediculus hominus louse causes which diseases

A

R. Prowazzecki, Bartonella quintana, borrelia recurrentis

123
Q

Raw fish causes which diseases

A

gnasthomiasis, clonorchis, angiostrongylus, dibothriocephalus, anisakis

124
Q

What would you treat a ghanain child with uncomplicated falciparum malaria with?

A

ACT: Artesunate/amodiaquine

125
Q

4 year old girl from bangladesh presents with gross bloody mucoid diarrhea and fever of 2 days duration. What ist he most likely agent

A

Shigella Dysenteriae

126
Q

You are working or a HAART program in Africa and asked to evaluate the therapy for 27year old HIV+ CD4 440. She has Sputum positive TB and started RIPE. What is the first line HAART therapy?

A

Tenofovir, lamividuine, efavirenz
or tenofovir, lamividunie, doltegravir (incr dose)

127
Q

List the Severe Malaria Criteria

A
128
Q

Which drug kills gametocytes of P falciparum

A

primaquine, tafequinone, ACT

129
Q

26year old from senegal, diarrhea and fever. fever ha after 2-3 weeks. LP WBC 350 95% L, protein 125. Fever crisis when given abx.

A

Borrelia-relapsing fever

130
Q

In contrast to helminths, protozoa do what?

A

Multiply in the host. Helminths multiply out of hte host.
They can both cause eosinophila (cystoisospora in protozoa), they both have disease in proprotion to parasite b urden

131
Q

Tropical pulmonary eosinophilia buzz word

A

Wuchereria bancrofti

132
Q

what helminth can cause acute salpingitis

A

enterobius vermicularis

133
Q

List the food with each of the diseases:
A) Trichinella Spiralis
B) Taenia Solium
C) Diphylobotrhium Pacificum
D) Paragonium Mexicanus
E) Gnasthastoma

A

A) Bear meat
B) Pork Meat
C) Raw fish
D) Crabs, Crayfish
E) Raw fish

134
Q

Which parasite causes obstructive jaundice

A

Clonorchis Sinensis: Liver Fluke

135
Q

What are the live vaccines

A

MYROMETRIP:
Mumps, yellow fever, rubella, OPV, Measles, typhoid , TB (bcg), Rubella, Influenza, Plague

136
Q

Which TB drugs cause hepatotoxicity?

A

INH (anytime), Rifampin (Early ), Pyrizinamide (late), bedaquiline (esp with PZA), etonamide

137
Q

Which TB drugs cause anemia, myelosuppresion?

A

isoniazid (aplastic), Rifampin (thrombocytopenia), linezolid (myelosuppression)

138
Q

which TB drugs cause rash

A

rifampin, ethambutol
*clofazamine is more skin color changes

139
Q

Which larvae penetrate the intact skin

A

Strongy, Ancylostoma, Schisto

140
Q

Which HIV drugs cause lactic acidosis

A

Zidovudine, tenofovir, abacavir

141
Q

Which HIV drug causes anemia

A

zidovudine

142
Q

Which HIV drug causes renal failure

A

tenofovir

143
Q

h HIV drugs cause diarrhea

A

Lopinavir/Ritanavir

144
Q

List your TB mimickers by Bacteria, Fungi, Parasites

A

Bacteria: NTMs, Leptospira, burkholderia Pseudomallei, Rhodococus, NOcardia

Fungi: Crypto, Histo, Penicillium Marneffei, Paracocci, Pneumocystis

Parasites: Paragonimus Mexicanus, Dirofiliaria Immitis

145
Q

Ccauses of fever, rash, jaundice

A

Lepto, CMV/EBV, Dengue, Malaria, Rickettsia, Louse Borne Relapsing fever, Hep A (ALT will be very high), syphilis

146
Q

DDx for cavitating PNA

A

TANKSSCRAMPD
Tuberculosis/NTM, aspergillosus, nocardia, klebsiella, Strep/Staph, Crypto, Rhoddocus, Actinomyces, Melioid, Mucor, Paragonium, Dimorphic fungi (histo, blasto, cocci, paracocci, sporothrix)

tropical medicine (19 decks)

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