Lemol

ogySel
f-
MadeMat
eri
als

MULPLECHOI
CEQUESTI
ONS.
2012- 2013
1.Thechar acteristicsmani festat i
onofper t
usi si s:-
Coughi ngfit
2.Whati st hemosti mpor tantchar act ert hati susef ult odoct orformaki ngt he
diagnosi sofTsut sugamushi disease? :-Escher
3.Whati st heot hernameofTsut sugamushi disease? :
-ScrubbTy phus
4.Whati st het ransmi ttingv ectorofTsut sugamushi disease? :-
Chi gger
?5.Whi chki ndofv iral hepat it
isr arelypr ogr essi ntochr oni chepat iti
s
?:-
Hepat i
t i
sA
6.In Chi na,whatar et hemai n sour cesofi nf ect ion in HFRS? :
-Apodemus
agaricus, Musnor vegi cus
7.Whi ch oft he f ollowi ng sel ect ions i s nott he cl i
nicalchar act eri
st i
cs of
thypoidf ev er ?:
-Tachy car dia
8.How t odi agnoset hy poi df everi nwi dalt est ? :
-“O” aggl uti
nint i
ter>=1: 80and
“H”>=1: 180
9.Compl icat i
onsf r
om HFMDnoti ncludi ng: -Endot oxi cshock
10.Phar yngealdi pther iacanbecl assi fiedi nt o4t ypesaccor dingt hesi zeof
pseudomembr aneandsev erity,noti ncl udi ng:-At ypical type
11.Themai nsour ceofi nfectionofchi ckenpox: -Thepat i
ents
12.Whi chdi seasesshoul dbedi fferent iat edmai nlywi thmumps? :
-Suppur ati
ve
parotitis
13.Themai nsour ceofi nfectionofEpi demi cencehal it
isBi s:
-Mosqui to
14.Themai n causeofdeat hofEpi demi cencehal itisBi s:-
Respi ratoryfai lure
15.Treat mentofchol er ashoul dgi v epr i
or it
yt o:-Fluidr eplacement
16.Whi chi snoHCVv irusst ruct ure? :
-Noenv elope
17.Whi chwayy oucannotbei nf ectedwi t
hHepat i
t i
sC ? :
-Dinnerwi thHCV
carri
er
18.Whi chi snotaki ndofI ndicat i
onf ordi agnosi ngHepat it
isC? :
-Antibodyof
HCVI gM orI gGi sposi ti
ve
19.Cel lty pescanbei nfectedbyt hev irusi nnat uralst atus,whi choft he
foll
owi ngi snoti ncl uded? :
-Langer hanscel l
s
20.Theent eringoft hev ir
uspar ticlesi nt ot het ar getcel lsdependson: -gp120
2013
21.Whati scor relatedwi t
ht hegr av i
tyofJapaneseencephal i
tis?:-
Conv ulsion
22.Whi choft hef ollowi ngsel ect ionsi snott hecl i
nicalchar acteri
st icsof
CHB? :-Rosespot s
23.Ify ouwer ei nfect edwi thHI V,how l ongmi ghty oushow sy mpt oms? :-Ina
year
24.InChi na, whatar et hemai nsour cesofi nfect ionsi nCHB? :
-pat i
ent swi t
h
CHB
25.Treatmentofchol erashoul dgivepr i
orityto:-Fluil
dr eplacement
26.Whi ch complicati
on i s noti ncluded due t o decompensat i
on ofl i
ver
function?:
-Jaundi
ce
27.Thepat hogenofwhi chdiseaseisnotaki ndofv i
rus? :
-choler
a
28.Themosti mportantchar acteri
sticsf eatureoft her ashi npati
ent
swi th
chi ckenpoxis:-
popul aronf aceandscal p
29.Whi choft hefoll
owi ngi strueaboutt hedescr i
ptionoft heasymptomatic
infection phaseofHI V? :
-Lastsf ora l ong ti
me,up t o
sev eralyearsorlonger .
30.ThegoalofCHDTr eat mentisnotf ollowing( )
A.
B
C.r educing and prev enting t
hepr ogr ession ofl iverdi seaseto cir
rhosi
s,
decomposi ti
onofcir
r hosis,HCCandr el
at edcompl i
cation.
D.Impr ovingquali
tyofl if
eandpr olongingsur v
ivalti
me
E.eliminatingHBV

31.Themai nlycompl i
cati
onsof chol
eraar
e( )
A.acuteliverfail
ure
B.heartfail
ure
C.gastrointesti
nalbl
eeding
D.Acuter enalfail
ure
E.Respiratoryfail
ure

32.Whichofthefoll
owingisnotthecorr
ectwayt
opr
eventAI
DS?
A.Safesex
B.stayawayfr
om inj
ecti
ondr ugs
C.avoidmenstr
uati
oninfecti
on
D.stayawayfr
om peopleliv
ingwithHI
VandAIDS
E.safebl
oodtransf
usion

33.Whatcel lsdoesHIVmainl
yatt
ackinthehumanbody?
A.redbloodcell
s
B.whitebloodcells
C.CD4*Tl ymphocyte
D.CD8*l y
mphocy tes
E.CD4*Tl y
mphocy teand CD8*l
ymphocyt
es

34.Thepat i
enthadf ever,coughlast
ingf
or1month,CD4*Tcel
lcount
200/mm³ ,
andposi ti
ve,whatwast hest
ageoft
hedi
sease?
A.Pr
imaryHIVi nf
ection
B.Cl
ini
call
yasympt omaticstage
C.SymptomaticHIVinfecti
on
D.Incubat
ionperi
od
E.Prodominalper
iod

35.
Whati sthecommonest r out
ineofchol
era?
A.Air
bornet r
ansmi ssion
B.f
ecal-or
al t
ransmi ssion
C.Contagi
oust ransmi ssion
D.Art
hropodt ransmi ssion
E.ver
ti
caltransmi ssion

36.Thepat ienthadwaterydiar
rhea10t i
mesaday, r
esembl
ingri
ce-
wat
er
andhav i
ngabdomi nalpai
n,strainorfever,f
oll
owedvomi
ti
ng.Themost
l
ikelydi agnosiswas ( )
A.typhoid f ever
B.Ty pus
C.chol era
D.Hemor r
hagicfev
erwithr
enal symptoms
E.

37.Theonl ysourceofmeaslesinf
ecti
onis:
A.chroniccarri
ers
B.Patients
C.Pigs
D.mosqui to
E.thecont aminatedwater
38.Chickenpoxmost lyoccur
sinwhichagegroup?
A.4-10y earsol
d
B.12-18y earsol
d
C.18-25y earsol
d
D.26-32y earsol
d
E.Allages

39.Thesympt
omsofher
pesi
snoti
ncl
udes( )
A. pain
B.it
chi
ng
C.vomit
ing
D.
E.depr
essi
on

40.Themai ninf
ecti
onsourceofdenguevir
us.
A.thepig
B.carr
ier
sofdenguev i
rus
C.thepati
entsoroccul
tinf
ecti
ousperson
D.mosquito
E.r
ats

41.Themai nr outesoftransmissi
onofcerebr
ospi
nalmeni
ngi
ti
sis( )
A. Respi r
atorytr
actt r
ansmission
B.Digesti
vetractspreads
C.insectvectorspreads
D.contactspreads
E.throughthebodyf lui
d,thebl
oodspresds

42.Thepeakoft heonsetageofepi
demi
c cer
ebr
ospi
nalmeni
ngi
ti
sis( )
A.<6mont hs
B.6mont hsto2y ears
C.preschoolchil
dren
D.schoolchil
dren
E.7-
14y ears

43.Themai nclini
calfeaturesofepi demiccerebr ospinalmeningi
tisare( )
A.hi
ghfev er,
headache, vomi t
ing,coma,meni ngeal stimulat
ionsi
gn
B.hi
ghfev er,
headache, stoke,coma, meningeal stimulati
onsign
C.hi
ghfev er,
headache, Twi tch,coma, meningeal st
imulat
ionsign
D.highfever,headache,v omit i
ng,respi
rat
oryf ailur
e,meni ngealsti
mulati
on
si
gn
E.highf ever,headache, pet echiaeorecchy mosi s,coma,meni ngeal
st
imulat
ionsi gn

44. The f i
rstchoi
ce dr
ug f
ort
he pat
hogen t
reat
mentoff
ulmi
nant
meningit
isis( )
A.sul
fadiazi
ne
B.peni
cil
lin
C.chl
orampheni col
D.Ampicill
in
E.Ceft
ri
axone

45.Themosti mportantsi
gntoidenyti
fythemeningi
ti
sandJEi
s( )
A.Obviousmeningealsti
mulati
onsyndrome
B.Abnormalphysiol
ogicalr
efl
exandpathologi
cal
refl
ecti
on
c.sei
zuresever
it
y
D.Ecchymosis
E.Obvi
ousbreathi
ngi r
regul
ari
ti
es

46.Theleadingcauseoft
hedeat
hoft
heepi
demi
cencephal
it
isB₁
A.tremers
B.circul
ati
onfail
ure
C.respir
atoryfai
l
ure
D.Hypert
hermi
a
E.consci
ousdi
stur
bance

TERMS
CHOLERA :Ana
1. cut
einf
ect
iousdi
seaseoft
hesmal
lint
est
ine,

causedbyt
hebact
erum Vi
i bri
ochol
eraeandchar
act
eri
zedby

pr
ofuse wat
ery di
arr
hea,v
omi
ti
ng,muscl
e cr
amps,sev
ere

dehy
drat
ion,and depl
eti
on ofel
ect
rol
ytes.Al
so cal
led Asi
ati
c

chol
era.

2.
PERTUSSI
S: Per
tussi
s,al
soknownaswhoopi
ngcough, i
s

an acut
e i
nfect
ionof t
her
espi
rat
ory sy
stem caused by

t
he bact
eri
um Bor
det
ell
a per
tussi
s. I
tischar
act
eri
zed by

sev
erecoughi
ngf
it
s t
hat end i
n a “
woopi
ng” sound

whent
heper
sonbr
eat
hesi
n.

3. D FEVER:Ty
TYPHOI phoi
disanacut
egast
ro-
int
est
inali
nfect
ion

causedpr
imar
il
ybysal
minel
lat
yphi
.

4. SEASE :Ts
TSUTSUGAMUSHIDI ut
sugamushidi
seasei
sanact
ue

f
ebr
il
e i
ll
ness of humans t
hat i
s caused by Or
ient
ia

Tsut
sugamushi,f
ormer
ly Ri
cket
tsi
a Tsut
sugamushi； i
tis

t
ransmi
tt
ed t
o humansbyt
hebi
teofl
arv
al-
staget
rombi
cul
id

mi
tes(
chi
gger
s).Nat
ural
lyoccur
ri
ngdi
seasei
nhumansoccur
s

mai
nlyi
ntheFarEast
.
5.
VI CALBREAKTHROUGH:Vi
ROLOGI rol
ogi
albr
eakt
hroughi
sdef
ined

asaconf
ir
med i
ncr
easei
nHBVDNAl
evelofmor
ethan1 ㏒ 10

I
U/mlcompar
edt
othenadi
r(l
owestv
alue)HBVDNA l
evelon

t
her
apy
;it usual
ly pr
ecedes a bi
ochemi
calbr
eakt
hrough ,

char
act
eri
zedbyani
ncr
easei
nALTl
evel
s.

DS: i
6.AI sadi
seaseoft
hehumani
mmunesy
stem causedby

i
nfect
ion wi
thhuman i
mmunodef
ici
ency v
irus(
HIV)
. Thi
sis

t
ypi
cal
lyf
oll
owedbyapr
olongedper
iodwi
thoutsy
mpt
oms.As

t
he i
ll
ness pr
ogr
esses,i
tint
erf
eres mor
e and mor
e wi
tht
he

i
mmunesy
stem,maki
ng t
heper
son much mor
eli
kel
yto get

i
nfect
ions, i
ncl
udi
ngoppor
tuni
sti
c i
nfect
ionsandt
umor
s. HI
V

i
str
ansmi
tt
edpr
imar
il
y v
ia

unpr
otect
edsexual
-i
nter
cour
se,
cont
ami
nat
edbl
oodt
ransf
usi
ons,

hy
poder
micneedl
es,andf
rom mot
hert
ochi
lddur
ingpr
egnancy
,

del
iv
ery
,orbr
east
feedi
ng.

7.ROSESPOTS:30%,r
oundorl
ent
icul
ar,sl
ight
lyr
aised,af
aintpal
e

col
or,f
ade on pr
essur
e,2-
4 mm i
n di
amet
er,l
ess t
han 10 i
n

number
, di
sappeari
n2-
3day
s.I
tIsf
oundi
nty
phoi
d.

8.
ENVELOPE( NofJEV:
E)PROTEI t
hemosti
mmunol
ogi
cali
mpor
tant

pr
otei
n whi
ch i
s usef
ulf
orcl
ini
caldi
agnosi
s and epi
demi
c

i
nvest
igat
ionofJEV.

9. S:a
ZOONOSI nani
maldi
seaset
hatcanbet
ransmi
tt
edt
ohumans.
 SARS:a
10. nv
iralr
espi
rat
orydi
seasewi
thsy
mpt
omsl
ikef
everand

cough and i
n some cases pr
ogr
essi
ng t
o pneumoni
a and

r
espi
rat
oryf
ail
ure.I
tiscausedbycor
onav
irus.

11. A:Ap
MALARI ar
asi
ti
cdi
seasescausedbypl
asmodi
um speci
es.

Tr
ansmi
tt
ed by t
he bi
te of i
nfect
ed f
emal
e of anophel
es

mosqui
toes.Char
act
eri
zedbyper
iodi
cpar
oxy
sm wi
thshaki
ng

chi
ll
s,hi
ghf
ever
,heav
ysweat
ing.

UNDULANT FEVER :I
12. tis al
so cal
led Br
ucel
losi
s.A zoonot
ic

di
seasecausedbyBr
ucel
la.I
tischar
act
eri
zedbyl
ong-
ter
mfev
er,

sweat
ing,f
ati
gue,j
ointpai
n,l
iv
erandspl
eenmegal
yandswol
len

l
ymphnodes.

13.
PASTI
A’ GN:oc
S SI curpr
iort
othe appear
ance ofr
ash and

per
sist
saspi
gment
edl
inesaf
terdesquamat
ion.

BLACKWATER FEVER :I
14. tis due t
o wi
despr
ead i
ntr
avascul
ar

haemol
ysi
s,af
fect
ingbot
hpar
aly
sedandunpar
aly
sedr
edcel
ls,

gi
vi
ngr
iset
odar
kur
ine.I
tisf
oundi
nadul
twi
thsev
eremal
ari
a.

15.
KOPLI
K’SSPOTS:Li
tt
lespot
sinsi
det
hemout
hthatar
ehi
ghl
y

char
act
eri
sti
coft
heear
lyphasesofmeasl
es(
rubeol
a).

17.I
NFECTI SEASE:Ani
OUSDI nfect
iousdi
seasei
sacl
ini
cal
lyev
ident

i
ll
ness r
esul
ti
ng f
rom t
he pr
esence ofpat
hogeni
c mi
crobi
al

agent
s,i
ncl
udi
ng pat
hogeni
c bact
eri
a, f
ungi
, pr
otozoa,

mul
ti
cel
lul
arpar
asi
tes,andaber
rantpr
otei
nsknownaspr
ions.
Thesepat
hogensar
eabl
etocausedi
seasei
nani
mal
sand/
or

pl
ant
s.I
nfect
ious pat
hol
ogi
es ar
e al
so cal
led communi
cbl
e

di
seases ort
ransmi
ssi
be di
seases due t
othei
rpot
ent
ialof

t
ransmi
ssi
on f
rom one per
son t
o anot
herby a r
epl
icat
ing

agent
(asopposedt
oat
oxi
n).

18. CELLA :Ch

VARI i
ckenpox(
var
icel
la)i
sanacut
evi
rali
ll
nessof

suddenonsetchar
act
eri
zedbyf
ever
,fat
igue,andagener
ali
zed

er
upt
ionoft
heski
n.Eachl
esi
onbegi
nsasasmal
ldewdr
op-
li
ke

v
esi
cle t
hatscabsov
eri
n3–4day
s.Thesel
esi
onst
endt
obe

mor
eabundantont
het
runkt
hanont
hear
msandl
egs.Lesi
onsi
n

t
heey
esandmout
hmaynotappeart
ypi
calandmaynothav
e

v
esi
cles(
bli
ster
s).

HERPESZOSTER: Al
19. socal
ledshi
ngl
es,zona,andzost
er.The

cul
pri
tist
hev
ari
cel
la-
zost
erv
irus.Pr
imar
yinf
ect
ionwi
tht
his

v
iruscauseschi
ckenpox(
var
icel
la)
.Att
hist
imet
hev
irusi
nfect
s

ner
ves(
namel
y,t
hedor
salr
ootgangl
ia)wher
eitr
emai
nsl
atent

(
li
es l
ow) f
or y
ear
s. I
t can t
hen be r
eact
ivat
ed t
o

causeshi
ngl
eswi
thbl
ist
ersov
ert
hedi
str
ibut
ionoft
heaf
fect
ed

ner
veaccompani
edbyof
teni
ntensepai
nandi
tchi
ng.

20.
SHI
NGLES : al
so known asher
pes zost
er,i
s av
iral

di
seasechar
act
eri
zed by apai
nfulski
nrash wi
thbl
ist
ersi
na

l
ocal
izedar
ea.
Typi
cal
lyt
her
ashoccur
sinasi
ngl
est
ri
peei
theron
t
hel
eftorr
ightoft
hebodyorf
ace

21.
LIVER FAI
LURE : i
sthe i
nabi
li
tyoft
hel
iv
ert
o per
for
m i
ts

nor
malsy
nthet
icand met
abol
icf
unct
ion as par
t of nor
mal

phy
siol
ogy
.Twof
ormsar
erecogni
sed,
acut
eandchr
oni
c.

22.
EPI
DEMI
CENCEPHALI
TISB:Epi
demi
cencephal
it
is Bi
sanacut
e

i
nfect
iousdi
seasecausedbyencephal
it
isBv
irus,
usual
lyoccur
s

i
nsummer&f
all
.Thev
irusi
str
ansmi
tt
edbymosqui
to.

HEPATORENAL SYNDROME:He
23. pat
orenalsy
ndr
ome(
HRS)i
sa

l
if
e-t
hreat
eni
ng medi
cal condi
ti
on t
hat consi
sts ofr
api
d

det
eri
orat
ion i
n ki
dney f
unct
ioni
nindi
vi
dual
s wi
thci
rr
hosi
sor

f
ulmi
nantl
iv
erf
ail
ure.

MUMPS :Mu
24. mps,al
soknownasepi
demi
cpar
oti
ti
s,i
sav
iral

di
seasecaused by t
hemumps v
irus. Mumps i
s

hi
ghl
ycont
agi
ousandspr
eadsr
api
dlyamongpeopl
eLI
VING i
n

cl
ose quar
ter
s. Mumps i
s pr
event
abl
e by t
wo doses of

t
hemumpsv
acci
ne.

25.
TYPI LLARY DYSENTERY :i
CAL ACUTE BACI s associ
ated wi
th

speci
esofbact
eri
afr
om t
hef
ami
lyEnt
erobact
eri
aceae.Thet
erm

i
susual
lyr
est
ri
ctedt
oShi
gel
lai
nfect
ions.Shi
gel
losi
siscaused

byoneofsev
eralt
ypesofShi
gel
labact
eri
a

26.
Measl
es(
rubel
l
a)

Si
gn :
-fev
er,mal
aise,macul
opapul
arr
ash orpal
ms sol
es ,
r
hinor
rhea,
cough

Sy
mpt
oms:
-sor
ethr
oat
,cough,
conj
unct
ivi
ti
s,kopl
i
kspot
s

Quest
ionandAnswer
s
1.
HOW MANYSTAGESAREHFRS(
Hant
avi
rushemor
rhagi
cfev
er

wi
thRenalSy
ndr
ome)CONTAI
N?WHATARETHEY?

Ther
ear
efi
vest
ages:

 Febr
il
ephase:

 Fev
erar
ound39-
40℃

 chi
l
ls

 r
enal
disor
der

 headaches

 nausea

 abdomi
nal
andbackpai
n

 Hy
pot
ensi
vephase:

 Col
dandmoi
stur
eski
nandext
remi
ti
es

 Sy
stol
i
cpr
essur
edecr
eases

 Thepul
sepr
essur
enar
rows

 Tachy
car
diai
sav
aluesi
gnofshock

 Ol
igur
icphase:

 Ur
emi
a,
Aci
dosi
s

 Fl
uidandel
ect
rol
ytei
mbal
ances
  Hi
ghv
olumeofbl
ood

 Pul
monar
yedema

 Anor
exi
a

 I
nthi
s st
age some compl
i
cat
ions mayappear
,incl
udi
ng

hy
per
vol
emi
c sy
ndr
ome, or
gan hemor
rhage, pul
monar
y

edemaandi
nfect
ionoracut
erespi
rat
orydepr
esssy
ndr
ome,

cent
ralner
vous sy
stem i
nvol
vementand acut
e car
diac

f
ail
ure

 Di
uret
icphase:

 BUNi
ncr
ease,
thenr
etur
nst
onor
mal

 Pr
otei
nur
iasdi
sappear

 Some pat
ient
s mi
ghtpr
esentnegat
ivef
lui
d bal
ance and

el
ect
rol
yteabnor
mal
i
ties

 Conv
alescentphase:

 Ur
inev
olumer
etur
nst
olesst
han2000ml
per24h.

 Anemi
aandi
mpai
redur
inar
yconcent
rat
ingabi
l
ityper
sistf
or

mor
ethanf
ourmont
hsi
nsomeoft
hesei
nst
ances

2.
WHATI
SGENERALI
NDI
CATI
ON OFHEPATI
TISBANTI
VIRAL

TREATMENT?

t
hei
ndi
cat
ionf
ort
reat
menti
s

• Basedmai
nlyont
hecombi
nat
ionoft
hreecr
it
eri
a

•-
-Ser
um HBVDNAl
evel
sabov
e2000I
U/ml
(i
.e.
 • appr
oxi
mat
ely10,
000copi
es/
ml)
.

•-
-Ser
um ami
not
ransf
erase l
evel
sabov
e2t
imesofupper

l
imi
tofnor
mal(
ULN)f
ort
hel
abor
ator
y.

• Hi
stol
ogi
calshowsmoder
ateact
ive

• necr
oinf
lammat
ionand/
orf
ibr
osi
s

3.
WHATI
STHEROUTEOFHI
VTRANSMI
SSI
ON?

 unpr
otect
edpenet
rat
ivesexwi
thsomeonewhoi
sinf
ect
ed.

 I
nject
ion ort
ransf
usi
on ofcont
ami
nat
ed bl
ood orbl
ood

pr
oduct
s,donat
ionsofsemen(
art
if
ici
ali
nsemi
nat
ion)
,ski
n

gr
aft
soror
gan t
ranspl
ant
staken f
rom someonewho i
s

i
nfect
ed.

 Fr
om amot
herwhoi
sinf
ect
edt
oherbaby
;thi
scanoccur

dur
ingpr
egnancy
,atbi
rt
handt
hroughbr
east
feedi
ng.

 Shar
ingunst
eri
l
isedi
nject
ionequi
pmentt
hathaspr
evi
ousl
y

beenusedbysomeonewhoi
sinf
ect
ed.

4.
whatar
ethe mostcommon compl
i
cat
ion of
mumps?
Compl
i
cat
ions

*
Meni
ngi
ti
s;
-Asept
icmeni
ngi
ti
soccur
sin10% ofpat
ient
swi
th

mumpsbutasmanyas50%showabnor
mal
i
tiesi
ntheCSF.
*
Encephal
i
tis;
-encephal
i
tis occur
srar
elyas a compl
i
cat
ion of

mumps,wher
elesi
onsar
efoundi
nthebr
ainandspi
nalcor
d.The

i
nci
denceofencephal
i
tisi
sar
ound1i
n6000casesofmumps.

*
Hear
ingLoss;
-bef
orev
acci
nat
ions,
mumpsusedt
obeoneoft
he

l
eadi
ngcausesofhear
ingl
ossi
nchi
l
drenandy
oungadul
ts.

5.
whatar
ethedi
ff
erent
ial
diagnosi
sofchi
ckenpox?
1.
druger
upt
ion

2.
bul
l
ouspemphi
goi
d

3.
impet
igo

4.
hand-
foot
-mout
hdi
sease

5.
otherv
irusi
nfect
ion

6.
der
mat
it
isher
pet
if
ormi
s

7.
ery
themamul
ti
for
me

8.
smal
lpox

6.
whatar
ethemai
nsi
gni
nthepr
oxi
mit
yst
ageof
epi
demi
cencephal
i
tisB?
f
our
tht
otent
hday
soft
hecour
se

Hy
per
ther
mia:upt
omor
ethan40℃,l
ast7-
10day
s,somegr
ave

casescanl
astf
or3weeks

 Consci
ous di
stur
bance: l
ethar
gy, del
i
rium, coma and

di
sor
ient
ati
on,
most
lyat3-
8day
s,l
ast
ingf
oral
most1week.

 Ot
herner
voussy
mpt
omsandsi
gns
 1.
super
fi
cial
ref
lex:

di
sappearorweaken

2.
deepr
efl
ex:

accent
uat
efi
rstandt
hen di
sappear

3.sy
mpt
omsandsi
gnsofmeni
ngeal i
rr
it
ati
on

 Respi
rat
oryf
ail
ure:
thel
eadi
ngcauseoft
hedeat
h

causedby

1.
inf
lammat
oryofbr
ainpar
enchy
ma

2.
hypoxi
a,
cer
ebr
aledema

3.
acut
eint
racr
ani
alhy
per
tensi
on

4.
cer
ebr
alher
nia

 Ci
rcul
ati
onf
ail
ure:
rar
ely

ci
rcul
ati
on f
ail
ure,t
achy
car
dia,hy
perorhy
pot
ent
ion,

per
icar
dit
is

7.
whatar
ebasi
cfeat
ureofi
nfect
iousdi
sease?
 Pat
hogens

 I
nfect
ivi
ty

 Epi
demi
ologi
cfeat
ure

 Post
inf
ect
ioni
mmuni
ty

8.
howmanust
agesdot
ypi
calmani
fest
ati
onof
 epi
demi
cencephal
i
tisB,
whatar
ethey
?
Ty
pical
mani
fest
ati
on:
fourst
ages

St
age1. t
hepr
imar
yst
age

St
age2. t
hepr
oxi
mit
yst
age

St
age3. t
heconv
alescencest
age

St
age4. t
hesequel
aest
age

9.
diagnosi
sofr
abi
es.
 Headache,
fev
er,
sor
ethr
oat

 Ner
vousness,
conf
usi
on

 Pai
nort
ingl
i
ngatt
hesi
teoft
hebi
te

 Hal
luci
nat
ions

 Seei
ngt
hingst
hatar
enotr
eal
l
yther
e

 Hy
drophobi
a

“
Fearofwat
er"duet
ospasmsi
nthet
hroat

 Par
aly
sis

 Unabl
etomov
epar
tsoft
hebody

 Comaanddeat
h

10.
whati
sdenguef
evercont
ract
edwhet
heri
f
i
scont
agi
ous?
Onemosqui
tobi
tecancauset
hedi
sease.Thev
irusi
snot
 cont
agi
ous and cannotspr
ead di
rect
lyf
rom per
son t
o

per
son. I
tis mosqui
to-
bor
ne, so t
her
e must be a

per
son-
to-
mosqui
to-
to-
anot
her
-per
sonpat
hway
.Amosqui
to

bi
tesadengue-
inf
ect
edper
sonandbecomesi
nfect
edwi
th

dengue.Denguecannotbespr
eaddi
rect
lyf
rom oneper
son

t
oanot
her
,andmosqui
toesar
enecessar
yfort
ransmi
ssi
on

oft
hedenguev
irus.

11.Whi
chdi
seasescanbe di
ff
erent
iat
edmai
nlywi
thmumps?
①Suppur
ati
vepar
oti
ti
s:l
ocalr
edt
ender
nessobv
iousl
y,i
tonl
yinv
olv
esuni
l
ater
alpar
oti
dgl
and,no
or
chi
ti
soroophor
it
is i
s compl
i
cat
ed.
The per
ipher
alWBC and neut
rophi
lcount
sar
eappar
ent
ly
el
evat
ed

②Asy
mpt
omat
icpar
oti
d enl
argement
:isof
tencompl
i
cat
edbydi
abet
es,mal
nut
ri
ti
on,chr
oni
cli
ver
di
seaseorappl
yiodi
de,hy
droxy
lbut
e,i
sopr
opy
ladr
enal
i
nepr
ocess,suchaspar
oti
denl
argement
bi
l
ater
alsy
mmet
ry,
sof
t,noswel
l
ingpai
n.neut
rophi
l
sincr
eased;

③Neckl
ymphnodephl
ogi
sti
cbef
oreear
:conf
inedt
othear
eabef
oret
heneckorear
, t
ender
ness,
swel
l
ingi
snotcent
eredont
heear
lobe,
associ
atedwi
thangi
na,
earboi
l
,et
c.

④Ot
hercausesofpar
oti
dgl
and enl
argement
:suchassi
mpl
epar
oti
dgl
andenl
argementi
sseeni
n
adol
escentmal
e,asy
mpt
omat
ic,andf
unct
ionalsecr
eti
oni
ncr
easest
hecompensat
orypar
oti
dgl
and
enl
argement。

• 12.Whati
sthegener
ali
ndi
cat
ionsofhepat
it
isant
ivi
ral

t
reat
ment
？

HBV:
thei
ndi
cat
ionf
ort
reat
menti
sBasedmai
nlyont
he

combi
nat
ionoft
hreecr
it
eri
a

•-
-Ser
um HBVDNAl
evel
sabov
e2000I
U/ml
(i
.e.
 appr
oxi
mat
ely10,
000copi
es/
ml)
.

•-
-Ser
um ami
not
ransf
erase l
evel
sabov
e2t
imesofupper

l
imi
tofnor
mal(
ULN)f
ort
hel
abor
ator
y.

• Hi
stol
ogi
calshowsmoder
ateact
ivenecr
oinf
lammat
ionand

/
orf
ibr
osi
s

13.
Whatar
ethedi
agnost
icpr
inci
plesofchol
era?

Epi
demi
ologi
cdat
a:t
rav
ell
i
nghi
stor
y;di
ethi
stor
y;cont
acthi
stor
y

==Cl
i
nical
mani
fest
ati
on:

Di
arr
hea&v
omi
ti
ngper
iod:

Di
arr
hea:
100%,
ricewat
eryst
ool
swi
thsl
i
ght
lyf
ishysmel
l
;,
nopai
n,

not
enesmus,
nof
ever

Vomi
ti
ng:
80%,
aft
eronsetofdi
arr
hea,
nonausea,
cont
inuousandef
f

or
tl
ess.

=Dehy
drat
ion

=Ci
rcul
ator
ycol
l
apse:
hypov
olemi
cshock

Muscul
arcr
amps:
lossofNa+,
i
next
remi
ti
es(
cal
ves)andabdomi
na

l
muscl
es

=Di
stur
banceofel
ect
rol
yte:

=Renal
fai
l
ure:
oli
gur
ia-
anur
ia-ur
emi
a

=Fev
er:
in1/
3pat
ient
s

===Labor
ator
yfi
ndi
ngs:
Bloodpi
ctur
e:hemo-
concent
rat
ion

=Ur
inet
est
:pr
o.+~ ++,
RBC
=St
ool
test
:

=Di
rectobser
vat
ion:
dar
ti
ngmov
ement

=I
mmobi
l
izedt
est
:

=Ser
ologi
cal
test
:haemaggl
uti
nat
ion

14.Whatar
ether
out
esofHRFCt
ransmi
ssi
on？

(1)Infecti
onscanbespr eadinaer osol
s.
(2)Cont aminatedfoodorwat er:RodentscanshedHVi n
saliva,fecesandur i
ne.
(3)Cont acttransmissi
on:br oken ski
n,the conj
uncti
va
andot hermucousmembr anes.
4)Ver ti
caltr
ansmission
(5)Gamasi daandt rombidi
um mi tesbi
te
Virussheddi ngdecreasesbyei ghtweeksaft
eri
nfect
ion.

15.Thedi
agnosi
s,di
ff
erent
ialdi
agnosi
sandt
reat
mentpr
inci
ples

ofhepat
it
is

HCV:
epi
demi
ology
:Ident
if
iedi
n1989,
Bloodt
estbecameav
ail
abl
e

i
n1992,
Usedt
obeknownas“
non-
A,non-
B”hepat
it
is.
Spr
ead

t
hroughbl
ood-
to-bl
oodcont
act
.Nov
acci
neav
ail
abl
etopr
event

hepat
it
isC.
About3mi
l
li
onAmer
icansi
nfect
ed,
About170mi
l
li
on

i
nfect
edwor
ldwi
de,
Manydonotexper
iencesy
mpt
oms

Hi
ghRi
sk:

• Bl
oodpr
oduct
s

• Bl
oodt
ransf
usi
onsbef
ore1992

• Cur
rentt
ransf
usi
onsnol
ongeramaj
orr
iskf
act
or

•I
nject
ion(
IV)dr
uguse–60%ofal
lnewi
nfect
ions
 • Lowerr
isk:
Snor
ti
ngcocai
neorot
herdr
ugs

• Occupat
ional
exposur
e

• Bodypi
erci
ng&acupunct
urewi
th

unst
eri
l
izedneedl
e,
Tat
tooi
ng

• Fr
om pr
egnantmot
hert
ochi
l
d,Shar
ingr
azor
sand/
or

t
oot
hbr
ushes

• Sexual
transmi
ssi
on,
Lowr
iski
nmonogamousr
elat
ionshi
p

• HowCanYouPr
eventt
heSpr
eadofHepat
it
isC?Cov
eropen

wounds

• Tel
lpeopl
enott
otouchy
ourbl
ood

• Cl
eanbl
oodspi
l
lsy
our
sel
fori
nfor
m ot
her
stousel
atex

gl
oves

• Di
sposeofneedl
es/
mat
eri
alspr
oper
ly

• Donoti
njectdr
ugs

• Av
oidshar
ingcont
ami
nat
edar
ti
cles

• Razor
s,t
oot
hbr
ushes,
orot
herper
sonal
car
eit
ems

•I
nfor
m heal
thcar
epr
ofessi
onal
s/ot
her
s

• Donotdonat
ebl
ood,
bodyor
gans,
tissuesorsemen

• Pr
act
icesaf
esex

Cl
ini
calmani
fest
ati
on:
Manypeopl
ehav
enosy
mpt
omsoft
he

v
irus
I
fyoudohav
esy
mpt
oms;
Fat
igue,
l
ossofappet
it
e,t
roubl
e

sl
eepi
ng,
discomf
orti
nli
verar
ea,
achi
ngj
oint
s,depr
essi
on.

• Hepat
it
isCcausesser
iouspr
obl
emsi
nsomepat
ient
s

Fi
brosi
s,
Cir
rhosi
s.Adv
ancedl
i
verdi
sease,
Hepat
ocel
l
ular

car
cinoma(
li
vercancer
)

Theonl
ywayt
oknowi
fyouhav
ehepat
it
isci
stohav
eabl
oodt
est

• Di
agnosi
s:Bl
oodt
est
ing

1.Hepat
it
isCant
ibodyt
est

2.Hepat
it
isCPCRt
estt
ofi
ndv
irusi
nbl
ood

• Li
verf
unct
iont
est
s

• Bl
oodt
est
s

1.Canbenor
mal
evenwi
thl
i
verdamage

• Li
verbi
opsy

1.Onl
ywayt
odet
ermi
net
heamountofscar
ri
ng

2.Smal
lri
skofcompl
i
cat
ionsandv
eryf
ewsi
deef
fect
s

3.Shoul
dbef
reeofal
cohol
andst
reetdr
ugs

• Goal
sofTr
eat
mentCl
earal
lthehepat
it
isC

• Sl
oworst
opdamaget
othel
i
ver

• Hel
pdecr
easesy
mpt
oms

Tr
eat
ment
:

•I
nter
fer
on

• Gi
venbyshot
,usual
l
y3t
imesaweek
• Pegy
lat
edi
nter
fer
on

• Long-
act
ing,
takenonceaweek

• Combi
nat
iont
her
apy

•I
nter
fer
on(
standar
dorpegy
lat
ed)t
akenwi
thr
ibav
iri
n

• Ri
bav
iri
nisapi
l
ltakent
wicedai
l
y

• HBV:Epi
demi
ologyI
ntheFarEast
,theMi
ddl
eEast
,Af
ri
ca,

andpar
tsofSout
hAmer
ica,t
hepr
eval
enceofHBVi
shi
gh,

wi
thHBsAgposi
ti
vi
tyr
atesr
angi
ngf
rom 8%t
o15%.

• Per
inat
alt
ransmi
ssi
oni
smostcommoni
nhi
ghpr
eval
ence

ar
eassuchassout
heastAsi
aandChi
na.

•I
tiswel
lest
abl
i
shedt
hatt
her
iskofper
sist
enti
nfect
ioni
s

muchgr
eat
eri
ninf
ant
sthani
nadul
ts.

• Sexualcont
actandper
cut
aneoust
ransmi
ssi
on(
e.g,

i
ntr
avenousdr
uguse)ar
emostcommoni
ntheUni
ted

St
ates,
Canada,
andwest
ernEur
ope.

• Theonl
yregi
oni
ntheUni
tedSt
atesofhi
ghpr
eval
encei
s

Al
aska,
wher
ethepr
eval
encer
atei
nthenat
ivepopul
ati
oni
s

6.
4%.

• HBVi
nfect
ioni
smor
ecommoni
nment
hani
nwomen,
wit
h

t
hepeakpr
eval
encei
nmenoccur
ri
ngbet
weent
heagesof

10and29.
• Sexual
act
ivi
tyi
spr
obabl
ythesi
ngl
emosti
mpor
tantmode

ofHBVt
ransmi
ssi
oni
nar
easoft
hewor
ldl
i
ket
heUS.

• Het
erosexual
sexnowaccount
sfort
hemaj
ori
tyofcasesof

HBVi
nfect
ion(
26%)i
ntheUS.

• Becausemanypat
ient
swi
thchr
oni
cHBVi
nfect
ionar
e

unawar
eoft
hei
rinf
ect
ion,
sexual
cont
acti
sli
kel
ytobean

i
mpor
tantmodeoft
ransmi
ssi
onwor
ldwi
de.

• Theuseofcondomsappear
stor
educet
her
iskofsexual

t
ransmi
ssi
on.

• Chi
l
drenofHBsAg-
posi
ti
vemot
her
swhoar
enoti
nfect
edat

bi
rt
hremai
nathi
ghr
iskofear
lychi
l
dhoodi
nfect
ion;
60%

becomei
nfect
edbyt
heageof5y
ear
s.

• Ev
enwi
thact
iveandpassi
vei
mmuni
zat
ion,
5%t
o10%of

babi
esmayacqui
reHBVi
nfect
ionatbi
rt
h.

•I
ntheUni
tedSt
atesandWest
ernEur
ope,
inj
ect
iondr
uguse

r
emai
nsav
eryi
mpor
tantmodeofHBVt
ransmi
ssi
on

cl
i
nical
mani

•(
1)acut
ehepat
it
is

•(
2)chr
oni
chepat
it
is

•(
3)l
iv
erf
ail
ure

•(
4)ci
rr
hosi
s

• Rx:Tr
eat
mentofchr
oni
chepat
it
isB
• 1)Goaloft
reat
ment:t
hemai
ngoaloft
reat
mentofchr
oni
c

hepat
it
isBi
stopr
eventci
rr
hosi
s,hepat
icf
ail
ureandHCC.

Thi
sgoali
sbestachi
evedbyer
adi
cat
ing(HBVbef
oret
her
e

i
sir
rev
ersi
ble l
iv
erdamage.
Howev
er,
iti
snotpossi
blet
o

er
adi
cat
eHBVbecauseoft
hepr
esenceofext
rahepat
ic

r
eser
voi
rofHBV,
thei
ntegr
ati
on ofHBVDNAi
ntot
hehost

genome,
andt
hepr
esenceofani
ntr
acel
lul
arconv
ersi
on

pat
hwayt
hatr
epl
eni
shest
hepoolof

•t
ranscr
ipt
ionalt
empl
atescl
osedci
rcul
arHBVDNA[
cccDNA]

i
nthehepat
ocy
tesnucl
eu

• 2)end–poi
ntoft
reat
ment:t
her
apymustr
educeHBVDNA

t
oasl
owal
evelaspossi
ble,

•i
deal
lybel
owt
hel
owerl
imi
tofdet
ect
ionofr
eal
-t
imePCR

assay
s(10-
15I
U/ml
),
toensur
eadegr
eeofv
irol
ogi
cal

suppr
essi
ont
hatwi
llt
henl
eadt
obi
ochemi
calr
emi
ssi
on,

• hi
stol
ogi
cali
mpr
ovementandpr
event
ionofcompl
icat
ions.

• 3)def
ini
ti
onsr
esponse

• ① oni
nter
fer
onαt
erapy

•-
-pr
imar
ynon-
responsei
sdef
inedasl
esst
han1㏒ 10I
U/ml

decr
easei
nHBVDNAl
evel f
rom basel
ineat3mont
hsof

t
her
apy
.

•-
-vi
rol
ogi
alr
esponsei
sdef
inedasHBVDNA
 • cent
rat
ionofl
esst
han2000I
U/mlat24weeksoft
her
apy
.

•-
-ser
ologi
calr
esponsei
sdef
inedbyHBeAb

• ser
oconv
ersi
oni
npat
ient
swi
thHBeAg-
posi
ti
veCHB.

• ② ONNUCt
her
apy

•-
-pr
imar
ynon-
responsei
sdef
inedasl
esst
han1㏒ 10I
U/ml

decr
easei
nHBVDNAl
evel f
rom basel
ineat3mont
hsof

t
her
apy
.

•-
-vi
rol
ogi
alr
esponsei
sdef
inedasundet
ect
abl
eHBVDNAby

r
eal
-t
imePCRassaywi
thi
n48weeksoft
her
apy
.

•-
-Par
ti
alv
irol
ogi
calr
esponsei
sdef
inedasadecr
easei
n

HBVDNAofmor
ethan 1㏒ 10I
U/mlbutdet
ect
abl
e

HBVDNAbyr
eal
-t
imePCRassay
.

16.
Whati
sthechar
act
eri
sti
csi
gnaboutt
hel
ary
ngealdi
pht
her
ia?

“
yip-
li
ke”cough;
hoar
seness,
andabar
kingcough.

Def
luv
ium ofpseudomembr
anecanl
eadt
oai
rwayobst
ruct
ion,

coma,
anddeat
h.

17.
How manydi
seasecour
sesofper
tussi
shav
eanddescr
ibe

t
hei
rnames.
18.
Whati
sthechar
act
eri
sti
csi
gni
nthepar
oxy
smalst
age?

f
it
sCoughi
swor
seaf
terdef
erv
escenewi
thoutobv
iousl
ung

si
gns,each wi
th5t
o 10 f
orcef
ullcoughs,
fol
l
ow-
ed bya

hi
gh-
pit
ched “
whoopi
ng”sound

as t
he pat
ient st
ruggl
es t
o br
eat
he i
naf
ter
war
ds.

 Tr
igger
edf
act
ors :y
awni
ng,st
ret
chi
ng,l
aughi
ng,eat
ingor

y
ell
i
ng

Bel
astf
or2t
o6weeks
19.
Howdoest
yphoi
dfev
erspr
ead?

1.
fecal
-or
alr
out
e

2.
fi
veF'
s:f
li
es,
finger
s,f
ood,
feces,
andf
omi
tes

3.
Pol
l
utedwat
er:
themostcommonsour
ceofcont
ami
nat
ion

20.
Whatar
ethesy
mpt
omsoft
yphoi
dfev
er?

 Thei
nit
ial
per
iod

– Fi
rstweek.

I
nsi
diousonset
.

f
ever
、chi
l
ls、ai
l
ment
、ti
red、sor
ethr
oat
、Cough,

abdomi
nal
discomf
ortandconst
ipat
ion

 secondandt
hir
dweeks.

– Sust
ainedhi
ghf
ever
、par
tl
yremi
tt
entf
everori
rr
egul
ar
 f
ever
.Last10-
14day
s.

– Gast
ro-
int
est
inalsy
mpt
oms:anor
exi
a 、 abdomi
nal

di
stensi
onorpai
n、di
arr
heaorconst
ipat
ion

– Neur
opsy
chi
atr
icmani
fest
ati
ons:conf
usi
on、 ment
al

cl
oudi
ness、ev
endel
i
rium andcoma.

 Ci
rcul
ati
onsy
stem:

r
elat
ivebr
ady
car
dia

 spl
enomegal
y、 hepat
omegal
y、 occasi
onal
l
y poi
soned

hepat
it
is.

r
osespot
s:30%,r
oundorl
ent
icul
ar,sl
i
ght
lyr
aised,af
aint

pal
ecol
or,
fadeonpr
essur
e,2-
4mm i
ndi
amet
er,
lesst
han10

i
nnumber
, di
sappeari
n2-
3day
s.

 def
erv
escencest
age

–f
everandmostsy
mpt
omsdi
sappearbyt
hef
ort
hweek

ofi
nfect
ion.

–f
evercome down,al
lsy
mpt
omsand si
gnsgr
adual

i
mpr
oved,
butst
il
ldanger
.

 conv
alescencest
age

–t
hef
if
thweek.al
lsy
mpt
omswi
l
ldi
sappear
,butcan

r
elapse.

21.
Whatant
ibi
oti
csar
ethef
ir
stchoi
ceusedt
otr
eatt
yphoi
dfev
er

?
 =Qui
nol
one

nor
fl
oxaci
n (
0.1-
0.2t
id-
qid/
10-
14day
s).

of
loxaci
n (
0.2t
id10-
14day
s).

ci
prof
loxaci
n (
0.25t
id)

caut
ion:
noti
nchi
l
drenandpr
egnantwoman

 Chl
orampheni
col

– chi
l
dren or
aldose i
s 50-
60mg/
kg/
per day
.adul
t

1.
5-2g/
day
.ti
d

– af
terdef
erv
escencer
educedt
oahal
f.Cont
inuet
ouse

f
ora10-
14daycour
se

 Cephal
ospor
ines

– cef
tri
axoneandCef
tazi
dime2-
4g/
dayt
id.
1-2weeks.

22.
Whatar
ethepr
ecaut
ionsoft
yphoi
dfev
er?

 cont
rol
thesour
ceofi
nfect
ion

 cutt
her
out
eoft
ransmi
ssi
on

Washhandsaf
terdef
ecat
ingandbef
orehandl
i
ngf
ood

v
acci
nat
ion

23.
Whati
schol
era?

Anacut
einf
ect
iousdi
seaseoft
hesmal
lint
est
ine,causedbyt
he

bact
erum Vi
i bri
ochol
erae andchar
act
eri
zedbypr
ofusewat
ery

di
arr
hea,v
omi
ti
ng,muscl
e cr
amps,sev
ere dehy
drat
ion,and
depl
eti
onofel
ect
rol
ytes.Al edAsi
socal
l ati
cchol
era.

24.
Whatar
emai
nchar
act
eri
sti
csy
mpt
omsandsi
gnsofchol
era?

 pr
ofusedi
arr
hea&v
omi
ti
ng

 Sev
eredehy
drat
ion

 Muscul
arcr
amps

 Ci
rcul
ator
ycol
l
apse

 Renal
fai
l
ure

25.
Whati
sthet
reat
mentpr
inci
plef
orchol
era?
-Rehydrati
on.Thegoali stor epl
acelostfl
uidsand elect
roly
tesusi
ng a si
mpl
e
rehydrat
ionsolut
ion,or
alrehydr
ati
onsalt
s(ORS).TheORSsol uti
oni
savai
labl
easa
powdert hatcanbereconsti
tut
edinboi
l
edorbot t
ledwat
er.

-
Int
rav
enousfl
uids.Dur
ingachol er
aepi demi
c,mostpeopl
ecanbehelpedbyoral
r
ehydr
ati
onal
one,butsever
elydehydrat
edpeoplemayal
soneedi
ntr
avenousf
lui
ds.

-Anti
biot
ics.Whil
eant i
bioti
csar
enotanecessar
ypartofchol
eratreat
ment
,someof
thesedrugsmayr educebot ht
heamountanddurat
ionofchol
era-
relat
eddi
arr
heaf
or
peoplewhoar eseverel
yi l
l
.

-Zi
ncsupplements.Researchhasshownt hatzi
ncmaydecr
easeandshor
tent
he
durat
ionofdi
arr
heainchildrenwi
thchol
era.

Summar
yofSARS

• Causat
iveagent
: Cor
onav
irus(
UrbaniSARS)

•I
ncubat
ionper
iod: 2-
7day
s(10day
s)

• Modeofspr
ead:Dr
opl
et

• Commonestagegr
oup:25-
70y
ear
s.

• Fev
er,r
espi
rat
ory i
ll
ness, my
algi
a ar
e common
 sy
mpt
oms.Respi
rat
oryf
ail
urei
shi
gh.

• Adv
erseout
come:hi
ghLDH,hi
ghabsol
uteneut
rophi
l

count
.

• Pr
event
ivemeasur
esar
eimpor
tant
.

26.
Howmanyst
agesar
etheHFRScont
ains?

Ther
ear
e5pr
ogr
essi
vest
ages:

Febr
il
est
age-
Fev
erar
ound39-
40℃

chi
l
ls

r
enal
disor
der

headaches

nausea

abdomi
nal
andbackpai
n

Hy
pot
ensi
vest
age-
Col
dandmoi
stur
eski
nandext
remi
ti
es

Sy
stol
i
cpr
essur
edecr
eases

Thepul
sepr
essur
enar
rows

Tachy
car
diai
sav
aluesi
gnofshock

Ol
igur
icst
age-
Uremi
a

Aci
dosi
s

Fl
uidandel
ect
rol
ytei
mbal
ances

Hi
ghv
olumeofbl
ood

Pul
monar
yedema

Anor
exi
a
Di
uret
icst
age- BUNi
ncr
ease,
thenr
etur
nst
onor
mal

Conv
alescentst
age-
Uri
nev
olumer
etur
nst
olesst
han2000mlper

24h.

27.
Whatar
ethemostendemi
cser
oty
pesi
nChi
na?(
Hant
avi
rus

andSeoul
vir
us)

28.
HowmanyHant
avi
rusesar
epat
hogeni
ctohuman?20

29.
Whati
sthet
her
apypr
inci
plef
orHFRSpat
ient
?

Febr
il
est
age:

(
1)r
esti
nbed;
inf
use1000-
1500ml
ofGSandel
ect
rol
ytef
lui
ds.

(
2)ant
i-
vir
ust
her
apy(
ri
bav
iri
nandi
nter
fer
on-
ɑ)

(
3)r
eli
evet
hedamageandper
meabi
l
ityofbl
oodv
essel

(
4)sy
mpt
omat
ict
reat
ment

Hy
pot
ensi
vest
age:

(
1)suppl
yi
ngt
hebl
oodv
olume

(
2)cor
rect
ionofaci
dosi
s

(
3)mai
ntai
nthecar
diacout
put

(
4)ot
her
s

Ol
i
gur
icst
age:

(
1)mai
ntai
nint
ernal
env
ornmentbal
ance

(
2)di
uresi
s

(
3)di
aly
sis
Di
uret
icst
age:

 Payat
tent
iont
ounbal
ance,
dehy
drat
ionandi
nfect
ions.

Conv
alescentst
age:

 nut
ri
ti
on

 f
unct
ional
exer
cise

 t
radi
ti
onal
Chi
nesemedi
cine

HFMD（Hand,
footandmout
hdi
sease）

30.
Whoi
satt
her
iskandwhati
sthei
ncubat
ionper
iodf
orHFMD?

Age<10y
ear
sol
d

I
ncubat
ionper
iod

3-
7day
s

Ear
lyper
iod

besi
mil
art
omi
l
dfl
usy
mpt
om

31.
Whatar
ethecompl
icat
ionsf
rom HFMD?
 Vi
ral
meni
ngi
ti
sandencephal
i
tis:
EV-
71

Fev
er,headacheandv omit
ing/
conv ulsi
ons ortr
emors,sl
eep disor
ders, ny
stagmus,reflex
abnormal i
ti
esandmeni
ngeali
rr
it
ati
on-posi
ti
ve.
 Poliomy eli
ti
s-l
i
ke poli
o: Weakness of l i
mb muscles, f
laccid
paralysisandunabl
etowalk

Throatparal
ysi
s
Respir
atorymuscleparaly
sis
 My ocardi
tis and heartfai
lur
e:Pale,br
eathi
ng di
ff
icul
ti
es,l
oss of
appeti
te,
palpit
ati
on,suff
ocati
onanddi
zzi
ness.

Hear
tfai
l
ure
  Pul
monar
yedemaandpul
monar
yhemor
rhage:Att
heonesetof1t
o3
day
s

Themostser
iouscompli
cat
ion,
90%ofcasesdiedwit
hin12hour
s
Tachy
car
dia,
cough,dy
spnea,cy
anosi
sandpinkbubbl
esputum

32.
Whati
sthechar
act
eri
sti
cpy
sicalf
indi
ngsf
orHFMD?

Or
almucosar
ashes

Beear
li
er;
Tongue,
gums,
lat
erall
ipsand i
nsi
deoft
hecheeks

Ski
nrashes:nopai
n,noi
tchi
ng,
noscabbi
ng,
noscar
ri
ng

33.
What
sther
ecommendedr
egi
mentt
reat
mentofbr
ucel
losi
s?

Ans:
A)Acut
ephase

1)
Gener
alt
reat
ment:r
est,v
itami
n,suppl
ement
ati
on andwat
er

i
ntake .pat
ientwi
th hy
per
pyr
exi
a use phy
sicalmet
hods t
o

r
educebodyt
emper
atur
e.Cal
mat
iveshoul
dbeusedi
npat
ient
s

wi
thobv
ioust
oxi
csy
mpt
omsandor
chi
ti
c .

2)
Eti
ologi
calt
reat
ment
:tr
eat
ment i
ncl
udesant
ibi
oti
cst
hatcan

easi
l
yent
ercel
land ki
l
lbact
eri
ain cel
lsuch as t
etr
acy
cli
ne,

ami
nogl
ycosi
des,
rif
ampi
ci
n.Thecur
rentWHOr
ecommendat
ioni
s

r
if
ampi
n(600-
900mg/
d)pl
usdoxy
cycl
i
ne(
100mgt
wicedai
l
y)f
or6

weeks.

B.
Chr
oni
cphase

1)
Eti
ologi
calt
reat
ment
:Chr
oni
cpat
ient
swi
thacut
eepi
sodet
ype,

chr
oni
cact
ivet
ype,
local
lesi
onsorposi
ti
vebact
eri
alcul
tur
e
shoul
dal
lbet
reat
edwi
thant
ibi
oti
cs.Thepr
inci
pleoft
reat
menti
s

t
hesameasacut
est
age,
andsev
eral
cour
sesoft
reat
mentar
e

r
epeat
edi
fnecessar
y.

2)
Desensi
ti
zat
iont
reat
ment
:Tl
ymphocy
tessensi
ti
zedbyBr
ucel
l
a

ar
enowconsi
der
edt
obet
hebasi
sofbodydamage

Sy
3) mpt
omat
ict
reat
ment
Thi
scani
ncl
udesphy
siat
ri
c

34.
Rout
eoft
ransmi
ssi
onofbr
ucel
losi
s?

Rout
e of t
ransmi
ssi
on of br
ucel
losi
s:Humans can acqui
re

i
nfect
ion by i
ngest
ion,i
nhal
ati
on,mucosalor per
cut
aneous

exposur
e. 1.
Thr
oughski
nabr
asi
onsandot
her

woundsbyt
ouchi
ngBr
ucel
l
ainf
ect
edt
hings; Di
rectcont
actwi
th

si
ckani
mal
sort
hei
rexcr
ement
,vagi
naldi
schar
ge,
andexpul
sions;

I
nthe pr
ocess off
eedi
ng,mi
l
king,shear
ing,sl
aught
eri
ng and

pr
ocessi
ngofski
n,wool
,meat
,et
c.

2.Fr
om t
hedi
gest
ivet
ractbyeat
ingcont
ami
nat
edmi
l
k,wat
erand

f
ood.

3.Fr
om r
espi
rat
oryr
out
eint
hef
orm ofaer
osol
cont
aini
ngbr
ucel
l
a.

4.Ot
her
s,f
rom t
hebi
teoff
li
esandt
ick.

35.Cl
ini
calmani
fest
ati
onsofbr
ucel
losi
s

1.
Thei
ncubat
ionper
iodi
sabout1t
o3weeks,av
erage2weeks,

butmayext
endupt
osev
eral
mont
hsormor
ethan1y
ear
.
2.
Itcan be di
vi
ded i
nto subcl
ini
cali
nfect
ion,acut
einf
ect
ion,

subacut
einf
ect
ion,chr
oni
cinf
ect
ion,l
ocal
ized i
nfect
ion and

r
elapse.

3.
Acut
einf
ect
ionr
efer
stot
hecour
seofdi
seasewi
thi
n3mont
hs;

Subacut
einf
ect
ion:
3mont
hst
o1y
ear
;Chr
oni
cinf
ect
ion,mor
e

t
han1y
ear

4.
Subcl
ini
cali
nfect
ion

I
tof
tenoccur
sinhi
gh-
ri
skgr
oups,30%ofwhom hasahi
ghl
evel

ofant
i-
brucel
l
aint
heser
um whi
l
ethei
nfect
ionhi
stor
ycannotbe

def
ini
te

5.
Acut
eandsubacut
einf
ect
ion:
Theonsetofbr
ucel
l
osi
sisof
ten

sl
ow.Themai
nmani
fest
ati
onsi
ncl
udef
ever
,sweat
ing,ar
thr
algi
a,

sy
mpt
oms of t
he ner
vous sy
stem and ur
ogeni
tal sy
stem,

spl
enohepat
omegal
i
a,andl
ymphadenect
asi
s.

Fev
er:The t
ypes off
everar
evar
ied.Mostpat
ient
s hav
e

i
rr
egul
ar f
ever
, and t
he t
ypi
cal undul
ant f
ever i
s not

common.
Sweat
ing:Sweat
ingi
soneoft
hemai
nsy
mpt
omsoft
his

di
sease,i
rr
espect
iveofwhet
hert
hepat
ient
shav
eaf
everornot
,

of
teni
ntheweehour
sorni
ght
.Ar
thr
algi
a:Ar
thr
algi
aoccur
satt
he

begi
nni
ngoft
hedi
sease,canbecausedbyost
eoar
thr
it
is,and

somet
imesemer
gesaf
teramont
h.I
tiscommoni
nbi
gjoi
ntssuch
ast
heknee,
wai
st,
shoul
derandsacr
oil
i
acj
oint
.

6.
Chr
oni
cinf
ect
ion:
Itmaybecausedbyi
nadequat
etr
eat
menti
n

t
heacut
est
ageSy
mpt.
omsmayi
ncl
ude f
ixed and par
oxy
smal
ar
thr
algi
aandmuscl
epai
n,andt
her
emaybeor
gani
cdamageof

bonesandj
oint
s.

7.
Local
izedi
nfect
ion

Br
ucel
l
aor
gani
smscanl
ocal
i
zei
nal
mostanyor
gan,butmost

commonl
ylocal
i
zei
nthebone,j
oint
s,cent
ralner
voussy
stem,

hear
t,l
ung,spl
een,t
est
is,l
i
ver
,gal
l
bladder
,ki
dney
,pr
ost
ate,

pancr
eas,
andski
n.

showi
ngcor
respondi
ngcl
i
nical
sympt
omsandsi
gns.

Ost
eoar
ti
cul
ar compl
i
cat
ions ar
e most f
requent
,the most

commonsi
tei
ssacr
oil
i
iti
siny
oungerper
sonsandspondy
li
ti
sin

ol
derper
sons.

8.
Rel
apse

Mor
ethan10%ofpat
ient
swhohav
ebr
ucel
l
osi
sint
heacut
est
age

wi
l
lrel
apseaf
terant
ibi
oti
ctr
eat
ment
.Rel
apseusual
l
yhappens

af
tersev
eralmont
hs ofacut
einf
ect
ion,oraf
ter2 y
ear
s of

t
reat
ment

35.di
agnosi
sofbr
ucel
losi
s

Thet
ypi
calacut
ecasei
seasyt
o di
agnose,chr
oni
cpat
ienti
s
di
ff
icul
ttodi
agnose.

1.
Epi
demi
ologi
calhi
stor
y:Cl
ose cont
actwi
thl
i
vest
ock,wi
l
dli
fe,

l
i
vest
ockpr
oduct
s,etal
,thatcont
aini
ngBr
ucel
l
aorwasoncel
i
ved

i
nanepi
demi
car
eaofi
nfect
iousdi
sease.

2.
Cli
nical mani
fest
ati
ons:
In t
he acut
e st
age, nonspeci
fi
c

sy
mpt
omsi
ncl
udi
ngf
ever
,sweat
ing,mal
aise,anor
exi
a,headache,

my
algi
a, j
oint and ner
ve pai
n, spl
enohepat
omegal
i
a and

l
ymphadenect
asi
s. I
n t
he chr
oni
c phase, neur
ologi
c and

psy
chi
atr
icsy
mpt
omsmayoccur
,andt
hedamaget
obonesand

j
oint
scanal
sobeseen.

3.
Labor
ator
y exami
nat
ions:
A def
ini
te di
agnosi
srequi
res t
he

i
sol
ati
onofBr
ucel
l
aef
rom bl
ood,bonemar
row orot
hert
issues.

Wecanal
somakeadef
ini
tedi
agnosi
sont
hebasi
sofposi
ti
ve

r
esul
ts ofser
ology exami
nat
ion i
n combi
nat
ion wi
th medi
cal

hi
stor
yandphy
sicalsi
gns.
Brucel
l
a-speci
fi
cIgM andI
gGdet
ect
ion

ki
tar
eav
ail
abl
eforr
api
ddi
agnosi
sofhumanbr
ucel
l
osi
s,whi
ch

per
for
m equal
l
ywel
lindi
agnosi
ngpat
ient
satdi
ff
erentst
agesof

i
l
lnessi
ncl
udi
ngpat
ient
swi
thacut
e,subacut
e,orchr
oni
cdi
sease

andwi
thr
elapse,andcanbeusedt
omoni
tort
heef
fi
ciencyof

t
reat
ment
.

36.Howt
otr
eatscar
letf
ever
?
1.
Gener
alt
reat
menk-Repi
rat
oryi
sol
ati
onandbedr
estshoul
dbe

t
akeni
nacut
ephase.

2. Et
iol
ogi
c t
reat
mer
t : Peni
cil
l
in i
s gi
ven 800, 000 U

i
ntr
amuscul
arl
y2-
3ti
mesperdayf
or5-
7day
s.>Forpat
ientof

sept
ict
ype;dai
l
ydosageofpeni
cil
l
ini
nceasest
o8,
000,000-

20;
000,
000U

200000u/
kgf
orchi
l
dreni
.v
.admi
nist
eredby2-
3ti
mesf
or10

day
sor3day
saf
terf
eversubsi
dence.

Al
l
ergi
ctoper
ici
l
li
n,er
ythr
omy
cincoul
dbegi
ven1.
5-2gl
dforadul
ts

or30-
50mgl
dforchi
l
dreni
vadmi
nist
eredby1t
imes.

3.sy
mpt
omat
ict
reat
ment>I
ftoxi
cshockoccur
s,act
ive

measur
ement
sshor
ldbet
aken,
suchasr
epl
eni
shi
ngbl
oodv
olume,

cor
rect
ingaci
dosi
s,admi
nist
eri
ngv
asoact
ivedhuge,
etc

4.Abssessl
esi
oncoul
dbei
nci
sedanddr
ainednecessar
y.

37.
Mal
ari
a

Char
act
eri
sti
cofl
i
fecy
cle-
:i
nter
medi
atehost-human

Fi
nal
hostmosqui
to

I
nfect
ivest
age-
spor
ozoi
te.

>I
nfect
ivemode-mosqui
tobi
teski
nofhuman

>Par
asi
ti
cposi
ti
on-l
i
verandRBC

>Tr
anami
tt
edst
agegamet
ocy
tes

>Schi
zogoni
ccy
clei
nRBC-48h/
pv;
36-
48hm/
P.f
.
 Spor
ozi
te-Tachy
spor
ozi
te&br
ady
sponzoi
te.

Cl
i
nical
mani
fest
ion-1]i
ncubat
ionper
iod:
RV-
14-
17dPf
-8-
12d.

2.
Anat
tackoccur
sbecauseofsuddenl
i
ber
ati
onofmaožoi
tes,

mal
ari
alpi
gmentandRBCdebr
isi
ntobl
oodst
ream di
agnosi
s.

[
A]-
Cli
nical di
agnosi
s → Pat
ient
's sy
mpt
oms and phy
sical

exami
nat
ion·Thef
ir
stsy
mpt
om (
fev
er,chi
l
ls,
sweat
s,nauseaand

v
omi
ti
ng)ar
enotspeci
fi
c

>I
nsev
eremal
ari
a,cl
i
nicalf
indi
ngsar
emor
est
ri
ki
ng(conf
usi
on,

coma,
neur
ologi
cfocal
.si
gns,
etc)-

[
b]Mi
coscopi
cexami
nat
ionofbl
ood

1.
Thi
nfi
l
m andt
hick(
giemesast
ain)Tomast
ert
hemor
phol
ogyof

par
asi
tesandchangesofi
nfect
edr
edcel
l
s.

2Pf
alci
paaum :
onl
yri
ngf
ormsandgamet
ocy
tedcanbef
oundi
n

bl
oodf
il
m.

3Ot
hermet
hod :
pcr

C.
Treat
ment

1.
3pr
inci
ple

[
a]cont
rol
ofcl
i
nical
sympt
oms

[
b]er
adi
cat
ionofgamet
ocy
tes

[
c]i
rev
entr
elapse

Chl
orqui
ne,
qui
nine,
art
emi
sini
n and ar
temet
her-
-ant
ier
thr
ocy
tic

st
agedr
ugs:
Pri
maqui
ne&py
rimet
hami
ne-
-ant
iexoer
ythr
ocy
tic&
gamet
ecy
te.

Pr
event
ion:
Chemopr
ohy
laxi
cchemot
her
aphymal
ari
avacci
ne

38.Tr
eat
mentofJEV(
JapaneseEncephal
it
is)

Ans:
1)useant
ibodi
eswhennecessar
y

2)
mini
mizeext
ernal
sti
mul
ati
on(
sound,
l
ight
,t
ouchi
ng)

3)
managet
her
aisedi
ntr
acr
ani
alpr
essur
e(I
CU)

4)
decr
easebodyt
emper
atur
e:i
ce,
cool
,
sal
i
ne

5)
suppor
ti
vecar
e-f
eedi
ng,
ai
rwaymanagement
,sei
zur
econt
roland

ant
iconv
ulsant
s

7)
notbei
sol
ated

39.
Whati
sepi
demi
ccer
ebr
ospi
nalmeni
ngi
ti
s?

Ans:
- Epi
demi
c cer
ebr
ospi
nal meni
ngi
ti
s,
ref
err
ed t
o as

meni
ngococcal
,
is an acut
e r
espi
rat
oryi
nfect
ion caused by

meni
ngococcal
bact
eri
a.

Meni
ngococcalmeni
ngi
ti
sisf
orm of meni
ngi
ti
s caused by

Nei
sser
iameni
ngi
ti
s,
char
act
eri
zedbyi
nfl
ammat
ion

40.
Whatcauseepi
demi
ccer
ebr
ospi
nalmeni
ngi
ti
s?

Ans:
1.Pat
hogeni
sNei
sser
iameni
ngi
ti
dis(
Meni
ngococcus)
;gr
am

negat
ive,
aer
obi
cdi
plocciNei
sser
iameni
ngi
ti
sonbl
ood,
chocol
ate

ort
rypt
icar
esoy
agar

2.
aut
oly
sisbyaut
oly
sini
nvi
tr
o.

3.
the or
gani
sm can be det
ect
ed i
n pat
ient
s
nasophar
ynx,
blood,
CSF,
pet
echai
einski
n.

4.
Pat
hogeni
cfact
or:
endot
oxi
n

5.
Ser
ogr
oupsofmeni
ngococcus:
(13ser
ogr
oupsandmor
ethan

20ser
oty
pes)

6.
mostcommonser
ogr
oupsABCgr
oup

7.
groupAi
sthemostcommoni
nchi
na.

41.
Whoi
satr
iskf
orepi
demi
ccer
ebr
ospi
nalmeni
ngi
ti
s?

Ans:
-1.
Humansar
etheonl
ynat
ural
reser
voi
rofN.
meni
ngi
ti
dis

2.
Cont
actwi
thi
n 2met
ersofnon-
vent
il
ated ar
eaar
eatr
iskof

i
nfect
ion.

3.
Closecont
actwi
thsl
eepi
ng,
feedi
ng,
ki
rr
inget
c.i
simpor
tantf
or

t
het
ransmi
ssi
onofi
nfant
s,chi
l
drenunder2y
ear
sofage.

4.
Duscept
ibi
l
ity ofpopul
ati
on:
-uni
ver
salducept
ibl
e st
abl
e and

per
sist
enti
mmuni
ty

5.
Age:
-6mont
hst
o2y
ear
s

42.
WHATARETHEMAI
N CHARACTERI
STI
CSSYMPTOMSAND

SI
GNOFCHOLERA?

ANS:Mani
fest
ati
ons:st
ep 1:di
arr
hea and v
omi
ti
ng:a.abr
upt

onsetofwat
erydi
arr
hea,
b.qui
tdi
arr
hea,
c.v
omi
ti
ngaf
terdi
arr
hea.

St
ep2:a.
lossofel
ect
rol
yte:muscl
ecr
amps,b.
met
abol
i
caci
dosi
s,

c.
hypov
olemi
cshock,
d.l
ossofski
ntur
gor
,scaphoi
dabdomenand

weakpul
se.
St
ep3:conv
alescence.Ot
hersi
gnsi
ncl
ude1.
ski
ntur
gor
,sunken

ey
es,andwr
inkl
edhands,2.
tachy
car
diaandhy
per
capni
a,3.
tear
s

ar
erel
evantsi
gns onl
yforchi
l
dren and i
nfant
s,4.
forsev
ere

dehy
drat
ion:
absentr
adi
alpul
seandl
owB.
P.

43.
WHATI
SSOLUTI
ON541WI
THGLUCOSE?

ANS:
Itcont
ains:

Sodi
um chl
ori
de 5g 0.
9%Nacl 550ml

Sodi
um bi
car
bont
e 4g 5%NaCO3 80ml

Pot
assi
um chl
ori
de 1g 10%KCL 10ml

Gl
ucose 10g 5%GS 360ml

43.
HOW DOPPLGETJAPANESEENCEPHALI
TIS?

ANS:
sour
ceofi
nfect
ion:
JEzoonosi
s

Rout
eoft
ransmi
ssi
on:
bit
eofi
nfect
edmosqui
toe

Mai
nani
mal
reser
vior
:wadi
ngbi
rds

Deadendhost
:humans

Theonl
ycar
ri
ersandampl
i
fier
s:domest
icpi
gsandwi
l
dbi
rds.

Mosqui
toescanbei
nfect
edbyf
eedi
ngondomest
icpi
gsandwi
l
d

bi
rdsi
nfect
edwi
thJEV.Theni
nfect
edmosqui
toest
ransmi
tthe

JEVt
ohumansandani
mal
sdur
ingf
eedi
ngpr
ocess.

44.
WHAT ARE THE SYMPTOMS OF JEV (
JAPANESE

ENCEPHALI
TISVI
RUS)
?
ANS:
1.I
nit
ialpr
esent
ati
on:G.
Isy
mpt
omsofanor
rexi
a,nauseaor

abdomi
nal
pai
n,neckr
igi
dit
y,hi
ghbodyt
emper
tur
e,f
ati
gue.

2.Pr
oxi
mit age:4th t
y st o 10th day
s:hy
per
ther
mia,consci
ous

di
stur
bances,conv
ulsi
on,meni
ngeali
rr
it
ati
on,par
aly
sisofupper

ext
remi
ti
esi
smor
ecommont
hant
hatofl
egs,hy
poxi
a,cer
ebr
al

her
nia,
tachy
car
dia,
cer
ebr
aledema,
etc.

Respi
rat
oryf
ail
urei
sthel
eadi
ngcauseofdeat
hinJEV.

45.
Whati
sthecauseagentf
orv
ari
cel
laandher
pes
zost
er?

Cause:
-var
icel
l
a-zost
erv
irus(
VZV)
,amemberofher
pes
v
irusf
ami
l
y(DNA)

46.
Var
icel
laandher
peszost
ermost
lyoccuri
nwhi
ch
gr
oup?

Var
icel
l
a:-
4-10y
ear
sol
dHer
peszost
er:
-el
der
ly

47.
Whati
sther
out
eoft
ransmi
ssi
onf
orv
ari
cel
laand
her
pesZost
er?

Var
icel
l
a:-1.i
tisanai
rbor
nedi
seasewhi
chspr
eadseasi
l
y
t
hroughcoughandsneezesofani
nfect
edper
son(
90%)
Repl
i
cat
esi
nNasophar
ynxorupperr
espi
rat
oryt
ract
.2.
Cont
actwi
tht
hebl
i
ster
s(10-
30%)3.I
nfect
ioni
npr
egnant
womencanl
eadt
oear
lyt
ransmi
ssi
onv
iapl
acent
aand
i
nfect
ionoff
etusHer
peszost
er:
-1.t
hroughcoughand
sneezesofani
nfect
edper
son2.Cont
actwi
thbl
i
ster
s

Cl
ini
calmani
fest
ati
onsofv
ari
cel
laandher
peszost
er.

*
Var
icel
l
a:-I
ncubat
ionper
iod:
10-
21day
s(usual
l
y14-
16
day
s)Twost
ages:
prodr
omal
stageandexant
hem
st
age.1)
predr
omal
stage:
-*Af
ewpat
ientdev
elop*1-
2
day
sbef
oreonsetofexant
hem *Pr
edr
omal
sympt
oms
i
ncl
udef
ever
,mal
aise,
anor
exi
a,
headache,
sor
e
t
hroat
,st
omachache*Mi
l
dinchi
l
drenandmor
ecommon
i
nadul
ts*Tr
iadofr
ashmal
aiseandl
ow-
gradef
ever
si
gnal
sonsetofchi
ckenpox2)
exant
hem st
age:
-*
Vesi
cul
arer
upt
ioni
nfi
rstonet
o2day
sofi
l
lness*Lesi
on
checkwr
appedi
nsuccessi
vecr
opsev
olv
efr
om
macul
opapul
est
ovessi
cl
esov
erhour
stoday
s,i
sfi
rst
appear
sont
runkandf
aceandspr
eadt
oheadsar
msand
f
inal
l
ylegs.*Exant
hem i
scent
ri
pet
al,
wit
hmostl
esi
ons
bei
ngpr
esentont
runkandpr
oxi
mal
upperext
remi
ti
es
r
elat
ivespar
ingofdi
stal
andl
owerext
remi
ti
es.*Hal
l
mar
k
ofi
nfect
ion-
macul
opapul
es,
vesi
clesandscabsatv
ari
ous
st
agesofv
olut
ion*Thev
esi
cul
arf
lui
dopaci
fi
ersandi
n2
t
o3day
sacent
ral
Dimpl
eappear
sandt
hent
hecent
ral
umbi
l
icat
ioncr
ust
ingandscabf
ormat
ion.3)
pri
mar
yVZV
i
nfect
ionmayi
nvol
vemucosal
sur
facesofr
espi
rat
ory
al
i
ment
aryandgeni
tour
inar
ysy
stemst
her
efor
ethosewi
th
v
ari
cel
l
acanhav
esev
erel
ary
ngi
ti
s
l
ary
ngot
rachebr
onchi
ti
svagi
nit
isur
ethr
it
iset
c.4)
Ver
sicl
es
mayoccuronmucusmembr
anesandbr
eakdownt
ofor
m
shal
l
owapht
housul
cer
s.5)
Indi
cat
ionsofsev
eredi
sease
i
ncl
udeconf
luenceoft
her
ashandmul
ti
plemucosal
l
esi
onsandhaemor
rhagi
cvesi
cles6)
The
i
mmunocompr
omi
sedi
ndi
vi
dual
ssev
ereabdomi
nal
pai
n
orbackpai
ncanbei
ndi
cat
orofpr
ogr
essi
veVZV
i
nfect
ion7)
hemor
rhagi
cvesi
cles*
Her
peszost
er:
-*
pr
odr
omal
sympt
omsi
ncl
udenot
abl
epai
nand
par
aest
hesi
ainwhatwi
l
lbecomezost
eraf
fect
ed
der
mat
ome*Mal
aiseandi
tchi
ngar
efr
equentel
ement
s
ofpr
odr
ome*Onsetofdi
seasei
sher
aldedbypai
nwi
thi
n
der
mat
omepr
ecededbyappear
anceofl
esi
onsby48t
o
72hour
s*Pai
n*Exant
hem-char
act
eri
sti
cfeat
ure:
v
esi
cul
arr
ashofuni
l
ater
aldi
str
ibut
ionl
i
mit
edt
o1t
o3
adj
acentder
mat
ome*I
nit
ial
lesi
onsappearas
er
ythr
omat
ousmacul
opapul
eswhi
cht
urni
ntov
esi
cles
wi
thi
n12t
o24hour
sthenbecomepust
ulesi
naboutt
hree
day
sandf
orm scabs7t
o10day
slat
er*Lesi
onsbecome
conf
luent*Mostcommoni
nfect
ionssi
te-t
ri
gemi
nal
ner
ve,
thor
aci
sver
tebr
a*Ski
npi
gment
ati
oni
sof
tent
he
onl
ysequel
a

*Scar
ri
ngi
srar
e

*Scar
ri
ngi
srar
e

*
uni
quemani
fest
ati
on:
-*zost
ersi
neher
pet
e*Her
pes
zost
eropt
hal
micus*My
eli
ti
s*Ramsay
-huntsy
ndr
ome