Travel Medicine Flashcards

1
Q

General counselling for motion sickness, jet lag + VTE on flights

A

Motion sickness: sit in centre of vehicle, take prophylactic antiemetic
Jet lag: active in sunlight on arrival
VTE: fluids, move about

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2
Q

What should you have in a travel Health kit?

A

bandages, gauze, insect repellant, bite treatment, antihistamine, ORS, analgesiic, sunscreen

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3
Q

Food + water safety

A

Avoid tap water, ice from tap water
Unpasteurized foods
Open buffers

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4
Q

High risk activities

A

STI, blood exposure, car safety
Water safety
High altitudes

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5
Q

Malaria counselling

A

Avoid dawn and dusk, full length clothes, insect repellant, inspect for ticks

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6
Q

Malaria rx: when to start, SE

A

Atovaquone/proguanil (Malarone) daily
Start 1 day prior, continue 7d after
Avoid in children <5kg

Mefloquine (Lariam) weekly
Start 3w prior, continue 4w after
AE: Severe intolerance in some patients

Chloroquine 500mg weekly: start 1-2 wks before until 4wks after
Resistant areas: sub-saharan africa, south america except argetina, Asia

Doxycyline 100mg once daily: start 1d before travel until 4wks after

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7
Q

Ix for malaria

A

CBC (anemia, lymphopenia, thrombocytopenia, eosinophilia)
Thick and thin blood smear r/o Malaria (consider repeat q12h until three negative smears as parasitemia is cyclical)

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8
Q

Sx, signs + cause of malaria

A

Plasmodium protozoa
Sx: cough, fatigue, malaise, arthralgia, myalgias, fever
Signs: splenomegaly, jaundice

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9
Q

Complications of malaria

A

Complications: sz, AKI, hypoglycemia, pulmonary edema, lactic acidosis, hemolysis + bleeding

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10
Q

Travellers diarrhea rx

A

Typically lasts 2-4 days
Management: loperamide 4mg then 2mg after each BM, azithromycin 1000mg x1

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11
Q

Altitude sickness cause + sx

A

Pulmonary edema, cerebral edema, usually >2500m
Sx: HA, weakness, fatigue, nausea, insomnia, reduced appetite, SOB, cough, hemoptysis

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12
Q

Altitude sickness prevention + rx

A

Prevention: slow ascent, acetazolamide (diuretic)/ dexamethasone
Rx: dexamethasone, nifedipine, sildenafil, ventolin

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13
Q

Causes of Fever based on when travel was:
<10d
<21d
>21d
>30d

A

<10d: travelers diarrhea, dengue fever, yellow fever, spotted fever, diphtheria, malaria, rabies, typhoid, typhus
<21d: leptospirosis, malaria, typhoid
>21d: viral hepatitis, malaria, acute HIV, schistosomiasis, leishmaniasis
>30d: TB, malaria, hep B or C, HIV, syphilis

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14
Q

Travel hx qs

A

when, where, how long, why, PMH, allergies

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15
Q

Vaccines for travellers

A

hep A, B, rabies, routine vaccinations (flu, shingrix, tetanus, pertussis, covid), typhoid, meningitis, yellow fever, encephalitis depending on country

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16
Q

What places would you recommend typhoid vax?

A

Central and SE Asia

17
Q

Who would you advise NOT to have probiotics to prevent C diff?

A

Pregnant, ICU, prosthetic heart valves, IBD

18
Q

Bacteria causing travellers diarrhea

A

campylobacter, salmonella, e coli, shigella

19
Q

What to give before, during and after travel

A

before (antimalarials, vaccines)
during (antimalarials, antidiarrheals, insect precautions, activities)
after (antimalarials, Zika precautions)

20
Q

1st line antimalarial + key points to remember

A

malarone (atovaquone + proguanil) - expensive, only need for 7 days after trip

21
Q

2nd line antimalarial + key points to remember

A

doxycycline, cheap, photosensitivity rash, need for 30d after trip

22
Q

Antimalarial for use in pregnancy

A

advise not to travel, if they have to use mefloquine - once weekly, SE are wild dreams + psychosis

23
Q

Rx for confirmed malaria

A

artemisinin combo or quinine combo + prophylaxis drugs

24
Q

Advice for travellers

A

limit high risk activites (MVA, sex), don’t check meds into luggage

25
Q

Advice for travellers for diarrhea

A

Pack ORS, loperamide, azithromycin, pepto bismol (can use QID for prevention), boil/ peel/ cook food, avoid ice cubes/ salads, uncooked veggies, use bottled water, wash hands

26
Q

Meds for altitude above 2800m

A

acetazolamide, dexamethasone, nifedipine, viagra

27
Q

Causes of fever in travelers

A

malaria, travelers diarrhea, resp infections

28
Q

When should loperamide not be used in travelers diarrhea?

A

Severe diarrhea w/ dysentry (blood in stool)

29
Q

What can you use to prevent diarrhea when travelling?

A

Pepto bismol QID

30
Q

SE of pepto bismol

A

black tongue, black stools, constipation