Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

The ultimate test - Last Keystone exam > Tickborne diseases / HIV (one lecture > Flashcards

Tickborne diseases / HIV (one lecture Flashcards

1
Q

Case: 31yo male with:

  • malaise
  • frontal headache
  • myalgias
  • mild abdominal pain
  • 103F fever for 24 hrs.
  • just returned from a trip to Missouri, hunted and fished. Late June. Multiple tick exposures.
  • no rash, and no neck stiffness.
  • What is the likely diagnosis?
A

likely erlichiosis

-(could be anaplasmosis as well)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

most common tickborne infection in the US.

A

Lyme disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

which organism causes Lyme disease?

A

Borrelia Burgdorferi, a spirochete bacteria.

Note: Nymphs (not adults) transmit most of the disease!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Where is Lyme disease found?

A

Rare in Iowa but found in basically all the states North, south and east. Very rare in the Western part of the country.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the primary reservoir for Lyme disease?

A

small rodents.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What needed for transmission of Lyme?

A

-tick must attach to human host for AT LEASt 24 hours!! - b/c they must upregulate specific virulence genes to infect.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Findings in primary Lyme disease

A

systemic symptoms (fever, malaise, etc)

single, growing, targetoid rash = key. (in 80% of pt’s)
-grows a cm a day.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Findings in secondary Lyme disease

A
  • Multiple rashes, at places all over body (away from tick bite.)
  • cardiac conduction abnormalities
  • neurologic: bell’s palsy, aseptic meningitis

Typically a month after exposure.

-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Findings in tertiary Lyme disease

A
  • recurrent, migratory, oligoarticular arthritis in large joints (knee most common)
  • fever usually not present, as it is a persistent infection months after initial infection.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Case: patient comes in with an erythema migrans rash, which has grown 3 cm in the last 3 days. What is the next step?

A

Treat for Lyme (doxycycline)!!
Don’t wait for cultures, it is a very hard organism to culture. Diagnosis is clinical and is based on H & P, along with basic lab info.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Case: patient who may have Lyme, but no rash. What is the next step?

A
  • do an ELISA (sensitive test)

- if +, do an immunoblot to confirm.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When is serology useful for Lyme disease?

A
  • in tertiary disease (arthritis/neuro complications)

- atypical presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the treatment for Lyme disease?

A
  • 2-4 week regimen of Doxycycline
  • usually oral med’s are sufficient
  • IV doxycycline for meningitis, hospitalized cardiac manifestation.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is babesiosis and what is it’s transmission pattern//geography?

A

babesiosis = poor man’s north american malaria (but not as severe as malaria).
-same vector as Lyme disease, so same geographic distribution!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Treatment for babesiosis

A

NOT doxycycline!!
-more complicated therapy that we don’t need to know.
May need to co-treat for Lyme disease or Erlichiosis!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Clinical presentation of babesiosis.

A
  • fatigue
  • low Hb
  • low platelets
  • evidence of hemolysis
  • worse disease in those without spleen.

NO RASH!!!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Diagnosis of babesiosis

A
  • blood smear or PCR

- blood smear has characteristic small, blue dots on the peripheral edges of RBCs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is Human Granulocytic Anaplasmosis?

A
  • intracellular rickettsia-like organisms infecting WBC’s

- anaplasmosis infects neutrophils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is Human Monocytic Ehrlichiosis (HME)?

A
  • rickettsia-like organisms infecting WBC’s

- erlichiosis infects monocytes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What organism causes erlichiosis? What is it’s distribution

A
  • ehrlichia charreensis.
  • fort chaffee is in Arkansas
  • hence it’s distribution is southern.
21
Q

What organism causes anaplasmosis?

A

anaplasma phagocytophilum.

-same tick/ same geographic distribution as Lyme and Babesia

22
Q

Clinical manifestations of erlichiosis and anaplasmosis

A
  • fever
  • severe headaches
  • myalgias
  • cough sometimes present
  • rash sometimes present in erlichiosis (30% of time)

-people can get VERY sick from these infections.

23
Q

How do you diagnose erlichiosis or anaplasmosis?

A
  • Thrombocytopenia!!! = classic
  • it is a clinical diagnosis
  • you can do a smear but only 10-50% sensitive.
24
Q

Treatment for erlichiosis and anaplasmosis

A

Doxycycline for 1-2 weeks.

25
Q

Most severe tickborne disease.

A

-Rocky mountain spotted fever. (25% mortality for untreated disease)

26
Q

geographic distribution of Rocky Mountain Spotted Fever.

A

Misnomer!!

  • mainly found in the midwest and southeast
  • has been found in every state besides Maine, though.
27
Q

epidemiology of RMSF (Rocky Mountain Spotted Fever)

A
  • found in the midwest and southeast

- mainly in children

28
Q

Pathophyisiology of RMSF

A

-infect endothelial cells, causing diffuse organ dysfunction - poor perfusion, hypotension, edema, organ failure

29
Q

RMSF (Rocky Mountain Spotted Fever) clinical presentation. (Early and late)

A 
-fever
Early
-nausea
-vomiting
-severe headache
-muscle pain
-lack of appetite
-periorbital edema
-edema in hands and feet

Late (several days later)

  • RASH !! (macular or petechial is classic for disease)
  • abdominal pain, diarrhea, joint pain
30
Q

treatment for RMSF (Rocky Mountain Spotted Fever)

A

Doxycycline - even in kids!

-immediate treatment is important - it can be fatal.

31
Q

Case: a patient with a recent tick bite develops a febrile illness and bell’s palsy. You suspect:

A

Lyme disease, second stage!!

32
Q

Epidemiology of HIV

A

37 million infected and growing!

-rate of growth has slowed down the last year or so.

33
Q

Risk factors for HIV/AIDS (9)

A
  • men who have sex with men
  • IV drug user
  • unprotected sex with more than one partner
  • unprotected sex with someone at risk for the disease
  • exchanging sex for money or drugs
  • receptive anal intercourse, regardless of orientation
  • other STD
  • transfusion or derivatives 1978-85
  • asking for HIV test.
34
Q

Who should be screened for HIV?

A
  • Patients in health care settings
  • pregnant women
  • at high risk = test anually!!
  • Note: written consent not necessary to do an HIV test.
35
Q

HIV diagnostic testing.

A

HIV 1-2 Antigen / Antibody assay (4th generation)

  • very sensitive!! (rule out HIV if negative)
  • if positive, do an HIV 1/2 differentiation assay, to figure out whether it’s HIV1 or HIV2
36
Q

T/F: most people who are exposed to HV do not acquire it.

A

True.

37
Q

Median time from HIV transmission to AIDS in a given patient

A

10 years

38
Q

CD4 T cell counts in HIV

A

> 500 = normal count

39
Q

When does skin disease happen in HIV?

A
  • at all levels of CD4 cells!

- seborrheic dermatitis can occur at any time, along with some other infections.

40
Q

HIV manifestations in ppl with CD4 count >500

A
  • “HIV mono” - in 40-70% of pt’s
  • lymphadenopathy
  • aseptic meningitis
  • CNS disease (can occur at any time
  • idiopathic thrombocytopenic purpura
41
Q

HIV manifestations in ppl with CD4 count 200-500

A
  • pneumonia
  • candida (oral / vaginal)
  • HSV
  • shingles
  • oral hairy leukoplakia
  • seborrheic dermatitis
  • lymphoma/sarcoma
42
Q

Definition of AIDS

A

CD4

43
Q

Signs of CMV retinitis

A

hemorrhage, yellow-inflammation on fundoscopic exam

“ketchup with scrambled eggs)”

44
Q

What is Immune Reconstitution Inflammatory syndrome? (IRIS)

A

happens with treatment - CD4 T cell levels grow, cells wake up and attack all the stuff growing (like pneumocystis jiroveci) - causing a extreme local or systemic immune response. May need to stop therapy or use steroids to treat.

45
Q

T/F: Most opportunistic pathogens in HIV are not present in most people, but low CD4 counts allow transmission

A

False.
-Most opportunistic infections are present in most people, but immune system keeps them at bay or eliminates them. When cell counts lower, they can grow.

-Cure is not possible for many of these infections.

46
Q

Significance of viral load for HIV

A

-the higher your viral load, the faster you progress to AIDS (predicts RATE of disease better than CD4 count)

47
Q

General treatment for HIV

A

ART therapy

  • 3 drugs from at least 2 classes.
  • be aware that treatment may have many side-effects.
48
Q

Whom with HIV should be treated with ART?

A

Everybody with HIV!!

The ultimate test - Last Keystone exam (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions