Returning Travellers and Altitude Medicine

Question 1

What are the crucial pillars of a Travel Hx?

Answer 1

Where - travelled, exact locations
When - helps to understand incubation
Why - work vs leisure
What
Which - vaccines, previous exposure

Question 2

What is the most common presenting complaint in the the returning traveller?

Answer 2

Diarrhoea (± febrile illness, derm complaint, respiratory illness)

Question 3

Which database is used to monitor illnesses in the retruning traveller?

Answer 3

Geosentinel database https://www.istm.org/geosentinel

Question 4

What are the most common causes of fever in the returning traveller?

Answer 4

Malaria
Dengue

Question 5

What is the incubation of dengue?

Answer 5

4-7 days

Question 6

What mosquito causes dengue?

Answer 6

Aedes

Question 7

What are the symptoms of leptospirosisi ?

Answer 7

Flu like illess, conjunctival haemorrhage, Fever with a break in it, hepatomegaly,

Question 8

How does HIV seroconversion present?

Answer 8

Incubation: Up to 3 month s
Pharyngitis, lymphadenopathy, oral thrush
±meningoencephalitis (rare)

Question 9

Which cause of pneumonia has significant resistance to beta-lactams gloablly (i.e dont respond to penicillins)

Answer 9

Pneumococcal pneumonia

Question 10

Which resp. illness is assocaited with caving?

Answer 10

Histoplasmosis

Question 11

How do you diagnose Legionnaires?

Answer 11

Urinary Ag

Question 12

What is Katayma Syndrome?

Answer 12

Acute schisto –> headache, cough, wheeze, fever, fatigue Urticaria, Eosinophilia, Hepatosplenomegaly

Rx: Praziqnatal + Steroids + antihistamines

Question 13

Chronic Diarrhoea definitiion

Answer 13

Adults: >28 Days
HIV > 14 days
Kids >14 days

Question 14

How does Tick typhus present?

Answer 14

Fever, headache, dry cough, ESCHARS

Question 15

How do you manage cutaenous Leish?

Answer 15

SSG
l-AMB
Miltefisone

Question 16

How do HIV and secondary syphillis present?

Answer 16

Widespread macuopapular rash

Question 17

What is the presentation of Acute Mountain Sickness?

Answer 17

high altitude headache (>80% of people climbing >5000 metres)

Question 18

What are the risk factors for AMS

Answer 18

**Previous hx of AMS
Genetics
Usual living altitiude level

Question 19

At which Core Body temperature are you likely to go into Cardiac Arrest

Answer 19

<24C

Question 20

What are the symptmos of HAPE?

Answer 20

Dyspnoea on exertion, cough, sensation of chest pressure –> severe cough, white to reddish frothy sputum, dyspnoea, syanoss, tachypooea, crackles

High mortality if untreated, 24%

Question 21

How do you treated HAPE?

Answer 21

Descend
O2
Nifedipine 20mg TDS
Dexamethasone

NB: diuretics do not work as the person is usually pretty dry

Question 22

How does HACE present?

Answer 22

Ataxic gait !!!

±high altitude retinopathy
±impaired LOC
± neausea and vomiting
±vertigo
± any other generalised neurological symptoms

*** not HACE if no impreovement with descent, no headache, symptoms started >3 days after going to altitude

Question 23

WHat is the mortality of HACE?

Answer 23

40% –> every unclear health disorder should be treated as HACE until proven otherwise

Question 24

How do you manage HACE?

Answer 24

Dexamethasone 8mg STAT –> 4mg PO Dex. 6 hourly

Question 25

What are the 4 stages of Frostbite?

Answer 25

1. Pre=freezing phase
2. Freezing and thawing
3. Vascular stasis stages
4. Late ischaemic Stage

Question 26

How do you manage Frostbite?

Answer 26

Rewarm
Analgesia
Vasodilators
Thombolytics
Surgery –> only done after final demarcation can take several weeks