MDT Infectious Disease 15.12 Test 1

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What is an acute febrile illness caused by infection, that is transmitted by small-particle aerosols and deposited on the respiratory epithelium has a Type A and B: Influenza
What are the 5 constitutional SX of all viral illnesses?: Fever
Chills
Myalgia
Prostration
Anorexia
What is a rare, but severe complication when ASA is used on a pt. suffering from an Influenza infection?: Reyes syndrome
What is an acute systemic infection caused by the RNA virus Morbillivirus?: Rubeola (Measles)
What acute systemic infection typically strikes children age 5 or less and is the leading cause of child death in developing countries?: Rubeola (Measles)
What is a mild systemic disease caused by the Togavirus?: Rubella (German Measles)
In pregnant women the highest risk of complications of Rubella occurs when?: 1st Trimester of gestation
Rubella is a mild illness that rarely last longer than how many days?: 3-4 days
What is an acute generalized paramyxoviral disease causing inflammation of the salivary glands?: Mumps
What acute generalized paramyxoviral disease is the leading cause of pancreatitis in children?: Mumps
What is the incubation period for Mumps?: 14-21 days with an average of 18 days
What are the SX in the prodrome phase of Mumps: The constitutional SX
In Mumps consumption of what could make SX worse?: Citrus or acidic foods
In Mumps a high fever could be accompanied by what 2 things?: Meningitis or Orchitis
In Mumps, Epididymitis occurs in what % of all cases?: 85%
A female pt. with lower abdominal pain and enlarged overies that has been DX with Mumps can also have what?: Oophoritis
DX of Oophoritis in the operational environment is difficult so the SX should be considered what?: Surgical Abdomen
What is a symptomatic infection caused by the Epstein-Barr Virus?: Infectious Mononucleosis
Infectious Mononucleosis is most common between what ages?: 15-24
What is the classic triad of SX for Infectious Mononucleosis?: Pharyngitis
Fever
Adenopathy
A pt. with pharyngitis, fever, adenopathy, prominent fatigue, malaise, and splenomegaly can be dx' with what?: Infectious Mono
Why must you not palapte the spleen of a pt suffering from Infectious Mono?: You risk creating a surgical abdomen
What is the hallmark sign of a CBC of a pt. who is suffering from Infectious Mono?: Atypical lymphocytes totaling 20%
What is a tx for a pt. who is suffering from Infectious Mono when an impending airway obstruction is suspected?: Prednisone 60 mg PO QD x 3 days, then taper over 1 wk
What is a complication of a pt. who is suffering from Infectious Mono?: Splenic rupture
A common viral illness characterized by a vesicular rash and fever is defined as?: Varicella (chicken pox)
What is the predominant age of a pt who is suffering from chicken pox?: 5 to 10 yrs old
Varicella peaks during which time of the year?: Springtime
What is the incubation period for Varicella?: 9 to 21 days
Symptoms of varicella are generally worse in whom?: Adults
In a varicella infection, when does a fever usually peak?: With the eruption of the vesicles
In pt. w/ a varicella infection, how does the rash usually present (lesions)?: Lesions at different states at the same time
What med can be given within the first 72 hrs in the tx of varicella infection?: Acyclovir 800 mg five times a day
A DNA virus due to the variola virus, that is a human virus with no known nonhuman reservoirs of diseases is defined as?: Variola (Smallpox)
When was variola (smallpox) eliminated and how was it eliminated?: In 1977 through vaccination (routine vaccination has since stopped per student guide)
When is a pt. infected w/ smallpox most infectious?: 1st week of infection
Group of infectious diseases caused by arthropod-borne viruses is defined as?: Viral Hemmorhagic Fever
What are the 5 genus of viruses that cause Viral Hemmorhagic Fever and what do they cause?: -Arenaviridae (lassa fever)
-Bunyaviridae (hanta virus & rift valley)
-Filoviridae (ebola & marburg)
-Flaviviridae (tick-borne encephalitis)
-Paramyxoviridae (hendra virus)
Spontaneous bleeding caused by a defect in clotting factor or blood vessel structure is a physical finding in Viral Hemmrhagic Fever that is defined as?: Hemorrhagic diathesis
In viral hemorrhagic fever, what is the tx in a pt. who has GI bleeding?: Zantac 150mg BID
Ice water lavage/gavage
A viral flavivirus transmitted by an arthropod bite is defined as?: Dengue fever
What is the most prominent vector of Dengue Fever?: Aedes mosquito
What is the causative vector in Africa of dengue fever?: Monkey mosquito
What is the causative vector in Mexico and Texas of dengue fever?: Asian Tiger Mosquito
What are initial signs of dengue fever?: Severe myalgia to back, head, and extremities (break-bone fever). Redness, flsuhing, and blotching of the skin.
What is the febrile pattern of a pt. who suffers from dengue fever? It's also known as what?: Initial fever will last 3-7 days, then a remission period followed by another febrile period lasting 1-2 days. (biaphasic fever curve)
What laboratory finding will you see in the CBC of a pt. who suffers from dengue fever?: Leukopenia and thrombocytopenia
A viral disease infection of the liver, having systemic manifestations caused by the Yellow Fever Virus (YFV) is defined as?: Yellow Fever
What are the 2 transmission cycles of Yellow Fever?: A sylvatic (jungle cycle)and urban cycle
What is involved in the sylvatic (jungle cycle) of YF?: Mosquito and nonhuman primates
What is involved in the urban cycle of YF?: Aedes aegypti mosquito and humans
In YF, constitutional symptoms, myalgia, conjunctivitis, and bradycardia can be seen in which phase?: Viremic (early phase)
In YF, jaundice, oliguria, albuminuria, hemorrhage, encephalopathy, shock and acidosis can be seen in which phase?: Toxic phase
What are the 3 stages of YF?: Viremic (early phase), Brief recovery period, and toxic phase
What is the tx for GI bleeding in YF?: Zantac 150 mg PO QD
Ice lavage/gavage
An arbovirus encephalitides that produces clinical manifestations in humans is defined as?: West Nile Virus
When was West Nile Virus identified in the U.S.?: 1999
How is West Nile Virus transmitted?: By the Culex Mosquito
What is the incubation period for West Nile Virus?: 3 to 14 days, symptoms generally last 3-6 days
True or false. Most people infected by West Nile Virus are symptomatic?: False.
Most people are asymptomatic
A zoonotic disease caused by the spirochete Leptospira interrogans is defined as?: Leptospirosis
What are the stages of Leptospirosis?: Septicemic stage (stage last about 1 wk) and Immune stage
What physical findings can be seen in the septicemic stage of Leptospirosis?: Pharyngitis, Lymphadenopathy, Hepatomegaly, Splenomegaly
What physical findings can be seen in the Immune stage of Leptospirosis?: Same symptoms of initial phase, with the addition of "aseptic meningitis"
What is the tx of Leptospirosis?: Supportive Therapy
Tylenol 500 mg II PO Q6
Volume replacement
PCN G 1 M.U. IM Q4
Doxycycline 100 mg PO BID x 7 Days
A viral (rhabdovirus) encephalitis is defined as?: Rabies
What is the incubation period of Rabies?: 10-90 days. (Incubation periods vary with location of biest and amount of contac made)
What are the prodromal symptoms of Rabies?: Constitutional sx's; px or anesthesia at exposure site; psychiatric sx's; sore throat, GI sx's
What are the phases of Rabies?: Prodrome and Acute Neurological period
Larynx, pharynx spasm and severe px when drinking as well as hydrophobia and thick tenacious saliva can be seen in which phase of Rabies?: Acute Neurological Period
How is Poliomelitis transmitted?: Fecal-oral route
What is seen in the bulbar muscles innervated by cranial nerves during paralytic poliomyelitis?: Flaccid paralysis w/o sensory defects
What is the mortality rate in bulbar polio?: 50%
What is the transmission route for HAV?: Fecal Oral route
What is the transmission route for HBV?: Parenteral Route
What is the transmission route for HCV?: Parenteral route, iv drug accounts for most cases
What is the transmission route for HDV?: Possibly superinfection of HBV
What is the transmission route for HEV?: Water borne, ingestion
What is the transmission route for HGV?: Unknown
In which stage of Hepatitis will you see aversion or distaste to smoking as well as fatty, floating, clay stools?: Prodrome Stage
What are the 3 stages of hepatitis?: Prodrome, Icteric, and Convalescent
What is the transmission method of Salmonellosis?: Consumption of contaminated food/drink
Which serotypes of Salmonellosis will cause infection?: Typhi
How is the diarrhea described in a pt. who suffers from Salmonellosis?: "Pea-soup"
What are the latent sx's of Salmonellosis?: Splenomegaly, Abdominal distension, Bradycardia, and Dicrotic pulse
What is an acute diarrheal infection?: Cholera
What is the causative agent of cholera? How is it transmitted?: Vibrio cholera and it is transmitted by consumption of contaminated shellfish, h20, food
In cholera, stool that is liquid gray, turbid and w/o fecal odor, blood or pus is described as?: Rice water stool
In cholera, what is the amount of diarrhea that can be produced in 1 day?: 15 liters
What is the first rule in the operational tx of cholera?: Fluid replacement
What antimicrobials can be used in shortening the course of Cholera?: Tetracycline
Cloramphenicol
Ampicillin
What is a complication that can occur from Cholera?: Shock and Death
What disease due to its severe toxicity and durability has a great potential to be used as a bioweapon?: Botulism
What is the most powerful neurotoxin known to man that prevents acetylcholine at the neuromuscular junction and autonomic synapses?: Botulism
Cranial nerve palsies (bilateral nerve involvement) such as Diplopia, Opthoalmoplegia, dysphagia, dysarthria, and dry mouth are physical findings of what disease?: Botulism
What type of GI symptoms can be seen in botulism?: N/V/D or constipation and cramps
What medication needs to be given asap (even prior to lab confirmation) in the tx of botulism in the operational setting?: Antitoxin (trivalent equine botulinum)- antitoxin available at CDC
In an outbreak of botulism, describe the the prognosis?: High mortality rate in 1st case of an outbreak, subsequent cases tend to recover completely
An inflammatory disease of the bowel caused by one of the several species of shigella is described as?: Shigellosis (bacillary dysentery)
Outbreaks that occur in crowded conditions, where personal hygien is poor such as jails, mental hospitals, child care centers, and refugee camps; with male homosexuals being at increased risk can be seen in what disease?: Shigellosis (bacillary dysentery)
Shigellas are composed of how many species?: 4
What is the most common isolated species in the U.S. of Shigellosis?: S. Sonnei
What is the most serious form of Shigellosis?: S. Dysenteriae
In obtaining the medical history of a pt. w/ shigellosis, what are 2 important ?'s to ask?: Environmental/Social hx
A specific zoonosis disease involving rodents and their fleas is defined as?: Plague
What continues to be a threat worldwide due to persistent rodent infection?: Plague
What is the infectious agent of Plague? What is the most common vector?: Yersinia pestis
Oriental rat flea
What is the incubation period of Plague?: 1-7 days, plus or minus 2-3 days
What are 3 initial symptoms that can be of sudden onset in Plague?: Intense headache, delirium, and tachycardia
What % of lymph fluid will drain to the inguinial lymph nodes when affected with the Plague: 90%
In Plague what has a high risk of fatality without TX being started within a few hours of onset?: Fulminant Pneumonitis
A systemic illness caused by a generalized bacterial infection can be defined as what?: Bacterial Sepsis (Septicemia)
What is the approximate number of Gram-negative bacteremia among hospitalized pt.: 300,000
What are predisposing factors for a Bacterial Sepsis infection?: General medical status
Age
Immunosuppressive therapy
Recent surgery
Diabetes
Hyposplenism
E. Coli, Klebsiella, Pseudomonas aeruginosa, Staphyloccus, Streptococcus, Neisseria meningitides, and Gram-Negative bacteria can cause which disseminated infection?: Bacterial Sepsis (septicemia)
What are the less common sources of infection in Bacterial Sepsis?: Fungal
Viral
Rickettsial
Parasitic
What is the tx of Bacterial Sepsis that is based on the possible disease process?: Broad spectrum IV antibiotics (used judiciously by the IDC)
What are the four species of Typhus?: Epidemic (louse bourne)
California Flea
Endemic (murine)
Scrub
What is the causative pathogen in Epidemic (louse bourne) typhus?: Rickettsia prowazekii
What is the geographic prevalence for epidemic (louse bourne) typhus?: North and South America, Africa, and Asia
What is the causitive pathogen of California flea typhus?: Rickettsia felis
What is the geographic prevalence for California flea typhus?: Southern California and Texas
What is the causitive pathogen in endemic (murine) typhus?: Rickettsia typhi
What is the only typhus with a worldwide geographic distribution?: Endemic (murine) typhus
What is the causitave pathogen of scrub typhus?: Orietia tsutsugamushi
The prevalence for this type of typhus is Southeast Asia, Japan, and Austalia?: Scrub typhus
A macular rash to trunk, axial, then spreading the the rest of the body sparing face, palms, and soles is seen in what type of typhus?: Epidemic (louse bourne) typhus
A macularpapular rash concentrated on the trunk and fades rapidly in which type of typhus?: Endemic (murine) typus
The development of a flat black eschar with regional lymphadenitis at the site of a bite and a macular rash the appeats primarily to the trunk after a week long fever is present in which typhus?: Scrub typhus
What are the late S/S that develop in the second or third week of a typhus infection?: Obtunded
Pneumonitis
Myocarditis
Encephalitis
Meningitis
Acute Abd pain
Cardiac failure
Hepatitis
Renal failure
What is the primary antimicrobial treatment in typhus?: Doxyclycline 100mg PO BID for 7 days or until 2 days after temp returns to normal
This is an acute or chronic systemic febrile illness aquired most often via inhalation of feces, placenta, and milk remnants contained in dust.: Q fever
What is the incubation period for Q fever?: 1 to 3 weeks
In Q fever where might abdominal pain be generalized to?: RUQ
In an operational setting what are lab test that should be ordered for Q fever?: CBC
UA
PPD
What is the operational treatment for Q fever infection?: Supportive care
Tylenol 500mg 2 PO q6hrs
O2 and fluids PRN
Doxyclycline 100mg PO BID x 14 - 21 days.
Alternate: E-mycin 500mg PO QID x 14 days
Contact M.O.
What are the complications of Q fever?: Pleural effusions
Hepatitis
Endocarditis
Encephalitis
What is a febrile arthropod bourne illness?: Rocky Mountain Spotted Fever
In the U.S. what two ticks are responsible for the transmission of Rocky Mountain Spotted Fever in the west and east?: Western = Wood tick
Eastern = Dog tick
What is the incubation period for Rocky Mountain Spotted Fever?: 3 to 12 days, mean is 7 days.
In which disease rash appears first to wrist and ankles progressing centrally to the trunk and to include the palms and soles?: Rocky Mountain Spotted fever with Hx of tick bite.
In operational setting what labs should be ordered in suspected case of Rocky Mountain Spotted Fever?: CBC
UA
RPR, & STD work up
Serum glucose
What is treatment for Rocky Mountain Spotted fever?: Doxycylcine 100mg PO BID until 2 days after fever.

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