1. Fever in the returning traveller

Question 1

Patients presenting with fever - most common cause is?

Answer 1

Viral

Question 2

Patients presenting with fever - second most common cause is?

Answer 2

Malaria

Question 3

Majority of malaria infections are due to which pathogen?

Answer 3

P. falciparum

Question 4

Most second common cause of malarial infections is due to which pathogen?

Answer 4

P. vivax

Question 5

P. falciparum is responsible for what percentage of outpatients travellers presenting with fever?

Answer 5

14%

Question 6

P. vivax is responsible for what percentage of outpatients travellers presenting with fever?

Answer 6

6%

Question 7

Malaria is responsible for what percentage of outpatients travellers presenting with fever?

Answer 7

21%

Question 8

Viral hemorrhagic fever (VHF) will present in a patient up to how many days following the return of a patient from holiday?

Answer 8

Fever and their visit must both be within 21 days

Question 9

TB most commonly seen in what patient type?

Answer 9

Those returning home e.g. Bangladesh to visit their family

Question 10

VHF is common or uncommon?

Answer 10

Uncommon

Question 11

Malaria film is important for patient suspected of having VHF why?

Answer 11

Patient most likely to actually have malaria rather than VHF

Question 12

Fresh water exposure carries risk of what two infections?

Answer 12

Acute schistosomiasis

Leptospirosis

Question 13

Acute schistosomiasis presents when post-exposure?

Answer 13

2-12 weeks post-exposure

Question 14

Leptospirosis presents when post-exposure?

Answer 14

<4 weeks post-exposure

Question 15

Presentation of acute schistosomiasis? x1

Answer 15

Eosinophilia

Question 16

Presentation of leptospirosis? x3

Answer 16

Jaundice
Conjunctival suffusion
Liver/renal impairment

Question 17

Three infections likely to be contracted abroad in game park/safari?

Answer 17

Tick typhus
Trypanosomiasis
Anthrax

Question 18

Four danger signs in the returning traveller

Answer 18

Altered mental status
Respiratory distress
Shock
Liver/renal impairment

Question 19

What is the gold standard investigation for malaria?

Answer 19

Malaria film

Question 20

Malaria - vivax and falciparum - which presents earlier/later than the other?

Answer 20

Falciparum presents first

Vivax present later

Question 21

How does p. falciparum present on a blood film?

Answer 21

Rings and dots can be seen

Question 22

Problem with malarial blood film during pregnancy is?

Answer 22

Parasites sequester in the placenta and cannot be seen in blood film - should send to speciality lab

Question 23

Severe p.falciparum infection of malaria - what should be considered?

Answer 23

IUC admission

Question 24

Treatment for severe/complicated p.falciparum is what? x3

Answer 24

IV artensunate or IV quinine
Oral therapy once improved
Check blood film daily

Question 25

Preferred treatment for severe/complicated p.falciparum is what?

Answer 25

IV artensunate

Question 26

IV therapy for malaria treatment indicated when? x3

Answer 26

Parasitaemia >2% or presence of schizonts Vomiting Pregnancy

Question 27

Treatment for uncomplicated p.falciparum is what? x3

Answer 27

Oral therapy with wither: Malarone Riamet Quinine and Doxy

Question 28

Treatment for non-p.-falciparum malarial infection is what?

Answer 28

Chloroquine followed by primaquine

Question 29

Importance of G6PD in malarial infection is what?

Answer 29

G6PD status should be checked prior to treatment with primaquine

Question 30

Incubation period for dengue is?

Answer 30

3-14 days

Question 31

Parasite responsible for dengue is?

Answer 31

Aedes spp. mosquitos

Question 32

First vs. second contraction of dengue - which is more severe?

Answer 32

Second

Question 33

Two presentations of dengue

Answer 33

Erythrodermic | Petechial with 'white islands'

Question 34

Drug that should be avoided when treating dengue is? why?

Answer 34

NSAIDs | Risk of renal impairment

Question 35

Main treatment for dengue?

Answer 35

Simple analgesia

Question 36

Incubation period for chikungunya is?

Answer 36

1-12 days

Question 37

Two presentations of chikungunya is?

Answer 37

Fever | Severe arthralgia

Question 38

Two ways to diagnose chikungunya

Answer 38

PCR | Serology - IgM

Question 39

Parasite responsible for typhoid and paratyphoid is? x2

Answer 39

Salmonella Typhi | Salmonella Paratyphi

Question 40

Incubation period for typhoid/paratyphoid is?

Answer 40

1-3 weeks

Question 41

Typhoid/paratyphoid - what percentage is life threatening?

Answer 41

3%

Question 42

Is vaccination effective against typhoid?

Answer 42

Only partially

Question 43

Is vaccination effective against paratyphoid?

Answer 43

No

Question 44

Typhoid/paratyphoid is also known as?

Answer 44

Enteric fever

Question 45

Blood count results for enteric fever is?

Answer 45

Normal FBC Decreased WBC Decreased platelets

Question 46

Treatment for enteric fever is? x2

Answer 46

IV ceftriaxone May be azithromycin in non-complicated disease

Question 47

Enteric fever - patient isolated or not?

Answer 47

Yes

Question 48

Specific name for tick typhus is?

Answer 48

Rickettsia

Question 49

Incubation period for rickettsia is?

Answer 49

5-10 days

Question 50

Classic presentation of rickettsia/typhus is? x3

Answer 50

Fever Headache Rash and myalgia

Question 51

Treatment for rickettsia is?

Answer 51

Doxycycline