Travel Medicine

Question 1

Two complications of acute mountain sickness

Answer 1

HACE/HAPE

• HACE is the natural progression of untreated AMS more severe alcohol like intoxication

Question 2

Prophylaxis/ treatment of altitude illness is with:

Answer 2

Acetazolamide

Question 3

____ are mosquitos active during the daytime (dengue, zika)

Answer 3

AEDES

Question 4

___ are mosquitos active during the night (malaria)

Answer 4

anopheles

Question 5

Insect protection is primarily with this product:
1.

Answer 5

DEET
30% TID for >12
10% TID for 2-12
10% once for 6m -2y

Question 6

Malaria is caused by a parasite of the Plasmodium genus. The most severe genotype is:

Answer 6

P. Falciparum

Question 7

Atovaquone-Proguanil should be taken:

____ before travel / ___ post travel

Answer 7

1-2 days before / 7 days post

Question 8

Primaquine should be taken:
__ before travel / ___ post travel

Answer 8

1-2 days before / 7 days post

Question 9

Hydroxychloroquine should be taken:
____ before travel/ ___ post travel

Answer 9

1 week before / 4 weeks post

Question 10

Doxycycline should be taken:
____ before travel / ____ post travel

Answer 10

1-2 days before / 4 weeks post

Question 11

Mefloquine should be taken:
____ before travel/ ___ post travel

Answer 11

1 week before / 4 week post

Question 12

The two prophylaxis treatments for malaria safe in pregnancy are
1.
2.

Answer 12

Hydroxychloroquine
Mefloquine (if resistant to above)

Question 13

Primaquine should be avoided in individuals with a _____ deficiency

Answer 13

G6PD

Question 14

Atovaqone-proguanil is contraindicated in:
1.
2.

Answer 14

Pregnancy
Renal deficiency <30

Question 15

Mefloquine is contraindicated in :
1.
2.
3.

Answer 15

Depression, seizure, anxiety

“DIRTY DRUG”

Question 16

Anyone travelling more than __ hours by air, car, bus may be at risk of blood clot

Answer 16

4 hours

Question 17

Firs line therapy for jet lag?

Answer 17

Melatonin, first night after arrival (dizzy, headache, drowsy, cramp)

Question 18

Travellers diarrhea prevention :
1.
2.

Answer 18

1. Dukoral (2 doses, 1 week apart, 2nd dose atleast 1 week prior to travel) – A 2013 Cochrane review concluded there is insufficient evidence from randomized controlled trials to support the use of this vaccine for protecting travellers against ETEC diarrhea,​ and the Committee to Advise on Tropical Medicine and Travel (CATMAT) advises that the oral cholera vaccine not be routinely administered to Canadian travellers as a means of preventing TD.
2. Pepto bismol (contraindicated pregnancy and children < 12)

Antibiotics are not for prevention unless very high risk (IC) - FQ effective but ++ resistance rates, Rifaximin could be used for tx / prevention

Question 19

Travellers diarrhea treatment:
1.
2.
3.
4.

Answer 19

1. ORT
2. Loperamide MILD-MOD only (CI <2)
3. Pepto-Bismol MILD
4. ABX ( SEVERE ) Azithro for children/prego
   - FQ alternative (CI pregnancy/children <8, also associated with tendon rupture)

Question 20

Do not recommend bismuth subsalicylate in travellers taking ______________ or salicylates or those who are allergic to salicylates.

Answer 20

anticoagulants

Question 21

The antibiotic of choice in the treatment of travellers diarrhea for someone who went to Asia would be?

Answer 21

Azithromycin

Question 22

The antibiotic of choice in the treatment of travellers diarrhea for someone who went to Africa or somewhere in Latina America would be?

Answer 22

FQs

Question 23

True or False: Rifaximin has demonstrated comparable efficacy and safety to fluoroquinolones in the treatment of TD; however, this is not currently an approved indication in Canada

Answer 23

True

Question 24

Pregnant patients with travellers diarrhea have these options for treatment of TD:
1.
2.
3.

Answer 24

1. ORT
2. Loperamide,
3. Azithromycin if severe