Travel

Question 1

A traveler has a fever. DDX.

Answer 1

Malaria
Travel’s diarrhea
Resp infection

But it’s almost certainly malaria

Question 2

Important history on travelers asking for prevention

Answer 2

When are you going
Where are you going
How long are you going
What are you doing while you are there 
Pregnancy

Question 3

Vaccines to discuss with travelers

Answer 3

Hep A
Hep B
Rabies
Typhoid (in south east asia) 
Meningitis
Yellow fever
Encephalitis 
Flu shot
Pneumococcal
Tetanus 
Covid

Question 4

Prevention tips for travelers

Answer 4

Malaria medicaion 
Vaccines 
Precautions like mosquito nets 
Water purification 
Condoms 
Ear plugs 
Sunscreen 
DEET

Question 5

Doctor what medication should I take with me

Answer 5

All of your normal medication 
Anti-motion sickness medication 
Advil/tylenol
Antacids and laxatives
Oral rehydration solution 
Azithromycin 
Atovaqone-Proguanil (for malaria) or Doxycycline (not as good becuase have to continue for 30 days after and photosensitivity 
Acetazolamide (High altitude) if above 2000m 
Bismuth subsalicylate  

DON’T PUT IT IN YOUR CHECKED BAG. MAY GET LOST AND TOO COLD

Question 6

List two first line and two second line preventative medications for malaria

Answer 6

Malarone (daily) start 1 day before and go 7 days after
Doxycycline (daily) start 1 day before and go 30 days after

Chloroquine (lots of resistance)
Primaquine
Mefloquine (weird dreams)

Question 7

Why don’t we prescribe a lot of doxy

Answer 7

Sun sensitivity

Teeth staining in kids under 8

Question 8

How do we treat malaria

Answer 8

IV quinidine and doxycycline (severe)

Or artemisinin (quighaosu combo) - 90% effective and safe in preg, treatment only as short half life.

Question 9

List 5 tests you would do for a returning traveler with a fever

Answer 9

Blood smear 
ALT
AST
Hemoglovin
WVC
Creat
NA
K
Blood cultulres
Urine culture (midstream)
CXR
Dengue serology 
CRP
Widal test (typhoid)
LP

Question 10

How do we prevent traveler’s diarrhea? List 4 non pharm and 2 pharm

Answer 10

Wash hands
Boil/Peel/Cook food
Avoid ice cubes and raw veggies
Use bottled water even when brushing teeth

Dukoral vaccine? (Prevents 1-7%)
2 bismuth subsalicylate qid (prevents 60%)

Question 11

How do we treat traveler’s diarrhea

Answer 11

Oral rehydration
Loperamide (but not if abdominal pain or persistent diarrhea)
Azithromycin 1000 MG po x 1
Ciprofloxacin 500 mg po BID

Question 12

You give someone abx. that they should take if they get traveler’s diarrhea. What do you tell them in respect to when they should take it

Answer 12

> 4 loose stools
Fever
Blood, pus or mucus in the stool

Question 13

When would you give Azithro instead of cipro for travelers diarrhea

Answer 13

Children, preggos, people going to Asia, Dysenteric diarrhea

Question 14

List two complications of Travelers Diarrhea

Answer 14

IBS
Reactive arthritis
Guillain barre syndrome

Question 15

When should you prescribe someone something for altitude sickness

Answer 15

Over 2800 m

Question 16

What do we prescribe for altitude sickness prevention

Answer 16

Acetazolamide (carbonic anhydrase inhibitor)
Dexamethasone (also treats it)
Nifedipine (CCB)
Sidenafil/Radalafil (Phosphodiesterase 5 enxyme inhibitor

Question 17

Symptoms of high altitude sickness

Answer 17

Ataxia
Encephalopathy 
Nausea 
Vomiting 
Myalgias

Question 18

What causes travelers diarrhea

Answer 18

Campylobactor
Ecoli
Shigella
Salmonella

Viruses (norovirus, rotavirus)
Parasites

Question 19

List ten pieces of general advise you would give travelers

Answer 19

Don't drive after dark
Avoid high risk activities
Wash food
Bottled water
Bring all medications in carry on bag 
Carry card with medications and diagnoses 
See travel clinic 6 weeks before travel 
Use mosquito spray and nets 
Carry basic first aid including gloves, pauze, rehydration salts, and bandaids 
Wash hands frequently