Green PANCE book

Question 1

How is norovirus spread?

Answer 1

Food
water
person to person

Question 2

Onset 1-3 days
Watery diarrhea
Low grade fever
Duration= 1-2 days

Therapy= hydration! and prevention (hand washing)

Answer 2

Norovirus

Question 3

How is cholera (vibrio spp.) spread?

Answer 3

Water

Question 4

Onset 2-3 days
Profuse, watery diarrhea 
Some N/V
Rarely a fever
Duration= days!

Therapy= hydration!

Answer 4

Cholera (vibrio spp.)

Question 5

What is the source of enterotoxic E. coli

Answer 5

Food

Question 6

Onset 5-15 days
Cramping, watery diarrhea
Some N/V
Low grade fever
Duration= 1-5 days

Therapy= hydration, bismuth/loperamide

Answer 6

Enterotoxic E. Coli

Question 7

What is the source of Salmonella?

Answer 7

Poultry

Question 8

Onset 6-72 hours
Purulent diarrhea
Nausea, some vomiting
FEVER! Septicemia
Duration= 4-7 days

Therapy= hydration!

Answer 8

Salmonella

Question 9

What is the source of Enterohemorrhagic E. coli?

Answer 9

Undercooked ground beef

Question 10

Onset 12-60 hours
Purulent, bloody diarrhea. cramping
No N/V
Fever
Duration= 5-10 days

Therapy= supportive, unless severe

Answer 10

Enterohemorrhagic E. Coli

Question 11

What is the source of Shigella?

Answer 11

Fecal-oral

Question 12

Onset 1-6 days
Purulent, bloody diarrhea. cramping
No N/V
Fever
Duration= 1-7 days

Therapy= supportive

Answer 12

Shigella

Question 13

systemic immune response occurring 15-20 days after exposure to streptococcal pharyngitis

*early tx of streptococcal infection is imperative to prevent!

Answer 13

Acute rheumatic fever

Question 14

A strictly anaerobic, spore forming bacillus found in the soil
*may accidentally end up in food (home canned, smoked or commercial)

Answer 14

Clostridium botulinum

Question 15

Inhibits the release of Ach at the neuromuscular junction

• IV drug users at high risk!
• babies who eat honey are at high risk!

Answer 15

Botulism

Question 16

Initial clinical sx= visual changes, including diplopia and loss of accommodation
*manifestation usually 12-36 H after ingestion

Additional sxs…ptosis, impaired EOM, fixed dilated pupils, cranial nerve palsies, dysphonia, dry mouth, dysphagia, N/V

Answer 16

Botulism

Question 17

Tx of botulism?

Answer 17

Anti toxin

and respiratory support if needed

Question 18

Produces a toxin than activates adenylyl cyclase in intestinal epithelia cells of the small intestine..results in hyper secretion of water and Cl ion and massive diarrhea

*death results from HYPOvolemia

Answer 18

Cholera

Question 19

“rice water” diarrhea (gray, turbid and without odor, blood or pus”

Answer 19

Cholera

stool cultures positive for Vibrio cholerae

Question 20

Tx of cholera

Answer 20

Fluid and electrolyte replacement

Oral if tolerated, IV if severe
*Abx will shorten duration and reduce severity of symptoms (tetracycline, ampicillin, etc)

Question 21

Is a cholera vaccine available?

Answer 21

Yes! but protection is temporary, with boosters needed every 6 months

Question 22

Clostridium tetani spores are found in…

Answer 22

soil

Question 23

Spores germinate in wounds (esp puncture wounds!!) where the bacteria produce a neurotoxin, which interferes with neurotransmission at spinal synapses of inhibitory neurons

*result=uncontrolled spasm and exaggerated reflexes

Answer 23

Tetanus

incubation pd= 5 days to 15 weeks

Question 24

Pain and tingling at site of inoculation, followed by spasticity of muscles nearby

• *jaw and neck stiffness, dysphagia, irritability
• hyerperreflexia and muscle spasms, especially in jaw (truisms) and face

Answer 24

Tetanus

Question 25

Painful tonic convulsions, spasms of the glottis and respiratory muscles and asphyxia if pts is untreated

Answer 25

Tetanus

Question 26

Treatment for tetanus?

Answer 26

Tetanus immune globulin given intramuscularly (IM) Full course of tetanus toxoid once pt recovers

Question 27

Salmonella enteric are transmitted by ingestion of contaminated....

Answer 27

food and water

Question 28

Enteric fever (typhoid fever) Gastroenteritis Bacteremia

Answer 28

3 patterns of Salmonellosis

Question 29

incubation pd 5-14 days *organisms enter mucosal epithelium of the intestine and invade and replicate within macrophages in Peyer patches, mesenteric lymph nodes and the spleen

Answer 29

Enteric (typhoid) fever

Question 30

Onset insidious with a prodrome of malaise, HA, cough and sore throat *abdominal pain, distention and constipation and/or diarrhea ("pea soup") develops as fever increases *fever reaches peak on 7-10 days and the pt appears toxic, then generally improves over the next 7-10 days

Answer 30

Typhoid fever

Question 31

Splenomegaly, abdominal distention and tenderness, bradycardia * rash develops during second week * organism can be isolated from blood during 1st week

Answer 31

Typhoid fever

Question 32

DOC- ampicillin, chloramphenicol, TMP-SMX | if resistant, ceftriaxone or fluoroquinolones

Answer 32

Typhoid fever

Question 33

Most common form of Salmonella infection *incubation= 8-48 hrs after ingestion of food or drink that is contaminated *fever, N/V/D BLOOD DIARRHEA 3-5 DAYS!*

Answer 33

Gastroenteritis

Question 34

Dx and treatment of Gastroenteritis

Answer 34

Dx= stool culture Tx=usually self limiting

Question 35

Caused by salmonella *characterized by prolonged or recurrent fevers, can have local infection in bone, joints, pleura, pericardium, lungs or other sites

Answer 35

Bacteremia

Question 36

Shigella sonnei Shigella flexneri Shigella dysenteriae *most common species that cause dysentery

Answer 36

Shigellosis

Question 37

Illness starts abruptly with diarrhea, lower abdominal cramps and tenesmus accompanied by fever, chills, anorexia, HA and malase *stools are loose and mixed with blood and mucus!****

Answer 37

Shigellosis

Question 38

Stool positive for leukocytes and RBCs, culture yields shigella spp. *sigmoidoscopy will reveal inflamed engorged mucosa, punctate lesions or ulcers

Answer 38

Shigellosis

Question 39

Shigellosis tx

Answer 39

Replacement of fluid volume Abx= TMP-SMX

Question 40

Corynebacterium diphtheria is transmitted via...

Answer 40

respiratory secretions | organism has a propensity for mucous membranes, especially respiratory tract

Question 41

* nasal infection produces few symptoms other than nasal discharge * laryngeal infection causes upper airway and bronchial obstruction * pharyngeal is MOST COMMON! a tenacious gray membrane cover the tonsils and phyarnx. pt will have mild sore throat, fever and malaise * myocarditis ad neuropathy

Answer 41

types of Diphtheria infections

Question 42

Pharyngeal infection= most common type!! A tenacious gray membrane covers the tonsils and pharynx, and pts complain of mild sore throat, fever, malaise

Answer 42

Diphtheria | diagnosis is clinical!!!!

Question 43

A horse serum antitoxin must be given in all cases of...

Answer 43

Diphtheria

Question 44

Does diphtheria have a vaccine?

Answer 44

YES!

Question 45

Human herpes virus 4, a universal virus transmitted via saliva

Answer 45

EBV

Question 46

``` Mono Burkitt lymphoma Nasopharyngeal carcino,a Pediatric leiomyomas Collagen vascular dz ```

Answer 46

caused by EBV

Question 47

Oral lesions: exudative pharyngitis, tonsillitis, gingivitis, soft palate petechiae *malaise, anorexia, myalgias

Answer 47

EBV

Question 48

An early granulocytopenia is followed by a lymphocytic leukocytosis *atypical leukocytes appear as larger cells that stain darker and frequently vacuolated

Answer 48

EBV

Question 49

Tx of EBV?

Answer 49

Symptomatic!

Question 50

caused by orthomyxovirus *readily transmitted thru droplet nuclei and occurs in epidemics and pandemics during fall and winter

Answer 50

influenza

Question 51

3 strains exist: A (more pathogenic), B, C *different types based on surface antigens hemagglutinin (H) and neuraminidase (N)

Answer 51

influenza

Question 52

Incubation period 18-72 hours fever, chills, malaise, muscle aches, substernal CP, HA, nasal stuffiness fever lasts 1-7 days accompanied by coryza, nonproductive cough, photophobia, eye pain, sore throat, pharyngeal injection and flushed facies

Answer 52

influenza

Question 53

Reye syndrome (fatty liver with encephalopathy) is a potential complication

Answer 53

influenza

Question 54

Tx of influenza

Answer 54

supportive care

Question 55

member of herpesvirus family * highly contagious, especially the day before the rash appears * incubation period is 10-20 days benign in children, can be life threaetning in elderly or immunocompromised

Answer 55

Varicella(chicken pox)

Question 56

lesions begin as erythematous eruption that follows a centripetal pattern * lesions appear in crops * mucous membranes may be involved

Answer 56

Varicella (chicken pox)

Question 57

painful eruptions along dermatomal pattern thoracic and lumbar regions! trigeminal eruptions that include the tip of the nose (Hutchinsons sign) risk corneal involvement

Answer 57

Zoster (shingles)

Question 58

Rhabdovirus is transmitted via infection from an animal bite or an open wound *vectors= bats, dogs, foxes, raccoons, coyotes,

Answer 58

Rabies

Question 59

incubation pd between bite and onset of symptoms in from 10 days-years (typically 3-7 weeks) typically pain and prosthesis at site; skin is sensitive to changes in temp and wind

Answer 59

rabies

Question 60

pts are restless, with muscle spasms and extreme excitability Bizarre behavior, convulsions, paralysis *THICK, tenacious saliva *hydrophobia (painful spasms caused by drinking water)

Answer 60

Rabies

Question 61

Suspect animals: brains tested for virus using fluorescent antibody markers *CSF may show rabies revere transcriptase by PCR

Answer 61

Rabies

Question 62

Is there a cure for rabies?

Answer 62

NO! prevention is key!!

Question 63

Post exposure immunization includes rabies immunoglobulin (in wound and IM at a distant site)

Answer 63

Rabies | if pt has receives active immunization in past, immunoglobulin is NOT given

Question 64

Pre exposure vaccination of persons at high risk

Answer 64

rabies

Question 65

infects all cells containing the T4 antigen, primarily the CD4 helper inducer lymphocytes *transmitted thru bodily fluids

Answer 65

HIV

Question 66

CD4 count below 200

Answer 66

AIDS

Question 67

the measure of actively replicating virus

Answer 67

viral load

Question 68

if possibly exposed to HIV, post exposure prophylaxis should be started within...

Answer 68

72 hours

Question 69

secondary prevention efforts include anti-retrovirals and chemoprophylaxis

Answer 69

HIV treatment

Question 70

Spread via... Sex, breast milk, blood transfusions, respiratory droplets * *owl eyes in biopsy * *pizza pie retinopathy

Answer 70

Cytomegalovirus (herpes virus 5)

Question 71

Dimorphic fungus found in soil infested with bird and bat droppings

Answer 71

Histoplasmosis

Question 72

Urine assay can be used to confirm dx DOC= itraconazole

Answer 72

Histoplasmosis

Question 73

Encapsulated budding yeast found in soil with dried pigeon dung Pulmonary dz can develop Fever,cough dyspnea Dx= CSF. Tx=Fluconazole

Answer 73

Cryptococcus

Question 74

India ink stain or serology with latex agglutination used in dx of

Answer 74

Cryptococcus

Question 75

Fungus found in lungs of humans and animals **MOST COMMON HIV OPPORTUNISTIC INFECTIONS SOB, nonproductive cough Diffuse interstitial infiltrates DOC: TMP-SMX

Answer 75

Pneumocystis jiroveci pneumonia

Question 76

Enterobius vermicularis (humans only host) Perianal itching Scotch tape test DOC= albendazole for whole house

Answer 76

Pinworms