General medicine

Question 1

Travel Medicine:

Short incubation period diseases

Answer 1

• Dengue - febrile illness with rash and body aches
• Influenza - febrile resp illness with body aches
• Enteric bacterial infections - febrile diarrhoeal illness >3 loose stools/day
• Yellow fever - acute febrile illness with abdo pain
• Malaria - febrile illness with headaches +/- diarrhoea

Question 2

Travel Medicine:

Intermediate incubation period diseases 10-21 days

Answer 2

• Viral haemorrhagic fevers - febrile illness leading to multi-system organ failure
• Typhoid - ‘enteric fever’ - abdo pain, constipation, diarrhoea in 50%
• Scrub typhus - Rickettsia tick, headache, rigors, myalgia
• Q fever - Coxiella burnettii - goats, cattle, sheep, headache, myalgia, chills
• Trypanosomiasis - ‘sleeping sickness’
• Malaria - febrile illness with headaches +/- diarrhoea

Question 3

Travel Medicine:

Long incubation period diseases >21 days

Answer 3

• Hepatitis A, B, C, E - fever, jaundice, abdominal pain, pruritis, dark urine, pale stools, +/- diarrhoea
• Schistosomiasis, leishmaniasis, filariasis
• TB
• HIV
• Malaria - febrile illness with headaches +/- diarrhoea

Question 4

Travel Medicine:

Returned traveller

Answer 4

• FBE - Hb, Hct, WCC, platelets
• Thick and thin blood films - malaria
• LFTs - ↑ in dengue, yellow fever
• Coags - ↑ INR in dengue, yellow fever
• Serology - dengue, yellow fever

Question 5

Travel Medicine:

Returned traveller 18 days ago presenting with fever and diarrhoea.

Investigations to order?

Answer 5

• FBE - Hb, WCC
• Blood cultures - S. typhi/paratyphi
• Thick and thin blood films - malaria
• Coags - ↑INR and DIC profile in typhoid
• Serology - Salmonella abs
• Stool M/C/S, ova/cysts/parasites, FOBT

Question 6

Travel Medicine: Travel prophylaxis for malaria

Answer 6

• Mefloquine
  • 1/wk, start 2-4 wks before travel - 4 wks after return
  • Resistance in Cambodia, Thailand, Myanmar
  • S/E - cardiac, neuro, psychotic episodes/seizures
  • Safe in 2nd and 3rd trimesters
• Doxycycline
  • 100mg daily with food
  • S/Ehotosensitivity, GIT, vaginal thrush
• Malarone
  • 1/daily, start 1 day before - 1 week after
  • Expensive
  • Not in pregnancy or children

Question 7

Travel Medicine: Symptoms of malaria

Answer 7

• Initially resembles flu
• Fever, chills
• Pain - headache, myalgia, back pain
• Fatigue, malaise
• n/v/d
• cough

Question 8

Travel Medicine: plasmodium species

Answer 8

• P. falciparum
  • Almost all deaths/severe disease
  • No dormant liver stage, no late relapses
  • Medical emergency
• P. vivax and P. ovale
  • Produces hypnozoites → late relapses
• P. malariae
  • Usually benign
  • May persist in blood >30 years

Question 9

Travel Medicine: management of malaria

Answer 9

• P. falciparum
  • Admit to hospital
  • Artemether-lumafantrine or other artesunates
  • iv abx and/or ICU monitoring if:
  ○ Unable to tolerate oral abx
  ○ Any severe manifestations of P. falciparum
• P. vivax and ovale
  • Chloroquine - blood stage (P. vivax resistance)
  • Primaquine - to treat liver hypnozoite
• P. malariae - chloroquine

Question 10

Travel Medicine: complications of malaria

Answer 10

• Severe disease in P. falciparum
• Usually 3-7 days after illness onset
• Endothelial adherence of infected RBCs
  • Cerebral malaria
  • Renal failure
  • ARDS
  • Hypoglycemia
  • Severe anaemia
  • Bleeding
• Mortality - 15-25%

Question 11

Travel Medicine: 4 most common illnesses, and 3 most life-threatening illnesses

Answer 11

Most common

• Traveller’s diarrhoea
• Respiratory tract infections
• Skin infections, rash, bites
• Febrile illness

Most-life threatening

• Falciparum malaria
• Bacterial sepsis - inc enteric fever
• Viral haemorrhagic fevers - including dengue