Travel Medicine

Question 1

What is the most common cause of fever in a returned traveller from Sub Saharan Africa?

Answer 1

Malaria

Question 2

What is the most common cause of fever in a returned traveller from SE Asia?

Answer 2

Dengue

Question 3

What is the most common cause of fever in a returned traveller from South Central Asia?

Answer 3

Enteric fever

Question 4

What travel infections have an incubation period < 10 days?

Answer 4

Dengue, influenza, zika

Question 5

What travel infections have an incubation 10-21 days?

Answer 5

Malaria, viral haemorrhagic fever, typhoid

Question 6

What travel infections have an incubation period > 21 days?

Answer 6

Malaria, hepatitis, TB

Question 7

How many times do you need to test for malaria?

Answer 7

Usually at least 3 times

Question 8

Which are the main live vaccines?

Answer 8

MMR, yellow fever, BCG, varicella/zoster

Question 9

What are the 5 parasitic amoeba that cause malaria?

Answer 9

p. falciparum, p. vivax, p. ovale, p. malariae, p. knowlesi

Question 10

What is the most common cause of severe malaria?

Answer 10

p. falciparum

Question 11

What diagnostic tests can be done for malaria?

Answer 11

Thick and thin blood films or antigen based rapid diagnostic tests

Question 12

What are the clinical features of severe malaria?

Answer 12

Anaemia, jaundice, seizures, AKI, shock, impaired consciousness

Question 13

What is the treatment for severe malaria?

Answer 13

IV artesunate with supportive treatment

Question 14

Where is there artemisinin resistance?

Answer 14

Border between Thailand and Cambodia

Question 15

What gene gives resistance of artemisinin?

Answer 15

Kelch gene on chromosome 13

Question 16

Why do patients with p. vivax and p. ovale get relapse?

Answer 16

Because the life cycle contains dormant hyponozoites

Question 17

What is the treatment for dormant hyponozoites?

Answer 17

Primaquine for 7-14 days

Question 18

Who can’t be treated with primaquine?

Answer 18

Patients with G6PD deficiency

Question 19

What parasite density causes severe malaria?

Answer 19

> 10%

Question 20

What is the incubation period for typhoid?

Answer 20

5-21 days

Question 21

What is the classic presentation for typhoid?

Answer 21

Week 1: rising fever and relative bradycardia
Week 2: abdo pain and rose spots
Week 3: septic shock, intestinal perforation, hepato-splenomegaly

Question 22

What investigations should be done for typhoid?

Answer 22

Blood and stool cultures

Question 23

What is the sensitivity of blood cultures for typhoid?

Answer 23

50%

Question 24

What is the treatment for typhoid?

Answer 24

Azithromycin or ceftriaxone

Dexamethasone in severe infection

Question 25

What is the treatment for typhoid acquired in Pakistan?

Answer 25

Carbapenem

Question 26

What is the treatment for chronic carriage of typhoid?

Answer 26

Ciprofloxacin 500mg BD for 4/52

Question 27

What type of virus is dengue?

Answer 27

Flavivirus

Question 28

What type of virus is chikungunya?

Answer 28

Alpha virus

Question 29

What is the transmission for dengue?

Answer 29

Mostly from mosquitos | Can also be via blood transfusion, organ transplant, needle stick, mucosal splashes`

Question 30

Is there vertical transmission of dengue?

Answer 30

Yes if mother is viraemic at delivery

Question 31

What is the incubation period of dengue?

Answer 31

4-10 days`

Question 32

What are the classical symptoms of dengue?

Answer 32

High fever, malaise, headache, GI disturbance, aches and pains May have transient macular rash

Question 33

What are the complications of dengue?

Answer 33

Vasculopathy (IV volume depletion), myocarditis, bradycardia, hepatitis, encephalitis, GBS, retinal vasculopathy, optic neuropathy

Question 34

What are the common laboratory findings for dengue?

Answer 34

``` Thrombocytopaenia Leukopaenia Neutropaenia Elevated APTT Decreased fibrinogen Increased transamimase AST > ALT ```

Question 35

What are the diagnostic tests for dengue?

Answer 35

Before day 5 – PCR or NS1 antigen | After day 5 serology

Question 36

What is the management for dengue?

Answer 36

Symptomatic care

Question 37

Who should the dengue vaccine be given to?

Answer 37

Seropositive patients living in endemic areas

Question 38

What is the incubation perod for zika?

Answer 38

3-14 days

Question 39

What are the most common symptoms of zika?

Answer 39

Usually asymptomatic | Can have rash, pruritus, headache, arthralgia, myalgia, conjunctivitis, fever

Question 40

What are the complications of zika?

Answer 40

GBS | Congenital infection – microcephaly, macular scarring/retinal mottling, congenital contractures, hypotonia

Question 41

What is the incubation period for chikungunya?

Answer 41

1-12 days

Question 42

What are the clinical features of acute phase chikungunya?

Answer 42

Fever, itchy rash, severe symmetrical distal joint pain, headache, myalgia, conjunctivitis, GI symptoms

Question 43

What is the treatment for chikungunya?

Answer 43

Analgesia

Question 44

What is chronic chikungunya?

Answer 44

Joint stiffness and pain lasting > 3 months