220.3 🩺 內科專科考前版

220.3.0.1 1⃣ Zika in Returning Travelers + Pregnancy Counseling

  • Pregnant + travel to Zika-active area → defer travel
  • Returning + symptomatic → PCR
  • Asymptomatic exposure → IgM testing 2-12 wk later
  • Sexual partner condoms 3 months
  • Pre-conception counseling

220.3.0.2 2⃣ CZS Lifelong Impact

  • Severe motor + cognitive impairment
  • Hearing + vision loss
  • Seizures common
  • Multi-disciplinary team
  • Family + community support
  • Genetic counseling subsequent pregnancies (low CZS recurrence risk in subsequent pregnancies)

220.3.0.3 3⃣ Differential — Zika vs Dengue

  • Zika: mild illness, conjunctivitis, less severe
  • Dengue: severe + warning signs + hemorrhage possible
  • Treatment differs (avoid NSAIDs in dengue)
  • Concurrent infection possible
  • PCR + IgM cross-reactivity considerations

220.3.0.4 4⃣ Chikungunya Chronic Arthritis

  • Mimics RA
  • Mechanism: viral antigen persistence + immune response
  • Treatment ladder:
    1. NSAIDs + analgesia
    2. DMARDs (methotrexate, hydroxychloroquine)
    3. Combination DMARDs
    4. Anti-TNF (etanercept, adalimumab)
  • Rheumatology consultation common
  • 30-50% with significant residual joint disease at 1 year

220.3.0.5 5⃣ Ixchiq Vaccine Implementation

  • Single dose for travelers + outbreak areas
  • Live attenuated → caution in immunocompromise (HIV CD4 < 200), pregnancy
  • Adverse events: short-term fever, headache, joint pain (immune response signal)
  • Cost considerations

220.3.0.6 6⃣ Aedes Mosquito Control Programs

  • Aedes albopictus expanding north (climate + travel)
  • Europe local outbreaks
  • USA southern + east Coast monitoring
  • Wolbachia infected releases (Brazil + others)
  • Sterile insect technique
  • Larvicide (BTI)

220.3.0.7 7⃣ Hard-Mode Pediatric Zika

  • Neurological monitoring
  • Hearing + vision + developmental screening
  • Multi-disciplinary care
  • Early intervention services

220.3.0.8 8⃣ 健保 / Taiwan

  • 通報 mandatory
  • 健保 Zika + chikungunya PCR / serology in 旅遊 medicine context
  • 公費 mosquito control + outbreak response
  • Ixchiq 自費

220.3.0.9 9⃣ Sexual Transmission Counseling — Zika

  • Both partners (M-to-F, F-to-M, M-to-M reported)
  • Condoms for 3+ months post-exposure
  • Defer conception 3-6 months
  • Asymptomatic infected partner can still transmit

220.3.0.10 10. Future Vaccines

  • Zika vaccines in Phase 2-3 (DNA, mRNA, VLP)
  • Pan-flavivirus vaccines researched
  • Improved chikungunya vaccines (mRNA, VLP)