Viruses Gone Wild
Tick Talk
We Bought a Zoo!-notic Disease
Blame it on the ETOH
Breaking Bad
Toxidromes
Menacing Mosquitoes
Noteworthy Nematodes
Bloodborne Bugs
200
Identified by its single-stranded, enveloped, negative sense RNA, this bullet-shaped virion causes an acute encephalitis in warm-blooded hosts, including humans.
Rhabdovirus
200
The first-line medication you use to treat tick-borne diseases
Doxycycline
200
Known by names such as rabbit fever, this highly infectious Gram-negative coccobacilli causes infection of the skin and swollen lymph nodes in 75-85% of cases.
Francisella tularensis
**DAILY DOUBLE**
200
Excessive alcohol intake can result in nutritional deficiencies, particularly in this vitamin:
Thiamine
200
This class of drugs does not cause physical dependence or withdrawal symptoms. They are 5HT2 receptor agonists.
Hallucinogens
200
The triad of altered mental status, pinpoint pupils, and low respiratory rate corresponds to this toxidrome:
Opioid overdose
200
This mosquito is responsible for transmitting malaria
Anopheles
200
Inhabiting the stomach of its final hosts, this parasitic nematode is acquired through the ingestion of raw or undercooked seafood and can penetrate through gastric mucosa, causing intra abdominal abscess
Anisakis
200
This parasitic disease, transmitted by the female sand fly, manifests as either skin ulcers or with fever, weight loss, and hepatosplenomegaly. On microscopy, you see the following:
Leishmaniasis
(Picture: macrophages that contain amastigotes)
400
Replicating in the cytoplasm and featuring a glycoprotein crown, coronavirus, originating from bats, is known for causing the common cold. However, certain strains, such as MERS and SARS, can do this, leading to more severe respiratory conditions.
Replicate at body temperature
400
This tick vector, known for the most common arthropod-borne infection in the US, causes a 3-stage disease with circular rash with central clearing, facial nerve palsy, and arthritis/meningitis
Ixodes scapularis
400
This Gram-negative, aerobic coccobacillus, known for its ability to survive and replicate within macrophages, causes an illness with waxing and waning fevers. You find it on farms or in patients who consume unpasteurized dairy.
Brucella
400
The leading preventable cause of birth defects and developmental disabilities
Prenatal alcohol exposure
400
Cocaine and amphetamines both cause sympathetic responses including increased BP and HR, as well as euphoria, increased energy, and enhanced concentration. Cocaine, specifically, does this by this mechanism
Blocking reuptake of dopamine and norepinephrine
400
This toxidrome is known for secretions essentially coming out of all orifices. Think “DUMBBELLS”
Cholinergic
400
These 2 types of malaria can cause relapse as they have liver hypnozoites that can lie dormant and enter into the blood stage at any time, causing symptoms
P. vivax and P. ovale
**DAILY DOUBLE**
400
This parasitic nematode takes the lead as the most frequent cause of eosinophilic meningitis globally. If you see meningitis + CSF eosinophilia + possible exposure history, you should think this:
Angiostrongylus cantonensis
400
60 y.o. patient complains of chest pain, difficulty breathing on exertion, and worsening constipation and abdominal pain. Reports a history of unilateral painless edema of the eyelid about 15 years ago that she did not get checked out. The patient most likely has:
Chagas disease
(cardiomyopathy, megacolon)
**DAILY DOUBLE**
600
Characterized by its linear dsDNA, complex structure, and brick-shaped appearance, this very large virus replicates in the cytoplasm and is responsible for a disease that causes wart-like, flesh-colored, papular lesions mainly in children
Poxvirus
600
This bacterial infection, characterized by symptoms like headache and conjunctival suffusion, is known to lead to more severe conditions such as Weil's disease. Individuals at risk include farmers, mine workers, veterinarians, and recreational swimmers, with an increased threat during floods.
Leptospirosis
600
This bacterium is known for causing cat scratch disease in immunocompetent patients and bacillary angiomatosis in the immunocompromised, as well as trench fever and Carrion's disease.
Bartonella
600
When consumed, alcohol exerts its effects on the nervous system by directly potentiating these receptors and inhibiting these other receptors, contributing to its well-known sedative and inhibitory effects.
GABA; NMDA
600
Drugs like nabilone and dronabinol are synthetic forms of THC used for this purpose
Nausea/vomiting associated with cancer chemotherapy
600
Mad as a hatter, Blind as a bat, Red as a beet, Hot as a hare, Dry as a bone OR can’t see, can’t pee, can’t spit, can’t sh*t
Anticholinergic
600
This type of malaria can cause Hyperreactive Malarial Syndrome (Tropical Splenomegaly Syndrome), manifesting as a huge spleen, anemia, elevated IgM and anti-malaria antibodies
P. falciparum
600
Transmitted by the Chrysops deerfly, this filarial nematode causes Non-specific symptoms such as fatigue, urticaria, arthralgias, myalgias in addition to Calabar swellings and eyeworm. How would you treat it?
DEC (loa loa)
600
Sleeping sickness, transmitted by the bite of the tsetse fly, causes intermittent fever, painless lymph node enlargement (especially in the neck), and a trypanosomal chancre. Persistence of the disease is explained by this:
Antigenic variation
800
This rodent-borne Bunyavirus is primarily transmitted by inhaling infected rodent excrement or through direct skin contact, and causes damage predominantly in the lungs or kidneys
Hantavirus
800
This organism causes a disease characterized by recurrent episodes of fever separated by asymptomatic intervals and is linked to sleeping in rustic cabins. Can be transmitted by lice or ticks.
Borrelia
800
Employing a clever strategy, this organism sticks to and enters endothelial cells by tricking them into engulfing the bacteria. With the help of OmpA, they stick to host cells, and their actin-based movement creates a comet-like tail, allowing them to spread to neighboring cells.
Rickettsia rickettsi
**DAILY DOUBLE**
800
Known for its unique metabolism, alcohol takes advantage of this type of elimination, meaning it is cleared from the body at a constant rate regardless of concentration.
Zero-order / linear
**DAILY DOUBLE**
800
This pathway originates in the ventral tegmental area and projects to the nucleus accumbens, amygdala, and prefrontal cortex, reinforcing the effect of drugs and causing euphoria
Mesolimbic Dopamine pathway
800
The main limitation of urine drug screening is this:
Some drugs can be found in the urine long after they were last in use
800
This red blood cell disorder can prevent severe malarial disease but does not prevent infection (4 possible answers)
Sickle cell anemia, thalassemia, G6PD deficiency, Duffy antigen negativity
800
Carried by blackflies, this skin-dwelling nematode can cause skin nodules, depigmentation, keratitis, and hanging groin
Onchocerciasis (river blindness)
**DAILY DOUBLE**
800
Patient presents with flu-like symptoms, abdominal pain, and distention after going camping about a month ago. On blood smear, you see the following and are concerned for this disease:
Babesiosis
(maltese cross on smear)
1000
Known as “break bone fever”, this virus is the biggest arbovirus problem globally due to its movement through air travel. It presents with high fever, retroorbital pain, lymphadenopathy, maculopapular rash, leukopenia, thrombocytopenia, and increased serum transaminases
Dengue fever
1000
Serological testing for Lyme disease is not required for patients with erythema migrans for this reason:
Early sign → won’t test positive yet (useless)
1000
This bacterium is transmitted by the same tick vector responsible for Lyme disease, Borrelia burgdorferi, and causes fever, chills, headache, and muscle aches. What cells does it primarily infect?
Granulocytes
1000
Medication that exacerbates alcohol intoxication symptoms and induces negative conditioning (only recommended in patients who show strong motivation and commitment for abstinence)
Disulfiram
**DAILY DOUBLE**
1000
This medication is more effective than bupropion and nicotine replacement therapies at reducing cravings for nicotine. It also reduces pleasure from smoking and helps with withdrawal. Smokers were nearly 3x more likely to quit on this than with the placebo.
Varenicline (Chantix)
1000
Which, if either, of these is an emergency and must be recognized on imaging or it will be fatal?
Right = button battery
1000
This medication is first line therapy for severe P. falciparum infection
IV artesunate
1000
If there is a high microfilariae level in these diseases, you must avoid DEC and ivermectin due to risk of this reaction, caused by the inflammatory response to the death of the microfilariae:
Mazotti reaction (encephalopathy)
1000
Treatment of Babesiosis
atovaquone + azithromycin