1.rose spots : a rash, characterized only of typhoid and called rose spots , appears in some cases of typhoid .

rose spots are small

2-4mm res spots that appear most often on the abdomen and chest . they appear in crops of upto a dozen at a time and fade aftr 34 days . the presence of rose spots is extremely helpful in confirming the impression of enteric fever.
2.typhoid psychosis : profound mental status changes such as picking at bed clothing , feeling slow , sluggish , lethargic , even
developing to delirium or come , which is corresponding to the severity of disease and gradually alleviated as the decreasing of
temperature.
3.infection : the process in which pathogen parasitizes the human body or host and a course of active interaction betwn human
body and pathogen.
4.pathogen carrier state : is an important sources of infection in many communicable disease and releases pathogens into the
environment without apparent symptoms .
5. aids : acquired immuno deficiency syndrome . caused by infection of human immune deficiency virus hiv-1 / hiv-2. it results in
severe damage of cd4-t cell.
6. remittent fever: varying (1c ) during the day , but never normal , as in septicemia.
16. sustained fever : >39c , little variation during the day (1c) as in typhoid fever.
8)intermittent fever: the temperature becomes normal at least once each day, as in malarias, septicemia, also known as septic
fever.
9)relapsing fever: periods of days of fever separated by days of normal temperature, as in tuberculosis, brucellosis.
10)undulant fever: relapsing fever repeats and lasts months, as in brucellosis.
11)saddle type fever: fever lasts days, resolves to normal for one day and then relapses for days, as in dengue fever.
7. cholera sicca : shock and death occur before diarrhea appears the voluminous secretions pooling in distended loops of bowel
and not escaping as either diarrhea or vomiting .
8. bacteremia : presence of bacteria in the blood ,a s evidenced by positive blood culture . tis transient and relatively mild.
9. sepsis syndrome: sepsis that leads to altered tissue perfusion of vital organs ( resulting in one or more of oliguria , hypoxemia ,
elevated lactate , or altered mentation ) is called sepsis syndrome.
10. septic shock : sepsis with hypotension ( arterial bp<90mmhg or 40mmhg less than normal bp ) .
11. long term relapse : two of 4 species p.vivax and p.ovale prodeuce dormant forms in the liver , which mature 6-11 months or
more after the initial infection and produce relapsing malaria .
12. hepatic encephalopathy : is the state that the hepatic dysfunction leads to cns manifestation . is mainly due to the increased
nh3 .
13. chronic carries of hbv : hbsag + lasted for more than 6 months , while there is no symptom and liver function is normal .
14. tenesmus : is the constant feeling of the need to pass stool , accompanied by pain , cramping nd straining due to inflammatory
of the bowel , but the little stool is passed away .
15. toxic dysentery : is usually found in healthy children with 2-7 yrs old . suddenly fever (400c) and serous toxemia . toxic
encephalopathy is responsible for death of children , usually without diarrhea or abdomen pain . is responsible for death of children .
it maybe relative to super-allergy reaction caused by endotoxin , particularly in children witth special immunity .
27)invasiveness: the ability that a pathogen invades the body and spreads within the body.
17. dane particle : large particles with a diameter of 42mm which is intact hbv , it consists of an outer protein shell and an inner
body .
18. p. falciparum : the parasite cause falciparum malaria , it maninly occurs in tropics and subtropics , usually lead to death .
19. relative bradycardia : when the temperature arised , the pulse or the heart arised less . it is often seen in typhoid fever .
20. incubation period : is between the implanting of an infectious disease and the appearance of manifestation . the duration in
different disease is also different . it is an important reference to quarantine.
21. inapparent infection : has no sign , symptoms even bipchemical change clinically and only can be detected by immunological
tests. most communicable diseases are commonest result . after inappaent infection , most people can acquire specific active
immunity .
22. cholera : is an acute watery diarrheal disease caused by vibrio cholera , which occurs both sporadically and as large outbreaks .
it infects peoples intestines ,causing diarrhea , vomiting and dehydration .
23)pathogen clearance: cleared by nonspecific immunity, or neutralized by specific active or passive immunity of the body.
24)covert infection (subclinical): only specific immune response and no or only minor tissue damage. no signs, symptoms, even
biochemical change clinically and only can be detected by immunological tests. after covert infection, most people can acquire
specific active immunity.
25)overt infection (clinical): not only immune response, but also tissue damage, pathological changes and clinical manifestations.
the percentage of overt infection is low in most. after this, usually acquire consolidated immunity or temporary immunity.
26)latent infection: pathogens colonize and persistently reside in the body, localized by the body's immunity and cannot cause
overt infection. but when compromised they can cause overt infection (herpes zoster, tb, malaria, etc). the difference with carrier
state is they dont release pathogen.
28)prodromal period: 0-3 days, from the onset of symptoms to the appearance of apparent manifestation. there are nonspecific
manifestations in this period, such as fever, headache, fatigue, anoxia, etc.
29)meningitis: an inflammation of the protective membrane lining the brain and spinal cord caused most often by infectious agents
that cross the bbb.
30)viral meningitis: caused by virus, less severe. resolves without specific treatment within a week or two. also called aseptic
meningitis. e.g. enteroviruses.
31)bacterial meningitis: caused by bacteria. quite severe and may results in brain damage, hearing loss, learning disability, even
death.
32)herd immunity: a substantial positive indirect effect was evident when a high proportion of the population was vaccinated with
ocv (oral cholera vaccine), with a possible reduction in the incidence of cholera among all age groups.
33)bacillary dysentery: an acute bacterial disease caused by shigella species. characterized by fever, nausea, vomiting, cramps,
diarrhea and tenesmus. in most cases, the stools contain blood and mucus. also called shigellosis.
34)mild dysentery: mild toxemia, no fever sometimes, without bloody purulent stool and less than 10 times/ day. most cases
recover completely.

35)typical dysentery: onset suddenly, whole body toxemia, cramping abdominal pain in left inferior abdomen, water stool initially
then bloody purulent stool, 10-20 times/day. accompanied by tenesmus.
36)sepsis: clinical evidence of infection plus systemic response to infection (fever/hypothermia, tachycardia, tachypnea,
leukocytosis).
37)severe sepsis: sepsis syndrome plus hypotension/ hypoperfusion.
38)refractory septic shock: shock lasting more than 1hr that is unresponsive to fluid administration and /or vasopressors.
39)sirs (systemic inflammatory response syndrome): wide variety of insults (infectious response syndrome and noninfectious)
that initiate profound systemic responses. sepsis syndrome is a subset of sirs and also a predominant cause of sirs.
40)bloodstream infection (bsi): implies the presence of microbial pathogens that can be cultured from blood.
41)recrudescence: the temperature doesn't resolve to normal and start to rise again.
42)haart (high active anti-retroviral therapy): two nucleoside analog rt inhibitors and 1 protease inhibitor or two nucleoside analog
rt inhibitors and 1 non-nucleoside.
43)ecm (epidemic cerebrospinal meningitis): acute infectious disease caused by meningococcus. it characterized by fever,
headache, vomiting, petechiae or ecchymosis and meningeal irritation signs. csf is purulent.
44)malaria: a parasitic protozoan infection, transmitted to human by the bite of female anopheles mosquitos. typical symptoms are
chills, rigor, fever, sweating & intermission. typical signs are anemia & splenomegaly.
45)fulminate meningitis: *
*septic shock,*hemorrhagic skin lesions, *dic,*meningoencephalitis ,*csf may be normal (?),*lack acute-phase inflammatory
response, * esr normal; crp low.
2.1 bacillary dysentery is transmitted directly or indirectly via the (fecal-oral) route and may occur due to the ingestion of
contaminated (food) or (water).
2.1 among the five hepatitis viruses, HAV and HEV only cause acute hepatitis, however, HBV, HDV and HCV often cause chronic
hepatitis. HAV and HBV can be effectively prevented by vaccination.
2.2 according to the documentary, aids was first reported in gay and iv drug users in 1981 in usa, and then in hemophiliacs due
to the comtamination of the blood product of factor .
2.3 in aids prevention, what a.b.c stand for abstinence , be faithful , condom.
2.4 the structure of hiv is similar to that of simian virus.
2.5 several kinds of antiretroviral drugs combined to make the standard treatment for aids, this method was named cocktail
therapy.
2.2 bacillary dysentery is an acute bacterial disease characterized by fever, nausea, vomiting, cramps and diarrhea caused by
shigella species. in most cases, the stools contain blood and mucus.
2.8)epidemic cerebrospinal meningitis is transmitted via the air born droplets or close contact. the spread of disease appears to be
mediates by carriers rather than by direct(case-to- case)transmission. the peak incidence is in the winter and early spring.
2.2 the basic requirements of epidemic process are source of infection , route of transmission and susceptibility of
population .
2.8 the typical courses of communicable diseases include incubation period, prodromal period, period of apparent
manifestation, convalescent period.
2.9 the occurrence of rashes from onset of fever: day 1 as in varicella and rubella, day 2 as in scarlet fever, day 3 as in smallpox,
day 4 as in measles.
2.7 two ways acquire immunity to a disease natural acquired immunity and artificially acquired immunity.
1. diagnosis of severe hepatitis :
*bilirubin in blood arised rapidly .
*albumin decreased , globulin arised.
*nh3 level in blood arised.
*pt delay . prothrombin activity decreased.
*liver become small .
2. laboratory findings of bacillary dysentery :
*ematology (blood test route) : wbc >10-2010/l.
*stool test route : bloody purulent appearance . leukocytes can be found >15/hp.
*bacteria culture of stool : positive with dusentery bacillus .
3. clinical manifestations of malaria : the clinical feature of malaria vary. the classic symptoms include persistant fever ,
shivering joint pains , headache and repeated vomiting. severe and complicated malaria causing renal failure , hypoglycemia
,anemia , pulomonary edema , shock and coma can have fatal consequences leading to death.
clinical course :
shivering phase : coolness of exttermities . total body coldness , skin wrinkles , lip cyanosis , whole body tremble , dens shudder .
20min - 1hr.
hyperpyrexia phase : temperature rise with coldness 2-6 hr.
sweating phase : sweat dripping wet 30min-1hr.
intermission phase : sense normal or slight malaise.
4. typical type of bacillary dysentery :
*suddenly onset , whole body toxemia: chill , fever , fatigue , headache .cramping abdominal pain , especially in inferior abdomen .
diarrhea: water stool initially , then bloody purulent stools,10-20 times/day.
burning sensation at anus: tenesmus , due to nerves of rectum being stimulated by local inflammation , a symptom characterized by
incomplete sense of evaluation with rectal (anus) pain press-pain on the left inferior abdomen .
5.principle of treatment of typical type bacillary dysentery
general treatment: isolate the patient , rest etc.
supportive treatment: given the oral rehydration salt (ors)
specific treatment: the first line medication of antibiotics : quinolones such as norfloxacin (0.4 tid for adult) or ciproflaxacin (0.2 tid for
adult) or ofloxacin (0.2 tid for adult) . the duration is 3-5 days .

symptomatic treatment : abdomen pain ,atropine 0.5mg (im) etc.

6. method and purpose of treatment of malaria :
therapeutics : purpose & task.
exterminate plasmodium in erythrocytic phase to control episode.
exterminate plasmodium in exoerythrocytic stage to prevent relapse.
exterminate gametophyte to prevent transmission.
methods :therapy of episode phase: take chloroquine 3days , primaquine - 8days
falciparum & transfusion malaria: take chloroquine & primaquine 3days
drug rersistense malaria: quinine-8days (orally) , mefloquine-0.75 once(orally) , artesunate orally
7)what are the main clinical manifestations in febrile period of epidemic hemorrhagic fever?
1.the symptoms of digestivetract:nausea,vomiting,abdominal pain
2.chemosis,albuminuria,there may be also toxic symptoms of central nervous system.
3.three pains
Headache, orbital pain, waist pain(which, in some cases, is of such severity as to suggest an acute surgical abdomen.)
4.three reds
flushed face,conjunctival hyperemia ,
flushed skin of the neck and upper chest (which are like drunken face).
8)basic features of infectious disease
pathogen (microorganism & parasites);
communicability;pathogen can be discharged and contaminates environments.
epidemiological feature;the epidemic process of communicable diseases manifests various features under the influence of the
natural and social factors.
postinfection immunity;host produces specific immunity to pathogen or its products after covert or overt infection.
9)what is widal test & its role in diagnosis?
a serodiagnosis using the somatic (o) and flagellar (h) antigens to detect the agglutinating antibodies in the blood of the infected
thyphoid fever patient. o is more specific the h. if o titer >1:80 and h titer >1:160 is define as positive widal test.
10)laboratory findings of epidemic cerebrospinal meningitis
routine blood test: wbc & sg increase. plt decreased in dic.
neutrophilia, eosinopenia.
75% patient of csf glucose level < 40mg/dl.
csf protein level ranged from 25 to more than 800mg/ml.
csf: gram- diplococci; suppurative.
pcr: have good specificity and sensitivity.
throat or nasopharyngeal, blood and/or csf culture.
immunologic test: antibody & antigen.
11)how to diagnose cholera?
epidemiological data: acute watery diarrhea in endemic area.
clinical manifestation: watery rice water stool, rapid pulse, dry skin, excessive thirst, lethargy, low urine output, abdominal cramps.
lab. findings: stool, blood, culture, antibody.
12)please give clinical manifestation of cholera during dehydration period in details and principle of fluid replacement.
clinical manifestation:
*dry skin, mucous membrane and mouth.*rapid pulse,
*thirsty,*sunken eyes,*low urine output,*abdominal cramps
principle of fluid replacement:
*evaluate the degree of dehydration upon arrival.
*rehydrates in two phases: rehydration & maintenance.
*register output & intake volumes on chart and periodically review these data.
*only use iv routes.
*during the maintenance phase, use ors at a rate of 800-1000 ml/h. match ongoing losses with ors administration.

13)what are the clinical manifestations of toxic type of acute dysentery? how does it be treated?
clinical manifestation:
found in healthy children 2-7 yo.
onset suddenly with fever (40oc) and serious toxemia.
toxin encephalopathy.
without diarrhea or abdominal pain.
infectious shock (bp, skin become cold, multiorgan failure, dic)
treatments:
antibiotics administered intravascularly.
anti-shock.
prevent and cure hydrocephalus
dehydration with 20% mannitol 125ml-250ml, q4-12h.
inhale oxygen.
keep respiratory function normal.
14)what are the clinical manifestations of aids?
stage 1: primary hiv infection lasting for days to several weeks;*flu like signs: fever, headache, tired, sweating, malaise, enlarged
lymph nodes;
hiv antibody test may not yet be positive;
there is a large amount of hiv in the peripheral blood;
the immune system begins to respond to the virus by producing hiv antibody and cytotoxic lymphocytes.
stage 2: clinically asymptomatic stage
lasts for 2-10 years and is free from any symptoms;
the level of hiv in the peripheral blood drops but people remain infectious and hiv antibodies are positive in the blood.
large amounts of helper t cells are infected and die and a large amount of virus is produced.
stage 3: persistent generalized lymphadenopathy (pgl)
the lymph nodes and tissues are damaged.
hiv mutates and becomes more pathogenic, leading to more helper t cell destruction;
symptoms develop. initially many of the symptoms are mild, but as the immune system deteriorates the symptoms worsen.
stage 4: aids
opportunistic infections
cancer.
15)hiv transmission routes
unprotected sex.
sharing needles with infected people.
blood transfusion.
from infected mother to fetus.

1)xxx, male, 32 years old. the patient has a continued fever for 12 days, accompanied by chills, aching pains all over the
body, anorexia, acratia, abdominal distension and diarrhea. he moved the bowels 2 or 3 times a day and his stools were
loose without mucus. his body temperature fluctuated from 38.7 to 39.6. he had been in local hospital for 5days, but
without remission. he came to our hospital for further treatment.

pe: t 40.4. he was in staring spells and dullness and sometimes raved. no bleeding spots were seen in his skin. slight
xanthochromia was on his sclera. cervical rigidity was positive. the liver is hardly palpable below the right costal margin and the
spleen was palpable 1.5cm below the left costal margin. the texture of spleen was soft. wbc 3.610 9/ln 0.62l 0.34,m 0.04. stool
occult blood test (++) and urine protein test (+). total bilirubin 51mol/lalt 168u/last 106u/land-hbs(+). he got in touch with
water before falling ill.
question 1: what is the probable diagnosis of the subject? list the diagnostic evidence of the disease
1:the probable diagnosis is typhoid fever.
the diagnostic evidence:
he got in touch with water before falling ill;
sustained fever, his body temperature fluctuated from 38.7 to 39.6;
the manifestation have chills, aching pains all over the body, anorexia, acratia, abdominal distension and diarrhea;
he was in staring spells and dullness and sometimes raved;
the liver is hardly palpable below the right costal margin and the spleen was palpable 1.5cm below the left costal margin;
wbc 3.6109/ln 0.62l 0.34,m 0.04. stool occult blood test (++) and urine protein test (+). total bilirubin 51mol/lalt 168u/last
106u/land-hbs(+).
question 2: differential diagnosis (only two diseases are required to be listed).
hav , aids
question 3: etiological treatment (only one drug is required to be listed) fluroquinolones
2) patient xxx ,male,31-years-old,mess steward,
suddenly onset 1 day ago with general malaise,

fatigue ,headache and cramping abdominal pain ,especially in left inferior abdomen ,then followed diarrhea with water
stool initially, and then bloody purulent stools, more than 10 times per day ,accompanied with burning sensation at
anus--- tenesmus.
two days ago this manwife had a diarrhea with the same symptom.
pet 37.5r 20/mp 80/mbp 120/80mmhgpress-pain on the left inferior abdomen
blood test: wbc 10.5109/l
stool test :wbc 20~30/hprbc10~20/hp
1. what disease is the patient suffered from?
bacillary dysentery or shigellosis
2. what is the principle of treatment for this patient?
general treatment: isolate the patient, rest etc.
supportive treatment : given the oral rehydration salt (ors)
specific treatment: the first line medication of antibiotics :quinolones,such as norfloxacin (0.4 tid for adult) or ciprofloxacin(0.2 tid for
adult) or ofloxacin(0.2 tid for adult) .the duration is 3~5 days.
symptomatic treatment: abdomen pain :atropine 0.5mg , im, etc. )
3. how to prevent this disease?
isolate the patient and washing hands with soap
3)a 32 year old white female has been an injection drug user for many years. she is now pregnant and is seeing her
obstetrician for her first prenatal visit. she has no history of hepatitis a or hepatitis b vaccination.
what viral hepatitis serologic tests would be appropriate to order?
hbsag, total anti-hbc, total anti-hav, anti-hcv
the results of serologic testing were as follows:
hbsag - negative
total anti-hbc - positive
total anti-hav - negative
anti-hcv - positive by enzyme immunoassay; confirmatory test pending
does the patient have chronic hbv infection? no
should the patient be evaluated for chronic liver disease?
Yes
should the patient be considered for vaccination against hepatitis a?yes
should the patient be vaccinated against hepatits b? no
should her positive anti-hcv test result be reported to the state health departemtn? Yes
4)xxx, male, 22 years old. the patient has a continued fever for 15 days, accompanied by chills, aching pains all over the
body, anorexia, acratia, abdominal distension and diarrhea. he moved the bowels about 3 times a day and his stools were
loose without mucus. his body temperature fluctuated from 38 to 40. he had been in local hospital for 6 days, but
without remission. he came to our hospital for further treatment.
pe: t 40.5. he was in staring spells and dullness and sometimes raved. no bleeding spots were seen in his skin. no xanthochromia
was on his sclera. the liver is hardly palpable below the right costal margin and the spleen was palpable 1.5cm below the left costal
margin. the texture of spleen was soft. wbc 3.4109/ln 0.62l 0.34,m 0.04. stool occult blood test (+) and urine protein test
(+).total bilirubin 18mol/lalt 68u/last 56u/lhbsab(+). he got in touch with contaminated water before falling ill.
question 1: what is the probable diagnosis of the subject? list the diagnostic evidence of the disease.
1:the probable diagnosis is typhoid fever.
the diagnostic evidence:
he got in touch with contaminated water before falling ill;
sustained fever, his body temperature fluctuated from 38 to 40;
the manifestation have chills, aching pains all over the body, anorexia, acratia, abdominal distension and diarrhea;
he was in staring spells and dullness and sometimes raved;
the liver is hardly palpable below the right costal margin and the spleen was palpable 1.5cm below the left costal margin;
wbc 3.4109/ln 0.62l 0.34,m 0.04. stool occult blood test (+) and urine protein test (+). total bilirubin 18mol/lalt 68u/last
56u/lhbsab(+).
question 2: etiological treatment (only one drug is required to be listed) fluroquinolones