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IDS REVIEW > MALARIA > Flashcards

MALARIA Flashcards

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1
Q

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

A

P. falciparum

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2
Q

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

A

P.vivax

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3
Q

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

A

P. malaria

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4
Q

Processes central to the pathogenesis of falciparum malaria

A

cytoadherence, rosetting, and agglutination

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5
Q

Genetic disorders that confer protection against death from falciparum malaria

A

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

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6
Q

Clinical features indicating poor prognosis in severe Falciparium malaria

A

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

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7
Q

Hematologic findings in severe Falciparium malaria

A

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

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8
Q

Manifestations of severe Falciparium malaria

A

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

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9
Q

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

A

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

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10
Q

True or False: Are convulsions in cerebral malaria generalized?

A

TRUE

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11
Q

Pathogenesis of Hypoglycemia in cerebral malaria

A

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.

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12
Q

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

A

TRUE

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13
Q

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

A

TRUE

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14
Q

Definitive diagnosis of malaria

A

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

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15
Q

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

A

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

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16
Q

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

A

Artemisinin-based combination therapy (ACT)

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17
Q

Drug for malaria that may exacerbate psoriasis?

A

Chloroquine and Hydroxycholoroquine

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18
Q

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

A

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.

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19
Q

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

A

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.

20
Q

This drug is contraindicated in patients with G6PD and pregnancy?

A

Primaquine

21
Q

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.

A

Mefloquine

22
Q

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

A

TRUE

23
Q

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

A

TRUE

24
Q

What is the primary mode of malaria transmission?
A) Contaminated food and water
B) Inhalation of infected droplets
C) Bite of an infected female Anopheles mosquito
D) Direct contact with an infected person

A

Answer: C) Bite of an infected female Anopheles mosquito

Rationale: Malaria is caused by protozoan parasites of the genus Plasmodium, which are transmitted to humans through the bite of an infected female Anopheles mosquito. It is not spread through food, air, or direct contact.

25
Q

Which Plasmodium species is most commonly responsible for severe malaria?
A) Plasmodium vivax
B) Plasmodium malariae
C) Plasmodium falciparum
D) Plasmodium ovale

A

Answer: C) Plasmodium falciparum

Rationale: P. falciparum is the most virulent species, responsible for the majority of severe malaria cases, including cerebral malaria, multi-organ failure, and high mortality rates.

26
Q

What is the dormant form of Plasmodium found in P. vivax and P. ovale infections that can cause relapses?
A) Trophozoites
B) Schizonts
C) Hypnozoites
D) Merozoites

A

Answer: C) Hypnozoites

Rationale: Hypnozoites are dormant liver-stage parasites in P. vivax and P. ovale infections that can remain in the liver for weeks to years, causing relapses.

27
Q

In which region is Plasmodium vivax more commonly found?
A) Africa
B) New Guinea
C) Hispaniola
D) Southeast Asia

A

Answer: D) Southeast Asia

Rationale: P. vivax is more common in Central and South America, as well as Southeast Asia, whereas P. falciparum predominates in Africa, New Guinea, and Hispaniola.

28
Q

What is the primary reason for anemia in malaria patients?
A) Vitamin B12 deficiency
B) Hemolysis and splenic clearance of infected RBCs
C) Decreased iron absorption
D) Autoimmune destruction of RBCs

A

Answer: B) Hemolysis and splenic clearance of infected RBCs

Rationale: Malaria-induced anemia occurs due to destruction of infected RBCs during schizogony, increased splenic clearance of RBCs, and ineffective erythropoiesis.

29
Q

Which genetic disorder provides protection against severe P. falciparum malaria?
A) Cystic fibrosis
B) Marfan syndrome
C) Sickle cell disease
D) Down syndrome

A

Answer: C) Sickle cell disease

Rationale: Individuals with sickle cell trait (HbS) have a protective advantage against P. falciparum malaria because the parasite has difficulty surviving in their red blood cells.

30
Q

What is a characteristic clinical feature of cerebral malaria?
A) Seizures and coma
B) Diarrhea and dehydration
C) Skin rash and joint pain
D) Severe cough and chest pain

A

Answer: A) Seizures and coma

Rationale: Cerebral malaria, caused by P. falciparum, presents with coma and generalized seizures due to sequestration of infected RBCs in brain capillaries.

31
Q

Which of the following is the World Health Organization’s (WHO) first-line treatment for uncomplicated P. falciparum malaria?
A) Chloroquine
B) Artemisinin-based combination therapy (ACT)
C) Doxycycline
D) Primaquine

A

Answer: B) Artemisinin-based combination therapy (ACT)

Rationale: WHO recommends ACT for uncomplicated P. falciparum malaria due to its high efficacy and ability to reduce resistance.

32
Q

What is the best laboratory test for diagnosing malaria?
A) PCR test
B) ELISA test
C) Blood smear (thick and thin)
D) Urine antigen test

A

Answer: C) Blood smear (thick and thin)

Rationale: Microscopic examination of thick and thin blood smears remains the gold standard for malaria diagnosis, allowing identification of parasite species and density.

33
Q

Which antimalarial drug is contraindicated in patients with psychiatric disorders?
A) Mefloquine
B) Artemisinin
C) Doxycycline
D) Primaquine

A

Answer: A) Mefloquine

Rationale: Mefloquine is contraindicated in individuals with a history of psychiatric disorders (e.g., depression, anxiety, schizophrenia) due to the risk of neuropsychiatric side effects.

34
Q

What is the recommended malaria prophylaxis for a pregnant woman traveling to a malaria-endemic area?
A) Atovaquone-proguanil
B) Mefloquine
C) Doxycycline
D) Primaquine

A

Answer: B) Mefloquine

Rationale: Mefloquine is the only antimalarial recommended for pregnant women traveling to malaria-endemic areas, particularly in the second and third trimesters.

35
Q

Which chronic complication is associated with Plasmodium malariae infection?
A) Hyperreactive malarial splenomegaly
B) Quartan malarial nephropathy
C) Burkitt’s lymphoma
D) Non-cardiogenic pulmonary edema

A

Answer: B) Quartan malarial nephropathy

Rationale: Chronic P. malariae infection can cause immune complex-mediated nephrotic syndrome, known as quartan malarial nephropathy.

36
Q

How long should travelers continue malaria prophylaxis after leaving an endemic area?
A) 1 week
B) 2 weeks
C) 4 weeks
D) 6 weeks

A

Answer: C) 4 weeks

Rationale: Antimalarial prophylaxis should be continued for 4 weeks after leaving an endemic area to ensure that any parasites acquired during travel are cleared.

37
Q

Which of the following laboratory findings is associated with an increased risk of mortality in severe malaria?
A) Hypoglycemia (<2.2 mmol/L)
B) Mild thrombocytosis
C) Normal serum creatinine
D) Mildly elevated ALT/AST

A

Answer: A) Hypoglycemia (<2.2 mmol/L)

Rationale: Severe malaria can cause hypoglycemia due to increased glucose consumption by the parasite and quinine-induced hyperinsulinemia, leading to poor prognosis.

38
Q

A patient with severe malaria has a serum lactate level of 6 mmol/L. What does this indicate?
A) Normal metabolic function
B) Mild dehydration
C) Hyperlactatemia and poor prognosis
D) Low risk of complications

A

Answer: C) Hyperlactatemia and poor prognosis

Rationale: Hyperlactatemia (>5 mmol/L) is a marker of tissue hypoxia and impaired perfusion, often due to microvascular sequestration of parasitized red blood cells, leading to poor outcomes.

39
Q

Which of the following is a major manifestation of cerebral malaria?
A) Brief headache episodes
B) Mild confusion
C) Unarousable coma persisting for >30 minutes after seizure
D) Occasional dizziness

A

Answer: C) Unarousable coma persisting for >30 minutes after seizure

Rationale: Cerebral malaria is characterized by a prolonged unarousable coma following a seizure, indicating severe neurological involvement and a poor prognosis.

40
Q

Which laboratory finding is associated with severe normochromic, normocytic anemia in severe malaria?
A) Hematocrit <15% or hemoglobin <50 g/L
B) Hematocrit >45%
C) Hemoglobin >13 g/dL
D) Increased platelet count

A

Answer: A) Hematocrit <15% or hemoglobin <50 g/L

Rationale: Severe anemia in malaria results from hemolysis of parasitized RBCs, leading to a significantly low hematocrit and hemoglobin, often with high parasitemia (>10,000/μL).

41
Q

Which seizure pattern is most concerning for severe malaria?
A) Brief focal seizures
B) Single tonic-clonic seizure lasting <1 minute
C) More than two generalized seizures in 24 hours
D) Absence seizures with full recovery

A

Answer: C) More than two generalized seizures in 24 hours

Rationale: Multiple generalized seizures in a short time indicate severe neurological involvement, which is a hallmark of cerebral malaria and associated with increased mortality.

42
Q

Which of the following antimalarial drugs is contraindicated in pregnant women?
A) Chloroquine
B) Doxycycline
C) Hydroxychloroquine
D) Mefloquine

A

Answer: B) Doxycycline
Rationale: Doxycycline is contraindicated in children under 8 years and pregnant women due to its potential effects on bone and teeth development.

43
Q

How long should Atovaquone-proguanil (Malarone) be continued after leaving a malaria-endemic area?
A) 3 days
B) 7 days
C) 4 weeks
D) 8 weeks

A

Answer: B) 7 days
Rationale: Atovaquone-proguanil should be taken daily while in malaria-endemic areas and continued for 7 days after leaving to ensure any remaining parasites are cleared.

44
Q

Which antimalarial is preferred for prophylaxis in areas with chloroquine-resistant Plasmodium falciparum?
A) Hydroxychloroquine
B) Chloroquine
C) Doxycycline
D) Primaquine

A

Answer: C) Doxycycline
Rationale: Doxycycline is recommended for prophylaxis in areas with chloroquine- or mefloquine-resistant P. falciparum.

45
Q

Which antimalarial should be avoided in individuals with a history of psychiatric disorders or seizures?
A) Chloroquine
B) Mefloquine
C) Doxycycline
D) Hydroxychloroquine

A

Answer: B) Mefloquine
Rationale: Mefloquine has been associated with serious neuropsychiatric effects, including depression, anxiety, and seizures, making it unsuitable for individuals with such histories.

46
Q

Which of the following drugs should NOT be given to individuals with G6PD deficiency?
A) Hydroxychloroquine
B) Primaquine
C) Mefloquine
D) Doxycycline

A

Answer: B) Primaquine
Rationale: Primaquine can cause hemolysis in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency, making it contraindicated in such patients.

IDS REVIEW (21 decks)

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