ID CM Flashcards
(303 cards)
1
Q
definition of epidemiology
A
study of distribution of disease and the distribution of determinants (RF, exposures) of disease (or health related states) in disease specific populations
2
Q
what are the 3 goals of epidemiology?
A
describe patterns
identify causes of disease
provide data for the management, evaluation and planning of services
3
Q
what are the 5 goals of surveillance?
A
detect outbreaks
quantify magnitude of the problem
evaluate prevention measures
detect changes in the health care practice
facilitate planning
4
Q
what are the 5 categories of reportable conditions?
A
STDs
gastrointestinal (cholera)
biologic threat agents
Vector Borne
zoonotic
5
Q
what are there reportable disease
category 1
category 2
A
Category 1: immediate notification
Category 2: Notification within 48 hours
6
Q
how long can it take for H1N1 to become a pandemic?
A
48 hours
she wrote this down
7
Q
what are the 4 goals of influenza surveillance?
what is this accomplished by?
A
identify circulating strains
assist in controlling outbreaks
provide information to policy makers
build rapid response
accomplished by syndromic surveillance
8
Q
who is exempt from HIPPA privacy rule?
A
public health investigators
they have the right to acess the information on reportable disease
9
Q
if someone has a reportable condition…what is provided to the public health official?
(4)
A
condition diagnosed or suspected
unusual or sudden increase
Name, date, phone number
10
Q
who are specifically vulnerable to disease?
A
elderly living alone
those with chronic diseases
11
Q
what number in the country are we for elderly living at home?
why do we care?
A
3rd!
especially living at home is an issue if there is a flu outbreak or also a heat wave!! think about this!!
12
Q
what number are we in the country of peope living outside of an urban area?
A
2nd for % living outside of urban area!
need to consider this if there was epidemic or anything because they would be more vulnerable and have less access to care!
13
Q
does the federal authority have the right to quarentine or isolate someone?
who is responsible for public health?
A
yes, federal authority has the right to quarentine someone TO PROTECT THE PUBLICAND IF EMERENCY HEALTH RISK
**states are responsible for public health within their own borders**
14
Q
what are 4 RECENT conditions that the federal authority can DETAIN somoene for having?
A
XDR-TB: air traffic
Bushmeat: possible ebola
measles: europe
H1N1 pandemic (young people)
15
Q
who did H1N1 pandemic effect?
A
young healthy people
16
Q
what are 7 isolateable diseases?
A
cholera
diphtheria
plague
TB
smallpox
yellow fever
hemorrhagic fever
17
Q
what is it always important to do in a patient presenting with a illness
A
ask about travel hx!!
18
Q
what is important to remeber when doffing PPE?
A
important to remove most contaminated PPE first to prevent self-contamination
19
Q
have they started vaccination trials for ebola?
A
YES!
20
Q
explain the source of peoples confusion surrounding vaccine and autism?
A
MEASLES MUMPS REBULA VACCINE IN LANCET PUBLISHED IT CAUSED AUTISM,
12 YEARS LATER IN 2010 THE ARTICLE AS REMOVED AND REATRACTED. THE ONLY TIME THAT THE JOURNAL MOVED ARTICLE BECAUSE ITS A PRETIGIOUS JOURNAL
THE RESERACHER FALSIFIED DATA AND LOST OFF OF HIS FUNDING, MULTIPLE STUDIES SINCE SHOWING NO RELATIONSHIP!!!
21
Q
how many americans get ill with food borne illness?
A
1 in 4 Americans ill
22
Q
what are 3 long term sequelae of food born illness and what are they caused by?
A
1. Hemolytic uremic syndrome (HUS)
E. coli
long term kidney dysfunction in 33%
2. Guillain Barre Syndrome (GBS)
campylobacter jejuni
40% ventilated
85% with residual deficits
3. Reactive arthropathy
salmonella, campylobacter, yersinia, enterocolitia, shigella
23
Q
what is the 1 foodborne illness that has increased in influnence for infection?
A
vibrio
24
Q
how much has ecoli food born illness decreased over the last 4 years?
A
25%
25
what are the 7 most influential food born illnesses?
1. listeria
2. E. coli
3. toxoplasmosis
4. salmonella
5. campylobacter
6. norovirus
7. _vibro_ (increasing in prevalance)
26
vibrio
## Footnote
2 things that cause this?
what does it come from?
what is the control strategy?
v. parahaemolyticus, v. vulnificus
## Footnote
underling liver disease, immunocomprimised
**_WARM WATERS, RAW SHELLFISH_**
Control strategy: educate the consumer
27
focal outbreak
## Footnote
what is this characterized by?
who detects it?
what happens?
likely cause?
is there a fix?
1. large number of cases in one jurisdiction
2. detected by the infected group themselves
3. local investigation
4. local food handling error
5. local solution
28
dispersed outbreak
## Footnote
where does this occur?
who detects it?
who investigates?
likely cause?
implications?
1. small number in many jurisdictions
2. detected by lab-based subtype surveillance
3. multi-state investigation
4. industrial contamination event
5. broad implications
29
why do we see more dispersed outbreaks?
1. better surveillance
2. centralized production of foods means when there is a problem it occurs everywhere
3. more imported foods/ingredients
4.
30
when you think of ground beef
what bacteria should you think of? (2)
shigella producing E. coli
MDR salmonella
31
sprouts
## Footnote
why are these bad?
what is it difficult to prevent?
what are two intitiates put in place?
**_REALLY BAD DIRTY THING!!_**
grow in warm moist environment that harbors bacteria
Why difficult to prevent:
1. difficult to detect the bacteria once in the plant
2. rarely cooked by consumer
3. scarification, bacteria enters the seed so hard to find
Prevention:
1. NACMCF spout guidance white paper!
2. sprout guidance by the FDA
32
what are the two common pathogens that infect sprouts?
E.coli
salmonella
33
what are the steps to following an outbreak?
(4)
determine whether there is an outbreak
describe the outbreak
measure the outbreak
stop further outbreaks
34
case definition
what is this?
in epidemiology it is:
what is is required to be included in the outbreak and be considered positive
35
what is descriptive epidemiology?
the summary of health-related characteristics according to the **person place and time**, tells you **“who, what, when, where, why”**
used to determine the cause of the outbreak
36
yellow fever vaccine
## Footnote
where geographic locations do you need this?
can it be required?
living/dead?
central/south america and Africa
\*1 of 2 required vaccines for travel\*
_required every 10 years to travel to infect areas with endemic levels_
attenuated _live_ vaccine
1 vaccine last 10 years
37
what are the two vaccines that are the only two LEGALLY required for international travel?
1. yellow fever
2. cholera
38
is there polio in the americas?
NOPE! americas are polio free now!
39
cholera vaccine
## Footnote
are travelers at high risk?
helpful vaccine?
how many shots?
booster?
what is there no vaccine to?
most travelers _low_ risk
vaccine of limited use now
**_no vaccine to vibrio cholera 0139 strain_**
full 3 shot series
booster in 6 months might be needed
40
what should you know about the parentral cholera vaccine?
poorly protective in 50% for only a few months
uncomfortable and rarely reccomended
41
what are some vaccines that may be indicated depending where you are traveling to?
(8 of them)
1. typhoid
2. plaque
3. measles
4. polio
5. rabies
6. Hep A
7. Hep B
8. Tetnus
42
measles vaccine
MMR
live/dead?
of doses?
LIVE
two doses
43
polio vaccine
options for admin?
what 3 geographic locations?
single booster needed for _india, pakistan, afghanistan_
inactivated: parentral (18+ never vaccinated)
attenuated live oral
44
where is the only known transmission for polio?
pakistan and afghanistan
45
rabies vaccine
who gets it?
of doses?
people who are staying in a endemic region or remote area with close animal contact
4 vaccine doses
46
Hep A vaccine
who should get this?
who are there new reccomendations for?
when should first dose be given?
when do they get booster?
nearly all international travelers
new pediatric recommendations
first dose \>4 weeks prior
booster: 6-12/18 months
47
hepatitis B vaccine
who should get this?
how many series?
endemic in South America, Africa, SE Asia, South Pacific
close contact with locals
extended stay
0, 1, 6 month series
48
Tetnus
who should get this?
when is the booster indicated?
what is the nickname for this?
what age group qualifies?
EVERYONE SHOULD HAVE A PRIMARY SERIES
TETNUS-DIPHTHERIA TOXOID BOOSTER IS INDICATED _every 10 years_
**greater than 5 years old**
"Tdap"
49
when are the time frames for influenza in the different hemispheres?
November to March northern hemisphere
april to september in southern hemisphere
50
what are four unavaliable or uncommon vaccines?
if uncommon, where are they used?
small pox: ex: _millitary_
typhus-off the market
anthrax-CDC
BCG-_overseas_ use
51
what are 4 important hygiene considerations when traveling abroad?
(what to avoid as well)
**1. water acquisition...bottled!**
**2. other beverages**
**3. food precautions**
a. only well cooked meat
b. AVOID
- salad/raw veggies
- unpasteurized dairy products
- street vendors
- ice
**4. restaurant evaluation**
52
travels diareahh
## Footnote
what does this come from?
who is it common in?
what is the 4 most common causes?
what is the most common?
what are 3 symptoms?
what are 4 tx considerations?
**fecally contaminated water and food**
more common in _younger_ people
**_MOST COMON BACTERIA, then parasites_**
**_MOST COMMON: E.coli_**, shigella/salmonella, campylobacter, viral
symptoms:
1. abrupt onset of loose stools
2. abdominal cramping
3. rectal urgency
tx:
1. typically self limited
2. REHYDRATION
3. **_fluoroquinolones, short 3 day course_**
- rifaximin
- azithromycin
4. immodium
53
is prophylaxsis reccomended for travelers diarreah?
nope it is not...
## Footnote
but you can consider prophylaxsis in special situations with
fluorquinolones/refaxamin
54
what are 5 preventative measures you can take to prevent travelers diarreah?
1. avoid street vendors
2. buffets
3. raw or undercooked meats/seafoods
4. avoid raw fruits, vegetables
5. avoid tap water, ice and dairy products
55
what type of mosquitos bite humans?
explain the life cycle?
what do they need for their life cycle?
what do you find larvae?
only the **_female take blood meals_**
eggs to larvae to pupae to adult
mosquitos need to be in **_WATER_** for most of their lifecycle
mosquito larvae are found in **_stanidng water_**
56
what are some ways you can prevent arboviral illnesses?
5 ways
1. repellants like DEET, oil of lemon
2. protective premetherin treated clothing
3. limit outdoor activity in high-risk area
4. screens on windowns and doors
5. use bed nets
57
what are the two arboviruses that maine is most concerned with?
eastern equine encephalitis
west nile virus
58
explain how they test for rabies on the specimen you bring in?
euthanasia and decapitation
cold (not frozen shipment)
harvest braine and prepare slides
cerebellum, hippocampus, and brain step
fluorescent antibody staining
monoclonal typing of positive specimens
59
what are the 4 conditions transmitted by the ixodes scapularis (deer tick)?
1. **borrelia burdoferi: aka LYME DISEASE**
**2. babesia microti: HUMAN BABESIOSIS**
**3. anaplasma phagocytophilia: human granulocytic anaplasmosis**
**4. powassan virus**
60
lyme disease is caused by
borrelia burdoferi
61
human babesiosis is caused by
babesia microti
62
human granulocytic anaplasmosis aka human anaplasmosis is caused by
anaplasma phagocytophilia
63
what is the scientific name for deer tick?
ioxodes scapularis
64
what are the most common sxs seen with tickborne disease?
(3)
1. fever/chills
## Footnote
2. myalgias/pains
3. rash
65
what is the stage of ioxodes scapularis tick that bites humans to cause lyme?
THE NYMPH!!!!!!
not the adult!!...these prefer white tailed deer!!!
66
what is STARI? what is it transmitted by?
southern tick associated rash illness (STARI)
## Footnote
cause unknown
rash appeares like lyme disease
**_transmitted by lone star tick_**
67
what are relapsing fevers characterized by?
group of acute infections caused by arthropod born spirochetes of the genus **_BORRELIA_**
characterized by _reccurent cycles of febrile episodes, separated by asymptomatic intervals of **apparent** recovery_
68
what are the 3 types of body lice?
**1. head lice: pediculous humanus capitus**
**2. body lice: pediculus humanus humanus**
**3. pubic lice: phthirus pubis**
69
of the 3 types of body lice, which does spread disease and which ones do not?
body lice: SPREAD BACTERIAL DISEASE
## Footnote
head and public lice do NOT spread disease
70
borrelia reccurentis
## Footnote
what does this cause?
what causes this in africa?
what is this characterized by?
how often can it occur?
3 tx options?
louse born relapsing fever
_Borrelia croicudare_ causes replapsing fever in africa
\*\*\*portal of entry when infected lice are crushed into abraded skin\*\*\*
gets into the skin from lice being crushed into abraded skin
**_CLEARING OF CICULATING STRAIN BORRELIA IN 3-5 days then NEW ANTIGENIC VARIANTS APPEARE_**
\*\*\* **up to 3-5 relapses may occur\*\*\***
**TX:**
**penicillin**
**tetracycline**
**erythromycin**
71
how do people get bitten by a tick?
ticks don't fly or jump!!!
they grab onto persons clothes as they walk by and crawl to a feeding spot on the person's skin
72
where are some specific places you should look for hiding ticks on your body?
8 places
1. head
2. hairline
3. nape of the neck
4. armpits
5. waist
6. between legs
7. thighs
8. behind knees
\*\*\*basically everywhere\*\*
73
what is the best way to remove a tick?
1. promptly
2. with tweezers
3. pull gently and slowly till tick lets go
4. apply antiseptic to bite
74
Do not be alarmed if the tick’s mouthparts remain in the skin. Once the mouthparts are removed from the rest of the tick, it can no longer transmit the Lyme disease bacteria.
potentially a Dr. Sears mythbuster!
75
what are the requirements for HIV test in maine?
(3)
1. A patient must be informed that an HIV test will be performed
2. Information must include an explanation of what an HIV infection involves
3. If a test is positive, post-test counseling must be provided
76
what are the two reccomendations for pregnant women with regards to HIV?
2
1. testing included in routine panel of prenatal screening in ALL pregnant women
2. repeat screen in 3rd trimester in areas with elevated HIV among pregnant women
77
who is screen reccomended in for HIV/AIDS? (3)
what is not required?
what must be obtained to test?
1. routine screening in all health care settings for all patients 13-64
(annual tests for at risk populations)
2. tests all pts with signs and sxs or with opportunist infection associated with AIDS
3. prevention cousleing and written consent forms are not required
- testing must be voluntary with verbal consent informaed
78
what is the risk of HIV with needle stick?
what about risk after expsure from eye, nose, mouth to HIV infected blood?
.3% with needle stick
.09% from eye, nose, mouth to HIV infected blood
79
why is there resistance to HIV drugs?
| (3)
1. High replication rate
2. High mutation rate
3. Selective pressure of drugs favors mutant strains over wild type
80
what can be a down side of using antivirals to tx HIV?
when does this ocurr?
how long does it last?
sxs?
reconstitution syndromes
Inflammatory reactions that occur **_after_** initiation of effective antiretroviral therapy
Usually occur few **_weeks to several months_** after initiation of therapy
Usually self-limited, but manifestations may be **_severe_**
is a condition seen in some cases of AIDS orimmunosuppression, in which the immune system begins to recover, but then responds to a previously acquired opportunistic infection with an overwhelming inflammatoryresponse that paradoxically makes the symptoms of infection worse.[2]
81
what must you continue to monitor for when txing a patient with HIV?
(4)
1. new STDs **annually**
2. new onset Hep C **annually**
3. TB
4. metabolic disorders
82
what vaccines are particullary important to make sure HIV pt has?
(5)
Annual influenza
pneumococcal
tetanus
hepatitis A and B
83
what is the structure of influenza? what family? what types?
- single stranded RNA
- orthomyxovirdae family
- A, B, C types
84
what is the composition of influenza A? of these two, how many are there in humans?
hemagglutinin (HA)
neuramidase (NA)
3 HA types in humans
2 NA types in humans
85
what does drift and shift mean in terms of influenza?
**shift:** pandemics, have NEW HA or NA
**drift:** epidemics, development of new strains, but not whole new component
87
what are 3 challenges of containment of influenza?
1. short incubation time (1-7 days)
2. ability for person with asymptomatic infection to transmit virus (can be contagious 1 day before symptoms)
3. early symptoms of illness are likely to be non-specific, delaying recognition (need to get antivirals on board within 48 hours of onset)
88
Avian flu (H5N1)
## Footnote
who does this infect? how was this introduced into N. america? why are we so scared of this?
- usually only infects birds
- **effects younger patients**
- longer duration of infection
- introduced to N. america by **bird migration**, infected people migrating, transportation of infcted poultry
\*\*\*hasn't transferred from person to person but if it does, we will basically all die because no one has immunity and 1918 will happen all over again, working on vaccines now but super scary, race agains time\*\*\*
89
influenza
## Footnote
what are the three types and which one is most pathogenic? what is the season for this disease, how is it spread and how long can it survive on a surface? how long does it incubate? how long do symptoms last? when is a person contagious? when is peak shedding and what does it correlate with? what is the definition? what is the best choice for diagnosis?
3 types; A (most pathogenic), B, C; neuramidase and hemmaglutinin make up the subtypes
**Fall/winter outbreaks (october-november)**
spread through **aerosolized droplets**, can live on surfaces **2-8 hours**
1. incubates 1-7 days, avg 3
2. symptoms last 3-7 days, but up to 14
**3. contagious 1 day before symptoms, 5-7 days after**
**4. peak shedding 3 days of illness, correlates with fever**
**fever \>100 or 37.8C AND cough or sore throat in absence of know cause, ABRUPT onset,** can have myalgia in legs and lumbosacral area. Emergency if CNS symptoms.
PCR is best choice for diagnosis, can do rapid from throat or nose, but not as good
90
what is the best way to prevent influenza?
## Footnote
what are the two mechanisms of this? which age groups should be considereded for these two methods? what form is the virus in? which patients should you NOT use this in???
IMMUNIZATION!!
1. **inactive intradermal vaccine:** innactive, trivalent, quadrivalent, recombinant, higher antigen, contains 3-4 viruses, 70-90% effective **everyone older than 6 months**
**2. intranasal:** live attentuated, **2-49 year old**, caution in \>50 or pregnant
\*\*\*_don't use if allergic to eggs or gelatin\*\*\*_
91
what are the treatment options for influenza?
how are they used?
when do they need to be started?
who don't you use these in?
**neuriamidase inhibitors**
- oseltamivir
- zanamirvir
used for treatment and prophylaxis
**need to be started within 48 hours**
**don't use in**
92
what do you worry about when a child has influenza and are given asprin? what is the fatality rate?
REYE SYNDROME
(fatty liver and encephalopathy)
happens when pt has viral infection and given asprin, occurs 2-3 weeks after with a **30% fatality rate**
93
what do you worry about as a complication in elderly and chronically ill who have influenza? (2 things)
1. necrosis of the respiratory epithelium that leads to secondary bacterial infection by staph, strep, or haemoph
2. pneumonia development, significantly contributes to fatality
94
How many people are infected with TB? how many of those go on to develope the disease?
2 billion people are infected
9 million people develop the disease
Infected does not mean you will develop the disease!! Two completely different things!!!
95
what bacteria cause the most TB in the US? what are 4 other bacteria that can cause it?
**mycobacterium tuberculosis**
mycobacterium bovis
mycobacterium africanum
mycobacterium microti
mycobacterium canetti
96
what are the two populations of people that TB can be divided by?
hight risk for _becoming INFECTED with TB_
high risk for _DEVELOPING TB DISEASE_
97
what are 7 things that can put someone at high risk for TB _INFECTION (not disease)_
1. close contact
2. foreign born
3. low income and homeless
4. health care workers in high risk groups
5. racial and ethnic minorities
6. infants, children and adolescents
7. IV drug users
98
name five areas of the world where TB is common?
1. asia
2. africa
3. russia
4. eastern europe
5. latin america
99
what groups of people are at risk for _developing TB disease!? (7)_
1. people with **HIV** (thats why prevalence increased in the 80s)
2. infection of TB within **last two years (5% risk, and 10% lifetime)**
3. **infants and children**
**4. prolonged therapy with corticosteroids**
5. IV drug use
6. diabetes
7. silicosis
100
what is the greatest risk factor for devloping TB?
**HIV!!! 7-10% risk for devloping TB _disease_ each year when infected with both TB and HIV**
101
are people with LTBI infectious? what percent of these people will go on to develope the disease?
no they aren't infectious!!
10% will go on to develope disease!
102
Explain the pathogenisis steps for TB (5 steps)
1. tubercle bacilli are inhaled and travel to alveoli
2. multiple in alveoli, infection begins
3. small number of tubercle bacilli enter bloodstream and spread throughout body
4. within **2-4 weeks** macrophages survive bacilli, form a barrier shell that keeps the bacilli contained and under control know as **LBTI**
5. if the immune system can't keep tubercle bacilli under control, they multiple rapidly and cause _TB DISEASE_ \*it can occur in other places in the body too\*
103
In TB, explain the differences between LTBI and TB disease in these characteristic:
1. active/inactive bacilli
2. chest xray findings
3. sputum smears
4. symptoms
5. infectivity
6. a case of TB or not
105
Is LTBI treated with medication?
YES IT IS
you want to prevent these patients from getting it in the future!!!
106
who is high priority treatment for LTBI with a TST \>5 mm or postitive IGRA? (5 things)
1. close contacts of those with infectious TB disease
2. HIV
3. chest xrays indicating previous TB
4. organ donor transplants
5. immunocomprimised patients
107
who is high priority for LTBI treatment \>10 mm or positive IGRA test? (5 things)
1. people who came to US within last 5 years where TB is common
2. IV drug users
3. live or work in high risk facilities
4. micro labatories
5. children
108
what are the two ways HIV can influence the path of TB?
1. person with LTBI becomes infected with HIV and then developes TB disease as the immune system is weakened
2. a person with HIV becomes infected with TB and rapidly developes the disease
109
what is primary resistance?
cause by person to person transmission of drug resistant organisms
110
secondary resistance
develops during TB treatment
1. patients were not given appropriate treatment regimen
2. patients didn't follow the medication as it was prescribed
111
multi-drug resistant TB is resistant to which drugs?
isoniazid and rifampin (2 first line drugs avaliable)
112
extensively drug resistant (XDR-TB), what drugs are they resistant to?
isoniazid and rifampin, PLUS fluoroquinolones and at least 1 of the 3 second line drugs
\*\*this is a major issue around the world\*\*
113
how long should a patient be treated for TB?
what if this person has pos sputum after 2 months of treatment?
**at least 6 months**
if cavities on chest xray and postitive sputum cultures at 2 motnhs then treatment should be extended for **9 months**
114
what are the three phases of TB infection treatment?
1._initial phase_: first 8 weeks of treatment, four drugs are used
**isoniazid, rifampin, pyrazinamide, ethambutol**
_2. continuation phase_: after first 8 weeks of treatment, bacilli remaining after initial phase are treated with at least two drugs
_3. relapse phase:_ occurs when treatment is not continued for long enough, surviving bacilli may cause TB disease at a later time
115
in order to prevent drug resistance, TB disease must be treated with at least how many drugs?
2 ones the organism is suseptible to
116
Tuberculosis
## Footnote
what are the classic symptoms assosicated with TB (clinical and xray)?
clinical symptoms:
**coughing \>3 weeks**
**pleuritic chest pain**
**hemoptysis**
**positive rales**
**infiltrates** (collection of fluid and cells in lung tissues)
**cavities** (hollow spaces within lung usually in the upper lobe)
**caseating granuloms on biopsy** (necrotizing granulomas)
117
what tests do you use to diagnose TB?
1. **tuberculin skin test (TST)**
**2. interferon gamma assays (IGRAS)**-measures immune response to m. tuberculosis, less likely to be incorrect compared to TST
**3. culture with AFB staining**
**-**need 3 specimens, 8-24 hour collection intervals, can induce with inhaling saline mist spray
**4. chest x-ray** (infiltrates and cavities)
**5. nucleic acid amplification test**
**6. bronchoscopy or gastric wash if having hard time getting sample**
118
explain the tuberculin skin test? what can't this test do? what are positive test results for the three groups of people?
in lastent infection positive **2-4 weeks after infection**
-injected with inactive tubercle bacilli, read within 48-72 hours
\*\*this test can't differentiate between latent and active TB, just that a person has been infected at some point\*\*
Positive test results:
**15 mm in normal patients**
**10 mm in immigrants, children**
**5 mm in HIV, immunsuppressed, positive chest xray, primary TB exposure**
119
explain the difference on chest xray between primary and reactivated TB?
**primary:** homogeous infiltrates, hilar/paratracheal lymph node englargement, **middle/lower lobe consolidation**
**reactivation:** fibrocavity **apical** disease, nodules, infiltrates **\*\*TB reactivation presents at the top of the lungs instead of wher eit happened originally\*\***
120
what should you connect Ghon complexes and Ranke complexes? what are they?
**TB**
ghon complexes: calcified primary focus
ranke complexes: calcified primary focus and hilar lymph nodes
\*\*these represent healed primary infection\*\*
121
what does milliary TB look like?
millet seed like nodule lesions (2-4 mm)
123
what is the gold standard for TB testing?
acid fast bacilli tests
3 negative tests are considered negative!!
124
how long should a person be isolated and on treatment before being allowed in public when they have TB?
need to be isolated for a minimum of 2 weeks
125
what are the four drugs you use during the initial treatment phase for TB? what are their side effects? how do you treat someone if they have been exposed to someone with active TB? what is the treatment regiment for LBTI?
"RIPE acronym
1. rifampin (hepatitis, flu, **orange body secretions**)
2. isoniazid (hepatitis, periphreal neuropathy, **give B6 to prevent risk**)
3. Pyrazinamide
4. ethambutol (optic neuritis)
\*\*for LBTI: treat with isoniazid and pyrazinamide for 9 months, or 12 months if HIV pos or granulomas present on CXR\*\*
\*\*if someone is exposed to patient with active TB, then treat them emipircally for 12 weeks until negative TB can be obtained\*\*
126
what are the three main classifications of candidal infections based on location?
1. **cutaneous (diaper dermatitis and candidal intertrigo)**
## Footnote
**2. mucosal candida of the mouth and pharynx**
**3. vulvovaginal**
127
what is the most common species of candida?
candida albicans
128
Cutaneous candidal infection
1. candidal intertrigo
2. diaper dermatitis
what is the characterists of these? where are the places you would find these? what are the two TX options?
**patches and pustules on a ERYTHEM MATOUS BASE _beefy red_ the erode and confluent with "_SATELITE LESIONS_"** painful with puritis
**Candidal intertrigo**: *axillae, groin, intergluteal, cleft*
**diaper dermatitis:** irrritabiltiy with urination, defication, changing diapers, *genital region, inner aspect of thights and butt*
*TX:* **keep dry, antifungals nystatin, imidazole powder**
129
oropharyngeal candidiasis
what does this look like and what in what population can this look completely different? what is the key characteristic of this? what are the 2 treatment options?
thrush, _white curd_ like plaques that can be _scraped off_
## Footnote
what to find the percipitating cause and treat that, then treat with oral antifungals
\*\*\*\*\*KEEP IN MIND, PEOPLE IN DENTURES CAN APPEARE BIRGHT RED INSTEAD OF WHITE CURD LIKE\*\*\*\*
Tx: nystatin oral fluconazole or itraconazole suspension, swish and spit or swallow
132
vulvovaginal candidiasis
what percent of females can get this and what can it come from? what are 5 RF for this? what does it look like and what is an important symptoms? what are two treatment options?
**75% of females get this at least once,** \>20% are colonized with C.albicans normally, so this is a overgrowth of normal biota
RF: age extremes, pregnancy, DM, corticosteroids, HIV
white cottage cheese like discharge/plaques, burning while peeing, and puritis
TX: topical/intravaginal azoles or oral fluconazole
133
what can vulvovaginal candidiasis be closely related to?
some women just get it right befor their period because of the pH change that allows microbiota to grow better
134
balanitis candidiasis
## Footnote
who is this common in? who must you treat? treatment?
common in **uncircumsized men**
**erosions with white plaques under foreskin**
treat sexual partner
TX: topical nystatin, warm soaks to alievate itching/burning
135
what are 6 RF for candidiasis?
1. diabetes
2. pregancy
3. obesity
4. HIV/AIDS
5. moisture
6. IUD
136
what do you use to diagnose candidiasis? what do you see?
KOH
\*\*\*see pseudohyphae and budding yeast\*\*\*
137
varicella-zoster virus
## Footnote
explain the differences seen between the primary and secondary eroptios of this virus? how are they descirbed? what sign do you watch out for? what is the order of the lesion developement? where does it begin and where does it spread to?
VARICELLA-ZOSTER virus
**_varicella (chicken pox):_** 1st exsposure **vesicles on a erythematous base "DEW DROPS ON A ROSE PETAL"** describe the different stages
macules-\>papules-\>vesicles "dew drops on a rose petal"-\>pustules-\>crusts \*\*appeare in crops!\*\*
**BEGIN ON FACE AND TRUNK AND SPREADS TO EXTREMITIES**
**_Herpes zoster (shingles)_**: VZV reactivation along a **Dermatone in THORACIC OR LUMBAR REGIONS**, reactivation from **ganglionic satelite cells****!**
**-****Hutchinson's sign:**lesions on the nose mean lesions in the eye since**trigeminal nerve involvement CN #5**
138
what are the two complications you worry about with herpes zoster virus reactivation (shingles)?
1. **eye involement herpes zoster opthalmicus:** look for _hutchinson's sign_ which is lesions at the end of the nose, if seen here likely it is already in the eye since it follows along the _trigeminal nerve or CN 5_
2. **ear involvement herpes zoster oticus**: look for _ramsay hunt syndrome_ if lesions are seen on the ear, likely in the canal since it follows _facial nerve or CN 7_
141
how long can the post herpetic neuraligia with shingles last? what is a thing you worry about if eldery?
\>3 months...so give these people some pain meds
## Footnote
occurence likelyhood is greater if over 60!
142
what is the treatment options for varicella zoster virus? (4)
1. **acyclovir, valacyclovir**
2. **pain management for post therapeutic neuralgia**
3. **tricyclate antidepressants**
4. **corticosteroids**
143
what can you do to prevent varicella-zoster virus? (2 options)
VACCINATION!!
**child:** vaccinated 1-2 years old for varicella
**adult:** Zostavax single dose \>60yrs...basically literally a booster of varicella, becuase it is the same virus, just marketed differently to apeal to elder adults!
\*\*can't give if allergic to gellatin, neomycin, pregnant, or immunocomprimised!\*\*
144
acute rheumatic fever/RHEUMATIC VALVITIS
what fraction occur in developign countries? what organism is this caused by? what does this attack and cause? what is the main tx? (what about for other two symptoms?)
**2/3 of all cases in developing countries**
_group A streptococcus that cause oropharyngreal infection_, the antigens to this attack the heart
PERICARDITIS INVOLVING THE VALVES, CAUSING FIBROUS THICKENING/STENOSIS AND REGURG
Dx:
Jones criteria two major, 1 minor
plus evidence of B-hemolytic streptococci
Tx: **penicillin 10 day course**
salicyclates for arthritis in involvement
glucocorticoids if severe carditis
145
what are the complications of AFR?
| (3)
1. CHF
2. rheumatic pneumonitis
3. rheumatic heart disease \*\*\*most common and causes valvular disease\*\*\*
146
who is and who isn't reccomended to get prophyllactic abx before invasive procedures to prevent endocarditis?
**_prophylaxsis no longer reccomended in patients with hx of RHD_**
**_EXCEPTIONS!!!_**
1. PROSTETIC CARDIAC VALVE
2. PREVIOUS ENDOCARDITIS
3. CONGENITAL HEART DISEASE
147
what are the four main characteristis you should consider when dxing someone with strep that could lead to AFR?
1. tonsillar exudates
2. absence of a cough
3. tender _anterior_ lymphadenopathy
4. hx of fever
only need 3/4 for dx
148
brucella
## Footnote
where does this localized?
what do we worry about with this condition?
how do you dx it? (2)
can you treat it?
gram -
highly contagious zoonosis
**_localizes to bone marrow and liver_**
can be a bioterrorism agent
DX:
1. _PCR_
_2. elisa_
TX:
treatable but serious
\*\*\*must treat patient and those exposed\*\*\*
149
what are the 5 ways you can prevent the spread of brucella?
1. vaccination domesticated herds
2. serologic testing of animals
3. slaughter infected animals
4. protection of slaughter house workers
5. pasteurize milk
150
crytococcous
## Footnote
what organism causes this?
what does this most commonly cause?
what does it grow?
where do you find this bacteria?
how is it transmitted?
what are the sxs? (3)
what _CD4 count do you worry about_
**_crytococcus neoformans_**
**\*\*\*most common cause of fungal meningitis\*\*\***
**_grows mucoid colonies_**
budding yeast that is found in _SOIL CONTAMINED WITH DREID PIGEON dung_
transmission: inhalalation
SXS:
fever, cough, dyspnea
**_CNS in lose with less with CD4 less than 50_**
1. headache
2. meningeal sights
3. RARE **CRYTOCOMA** with intracerebral mass that can cause obstructive hydrocephalus
151
crytococcus
## Footnote
what are the 3 things you use to DX this?
what are the tx regiments between those with HIV and those without HIV?
CXR:
**nodules**
**pneumonitis**
CSF:
_india ink stain with latex agglutination_
_crytococcal antigen assay_
tx:
**HIV patient:**
1. oral _fluconazole_ 10 weeks
2. severe: _amphotericin B 2weeks then fluconazole_
**non-HIV pt:**
**amphotericin**
152
what people do you specifically worry about getting crytococcus?
(4)
immunodeficiency
HIV
cancer,
corticosteroids
153
histoplasmosis
## Footnote
what fungus causes this?
what does it come from?
who do you worry about it in?
transmission?
what are the _3 classifications_?
1
2 things to rememeber
3 who is it commom in, what do you see?
**_histoplasma capsulatum_**
dimorphic fungus foung in soild infected with _bird and bat droppings_
transmission: inhalation
especially risking in _late stage HIV CD4 \<100_
\*\*\* can see pancytopenia and anemia\*\*\*
1. _acute_
febrile, few pulmonary complaints
2. _progressive disseminated_
a. _fatal within 6 weeks_
_b. ulvers in the mouth, pharynx, liver, spleen, and adrenals_
3. _chronic progressive pulmonary histoplasmosis_
\*\*older patients esp with COPD\*\*
a. _cavitary lung disease_
_b. progressive pulmonary dx with **calcified nodules**_
_c. pericarditis_
154
histoplasmosis
## Footnote
3 tests?
1 tx?
1. CXR: milliary infiltrates
2. urine antigen assay
3. increased alkaline phosphatase lactatate dehydrogenase (LDH)
tx:
itracnazole for weeks to months
155
what is the most common opportunistic infection see in HIV/AIDS patients?
pneumocysistis
156
pneumocystis
## Footnote
what fungus causes this?
what should you know about this!\*\*\*
how is it transmitted?
what are the SXS and 1 uncommon one?
what are the two dx tests? findings?
what do you treat with?
**_pneumocystic jiroveci pneumonia_**
**most commmon opportunistic infeciton in HIV/AIDS**
transmission: airborne, _lies latent in the lung_
HIV concern: _CD4 count less than 200 in HIV/AIDS_
SXS:
fever, fatigue, weight loss, SOB
uncommon: pneumothorax
DX:
_1. CXR with interstital infiltrates_
- heterogenous
- miliary
- patchy
_2. blood gas_
- hypoxia
- hypocapnia
Tx:
tx empirically
TMP-SMX
157
do you prophylax HIV patients against pneumocystis has been treated?
um...yeah! its the most common opportunistic infection in HIV/AIDS pts
## Footnote
_give TMP-SMX if CD4 count below 200 ater suscessful treatment_
158
botulism
## Footnote
what organism causes this?
where dos it come from?
what is it _generalized transmitted through_? (3)
what is the differences between _inital presentation_ (2)and _late progression_ (4)?
**_clostridium botulium_**
## Footnote
spore forming bacillius found in _soil, produces toxin_
_canned food, vaccum packed, smoked food_ allows the toxin to be produced until it is ingested!!
**SXS:**
**1. initial-12-36 hours after ingestion**
- diplopia
- loss of _accomodation_
**2. later**
1. _ptosis_
_2. impaired extraoccular movements_
_3. fixed dilated pupils_
_4.flaccid paralysis_
\*\*needs ventilation and lead to death\*\*
159
what does the botulism toxin inhibit?
inhibits the release of acetylcholine at the neuromuscular junction
160
botulism
## Footnote
how do you dx?
tx?
2 things pt will likely need
**Dx:**
**_check for toxin using mouse inoculation with serum_**
TX:
**_antitoxin available through CDC_**
\*\*\*will need ventilation when respiratory failutre occures and IV nuitritional support during progression\*\*\*
161
why don't you give a baby honey? what can it cause?
dont' give them honey for fear of _botulism_, can cause "floppy baby syndrome"
162
cholera
## Footnote
what is the bacterial that causes this?
what does it cause in the body?
what does the pt present with?
transmission?
what are the 2 tx options?
**_vibrio cholera_**
## Footnote
toxin activates adenylyl cylase in the intestinal epithelial cells in the small intesting causes _hyper secretion of water and chloride ions with **massive diarreah**_
"rice water stool" grey turbid diarreah and causes _hypovolemia_
transmission: fecal-oral
Dx:
1. stool culture for vibrio cholerae
TX:
`1. **replace fluids and electrolytes** _sugar/salt water_, severe use IV replacement
2. **abx in severe cases**
163
what are the 3 things you can do to prevent cholera?
1. clean water and food
2. proper waste disposal
3. vaccine but protection is temporary and **booster is needed every 6 months**
164
yellow fever
## Footnote
what spreads this (2)?
what type of virus is this?
where does it effect?
what are the sxs? (4)
Dx?
tx?
spread by
aedes aeypti mosquito or infected monkey
_flavavirus_ infects _endothelium and liver_
SXS:
1. fever, heaaches, muscular aches
2. _liver failure_
3. _prostration and shock_
4. _hemmorahgia into the intestine showing melena_
5. _renal damage/tubular necrosis_
DX:
CLINICAL with IgM after 1 week
tx: **no treatment!!!!**
165
how to do prevent yellow fever?
live attenuated 17D yellow fever vaccine to anyone who has been exposed
lasts 10 years
_required to travel to endemic areas_
166
E. coli structure?
what are 3 virulence factors?
2 antigens?
gram?
gram -
somatic or O antigen LPS
flagellar or H antigen
serotype O:H
virluence factors:
1. hemolysin
2. intimin
3. shigatoxin
167
whare are the 4 ways E.coli is transmitted?
1. Food: cattle products, food contaminated with cattle or human feces
## Footnote
2. water: contaminated drinking water
3. animal contact: contact with farm animals ie petting zoo, farm
4. person: feces or infected people
168
what is the most common E.coli for what we think of as e. coli?
shigella toxin-producing (STEC) also called "enterohemmorrhagic"
## Footnote
E. COLI0157 is the one that we usually think of when taking about e.coli outbreak!!
169
what is the reservoir for e.coli?
ruminant bovine
## Footnote
so common with **_GROUND BEEF INGESTION!!!_**
170
what is the seasonal peak and trough for e. coli infection?
summer peak
winter nadir
171
what is the most common cause of travelers diarreah?
3 sxs? and duration?
tx?
e.coli
## Footnote
diarreah is:
1. purlulent
2. bloody
3. assocaited with abdominal cramping
4. 5-10 duration
tx:
supportive unless severe
172
diptheria
## Footnote
what is the bacteria that causes this?
where does it LIKE TO BE?
transmission?
what are the 3 types? which is most common and what is characterized by?
**_cornebacterium diptheriae_**
likes mucous membranes esp respiratory tract and spread by respiratory secretion, particullarily in children
3. TYPES
**_1. laryngeal_**
a. upper airway/bronchial obstructions
**_2. pharyngeal_**
a. **_MOST COMMON FORM!!_**
_b. **GRAY MEMBRANE "pseudo membrane" COVERS TONSILS AND PHARYNX**_
c. **_BULL NECK_** from swelling of cervical nodes
**_3. myocarditis/neuropathy_**
this occurs when the bacterial gets into the blood and settles other places creating that membrane and preventing the organs from working
173
diptheria
## Footnote
dx?
tx?
DX:
culture!!
Tx:
1. _horse serum antitoxin must be given in ALL cases and must be obtained from CDC_
2. penicillin/erythromycin
\*\*\*\*\*tx the contacts of infected with erythromycin to eradicate carrier state\*\*\*\*
174
what must you do for someone who has diptheria?
isolate the patient until 3 negative samples can be obtained
175
how do you prevent diptheria?
diptheria-tetnus-pertussive
DTaP vaccine!!
vaccination to toxins!!
176
salmonellosis
## Footnote
what is the main bacteria that causes this?
what is it most common in?
what does it break out across states?
what are the _3 types_?
_salmonella typhimurium MC_
## Footnote
**_POULTRY MC!!! c_**an also include leafy greens, beef, dairy, nuts
\*\*\*\*MULTISTATE OUTBREAKS COMMON since found in animal flocks and herds\*\*\*
1. enteric fever, TYPHOID FEVER
2. gastroenteritis
3. bacteremia
177
enteric fever salmonellosis
"enteric fever/typhoid fever"
where are the 3 places this replicates?
is there a prodrome?
what happens as fever develops? (5)
DX (what to keep in mind)?
Tx: 2 abx and for how long?
replicate in _peyer patches, mesenteric lymph nodes, spleen_
## Footnote
prodrome: malaise, headache, cough, sore throat
**as fever developes:** (peaks 7-10 days)
**1. abdominal pain/distension**
**2. _pea soup poop_**
**3. splenomegaly**
**4. bradycardia**
**5. _rash pink papules primarily on trunk during 2nd week_**
DX:
**1. _blood sample_**
**+ during first week**
**- after first week**
TX:
1. **ceftriazone**
2. **fluoroquinolines**
**TWO WEEKS!!!!**
178
salmonellosis
"gastroenteritis"
what is the incubration?
what are the 5 sxs and msot important?
DX?
tx?
most common form of salmonella infection!!
## Footnote
incubation **_8-48_** hours after ingestion of infected food or water
SXS:
fever
nausea
vomiting
**_bloody diarreah 3-5 days!!!!_**
DX:
STOOL CULTURE
Tx:
selflimited
symptomatic
179
salmonellosis
"bacteremia"
who is this common in?
what is this?
2 tx
prologned or _recurrent fevers_ with bacteremia and local infection of bone, joints, pleura, pericardia, lungs
\*\*\*most common in immunosuppresion person\*\*\*
Tx:
1. ceftriaxone
2. fluoroquinolones
3. tx for 2 weeks and drain absecess
180
shigellosis
## Footnote
what does this cause?
what are 5 sxs associated with this?
what are the 2 ways to dx this and what do you see?
what are 2 tx options?
dysentery
## Footnote
SXS:
1. starts abruptly with diarrhea
2. lower abdominal cramps
3. tenesmus with fever chills
4. _l**oose stools with mixed blood and mucous**_
5. tender abdomen
**DX:**
1. stool
2. sigmoidoscopy with _punctate lesions, ulcers and inflammed mucose_
TX:
1. _FLUIDS!!!!!!!_
2. TMP-SMX
181
what can HLA-B27 peopel get from shigellosis?
reactive arthritis
182
tetanus
## Footnote
what bacteria causes this?
where is it?
what does it produce that causes this?
what does it cause?
what types of wounds are most susceptible?
what are _5 symptoms?_
**_clostridium tetani_**
## Footnote
\*\*\*\*\*present in all soiil\*\*\*\*\*
they **germinate** in the **wounds** and produce a **neruotoxin _tetanospasm that interferes with neurotransmission at spinal synpases_**
uncontrolled spasm and exaggerated reflexes
\*\*\*puncture wounds most susceptible\*\*\*
sxs:
1. pain and tingling of stab site
2. _JAW TRISMUS/lockjaw_
3. _hyperreflexes and muscle spasms_
4. tonic convulsions with muscle ridigity in descending fashion
5. spasm of glottis and dysphagia
183
what is the 3 tx for tetnus?
1. tetanus immune globulin IM
2. penicillin
3. bedrest, sedation, and ventilation often needed
184
what are the ways to prevent tetanus?
1. active immunization in childhood
2. 3-4 initial doses followed by a booster _every 10 years_
185
relapsing fever
## Footnote
what two bacteria cause this?
what ist this characterized by and how does it accomplush this?
3 tx options?
borrelia recurrentis-louse
borrelia croicuidare-africa
characterized by **recurrent cycles of febrile episodes**, separated by asymptomatic intervals of apparent recovery
\*\*\*ALTERS MEMBRANE SURFACE PROTEIN TO CAUSE RELAPSING FEVER!!!\*\*\*
patients clear borrellia in _3-5 days,_ THEN _NEW ANTIGENIC VARIANTS APPEARE_
\*\*this creates the relapsing fevers\*\*
TX:
**_penicillin_**
**_teracylcine_**
**_erythromycin_**
186
atypical mycobacterial disease
## Footnote
"nontuberculous mycobacteria"
WHAT ARE THE TWO MOST COMMON BACTERIA?
WHAT CD4 LEVELS DO YOU WORRY ABOUT?
WHAT ARE 3 DIFFERENT PRESETNATIONS?
1. CAUSE, AGE, MOST COMMON, DX
2. MOST COMMON,DX REQUIREMENT
3. HX OF\_\_\_, 3 BACTERIA, WHAT IS THE UNIQUE SYMPTOM ASSOCIATED WITH THE FIRST?
mycobacteria avium complex (40%)
mycobacteria gordgonae (25%)
effects immunocomprised esp **_HIV WITH CD4 LESS THAN 50_**
\*\*doesn't spread person to person...found in water, soil, animals\*\*\*
1. lymphadenopathy type
\<5 years old
_unilateral, **submandibular most common**_
**_MAC MOST COMMON!!!_**
do need aspiration (seen in pic)
2. chronic pulmonary disease
**MAC MOST COMMON!!!**
cough weight loss sputum production
**must isolate 2+ sputum or bx site**
3. skin/soft tissue disease
**hx of trauma or superficial laceration**
1. **_mycobacterium marnium_**
**WATER, FISH**
**LAKE POOL AQUARIUM**
**1-2 MONTH IP TO _GRANULMATOUS NODULAR TO ULCERATIVE LESIONS ON HANDS_**
"FISH TANK GRANULOMA!!!!!"
\*\*person cleaning out their fishtank and they nick themselves and they don't think about it!!! slowly progressive and without treatment becomes necrotic\*\*\*
187
hookworm
explain the lifestyle cylce of this helminth
humans are the only host!
**_penetrate the skin_** and **_migrate in bloodstream to the pulmonary capillaries_** when they **_destroy the alveoli_** and are **_carried to the mouth by cilia_**
once swallowed, they attach to the small bowel mucose and suck the blood
once they mature they _release eggs_ and the cycle is repeated
188
what is the difference between a light and moderate infection with hookworm?
light infection 1000 eggs per g feces
moderate infection 2,000-8,000 eggs per g feces
189
what percent of the worlds population is infected with hookworm?
25%
190
what are the sxs associated with hookworm?
(5)
1. puritis at the site of penetration
2. erythematous dermatitis and maculopapular or vesicular rash folllows
3. pulmonary stages causes coughing with blood tinged sputum
4. _anemia, protein loss, malabsorption, ulcer like epigastric_
5. anorexia
191
how do you dx hookworm? what is the tx? (4)
dx:
eggs in feces
tx:
1. _mebendazole BID 3 days_
2. high protein diet
3. vitamins
4. ferrous sulfate
192
what is malaria spread by?
spread by **_anopheles mosquito_**
193
what are the four parasites taht cause malaria?
what is the most dangerous?
what are some brief characteristics of each?
1. plasmodium vivax: dormant in liver, requires more tx
## Footnote
2. plasmodium ovale: dorman in liver, requires more tx
3. plasmodium falciparum: MALIGNANT, MOST DANGEROUS
4. plasmodium malariae: chronic
194
what is the lifecyle of malaria?
1. **_sporozoites_** in mosquito saliva
2. go to liver develop in **_merozoites_**
3. RBCS (this is when people get really sick)
195
what are the sxs of malaria? (5)
what do you dx with?
1. _cyclical fevers_
_2. leukopenia_
_3. hemolytic anemia_
_4. thrombocytopenia_
5. fevers, childs, nausea blah blah
DX: _thick and thin geimsa stain_
196
what are the two goals of txing malaria?
decrease parasite load
eradicate the parasite
197
what are the DOCs for malaria? (3)
1. _DOC #1 chloroquine_
2. doxy in pregnant, children
3. mfleoquine: heart/seizure conditions
198
what are 3 complications of malaria?
DIC
splenic rupture
anemia
199
what is the best prevention for malaria?
control the mosquitos!!!
200
what are two conditions that provide protection against malaria?
sickle cell disease
thallesemia
201
pinworms
## Footnote
what parasite causes this?
who does it effect the most?
where are the eggs?
how long can they survive outside of the body?
transmission?
when does this become infective?
**_enterobius vermicularis_**
\*\*\*CHILDREN MORE THAN ADULTS\*\*\*
gravid females pass through **_the anus to lay eggs on the perianal skin_**
\*\*\*EGGS are viable outside of body 2-3 weeks\*\*\*
Transmission: hands, food, drinks!!
infective within a few hours
202
PINWORM
what are the sxs 3?
what are the 2 dx?
tx?
sxs:
**_1. perianal pruritis crawling sensation worse at night_**
**_2. examination at night may reveal worms in the anus or stool_**
**_3. scratching, excoriation, and secondary impetigo (staph) infection common_**
DX:
1. capture egg on piece of tape over perianal skin
2. 3 ries over 3 nights yield 90% success rate
tx:
\*\*must tx all members of the household at same time\*\*
_albendazole, mebendazole given single dose and **repeated 2-4 weeks later**_
203
leprosy
type of non typical mycobacteria'
mycobacterium leprae
numbness and paralysis of the hands and feet, travels along the nerve, debilitating
effects skin, nerves, mucous membranes
204
what is 2 important prevention methods for pinworms?
1. wash hands before eating
2. thorough linen washing
205
toxoplasmosis
## Footnote
what is this caused by?
what are associated symptoms?
what test do you want to do?
tx?
**_toxoplasmosis gondii_**
## Footnote
\*\*\*\*\*reactivation of latent T. gondii\*\*\*\*
COMMON OPPORTUNISTIC INFECTION WITH AIDS PATIENTS
SXS;
1. headaches
2. fevers
3. neurologic dysfunction
- confusion
- lethargy
- visual disturbances
- seizures
TEST OF CHOICE: **_MRI IMMEDIATELY_**
**_tx: TMP SMX_**
206
what is lyme disease cause by?
what is this spread by?
_borrelia burgdoferi_
SPIRIOCETE
spread by _ioxodes scapularis_
_"deer tick/black legged tick"_
207
explain the lifestyle of the ioxodes scapularis that causes lyme? which one attacks humans?
1. **egg**
2. six legged **larvae**-august to september
3. **_eight legged nymph-peaks may-july, agressive, bite humans_**
4. **adult**- peak in **spring and fall, prefer white tailed deer**
\*\*\* prefer to feed on different hosts at each life stage\*\*\*
208
what do the ixodes secrete when they bite you?
anesthesia and anticoagulation
209
in order for a tick to transmit lyme how long do they have to feed for?
at least 24 hours
210
what are the symtoms associated with lyme disease?
(6)
1. red rxn at the bite site when bit by a tick (different than bullseye)
2. _erythema migrans_ (buls eye rash)
- 10-30 days after bite
- only 80% get this
- can disseminate
3. muscle/joint pain
4. fatigue
5. fever/chills
6. swollen lymph nodes
211
explain the sxs of early disseminated lyme disease?
4
1. erythema migrains rash 80-90%
2. early presentation without the rash
a. arthalgias, olioarticular and migrator
b. post occipital headaches
c. paresthesias on face/arm/leg
212
early disseminated stage of lyme
6 sxs
how long?
1. _multiple erythema migrans_
2. sxs _weeks to months_
3. lyme carditis with **_AV block_**
4. neurological symptoms
- 7th nerve palsy
- lymphocytic meningitis
- post occipital headaches
- parenthesias on face, arms, legs
213
late symptoms of lyme
## Footnote
4 sxs
length of time
greater than 6 months
## Footnote
1. arthritis (migratory or monoarthritis)
2. neurologic
peripheral axonal neuropathy, mild encephalopathy, encephalomyelitis
214
what is chronic lyme?
patients with persistent sxs following tx of lyme disease but without relapsed infection
215
what are the two tests ordered for lyme in the order you order them?
what 2 fluids can you test?
whats 1 thing to keep in mind?
1. ELISA
2. Western blot
\*\*antibody tests\*\*
use synovial fluid or CSF
\*\*\*don’t order a lyme test unless you think that it is actually lyme because if not could give you false positives\*\*\*
216
what can early antibiotcsi prevent in lyme?
antibiotics in early disease can prevent seroconversion
217
explain the testing time for lyme?
**_less than 4 weeks_** test IgM and IgG
**_greater than 4 weeks_** test IgG
218
if you see the erythema migrans do you need to to the testing for lyme?
nope its made clinically dx
219
is reinfection with lyme likely to occure?
unlikely to occur beyond erythema migrains
220
what is the tx for lyme?
1. _doxycycline po 21 days_
_2. IV ceftriaxone for neuoborreliosis_ and some conditions like complete HB, meningoencephalitis
221
is prophylaxsis reccomended for lyme? what are the rules?
what do you tx with?
monitor?
Prophylaxis, **_NOT_** recommended unless these four conditions are met:
## Footnote
1. tick has been identified as engorged deer tick that has been attached for 36 hours
2. occurred in area where there is high rate of infected ticks
3. prophylaxis can be started within 72 hours
4. doxycycline is not contraindicated
prophylax single dose doxy 200 mg
\*\*monitor symptoms 30 days\*\*
222
what are 3 long term sequalae you worry about wiht lyme?
1. **_persistent arthritis 5-10%, usually monoarticular (knee)_** for 4-5 years
2. residual **_neurological impairment,_** gradual resolution
3**_. post-lyme syndrome:_** persistent fatigue, MSK pain, cognitive complaints for greater than **_6 months_**
223
rocky mountain spotted fever
## Footnote
what bacteria causes this?
what type carries it?
how does it occur?
what is it _characterized by for rash?_
_bacteria rickettsia ricketsiae_
**dermacenter ticks dog ticks, nantucket**
90% april-september, highest in CHILDREN
occur in CASE CLUSTERS in _hyperendemic foci_
**characterized by: _ring skin rash, high fever, headaches and muscle pain_** begins as 1-5 macules rash on ankles, wrists, forearms and spreds centripetaal to trunk _includes palms/soles_, **petechial rash on or after day 6**
224
what are two long term sequelae of rocky mountain spotted fever?
CNS deficit
amputations
225
rocky mountain spotted fever
## Footnote
dx?
tx?
_dx_
indirect immunofluorescence assay (IFA)
_acute and convalescent sampes 2-4 weeks apart_
Tx
tetracyclines DOC with respoinse 24-72 hours
226
anaplasmosis
## Footnote
what is the name of the bacteria?
what is it spread by?
what does it infect?
what are sxs?
waht is this nickname?
**_anaplasmosis phagocytophilium_**
spread by
_ioxodes scapularis black legged tick and infects_ _granulocytes WBC_
common: fever chils, headache, malasie, myalgia, arthalgia
less common: _GI upset, stiff neck_
nickname: summer flu
227
anaplasmosis:
dx?
lab tests results? 4
tx?
dx: PCR assay for DNA
## Footnote
labs:
1. mild anemia
2. thrombocytopenia
3. leukopenia with left shift
4. mild elevation of LFTs
tx:
adults: _doxy_
children: _bata lactam_
228
babesiosis
## Footnote
what causes this infection?
what type of infection is i?
what spreads it to humans?
where does it go?
what are the sxs and 4 unique things
what is common?
babesia microti protoazoan infection
\*parasitic infection\*
vector: ixodid tick
**_enters RBC and causes hemolysis_**
literally all the same SXS as other tick disease
**_splenomegaly, hepatomegaly, jaundice_**
**_severe: significant hemolysis_**
**_\*\*asymptomatic disease common\*\*_**
229
in asymptmatic babeosis...do you tx?
maybe not
## Footnote
monitor 4-6 weeks and may clear on its own
\*\*if no underlying disease watch\*\*!!
230
babeosis
dx?1
tx if symptomatic? 2 options
dx: PCR
## Footnote
tx if symptomatic
1. clindmycin/quinine or azithromycin
2. **_parasite levels more that 10% do abx PLUS transfusion till below 5%_**
231
what is the bacteria that causes tularemia?
## Footnote
how many people does it kill a year?
Francisella tularensis
## Footnote
less than 50 people a year
232
where can you find tularemia?
every state besides hawaii
233
tularemia
## Footnote
What is the bacterial that causes this?
what toe keep in mind? how many bacteria?
2 geographic locations?
3 things that transmit it?
7 presentations?
**_francisella tularensis_**
HIGHLY INFECTIOUS..inhalation of 10 bacteria can cause disease
biting flies: Utah, Nevada, California
tick: east rocky mountains
infects small rodents like squirrels, rabbits, hares, voles, muskrats
spread by **_american dog tick, lone star tick, and rocky wood tick_**
SXS:
1. **_ULCEROGLANDULAR_**
2. oculoglandular
3. typhoidal syndrome-greatest mortality if left untreated
4. oropharyngeal
5. gastrointestinal
6. secondary pneumonia
7. primary inhalational pneumonia
234
how is tualeremia transmissed?
(6)
ingestion by food or water
inhalation
direct contact
arthropod intermediates
animal bites
**_no person to person spread_**
235
tularemia
dx?
2 tx?
dx: PCR
tx:
1. steptomycin
2. gentamycin
236
what are 3 conditions that are caused by body lice disease?
1. louse-borne relapsing fever
2. trench fever
3. epidemic typhus
237
syphillis
## Footnote
what causes this?
2 ways it is transmitted?
dx? for tertiary?
Tx considerations? 2
**_tremponema pallidum_**
## Footnote
transmisison:
1. _sexually transmitted_
2. _congenital syphilis_
DX:
**_fluorescent treponemal antibody absorption FTA-ABS_**
tertiary: lumbar puncture
TX:
**_benzathine penicillin G 2.4 million U IM_**
tertiary: 3 weekly injections
_neurosyphilis_: _penicillin every 4 hours for 10-14 days_
238
early primary syphilis
2 characteristics of this
1. chancre-painless ulcer with clean base and firm indurated margins _most commonly in the genital region_
2. regional lymphadenopathy
239
secondary syphilis
lesions on skin, mucous membrane, eye, bone, kidneys, CNS, liver
240
late tertiary syphilis
6 sxs
1. gummatous lesions involving skin, bone,viscera
2. CVD
4. ophthalmic lesions
5. neurosyphilis
chronic meningitis
generalized paresthesia
6. tabes dorsalis: chronic progressive degeneration of parenchyma
impaired proprioception
_loss of vibratory sense_
_argyll robertson pupil (reacts to light but doesn’t accommodate)_
241
congenital syphilis
## Footnote
5 signs
if not txed can develope:
interstitial keratitis
hutchinson teeth
saddle nose
deafness
CNS abnormalities
242
cytomegalovirus
## Footnote
what causes this?
who does it occur in?
what are the 3 types?
what might you see on dx?
1 tx?
**_human herpes virus type 5_**
## Footnote
occurs in immunocomprimised esp HIV and post transplant
3 types
1. perinatal
2. acute acquired CMV
3. post transplant CMV
dx:
_"owl eyes" on tissue biospy_
_antigen_
tx:
1. glanciclovir
243
acute aquired CMV
## Footnote
3 ways this is transmitted?
what are the sxs and the key?
what do you diferentiate this from?
**_transmitted via:_**
1. breast milk
2. blood transfusion
3. droplet
SXS:
fever
malaise
myalgias
arthralgias
splenomegaly
_atypical lymphocytes_
similar to EBV infection _without pharyngitis, respiratory symptoms, or antibodies_
244
postransplant CMV
## Footnote
what are the 4 regions where sxs occure?
what is key preseentation buxx word?
1. retinitis CD4 less than 50
"pizza pie" neovascularization and proliferative lesions
2. GI
a. esophagitis
b. small bowel ulcers
c. hematochezia
d. abdominal pain
3. pulmonary
4. neuro
245
how can you prevent the transmission of CMV? (3)
1. limiting blood transfusions
2. filtering to remove leukocytes
3. restricting organ donor pool to seronegative donors
246
what are the 3 conditions CMV plays a role in?
IBS
atherlosclerosis
breast cancer
247
epstein barr virus
## Footnote
what is this caused by?
nickname for this?
what should they avoid?
5 symptoms?
2 dx? findings?
tx?
**_human herpes virus 4_**
**_"kissing disease" spread by saliva_**
\*\*don't participate in contact sports because of potential spleen rupture\*\*
SXS:
1. _EXUDATIVE PHARYNGITIS_
_2. SOFT PALATE PETECHIAE_
_3. **POSTERIOR CERVICAL NODE ENLARGEMENT**_
**_4. SPLENOMEGALY IN 50% OF PATIENTS_**
**_5. MACROPAPULAR/PETECHIAL RASH_**
DX:
1. ATYPICAL LYMPHOCYTES THAT ARE LARGER AND STAIN DARKER AND _VACULOATED_
2. MONOSPOT
tx: supportive
248
what should you not give to someone with mono?
ASA
249
what can administration of amoxicillin cause in someone who has EBV?
a rash!!
250
what test can give a false positive if the pt has EBV?
false positive syphilis test
251
what are some complications that can come from from EBV?
5
1. splenic rupture
## Footnote
pericarditis
myocarditis
encephalitis
aseptic meningitis
252
norovirus
what is this?
what is this most common strain?
\*\*most common cause of food poisoning"
Norovirus GII.4 new orleans most common circulating strain
253
norovirus
## Footnote
where so you most likely see?
what transmission?
when contagious?
reinfection?
most common complication?
"cruise ship plague"
extremely contagious
fecal oral route
salads, sandwhichs, shellfish, oyster
\*\*contagious from moment they feel ill to at least 2 days after, reinfection common\*\*
strikes quick 1-2 days
DEHYDRATION IS MOST COMMON AND DANGEROUS COMPLICATION esp in elderly/infant
254
what is the best way to prevent norovirus spread?
1. handwashing
2. environmental cleaning essential
255
rabies
## Footnote
how is this transmitted and by what 6 animals? which is most common?
transmitted by animals by bite or scratch
## Footnote
doesn't spread by petting rabid animal, blood, urine, or feces
reservoirs:
**_1.Bats_**-MOST COMMON \*any physical contact should be considered possible rabies infection until negative tests can be obtained or patient is certain there is no bite, scratch, or mucous membrane exposure
**_2. raccoons_**
**_3. skunks_**
4. foxes
5. cats
6. woodchuck
256
explain the infectious path of rabies?
## Footnote
when are they symptomatic?
1. raccoon bitten by rabid animal
2. rabies enters the racoon through infectious saliva
3. rabies virus _spreads through the nerves to the spinal cord and brain_
4. when it reaches the _brain the virus multiplies rapidly and passes to the salivary glands_ and the raccoon starts to show symptoms of the disease
\*\*virus MUST replicate in the CNS before getting to salivary glands....they are symptomatic once at the salivary glands\*\*
257
how many people have ever survived rabies?
6
258
explain the progression of rabies?
3 stages
2
4
3
incubation period: _4-12 weeks_
**_prodrome:_**
2-10 days
_paresthesia at the site of wound_, with fever, headache, and anorexia
**_acute neurological hase:_**
2-7 days signs of encephalitis
mental status change
paralysis
hyperactivity
**_late stage_**:
coma
dysrhythmia,
DEATH
259
is there tx for rabies?
no just PEP
260
what is the 5 qualifications for PEP for rabies?
1. suggested for anyone who was in the same room as a bat and might be unaware direct contact has occurred
2. person bitten with known rabies
3. person bitten with likely rabid animal
4. those bitten with skunk, fox, bat, raccon
5. certain non bite exposure
261
explain the difference between the PEP for those who have been vaccinated and those haven't for rabies?
**_1. with vaccination_**
-cleanse, irrigate wounds
0 and 3, _only 2 doses_
_DONT GIVE_ human immunoglobulin
**_2. without previous vaccination_**
cleanse and irrgation
0, 3, 7, 14, _total of 4 injections_
_give human rabies immunoglobulin_
262
what is the name of the post exposure protection options?
human diploid cell vaccine (HDCV)
## Footnote
MC reaction is skin reaction
human rabies immunoglobulin
passive and temporary, immediate
263
what should you do if you are bit by a suspected rabbid animal?
try to capture it so it can be tested
264
if you are concerned about pets having rabies, what to do?
can be monitored within 10 dayys because they will show symptoms within that time and
## Footnote
if reliable followup is avaliable can deferr vaccination if followup is avaliable
265
ebola
## Footnote
what family does this come from?
name?
where MC (2)?
how is it transmitted? what can you get it from?
when do you msot likely come down with it?
incubation time?
6 sxs
filovidae, ebola virus
"ebola hemmoragic fever"
MC in sierra leone, liberia
Transmission: through direct contact of blood, body fluids (urine feces, vomit, saliva, semen)...\*must be symptomatic to transfer ebola\* _you can get it from corpses_
sxs
appeare sudenly
incubation 2-21 days
_8-10 post expsure most common_
_SXS_
sudden fever
muscle pain
headache
V/D
_bruising and bleeding_
_impaired kidney/liver function_
266
what is the tx for ebola?
supportive!!
267
what is the death rate from ebola?
50-90% of patients in developing countries
268
what is the reccomended PPE for ebola?
gown (fluid impermeable)
goggles/face shield
facemask
double glove
disposable shoe covers
leg coverings
head covering
269
what is it important to do everytime a patient present with illness no matter what?!
get a travelers history!!! every freaking time!!!
270
how many people are living with HIV?
35 million
271
\*\*how many new cases of HIV are there a year?\*\*
50,000 new cases a year
272
\*\*what is the highest risk group for HIV infection\*\*\*
men having sex with men
273
what are the two receptors HIV uses to get into the cell?
CCR5 and CXCR4
274
what percent don't know they are infected with HIV?
1/8
275
explain the structure of the HIV virus? why does it mutate quickly?
1. RNA virus
2. glycoprotein 120 and stem gp14
3. viral protein _p24 core antigen_
4. CCR5 or CXCR4 receptors
\*\*\*\*MUTATIONS OCCUR QUICKLY SINCE THE RNA POLYMERASE USED TO MAKE THE DNA TO INSERT INTO THE HUMAN DNA ISN'T GOOD AT ITS JOB AND OFTEN THERE ARE COPYING ERROS LEADING TO MUTATIONS\*\*\*
276
what are the two strains of HIV and where are they found?
HIV1: most common in the US "M strain"
HIV2: Africa, less aggressive
277
what cells does HIV infection?
CD4 Helper T cells
also monocytes and macrophages because they have the CD4 receptor
278
briefly explain the differences between HIV and AIDS?
HIV is in the infection
## Footnote
patient is usually asymptomatic or minimally symptomatic and the infection hasn't yet effected the persons immune system yet
**_HAVING HIV DOESN"T MEAN YOU HAVE AIDS_**
AIDS
when the persons immune system has become compromised and the CD4 cells have become significantly diminished
279
\*\*\*Acquired immunodeficiency syndrome (AIDS)\*\*\*
## Footnote
what are the 3 options the CDC defines this?
1. clinically: **_opprtunistic infections effect patient_** that wouldn't otherwise if the pt wasn't immunocomprimised
## Footnote
2. biomedically: **_CD4 count less than 200_**
3. historically: at some potin in the past **_ever had opportunistic infections or a CD4 count lower than 200_**
\*\*must have one of these qualifications but you don' thave to have all of them\*\*\*
280
what is the percent chance of contracting HIV from a needle stick?
0.3%
281
how is HIV transmitted?
(4)
**_sexual_**
**_vertical- mother to child_**
**_parenteral- injection drug users_**
transfusion
**_Body fluids_**
1. blood
2. seme
3. vaginal fluids
282
what racial group have the highest burden of HIV/AIDS?
african americans
283
what are the four stages of HIV infection?
**stage 1 primary**
**stage 2 asymptomatic**
**stage 3 symptomatic with viral replication**
**stage 4 AIDS**
284
stage 1 HIV
## Footnote
when does this occur?
length?
sxs?
**_short_**
**_flu-like illness_**
**_6 weeks after infection_**
**_infectious_**
285
stage 2 asymptomatic
## Footnote
how llong does this last?
what might they have?
HIV levels?
antibodies?
lasts 10 years
## Footnote
_free of symptoms_
possible swollen glands
_levels of HIV in blood drop to low levels_
HIV antibodies are detectable in the blood
286
stage 3 HIV
symptomatic with viral replication
when odes this occur?
what happens?
what are theu suspectible to?
**_at what CD4 level are HIV patients susceptible to opportunistic infection_**??
after 10 years viral replication is triggered at a high rate
## Footnote
**_CD4 cells destroyed_** in the process and the **_loss is significant_**
cause increase symptoms of HIV and increased **susceptibility to opportunistic infections, disease and malignancy**
\*\*CD4 below 500 HIV infected pt is at risk for opportunistic infection\*\*
287
in stage 3 HIV what are 4 diseases that can suggest the patient may progress to AIDS?
1. persistent herpes-zoster infection (shingles)
## Footnote
2. oral candidiasis
3. oral hairy leukoplakia
4. kaposi sarcoma
288
stage 4 HIV/AIDs
## Footnote
what is this characterzied by?
what 2 CD4 levels suggest progression to stage 4?
what are disease that a person can be susceptible for both?
7
5
immune system significantly weakened
## Footnote
**_1. CD4 less than 500_**
**bacterial infection**
TB
Herpes simplex
**herpes zoster**
vaginal candidiasis
**karposi sarcoma**
**hairy leukoplakia**
**_2. CD4 less than 200_**
**toxoplasmosis**
**crytococcois**
coccidiodomycosis
crytospooriosis
non-hodgkin’s lymphoma
289
what is the order of tests you order if suspecting HIV in patient??
what do they tell us?
what test don't we use anymore?
1. **_TOC #1: 4th Gen_**
## Footnote
**_HIV-1 and HIV-2 IgG_**
**_and IgM plus HIV-1 p24 Antigen_**
\*\*tests antigen so can be detected earlier, 2-3 weeks after infection\*\*
\*if postitive then move onto next!!!!
TOC #2 if previous postivie: **_Multispot Or RNA PCR_**
\*\*distinguishes between presence of HIV1 or HIV2\*\*
\*\*\*this testing algorithm is more accurate, faster, and less expensive than previous so not longer use western blot\*\*
290
are there at home HIV tests?
yes!!!
oraquick (mouth)
or
HIV-1 test system
(prick finger, mail it in..wait a week)
291
what should you do if someones at home screening test is positive?
1. order 4th gen HIV1/2 IgG/IgM/p24Ag
if postivie.....
2. multispot HIV1
if postiive.....
3. order **_quantitative HIV-1 PCR to get viral load!!!_**
292
what should you continue to monitor in HIV/Aids patients every 3-6 months?
1. viral load
2. CD4 levels
293
Years ago, some patients and providers made the decision to delay initiation of HIV therapy with the thought that later treatment would reduce total medication exposure and decrease adverse effects.
Do we still follow these guidlines or suggestions?
NOPE!!!!!
## Footnote
data suggesting tha**_t earlier therapy improves long-term immune function_**
294
what are the 5 tx options reccomended to HIV?
4 integrase strand transfer inhibitor (INSTI)-based regimens
1 ritonavir-boosted protease inhibitor-based regiment
295
what are the goals of HIV treatment? (4)
1. supress HIV viral load
2. reconstitiute the immune system and get CD4 levels back
3. prevent reistance
4. prevent future infections
296
what is the HAART tx for HIV?
4 drug classes
highly active anti-retroviral tx
## Footnote
1. Fusion inhibitors
2. nucleoside/nucleotide reverse transcriptase inhibitors
3. non-nucleoside reverse transcriptase inhibitors
4. protease inhibitors
\*\*\*\*\*combination of 3 active anti-retrovirals\*\*\*\*
297
what is the post-exposure DOC for HIV?
when do you give it?
goal?
**_truvada plus raltegravir_**
_started ideally 1-2 hours after exposure but_ **must be within a minimum of 72 hours for best results**
tx for _28 days, but **high risk groups can start up to 2 weeks post exposure**_
\*\*\*goal: prevent initial infection with antivirals!!!\*\*\*
298
\*\*\*pre-exposure HIV prophlaxsis\*\*\*
## Footnote
who is this given in?
what does it do?
name of the drug?
how many times must you take it for it to be effective?
given to someone with partner who has HIV or someone who plans to participate in sexual activity with someone with HIV and wants to protec thtemself
PrEP is generally well-tolerated and can be dramatically successful
that early HIV treatment **_can reduce the risk of transmitting HIV to the uninfected partner by 96%.1_**
TRUVADA can prevent transmission!!!! must be take _more than or equal to 4 times a week_!!!!!
299
\*\*\*who does the CDC reccomend get tested for HIV\*\*\*
CDC reccomends everyone age **_13-64 to be tested at least once_**
## Footnote
and!!!...
**1. everyone who presents with symptoms of STD should be tested at that visit**
**2. testing anyone that starts new relationship**
300
\*\*\*\*what is the reccomendations for HIV testing in gay or bisexual testing for HIV?\*\*\*\*
For individuals who identify as gay or bisexual testing every **_3-6 months may be beneficial._**
## Footnote
but _AT LEAST ANNUALLY_
301
\*\*\*\*There is evidence that referring patients elsewhere for testing, e.g. to an STD clinic from an ED, Urgent Care, or PCP office, results in lower testing rates and missed diagnoses \*\*\*\*\*
fun fact!!!
302
\*\*\*\*\*what type of permission must be obtained before testing for HIV? 2 other considerations\*\*\*\*
Maine state law requires that testing be **_voluntary_** undertaken that **_informed consent obtained either written or oral_**, and the patients must be informated of what a positive or negative test means
303
what is the most common transmitted mutations for HIV?
makes emtricitabine not work and makes HIV susceptible to tenofovir
304
\*\*\*can people with HIV be infected with more than one strain?\*\*
yes they can!!
305
\*\*\*explain the life expectancy of someone living with HIV?\*\*\*
life expectancy for those living with HIV has increased to approximately the same as that for HIV negative individuals
306
\*\*\*what does HIV treatment regimen consist of?\*\*\*
regimens must **_consist of 3 or more active agents from multiple medication classes_**
## Footnote
many pills have a combination of multiple drugs in them to increase compliance
307
\*\*what was on of the first and most common combination pills used to treat HIV? what does it contain?\*\*
**_atripla_** is one of the first combination pills
## Footnote
contains efavirenz, emtricitabine, tenofovir
308
\*\*when should post exposure prophylaxsis be started\*\*\*
within a minimum of 72 hours for best results!!!
309
what are 5 notifiable diseases?
Infectious Diseases – Communicable
Infectious Diseases – Dangerous
Environmental Hazards
Bio-terrorism Agents
Public Health for Action
310
where can you find the notifiable diseases for maine law?
22 M.R.S.A., sections 801-825
## Footnote
Chapter 258: Rules for the Control of Notifiable Diseases and Conditions
