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Pathology > Mi - Imported Fevers > Flashcards

Mi - Imported Fevers Flashcards

1
Q

components of a good travel history (6)

A

where did you go - inc stop overs / rural vs urban / exact location
when did you go - inc sx onset
why did you go - holiday / VFR (visiting friends and relatives)
what did you do - activities / interactions
pre travel vaccines / malaria prophylaxis

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2
Q

what is the incubation period of malaria

A

months

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3
Q

what is the incubation period of viral haemorrhage fever

A

3 to 21 days

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4
Q

what can exposure to tic bite put you at risk of

A

CCHF (VHF)
Lyme disease

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5
Q

what can exposure to animal bites put you at risk of

A

CCHF (VHF)
MERS
rabies

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6
Q

what can being on a cruise put you at risk of

A

Legionnaires (zircon)
norovirus

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7
Q

what can freshwater activities put you at risk of

A

schistosomiasis
leptospirosis

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8
Q

what can sexual contact put you at risk of

A

HIV
hep
PID

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9
Q

what tropical diseases can you get from food /water

A

hep E
cholera

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10
Q

what travel activity type puts you at greater risk of tropical diseases and why

A

visiting friends and relatives (VFR)
less likely to adhere to prophylaxis and more likely to do weird activities / eat weird foods

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11
Q

54M fever, headache, rigors. UK national but visited Lagos 1 week ago VFR. Already had amoxicillin from GP but not helped. Dx?

A

malaria

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12
Q

what can cerebral malaria present with

A

confusion

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13
Q

Ix for malaria

A

FBC
CRP
U&Es
HIV
blood film - thick and thin
malaria rapid diagnostic test
blood parasitaemia

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14
Q

what does malaria look like on blood film

A

‘headphones’ - 2 dots on one cell

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15
Q

what Ix can show if malaria is severe or not

A

parasitaemia in blood

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16
Q

who carries the biggest mortality burden of malaria

A

<5 y/o African children

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17
Q

Africa has ___% of all malaria cases

A

95%

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18
Q

how many strains of malaria are there

A

5

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19
Q

what strain of malaria are 75% of cases

A

plasmodium falciparum

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20
Q

where does p.falciparim invade in the body

A

RBCs

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21
Q

what strain are 20% of malaria cases

A

p.vivax

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22
Q

main stages of malaria lifecycle

A

mosquito stage
human stage - liver then RBC stage

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23
Q

in which stage is asexual reproduction of malaria

A

RBC stage

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24
Q

what features are part of a malaria risk assessment

A

geography
altitude - lower risk at high altitude
preg
urban vs rural - inc accommodation

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25
Q

how can malaria be prevented

A

repellents
nets
prophylaxis

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26
Q

name 2 drugs that can be used as malaria prophylaxis

A

malarone
mefloquine

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27
Q

when do people present post bite with malaria

A

10 to 15 days usually but can be months

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28
Q

what stage does vivax have that means people can present at any time

A

hypnozoite stage

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29
Q

what type of fevers do you usually get in malaria

A

cyclical or spiking

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30
Q

what is the malaria paroxysm

A

chills, high fevers and sweats

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31
Q

what 10 features indicate malaria is severe

A

high parasitaemia
change in conciousness
respiratory distress
circulatory collapse
metabolic acidosis
renal or hepatic failure
coagulopathy / DIC
severe anaemia / intravascular haemolysis
hypoglycaemia
schizont on film

32
Q

what is a schizont

A

multiple malaria dots on 1 cyst

33
Q

what is classified as high parasitaemia in malaria

A

> 2% or >5% in non imm

34
Q

what is the purpose of the thick vs thin film in malaria

A

thick = see presence of any parasites
thin = see the species of malaria present

35
Q

what are the rapid malaria detection kits

A

lateral flow like test that you blob blood on and see if 1 or 2 lines become present

36
Q

name 2 brands of rapid malaria detection kits

A

Paracheck-Pf
OptiMAL-IT

37
Q

Tx of non falciparum malaria

A

3d oral tabs chloroquine and 14d primaquine

38
Q

what do you need to check before starting primaquine and why

A

G6PD
- if deficient, get severe haemolysis

39
Q

Tx for mild falciparum malaria

A

ACT / macarons

40
Q

Tx for severe falciparum malaria

A

IV artesanate

41
Q

3 features that make malaria mild

A

not vomitting
parasitaemia <2%
ambulatory

42
Q

what advice is given to patients regarding taking ACT

A

eat with a high fat meal to improve absorption

43
Q

3 additional Mx components of severe malaria

A

correct any hypoglycaemia
cautious fluids
daily parasitaemia then PO follow on with ACT

44
Q

why should fluids only be given cautiously in severe malaria

A

avoid pulmonary oedema

45
Q

side effects of artesemate

A

delayed haaemolysis

46
Q

side effects of quinine

A

cinchonism
arrhythmias
hyperinsulinaemia

47
Q

what is cinchonism

A

tinnitus and dizziness
- specific in quinine OD

48
Q

53M from Thailand, had visited Thailand 5/7 before Sx
PC: fever, headache, arthralgia, rash
No malaria prophylaxis
O/E: conjunctival injection, sunburn rash which can leave a palm print on skin
Dx?

A

Dengue fever

49
Q

what transmits dengue

A

aedes aegypti mosquito

50
Q

how many serotypes of dengue are there

A

4

51
Q

what type of virus is dengue

A

flavivirus

52
Q

if you recover from 1 type of dengue, what is your prognosis RE reinfections

A

lifelong immunity from that type
can get cross reactivity with other types

53
Q

where does dengue replicate and where does it migrate to

A

replicates in midgut
migrates to salivary glands

54
Q

2 risk factors for Dengue in terms of travel

A

day time > night time
urban > rural

55
Q

recovery time from dengue usually

A

1-2 weeks

56
Q

incubation period of dengue

A

4-7 days

57
Q

5 classic Sx of dengue

A

high fever
retrorbital headache
myalgia / arthralgia
sunburn rash
nausea and vomitting

58
Q

what complication can occur once the fever has subsided in dengue

A

haemorrhage sx eg shock / haemetemesis / organ impairment

59
Q

when should serology be done for dengue

A

after 5-7 days to get IgG/M

60
Q

33F
PC: fever, constipation, dry cough, abdominal pain, vacant expression
Been to India 2/52 ago.
O/E: high temp, normal HR, normal platelets, raised CRP
Clear CXR, clear ECG
Spiking fevers
Culture shows gram - rods on day 3, which are flagellated.
Dx?

A

salmonella typhi

61
Q

33F
PC: fever, constipation, dry cough, abdominal pain, vacant expression
Been to India 2/52 ago.
O/E: high temp, normal HR, normal platelets, raised CRP
Clear CXR, clear ECG
Spiking fevers
Culture shows gram - rods on day 3, which are flagellated.
relevance of the normal HR?

A

would expect HR to be high if spiking a fever so this is worrying

62
Q

33F
PC: fever, constipation, dry cough, abdominal pain, vacant expression
Been to India 2/52 ago.
O/E: high temp, normal HR, normal platelets, raised CRP
Clear CXR, clear ECG
Spiking fevers
Culture shows gram - rods on day 3, which are flagellated.
what can the spiking fevers pattern be described as in salmonella typhi?

A

‘Himalayan peak temperatures’

63
Q

33F
PC: fever, constipation, dry cough, abdominal pain, vacant expression
Been to India 2/52 ago.
O/E: high temp, normal HR, normal platelets, raised CRP
Clear CXR, clear ECG
Spiking fevers
Culture shows gram - rods on day 3, which are flagellated.
what is the significance of the normal platelets?

A

malaria and dengue cause a low platelet count

64
Q

33F
PC: fever, constipation, dry cough, abdominal pain, vacant expression
Been to India 2/52 ago.
O/E: high temp, normal HR, normal platelets, raised CRP
Clear CXR, clear ECG
Spiking fevers
Culture shows gram - rods on day 3, which are flagellated.
what is the relevance of the vacant expression?

A

classic with salmonella typhi

65
Q

what are some salmonella typhi resistant to

A

cipro

66
Q

how is salmonella typhi diagnosed

A

blood / BM / stool culture

67
Q

how is salmonella typhi transmitted

A

faeco-oral route

68
Q

is there an animal reservoir for salmonella typhi

A

NO

69
Q

how is salmonella typhi prevented

A

hand hygiene
vaccine

70
Q

salmonella typhi is ___x more likely in ____

A

10x in indian subcontinent

71
Q

features of salmonella typhi fever

A

gradual, high, prolonged fever

72
Q

other sx of salmonella typhi

A

rose spots (rare)
headache
constipation
dry cough

73
Q

3 stages of salmonella typhi sx

A

1 = fever with low / inappropriately normal HR
2 = extreme fatigue, delirium
3 = intestinal haemorrhage, encephalitis, resp complications

74
Q

Mx of salmonella typhi

A

oral rehydration solution
IV ceftriaxone
follow on with oral azithromycin

75
Q

what is the pre ABx fatality of salmonella typhi

A

10-20%

Pathology (87 decks)

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