Lecture 8 (Travel med+military medicine)- Exam 4 Flashcards

Question

Zika/Dengue/Chikungunya * What is the txt? * Pregnancy?

Answer 1

Treatment- Supportive * Tylenol- Not aspirin DO NOT GET PREGNANT- FEMALE FOR AT LEAST 8 WEEKS AND MALES FOR AT LEAST SIX MONTHS

Answer 2

* Flavavirus RNA Virus * Vaccine is good for life but not 100% effective. * Sub-Saharan Africa, South America * Spread by mosquitos (found in monkeys and humans are highly susceptible). Aedes Mosquito- feeds during the day.

Answer 3

* Injected through mosquito saliva and replication begins at site of inoculation. * Spreads through lymphatics then reaches the bloodstream. * Large amounts of virus are then seeded in the liver, spleen and lymph nodes where is continues to replicate and release.

Answer 4

* Mild symptoms: Fever, chills, headache, nausea, vomiting, muscle pain, and loss of appetite * Severe symptoms: Jaundice, bleeding, shock, organ failure, dark urine, stomach pain, and vomiting

Answer 5

* Fatal symptoms: Delirium, seizures, coma, and death * Dx’s with PCR * Treatment- Supportive * At risk of severe symptoms: Older, white men

Answer 6

* Area of Concern- Asia/Western Pacific * Flavavirus RNA Virus * Mosquito borne (pigs are infected). Humans are dead end hosts as they do not develop high levels of the virus. * Most at-risk are in rural areas for longer duration of travel.

Answer 7

the United States Advisory Committee on Immunization Practices (ACIP) which recommends JE vaccine for individuals moving to a JE-endemic country to take up residence, longer-term (eg, ≥1 month) travelers to JE-endemic areas, and frequent travelers to JE-endemic areas

Answer 8

* Most human JEV infections are asymptomatic or cause a nonspecific febrile illness. * Fewer than 1 percent of JEV infections result in symptomatic neuroinvasive disease. * However, when neurologic disease does occur, it is usually very severe with a high case-fatality rate; among survivors, neurological sequelae are common.

Answer 9

* Treatment- supportive * All travelers to JEV-endemic countries should be advised on measures to prevent JE, and JE should be considered among the differential diagnoses for patients with suspected neurological infection who have returned from recent travel in a JEV-endemic country in Asia or the Western Pacific region.

Answer 10

* Diagnosed by antibodies. * Should contact the CDC and refer to ID * Treatment- Supportive care * Mortality in hospitalized patients is 20-30%.

Answer 11

Longer duration of travel * ●Travel during the JEV transmission season * ●Spending time in rural areas * ●Participating in extensive outdoor activities * ●Staying in an accommodation without air conditioning, screens, or bed nets

Answer 12

However, if a person received the vaccine, but still came home with a fever, stiff neck, and headache, the next step would be a lumbar puncture.

Answer 13

* The organism classically responsible for the enteric fever syndrome is Salmonella enterica serotype Typhi * These organisms are ingested and survive exposure to gastric acid before gaining access to the small bowel, where they penetrate the epithelium, enter the lymphoid tissue, and disseminate via the lymphatic or hematogenous route.

Answer 14

* S. enterica serotype Typhi causes disease only in humans; it has no known animal reservoir. Infection therefore implies direct contact with an infected individual or indirect contact via contaminated food or water. * Vaccine is available but is not 100% effective.

Answer 15

* Onset of symptoms- 5-21 Days after exposure. * Majority of patients present with abdominal pain, fever, and chills. +/- Diarrhea or Constipation * 2nd Week of illness: rose spots" (faint salmon-colored macules on the trunk and abdomen) may be seen. (salmon colored rash)

Answer 16

* 3rd week of illness, hepatosplenomegaly, intestinal bleeding, and perforation due to ileocecal lymphatic hyperplasia of the Peyer's patches may occur, together with secondary bacteremia and peritonitis. * In the absence of acute complications or death from overwhelming sepsis, symptoms gradually resolve over weeks to months.

Answer 17

* Diagnosed by stool culture * Treatment- Fluoroquinolone, Zithromax, or ceftriaxone

Answer 18

Chronic Carriers of Salmonella carriage is defined as excretion of the organism in stool or urine >12 months after acute infection.

Answer 19

* Chronic carriers appear to reach an immunologic equilibrium in which they are chronically colonized (usually in the biliary tract) and may excrete many organisms but do not develop clinical disease. * Management of chronic carriage generally consists of antimicrobial therapy. If eradication is not achieved with antimicrobial therapy, cholecystectomy may be warranted.

Answer 20

* Hepatitis A infection is caused by the hepatitis A virus (HAV) Humans are the only known reservoir. * HAV is usually transmitted by the fecal-oral route (either via person-to-person contact or consumption of contaminated food or water).

Answer 21

* HAV can remain infectious on hands for several hours, on foods for several days, and on frozen foods, surfaces, and in feces for several months. * Maternal-fetal transmission has not been described.

Answer 22

* Infected individuals are contagious during the incubation period (28 days) and remain so for about a week after jaundice appears. * HAV replicates in the liver and is shed in the stool in high concentrations from two to three weeks before to one week after onset of clinical illness

Answer 23

In the United States, since vaccination was recommended for individuals at increased risk for infection (in 1996), for children living in states with the highest incidence of HAV (in 1999), and for all infants (in 2006), the rate has declined…. Until now- on the rise again.

Answer 24

* Symptoms and signs begin with abrupt onset of nausea, vomiting, anorexia, fever, malaise, and abdominal pain. * Within a few days to a week, dark urine (bilirubinuria) appears; pale stools (lacking bilirubin pigment) may also be observed. * These are followed by jaundice and pruritus (40 to 70 percent of cases). The early signs and symptoms usually diminish when jaundice appears, and jaundice typically peaks within two weeks.

Answer 25

* Elevated liver enzymes. * Diagnosed by serology (IgM/IgG) * Acute HAV infection in adults is usually a self-limited illness; fulminant hepatic failure occurs in fewer than 1 percent of cases.

Answer 26

* Enterotoxic e coli- most common * Norovirus- highly contagious * Giardia- “Beaver fever”

Answer 27

* Defined as passage of three or more unformed stools in a 24-hour period, accompanied by at least one of these other symptoms: nausea, vomiting, abdominal pain or cramps, fever, or blood in the stool. * Episodes of travelers' diarrhea are nearly always benign and self-limited, but dehydration may be severe.

Answer 28

* The organisms that cause travelers' diarrhea are most often transmitted by food and water; therefore, the risk of travelers' diarrhea is the highest in regions where sanitation and hygienic practices are poor and there is limited access to safe drinking water. Also, settings with inadequate electricity resulting in poor refrigeration can result in unsafe food storage and increased risk for disease. * Generally self-limiting and can be treated with loperamide and hydration. Dicyclomine is good option for crampy pain.

Answer 29

C. Jejuni (campylobacter) and Shigella: the initial symptoms are generally similar to those seen with ETEC, however, infections with these organisms may progress to include symptoms of colitis, such as fever, tenesmus, urgency, cramping, and bloody diarrhea.

Answer 30

When to treat with antibiotics: * Bloody or mucoid stools- get a stool culture first * Prescence of fever- get blood and stool culture first * Recent antibiotic use- test for c. diff * Persistent diarrhea- further workup Antibiotic- Azithromycin- single 1 gram dose * Fluoroquinolones had previously been the first choice of treatment for travelers' diarrhea; drug resistance has limited their utility.

Answer 31

Antibiotic chemoprophylaxis may be appropriate in short-term (eg, <2 weeks) travelers who have an underlying medical condition that would increase the risk of complications from diarrhea or would be severely exacerbated by dehydration from diarrhea such that the benefits of using antibiotic prophylaxis outweigh its risks [2,46]. Such situations include known severe inflammatory bowel disease that could be exacerbated by an episode of infectious diarrhea; severe vascular, cardiac, or renal disease that would be seriously compromised by dehydration; or a severe immunocompromised state.

Answer 32

If antibiotic chemoprophylaxis is used, we suggest rifaximin, a non-absorbed antibiotic with a favorable safety profile that has been effective at preventing travelers' diarrhea in several trials.

Answer 33

Tinidazole * other options: Nitazoxanide and metronidazole

Answer 34

* Meningococcal disease is caused by Neisseria meningitidis. * The five major serogroups most associated with invasive disease are A, B, C, Y and W135

Answer 35

Quadrivalent conjugate meningococcal vaccines (Men-C-ACYW) * Menactra® (meningococcal groups A, C, Y, and W-135 polysaccharides conjugated to diphtheria toxoid protein) * Menveo™ (meningococcal groups A, C, Y and W-135 oligosaccharides conjugated to CRM197 protein)

Answer 36

Is recommended for travellers to the African meningitis belt – Particularly during high transmission season (Dec to June)

Answer 37

* At least 22 states require the meningococcal vaccine for students * All 11- to 12-year-old adolescents should receive a MenACWY vaccine. Since protection wanes, CDC recommends a MenACWY booster dose at age 16 years. The booster dose provides protection during the ages when adolescents are at highest risk. * Effective for about 5 years and then you need a booster.

Answer 38

Culture- The values, traditions, and behaviors that characterize the U.S. Armed Forces and shape the experiences of military personnel and their families.

Answer 39

Branches of the U.S. Military: * Army, Navy, Air Force, Marine Corps, Coast Guard, and Space Force. Military Structure: * Enlisted Personnel: Non-commissioned officers (NCOs) and other ranks. * Officers: Commissioned leaders responsible for command and decision-making.

Answer 40

* Respect for authority, chain of command, and formal titles (e.g., addressing individuals by rank) is important. * Values and Traditions:Honor, duty, loyalty, courage, self-sacrifice, discipline, teamwork, and camaraderie.

Answer 41

* American Culture- individualistic culture- prioritizes self over group- values independence and autonomy * American Military- prioritize needs of group over self. Mission before anything- Team before Self.

Answer 42

Fear of career repercussions, distrust of civilian providers, and reluctance to seek mental health care due to perceived weakness. Multiple Fucked up trials: * Tuskegee Syphilis Experiment (1932-1972) * MK-Ultra (1950s-1973) * Operation Whitecoat (1954-1973) * Project 112/Project SHAD (1960s) * Burn Pits * Agent Orange

Answer 43

Recruitment and Training: * Introduction to military life, including physical and mental conditioning. Deployment and Combat Exposure: * High-stress environments, separation from family, and exposure to trauma.

Answer 44

Reintegration and Transition to Civilian Life: * Challenges related to finding new roles, mental health concerns, and adjusting to civilian norms. Military Family Life: * Frequent relocations, spouse employment challenges, and the stress on military children.

Answer 45

Reserve and National Guard Members Signed Up to Serve Part-Time, But They’re Deploying More Than Ever Before * are increasingly deployed more frequently and for longer durations. This surge is due to the growing reliance on these units to supplement active-duty military in global missions and domestic emergencies.

Answer 46

The increased deployment strains members, their families, and civilian employers, who must navigate the demands of frequent service.

Answer 47

* Frequent relocations, deployment separations, and financial stresses. * Healthcare Needs of Military Spouses and Children: * Mental health support for children facing deployment stress, access to consistent medical care, and addressing spouse employment and health needs.

Answer 48

about their service-related experiences, deployments, exposures to hazardous materials, combat situations, physical injuries, mental health impacts, and specific military occupational specialties, in addition to standard medical history questions, to fully understand their health needs and potential risks associated with their military service.

Answer 49

Per the Health Insurance Portability and Accountability Act (HIPAA), medical information may be disclosed to military commands in a variety of circumstances necessary for safety, fitness for duty determinations and mission requirements.

Answer 50

I acknowledge I am responsible to report medical (including mental health) and health issues that may affect my readiness to deploy or fitness to continue serving in an active status in accordance with Department of Defense Instruction 6025.19, Individual Medical Readiness. As a condition of continued participation in military service, I must report significant health information to my chain of command. In addition, I will authorize and facilitate disclosures of all health information by any non-DoD health care provider(s) to the Military Health System (MHS) and/or to my respective Reserve

Answer 51

Harm to self; harm to others; harm to mission; special personnel; inpatient care; acute medical conditions interfering with duty; substance abuse treatment program; command-directed evaluation

Answer 52

C) Reassuring them about patient confidentiality while explaining any mandatory reporting requirements.

Answer 53

Stigma surrounding mental health

Answer 54

Combat injuries, musculoskeletal disorders, hearing loss, and exposure to hazardous environments.

Answer 55

Mental Health: * PTSD, anxiety, depression, traumatic brain injury (TBI), and substance use disorders. Healthcare System Engagement: * Navigating the Veterans Affairs (VA) system or military health system (TRICARE).

Answer 56

Higher rates of military sexual trauma (MST), reproductive health concerns, and gender-specific health disparities.

Answer 57

* Chronic obstructive pulmonary disease (COPD): A common chronic disease among veterans * Type 2 diabetes: A common chronic disease among veterans * Alzheimer's: A common chronic disease among veterans * Cancers: Some types of cancer are more common among veterans than non-veterans * Chronic kidney disease (CKD): Veterans are more likely to have CKD than non-veterans

Answer 58

* Arthritis: A common condition among veterans, especially female veterans * Hypertension: A common condition among veterans, especially female veterans * PTSD: Affects 10–13% of veterans from the Vietnam, Gulf, Afghanistan, and Iraq Wars * Depression: A common mental health disorder among veterans

Answer 59

* Number one killer of veterans: Heart disease and cancer. * The most common disability is tinnitus.

Answer 60

PTSD is the most common mental health disorder for male veterans, and depression is the most common for female veterans.

Answer 61

Diagnosis: * Based on criteria from the DSM-5, including the presence of intrusive thoughts, avoidance, and altered cognition and arousal for over a month. Treatment: * Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), medications like SSRIs, and group therapy.

Answer 62

* PTSD in veterans may be linked to combat experiences, leading to higher rates of co-morbidities like substance abuse. * The Primary Care PTSD Screen for DSM-5, or PC-PTSD-5, is a 5-item questionnaire with yes/no response options specifically designed for administration by primary care providers.

Answer 63

Burn Pits-an open-air area used by the military to burn solid waste, such as trash, chemicals, and medical waste. Burn pits are used when there is no equipment for burning solid waste or when there are more than 100 personnel at a location for more than 90 days. (PACT Act)

Answer 64

* Asthma/COPD * Sinusitis/Rhinitis * Cancers * Sarcoidosis * Pleuritis

Answer 65

Gulf War Syndrome- widely used term to refer to the unexplained illnesses occurring in veterans of the 1991 Gulf War. Symptoms * Fatigue * Musculoskeletal pain * Cognitive problèm * Skin rashes * Diarrhea

Answer 66

1. Incubation Period Rabies incubation typically lasts 1-3 months but can range from a few days to years. The closer the bite is to the brain, the shorter the incubation. This patient’s symptoms two weeks post-exposure are consistent with rabies’ timeline. 2. Early vs. Late Signs Early signs: fever, malaise, tingling at the bite site. Late signs: hydrophobia, encephalitis, paralysis. This patient shows both early (fever, tingling) and late signs (dysphagia, hyperactivity). 3. Immediate Management Since rabies is almost universally fatal once symptoms start, palliative care is typically the focus. However, the Milwaukee Protocol (experimental) could be considered.

Answer 67

Effect of No PEP Without PEP, rabies infection is almost inevitable after exposure to a rabid animal. PEP is most effective when administered immediately after exposure. Prevention Policies Military personnel should have pre-exposure rabies vaccines in high-risk areas. Additionally, post-exposure protocols should be easily accessible in deployment zones, and rapid medical evacuation for treatment is crucial. Rabies vaccine – It is reasonable to administer rabies vaccine if the patient has not received a complete course of post-exposure prophylaxis (see "Rabies immune globulin and vaccine"). Viral clearance in rabies is associated with the development of an immune response, and an important hallmark of this response is the presence of neutralizing anti-rabies virus antibodies in the serum and cerebrospinal fluid [44]. Rabies Immune Globulin-- As much of the RIG dose as is anatomically feasible should be infiltrated in the area around and in the wound at the same depth as the wound. Any remaining dose should be given intramuscularly and at a different intramuscular site than the vaccine (such as the opposite deltoid).

Lecture 8 (Travel med+military medicine)- Exam 4 Flashcards

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