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RRPA Clinical Med II > Malaria and Tick borne illnesses (Exam 4) > Flashcards

Malaria and Tick borne illnesses (Exam 4) Flashcards

1
Q

There are 5 forms of malaria protozoa, what are they?

A

Plasmodium Falciparum- common to Africa
Plasmodium Vivax- India and South America
Plasmodium ovale
Plasmodium Malariae
Plasmodium Knowlesi- Primarily southeast Asia-Malaysia

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2
Q

What are the primary areas where malaria occurs?

A

central and South America, India and Africa (high incidence)

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3
Q

Modes of malaria transmission?

A 
Mosquito (of course) 
Blood transfusion 
organ transplant 
needle sharing 
mother to fetus
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4
Q

You are seeing a Pt who suspect malaria in because they just look awful. Y’all get to talking and find out they recently were in Africa for a mission trip. Which type of malaria are you suspecting?

A

Plasmodium Falciparum

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5
Q

All of the following are ways to prevent malaria except

A. Insect repellent 
B. Anopheles mosquito nocturnal feeders
C. Mosquito netting 
D. Permethrin clothing 
E. Malaria chemoprophylaxis 
F. All of the above are options
A

F. All of the above are options

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6
Q

You are seeing a group of rowdy college kids( not sure why you just are) wanting to go to Central America and you explain that they could get malaria but offer a chemoprophylaxis agent. You tell them there is one that is primarily used for Central America but has some resistance issues. Which of the following is the medication youre talking about?

A. Atovaquone/Proguanil (Malarone)
B. Chloroquine 
C. Doxycycline 
D. Mefloquine 
E. Primaquine
A

B. Chloroquine this is the go to malaria med for Central America

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7
Q

You are seeing a 32 year old pregnant women who is traveling to Africa for a mission trip. You tell her about a medication she can take to prevent malaria. You explain it can cause sever night terrors, depression, confusion, and hallucinations. Despite these awful side effects she agrees. Which of the following is the medication you prescribed?

A. Doxycycline
B. Primaquine
C. Mefloquine
D. Tafenoquine

A

C. Mefloquine is the only FDA approved treatment for pregnant women and chloroquine

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8
Q

You have a pt traveling to Cambodia and then moving to laos, and finally burma and they some how heard of Mefloquine. Can they use this med for malaria prophylaxis?

A

Na there is resistance in those areas

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9
Q

Match the following Meds with their dosing routine

A. Chloroquine 
B. Atovaquone/proguanil 
C. Doxycycline 
E. Mefloquine 
F. Primaquine 
G. Tafenoquine (arakoda, krintafel
  1. Start daily for 3 days prior to travel then weekly thru 1 week after return
  2. Daily dosing to continue for 7 days after return
  3. weekly dosing to continue through 4 weeks after return
  4. daily dosing to continue for 30 days after return
A

A and E match with number 3

G matches with 1

B and F match with number 2

C matches with 4

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10
Q

You just seem to work in a damn travel agency cause all your patients are going somewhere. You are seeing a Pt who is traveling to Sub-Sahran Africa. While looking at their chart you notice an allergy to fava beans. You find this interesting so you ask about it. They tell you its not really an allergy per say but if they eat them they will die due to a deficiency in something. Knowing what is wrong with them which medication can you not give for malaria prophylaxis?

A. Doxycycline 
B. Primaquine 
C. Mefloquine 
D. Tefenoquine 
E. B and D
A

B and D can not take this meds with a G6PD deficiency.

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11
Q

You are seeing a Pt who has just returned from India and has horrid sun burn. You had prescribed them a medication for malaria prophylaxis before their trip and warned them it could cause severe sun damage. They forgot (of course) and did not make sure to protect themselves. Which drug did you prescribe

A. Doxycycline
B. Primaquine
C. Mefloquine
D. Tenfenoquine

A

A. Doxycycline- causes severe sun damage even in dark skin people

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12
Q

Which of the following can be used for both prophylaxis and antirelapse?

A. Doxycycline
B. Primaquine
C. Mefloquine
D. Tenfenoquine

A

B. Primaquine

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13
Q

You have 50 year old male Pt who presents to the clinic with Fever, Headache, myalgia and chills. Vitals are BP 110/75, HR 18, RR 17, Temp 101.4, O2 94%. Recent travel history indicates trip to Brazil. Which test do you want to get to best (gold standard) diagnose?

A. PCR
B. Immunochromatographic methodology
C. Thin Blood smear
D. Thick and Thin Blood smear

A

D. a Thick and Thin blood smear is gold standard

Can determine species of malaria, most sensitive
best done when they are having a fever

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14
Q

What do you need to have access to in order to use PCR to diagnose Malaria?

A

a reference lab

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15
Q

You treated a Pt who had malaria and they have completed their course of medications. It is now 2 weeks later and just to make sure you want to test them again. You test them using immunochromatographic methodology. The test comes back positive (uhh ohhh). Do they still have malaria?

A

No very unlikely, you are a noob and forgot that immunochromatographic methodology can produce positive tests even weeks after treatment

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16
Q

A Pt presents to your clinic (in the U.S.) after their return from Africa. They have a fever, chills, experiencing seizure and some confusion. You do a thick and thin blood smear and it comes back positive for Plasmodium Falciparum. What do you treat them with?

A. Atovaquone/Proguanil (Malarone)
B. Chloroquine 
C. Doxycycline 
D. Mefloquine 
E. None of this will work because they cam from Africa and this all have resistant there
A

A. Atovaquone/Proguanil (Malarone) is standard Tx

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17
Q

A 40 year old Pt presents to your clinic with Fatigue, Fever, EXTREME muscle and body aches. In between the wrenching of Pain they tell you they were stung by a lot of mosquitos while in south-east asia. Vitals are taken BP 150/90, HR 110, RR 20, Temp 102.4, O2 96%. What does the Pt have?

A. West Nile virus
B. Malaria
C. Dengue Fever
D. Lyme Disease

A

C. Dengue fever aka bone break fever

-called this cause the body aches are so bad it feels like their bones are breaking

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18
Q

You have Diagnose a pt with Bone break fever aka dengue fever. How do you treat them?

A. NSAIDs for pain
B. Azithromycin
C. Supportive Tx
D. Clarithromycin

A

C. Supportive Tx

Also makes sure to avoid NSAIDS in these Pts

19
Q

A Pt presents to your clinic 14 days after being bit by a mosquito. They happen to be someone who studies insects. They were able to capture the mosquito that bit them and looked determined it to be a Culex mosquito (true story). They present with headache, partner says change in mental status, fever and body aches. What test do you want to run next?

A. PCR
B. Thick and Thin blood smear
C. IgG and IgM from spinal fluid
D. Stool sample

A

C. IgG and IgM from spinal fluid…can also get from blood

This pt suffers from West nile Virus. They could also have meningitis and flaccid paralysis though the paralysis is rare/unique

20
Q

How do you Tx someone with West Nile Virus?

A

Supportive Tx

21
Q

What three Tick borne illnesses should we know?

A

Lyme disease
Rickettsial diseases
Babesia

22
Q

If you go hiking in Northeastern, north central and pacific coastal regions in the U.S what are you at risk of?

A

Lyme disease

23
Q

When a Deer Tick bites you what is it they transfer that causes lyme disease?

A

Spirochete Borrelia Burgdorferi hopefully we dont have to remember that nonsense

24
Q

You are seeing a 28 year old male Pt who went backpacking 28 days ago in the northeastern part of America. They have a fever, fatigue and myalgias. You inspect their body and notice an erythema migrans. What stage of the disease do they have and how would you treat it?

A. Stage 1 and doxycycline 100mg po bid x21 days
B. Stage 1 and amoxicillin 50mg/kg/day divided into 3 doses q 8 hr X 14-21 days
C. Stage 2 and amoxicillin 50mg/kg/day divided into 3 doses q 8 hr X 14-21 days
D. stage 2 and doxycycline 100mg po bid x21 days

A

A. Stage 1 and doxycycline 100mg po bid x21 days

25
Q

You are seeing the 7 year old daughter who just got back from the backpacking trip with her father who was diagnosed with lyme disease. She presents with the same symptoms Fever, myalgias fatigue and a bulls eys spot. What stage does she have and how do you Tx it?

A. Stage 1 and doxycycline 100mg po bid x21 days
B. Stage 1 and amoxicillin 50mg/kg/day divided into 3 doses q 8 hr X 14-21 days
C. Stage 2 and amoxicillin 50mg/kg/day divided into 3 doses q 8 hr X 14-21 days
D. stage 2 and doxycycline 100mg po bid x21 days

A

B. Stage 1 and amoxicillin 50mg/kg/day divided into 3 doses q 8 hr X 14-21 days

This is for children less than 8 years old

26
Q

The mother also went on this backpacking trip. They all slept in a colony of deer ticks the poor family. She is pregnant and experiencing the same symptoms (Fever, myalgias fatigue and a bulls eys spot) . How do you Tx her?

A. Stage 1 and doxycycline 100mg po bid x21 days
B. Stage 1 and amoxicillin 500mg PO BiD
C. Stage 2 and amoxicillin 50mg/kg/day divided into 3 doses q 8 hr X 14-21 days
D. stage 2 and doxycycline 100mg po bid x21 days

A

B. Stage 1 and amoxicillin 500mg PO BiD

can not give pregos doxy

27
Q

Which of the following symptoms would someone with Stage 2 lyme disease have?

A. Weight loss
B. Conduction abnormalities (AV issues)
C. Arthritis type symptoms
D. None of the above

A

B.

28
Q

Which of the following symptoms would someone with stage 3 lyme disease have.

A. Persistent infection
B. Arthritis type symptoms
C. Headache
D. A and B

A

D. and usually these people have not been treated

29
Q

From the questions involving the family, besides the history of their hiking trip in a place known for lyme disease how did you (or could you) diagnose them?

A. Elisa followed by Western Blot
B. IgG and IgM blood test
C. PCR
D. lumbar puncture

A

A. Elisa followed by Western Blot

30
Q

If you suspect someone to have lymes disease however they do not have that classic bulls eye appearance for you to easily diagnose so you have to use serologic testing. Why would you want to wait 2-3 weeks after their exposure?

A

Because serologic testing is negative in 1st few weeks of infection

31
Q

You have 23 yr old female pt present to you with fatigue, body aches and splenomegaly along with minimal hepatomegaly. You draw labs and the results are Hgb 10.3, HCT 22, MCV 90, normal reticulocyte count, elevated LDH and decreased haptoglobin. And you notice a maltese cross formation in RBC. What should you treat her with?

A. Clarithromycin and Amoxicillin
B. Pipercillin/tazo
C. Doxycycline and Amoxicillin
D. Atorvaquone and Azithromycin

A

D. Atorvaquone and Azithromycin

32
Q

You have 23 yr old female pt present to you with fatigue, body aches and splenomegaly along with minimal hepatomegaly. You draw labs and the results are Hgb 10.3, HCT 22, MCV 90, normal reticulocyte count, elevated LDH and decreased haptoglobin. And you notice a maltese cross formation in RBC. What does this Pt have?

A. Lyme disease
B. Babesia
C. Spotted fever
D. Anaplasma

A

B. Babesia (hemolytic anemia and maltese cross formation give it away)

33
Q

A 35 year old male Pt presents to your clinic after hiking in the rocky mountain for a week. He says a rash started showing up on his hands and feet which then seems to spread to the rest of his body. He also has a fever, headache and abdominal pain. When looking at the rash it appear maculopapular in some areas and more petechia like in others. What is the next step in diagnosing this pt?

A. PCR
B. Stool sample
C. skin biopsy
D. UA

A

A. PCR (recent in the testing arena according to CDC)

You can also do acute and convalescent sera which is when you test the Pt in the first week of the disease then 2-4 weeks later

34
Q

A 35 year old male Pt presents to your clinic after hiking in the rocky mountain for a week. He says a rash started showing up on his hands and feet which then seems to spread to the rest of his body. He also has a fever, headache and abdominal pain. When looking at the rash it appear maculopapular in some areas and more petechia like in others. How would you treat this Pt?

A. Fluoroquinolone
B. Doxycycline
C. Amoxicillin
D. Tetracycline

A

B. Doxycycline 100mg Po BID x14 days

35
Q

A Pt presents with just fever and myalgia. Very vague symptoms so you do serology testing and it shows a mulberry appearing WBC also termed Morulae. What does the Pt have?

A. Babaesia
B. Rocky Mountain Spotted Fever
C. Anaplasma/ Ehrlichia
D. Lymes disease

A

C. Anaplasma/ Ehrlichia

Serology is how you diagnose this by the way

36
Q

A Pt presents with just fever and myalgia. Very vague symptoms so you do serology testing and it shows a mulberry appearing WBC also termed Morulae.
How do you Tx them?

A

With doxycycline

37
Q

While working in Colorado you are seeing a pt who complains of a fever, rash, pain behind their eyes. Being from Colorado you suspect they might have one other symptom to help you diagnose so you get a CBC. And you were spot on their platelet level is 90,000. What were you suspecting this Pt had?

A. Rocky mountain spotted fever
B. Anaplasma/ Ehrlichia
C. Zika Virus
D. Colorado Tick Fever

A

D. Colorado Tick Fever

38
Q

How do you treat a pt with colorado tick fever?

A

just supportive care, this disease is self limiting and is viral

39
Q

What testing do you do when you suspect someone to have Zika Virus?

A

PCR on serum and/or urine, IgM serum

40
Q

True or False: a Male should wait at least 2 months before having sex if recently in a Zika zone?

A

False it is 3 months

41
Q

What is the main risk of Zika Virus.

A. Microcephaly
B. Plagiocephaly
C. Craniosynostosis
D. All of the above

A

A. Microcephaly

42
Q

You are seeing a Pt who just recently return from Sub-Saharan Africa 2 days ago. They present with fever, myalgias, backache nausea and vomiting. You are on your 8 shift in a row so basically half asleep and you didnt pick up on their travel history and send them home with NSAIDs and antinausea meds. Then return 5 days later, you are now fresh, however the disease has progressed. The Pt now shows jaundice and hemorrhagic symptoms/ shock You realize what this pt has and you made a huge mistake in the first visit. What was it.

A. did not initiate treatment soon enough
B. NSAIDS
C. Anti-nausea meds
D. Worked to many days in a row to bank money

A

B. NSAIDS- Pts with yellow fever have an increased rick of hemorrhaging with NSAIDs

43
Q

How do you tx someone with yellow fever?

A

Supportive care- AVOID NSAIDS

44
Q

How do you prevent someone from getting yellow fever?

A

By vaccination but must have a YF certificate to give vaccine as it is a live virus. Can not give to pregnant women.

Also use caution in those over 60. yellow fever is associated with Viscerotropic disease (whatever that is)

RRPA Clinical Med II (45 decks)

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