FINAL

Question 1

Malaria uncomplicated vs severe S&S

Answer 1

-uncomplicated- paroxysmal fever, chills, malaise, arthralgia, myalgia, headaches, diaphoresis, tachycardia, tachypnea, abdominal pain, splenomegaly, nausea, vomiting
-severe- AMS, seizures, shock, adult respiratory distress syndrome (ARDS), metabolic acidosis, hemoglobinuria, renal failure, hypoglycemia, hepatic failure, coagulopathy, sever anemia

Question 2

malaria treatment

Answer 2

-uncomplicated -> atovaquone/proguanil, artemether/lumefantrine, quinine sulfate plus doxycycline, mefloquine (mefloquine can cause neuropsychiatric reactions)
-NO chloroquine resistance -> uncomplicated treated with chloroquine phosphate or hydroxychloroquine
-P. vivax and P. ovale -> primaquine
-severe- IV quinidine gluconate plus doxycycline or clindamycin

Question 3

toxoplasma infection

Answer 3

-can be inactive and become reactivated if immune system compromised
-flu like in immunocompromised
-parasitic protozoan

Question 4

amebiasis

Answer 4

-cysts can live outside body for weeks-months
-2-4 weeks incubation
-spectrum from asymptomatic to hemorrhagic colitis
-gradual
-amebas develop into trophozoites
-luminal agents are poorly absorbed and are effective against cysts
-1st- metrodazole or tinidazole
-2nd- paramomycin or iodoquinol (luminal)
-IV FOR SEVERE

Question 5

Giardiasis

Answer 5

-1-3 weeks incubation
-parasitic, flagellated, cystic
-acute and chronic
-chronic- anorexia, weight loss, malabsorption, B12 deficiency, postinfectious IBS, lactose intolerance
-ovum and parasite stool studies x3, stool antigen, and nucleic acid amplification testing (NAAT)
-tinidazole, nitazoxanide, metronidazole
-halogenated (chlorine or iodine) water

Question 6

hookworm

Answer 6

-filariform larvae enter
-mature and reproduce in small intestine
-N. americanus- 5 years
-A. duodenale- 6 months
-rain required for support
-eggs excreted in feces
-ground itch, diarrhea (Not bloody)
-iron anemia, low protein
-eosinophilia, microcytic anemia
-stool sample
-albendazole, mebendazole, pyrantel pamoate
-iron supplements

Question 7

pinworm

Answer 7

-enterobius vernicularis
-mate in ileum, cecum, appendix
-albendazole, mebendazole, pyrantel pamoate
-2 rounds, 2 weeks apart -> only kills adult (not eggs)

Question 8

tapeworm

Answer 8

-eating beef containing cysticerci (striated muscle, liver, lungs)
-cestode
-cyst hatch -> release protoscolices -> attach to intestine wall -> become heads (scolex) of adult tapeworms
-cattle eat infected poop
-nonproductive cough, pneumonia complication
-worms live for several years

Question 9

histoplasmosis

Answer 9

-spelunkers lung
-3-17 day incubation
-cave exploration +
-chest pain -> nonproductive cough, pericarditis, mediastinitis, hepatosplenomegaly
-erythema nodosum

Question 10

pneumocystis

Answer 10

-@ first normal chest x-ray
-bilateral ground glass, butterfly pattern
-sputum dx or broncheoalveolar lavage
-CD4 < 200
-TMP/SMX -> active -> Add prednisone if severe

Question 11

influenza

Answer 11

-type A -> hemagglutinin (HA or H) and neuraminidase (NA or N)
-antigenic DRIFT- frequent and minor
-antigenic SHIFT- infrequent and significant
-neuraminidase- oseltamivir (oral), zanamivir (inhaled), and peramivir (IV)
-treatment within 48h

Question 12

rubeola complications

Answer 12

-7-21 days incubation
-recovery phase- 2 week cough
-diarrhea, otitis media, pneumonia, encephalitis, seizures, and death
-subacute sclerosing panencephalitis- rare and fatal degenerative disease of CNS that occurs in some pts 7-10 years about initial infection

Question 13

mumps

Answer 13

-12-25 days incubation
-reproduces in URT
-spreads via saliva, oropharyngeal secretions, and droplets
-contagious 5 days after onset of parotitis
-progress first 72 hours, remains 1 week
-complications: orchitis, oophoritis (ovarian inflammation), infertility, pancreatitis, meningitis, and/or deafness

Question 14

rubella

Answer 14

-worse in adults
-12-23 days incubation
-posterior lrymphadenopathy
-arthralgia/arthritis***
-complications- thrombocytopenic purpura and encephalitis
-congenital rubella syndrome- cataracts, heart defects, deafness

Question 15

rabies

Answer 15

-1-3 months incubation
-prodrome- fever, headache, vomiting, pain/paresthesia at bite
-2 types once spread to CNS
-furious/encephalopathic- MC- hydrophobia, insomnia, paranoia, hallucination, coma, death
-paralytic/dumb- ascending paralysis, fever, confusion, coma, death
-skin bx, virus in serum or CSF
-die within 10 days of coma

Question 16

rabies treatment

Answer 16

-preexposure- 0, 7, 21/28
-postexposure- 0, 3, 7, 14 -> immunocompromised -> 5th dose on day 28
-ALSO weight based rabies immune globulin on day 0, with half the dose administered as close to wound as possible
-If you had preexposure vaccination -> dont need immune globulin -> booster shots at days 0 and 3
-cleaning with iodine to reduce spread

Question 17

fifths disease

Answer 17

-parvovirus B19
-erythema infectiosum (EI)
-4-14 day incubation
-2-5 day slap cheek -> lacelike reticular rash on trunk and extremities (not hands and feet)
-can be itchy
-triggered by sun, stress, heat, exertion
-polyarthritis

Question 18

dengue

Answer 18

-retroorbital headache
-often asymptomatic
-can progress to hemorrhagic or shock
-1. febrile- petechiae, bruise, + tourniquet, epistaxis
-2. critical (after fever breaks)- GI hemorrhage, capillary leak into chest/peritoneum (ascites) -> shock
-3. recovery- bradycardia, and white islands in sea of red
-high Hct, low albumin, leukopenia, thrombocytopenia

Question 19

west nile virus

Answer 19

-culex spp.
-asymptomatic
-encephalitis (rare) -> flaccid paralysis
-neurologic sequelae -> mortality

Question 20

Zika Virus

Answer 20

-conjunctivitis*****
-pregnancy -> microcephaly, brain defect
-guillian-barre

Question 21

chikungunya

Answer 21

-high fever (can be biphasic)
-polyarthralgia
-symptomatic
-guillian barre