Travel Medicine

Question 1

All of the following are true about international traveller except

a) The main diseases facing an international traveller are malaria and travellers diarrhoea
b) Enterotoxigenic e.coli and campylobacter species cause most cases of travellers diarrhoea
c) One bite from an infected mosquito during a single overnight stop in a malaria area does not result in an infection
d) Mosquitoes transmit infections such as malaria, yellow fever, Japanese B encephalitis, chikungunya and dengue fever
e) Malaria is a dusk-till dawn risk only but bites from day tiem mosquitoes can cause dengue

Answer 1

c) One bite from an infected mosquito during a single overnight stop in a malaria area does not result in an infection

Question 2

All of the following are true about international traveller except

a) Reputable soft-drinks and bottled water are not recommended for drinking
b) The commonest cause of death in travellers overseas are trauma particularly traffic accidents and homicides
c) Travellers diarrhoea is usally mild and lasts only 2-3 days
d) The key factor in treatment of travellers diarrhoea is rehydration
e) Antimotility agents are used only in adults if mild diarrhoea and no blood in stools

Answer 2

a) Reputable soft-drinks and bottled water are not recommended for drinking

Question 3

The antibiotic of choice in moderate travellers diarrhoea is

a) Doxycycline
b) Cotrimoxazole
c) Cephalexin
d) Norfloxacin
e) Metronidazole

Answer 3

d) Norfloxacin or azithromycin

Question 4

A 55 year old accountant comes to you with persisitent diarrhoea after visiting India. He has had mucous and occaisonal blood in stool. On examination, he is febrile. The most likely diagnosis is

a) Giardiasis
b) Amoebiasis
c) Rotavirus
d) Cholera
e) Salmonella

Answer 4

b) Amoebiasis

Question 5

A 55 year old accountant comes to you with persisitent diarrhoea after visiting India. He has had mucous and occaisonal blood in stool. On examination, he is febrile. The first line of management is

a) FBC/CRP/ESR
b) Three stool specimens
c) Prescibe oral cephalexin
d) Advise hydration and follow-up in 2 days
e) Antimotility agents

Answer 5

b) Three stool sample specimens

Question 6

A 55 year old accountant comes to you with persisitent diarrhoea after visiting India. He has had mucous and occaisonal blood in stool. On examination, he is febrile.The drug of choice is

a) Norflox
b) Azithromycin
c) Metronidazole
d) Augmentin
e) Doxycycline

Answer 6

c) Metronidazole or tinidazole

Question 7

A 55 year old accountant comes to you with persisitent diarrhoea after visiting India. He describes abdominal cramping, flatulence and bubbly foul smelling diarrhoea for 2 weeks. The most likely diagnosis is

a) Amoebiasis
b) Giardiasis
c) Cholera
d) Salmonella
e) E.coli

Answer 7

b) Giardiasis

Question 8

A 35 year old lady presents with fever, chills and associated headache after returning from a trip to Vietnam and Thailand. The most likely diagnosis is

a) Dengue
b) Chikungunya
c) Malaria
d) Meningitis
e) Japanese encephalitis

Answer 8

c) Malaria

Question 9

A 35 year old lady presents with fever, chills and associated headache 3 weeks after returning from a trip to Vietnam and Thailand. the first line of investigation is

a) FBC/CRP/ESR
b) Thick and thin blood films
c) Prophylactic cephalosporins
d) Start hydration and perform LP
e) Hepatitis serology

Answer 9

b) Thick and thin blood films

Question 10

A 35 year old lady presents with fever, chills and associated headache after returning from a trip to Vietnam and Thailand. The first line of MX is

a) Norfloxacin
b) Cephazolin
c) Doxycycline
d) Artemether+lumafantrine+primaquine
e) Metrondazole

Answer 10

d) Artemether+lumafantrine+primaquine

Question 11

Lisa, a 30 year old journalist is travelling to India for 10 weeks to cover a rural festival. She is 12 weeks pregnant. The recommended malarial prophylaxis is

a) Doxycycline
b) Mefloquine
c) Atorvaquone
d) Chloroquine
e) Proguanil

Answer 11

d) Chloroquine

Question 12

A 35 year old lady is planning on a trip to a mlti-drug resistant malaria endemic area for 8 weeks. What is the recommended prophylaxis

a) Mefloquine
b) Chloroquin
c) Proguanil
d) Atorvaquone
e) Malarone

Answer 12

e) Malarone

Question 13

Avi is a 40 year old man planning on a visit to Italy for 10 weeks. He does not recollect any vaccination in the last 20 years. He is healthy and takes no medicationsWhich of the following vaccines is recommended for him

a) Tetanus and diphtheria
b) Polio
c) Measles
d) Influenza
e) Pneumococcus

Answer 13

a) Tetans and diphtheria

Question 14

Jane; 27 year old is travelling to Mumbai for 8 weeks on a internship program. Which of the following vaccines are recommended for this travel

a) Hep A
b) Hep B if unimmunised
c) Typhoid
d) Yellow fever
e) tetanus toxoid +measles

Answer 14

d) Yellow fevers

Question 15

All of the following are true of Yellow Fever except

a) It is a a serious viral infection spread by Aedes mosquito and is a tropical disease
b) Vaccination is essential for travel to or through equatorial Africa, northern parts of South America and for re-entry to Australia from these countries
c) The clincial features are fever, bradycardia and jaundice
d) It can be given to children of all ages
e) One injection is required and it is valid for 10 years

Answer 15

d) It can be given to children of all ages (> 9 months)

Question 16

Which of the following is a mandatory vaccine for Haj pilgrimage

a) Yellow fever
b) Hep A
c) Typhoid
d) Meningococcal
e) Tetanus

Answer 16

d) Meningococcal

Question 17

Yun a 40 year old Australian resident returns after visitng her ailing mother in rural Burma in July. She has been complaining of fevers, vomiting and was brought in by her husband as he thinsk she is in and out of conscioussness since 1 hour. The most likely diagnosis is

a) Malaria
b) Dengue fever
c) Japanese Encephalitis
d) Meningitis
e) Dehydration secondary to gastroenteritis

Answer 17

c) Japanese encephalitis

Question 18

All of the following are true about rabies except

a) It is recommended for some internationa aid workers, travellers to rabies endemic areas for more than 1 month or shorter periods if working with affected animas
b) Routine vaccination before travel is recommended as vaccination following bite of a rabid animal s not effective
c) Dogs, cats, monkeys, camels and wild animals can transmit rabies to humans
d) The prebite vaccination does not remove the need for post-exposure vaccination
e) The classic triad of rabies is painful bite, paraesthesia and hydrophobia(pain with drinking)

Answer 18

b) Routine vaccination before travel is recommended as vaccination following bite of a rabid animal s not effective

Question 19

Sam, a 20 year old traveler has had sex with a stranger on a trip to Bangkok under the influence of alcohol. HE had unprotected sex and later realised that she is a comercial sex worker. the most appropriate treatment is

a) Single dose of ceftriaxone and either doxy or azithromycin
b) Norfloxacin and penicillin
c) Augmentin and keflex
d) Wait to see if he develops symptoms
e) Give azithro and ask him to return in 1 month

Answer 19

a) Single dose of ceftriaxone and either doxy or azithromycin

Question 20

Which of the following are not true with regards to travel in pregnancy?

a) Yellow fever vaccine is considered safe after the 6th month
b) International airlines does not allow travel after 36th week and may ask for medical certificate after 28 weeks
c) Chloroquine or doxycycline can be given as prophylaxis
d) Pregnant women should be advised against travel to third world countried if possible
e) Immunoglobulin can be safely given as prevention against hepatitis

Answer 20

c) Chloroquine or doxycycline can be given as prophylaxis (Doxycycline is contraindicated)

Question 21

Which of the following are not true with regards to children travelling to a developing country?

a) DPT, polio, BCG can safely be given in the first few weeks of life
b) Measles vaccine needs to be considered undr 12 months
c) Yellow fever is safe in children
d) Chloroquine, proguanil and quinine can be safely given for malarial prophylaxis
e) Air travel not recommended for infants <7 days or premature infants

Answer 21

c) Yellow fever is safe in children (>12 months only)

Question 22

Which of the following medication is efficacious in preventing jet lag?

a) Melatonin
b) Benzodiazepine
c) Acetazolamide
d) H2 receptor antagonist
e) Antiemetics

Answer 22

a) Melatonin

Question 23

Which of the following groups is fit to travel by air?

a) Acute respiratory/gastrointestinal infection
b) Severe respiratory/cardiac disease
c) Pregnancy beyond 36 weeks
d) Within a week of AMI/CVA/major surgery
e) Patients with pacemakers

Answer 23

e) Patients with pacemakers

Question 24

Which of the following is not true regarding altitude sickness?

a) It is usually safe to trek under 2500m
b) Rapid ascent or ascent beyon 3000m can cause altitude sickness
c) Frontal headache, fatigue, anorexia and insomnia 8-24hrs after ascent are symptoms
d) Acetazolamide helps
e) Immediate rapid descent to below 2000m, oxygen and dexamethasone are not helpful in management

Answer 24

e) Immediate rapid descent to below 2000m, oxygen and dexamethasone are not helpful in management-Standard care