MALARIA

Question 1

Malaria species that predominates in Africa, New Guinea, and Hispaniola (i.e., the Dominican Republic and Haiti)

Answer 1

P. falciparum

Question 2

Malaria species that is more common in Central and South America and Southeast Asia

Answer 2

P.vivax

Question 3

Malaria species that is found in most endemic areas, especially throughout sub-Saharan Africa

Answer 3

P. malaria

Question 4

Processes central to the pathogenesis of falciparum malaria

Answer 4

cytoadherence, rosetting, and agglutination

Question 5

Genetic disorders that confer protection against death from falciparum malaria

Answer 5

RBC disorders such as thalassemias, sickle cell disease, hemoglobins C and E, hereditary ovalocytosis, glucose-6- phosphate dehydrogenase (G6PD) deficiency

Question 6

Clinical features indicating poor prognosis in severe Falciparium malaria

Answer 6

Marked agitation, Hyperventilation (respiratory distress), low core temp (<36.5), bleeding, deep coma, repeated convulsions, anuria, shock

Question 7

Hematologic findings in severe Falciparium malaria

Answer 7

Leukocytosis >12,000/uL, severe anemia, coagulopathy (low plt <50,000, prolonged PT and APTT, decreased fibrinogen)

Question 8

Manifestations of severe Falciparium malaria

Answer 8

unarousable coma/cerebral malaria, acidemia/acidosis (ph<7.2, HcO3<15), severe normocytic normochromic anemia (Hct<15, Hgb<50), renal failure (crea>265 mmol/L or >3mg/dL), non-cardiogenic pulmonary edema, hypoglycemia (CBG<40mgdL), hypotension/shock, DIC and conculsion

Question 9

A drug used for the treatment of uncomplicated malaria that causes hypoglycemia?

Answer 9

Quinine - a powerful stimulant of pancreatic insulin secretion, which is still widely used for the treatment of both severe and uncomplicated falciparum malaria

Question 10

True or False: Are convulsions in cerebral malaria generalized?

Answer 10

TRUE

Question 11

Pathogenesis of Hypoglycemia in cerebral malaria

Answer 11

both a failure of hepatic gluconeogenesis and an increase in the consumption of glucose by the host and, to a much lesser extent, the malaria parasites.

Question 12

TRUE OR FALSE: In QUARTAN MALARIAL NEPHROPATHY, chronic or repeated infections with P. malariae may cause soluble immune complex injury to the renal glomeruli, resulting in the NEPHROTIC SYNDROME

Answer 12

TRUE

Question 13

TRUE OR FALSE: Childhood Burkitt’s lymphoma is strongly associated with Epstein-Barr virus (EBV) and with high transmission of P. falciparum

Answer 13

TRUE

Question 14

Definitive diagnosis of malaria

Answer 14

demonstration of asexual forms of the parasite in stained peripheral-blood smears.

Question 15

In severe malaria, a poor prognosis is indicated by what findings in microscopy?

Answer 15

Predominance of more mature P. falciparum parasites (i.e., >20% of parasites with visible pigment) in the peripheral-blood film or by the presence of phagocytosed malarial pigment in >5% of neutrophils

Question 16

WHO recommended first-line treatment for uncomplicated P. falciparum malaria in malaria-endemic areas

Answer 16

Artemisinin-based combination therapy (ACT)

Question 17

Drug for malaria that may exacerbate psoriasis?

Answer 17

Chloroquine and Hydroxycholoroquine

Question 18

How do you take Chloroquine, Hydoxycholorquine, and Mefloquine as chemoprophylaxis?

Answer 18

Begin 1–2 weeks before travel to malarious areas. Take weekly on the same day of the week while in the malarious areas and for 4 weeks after leaving such areas.

Question 19

How do you take Atovaquone-proguanil (Malarone) and primaquine as chemoprophylaxis?

Answer 19

Begin 1–2 days before travel to malarious areas. Take daily at the same time each day while in the malarious areas and for 7 days after leaving such areas.

Question 20

This drug is contraindicated in patients with G6PD and pregnancy?

Answer 20

Primaquine

Question 21

The only drug advised for pregnant women traveling to areas with drug-resistant malaria. This drug is generally considered safe in the second and third trimesters of pregnancy.

Answer 21

Mefloquine

Question 22

TRUE OR FALSE? Atovaquone-proguanil (Malarone) is not recommended if the estimated
glomerular filtration rate is <30 mL/min.

Answer 22

TRUE

Question 23

TRUE OR FALSE: Mefloquine is contraindicated for use by travelers with known hypersensitivity and by persons with active or recent depression, anxiety disorder, psychosis, schizophrenia, another major psychiatric disorder, or seizures

Answer 23

TRUE