Travelling

Question 1

What organism causes malaria?

Answer 1

Plasmodium:
Falciparum: Common
Vivax: Benign tertian malaria
Ovale:
Malariae: Rare, benign quartan malaria

Question 2

How does malaria cause infection?

Answer 2

1st anopheles mosquito infects person
Plasmodium travels to liver
Gets into blood causing haemolysis, RBC sequestration and cytokine release
2nd mosquito sucks blood and acts as another vector to infect more

Question 3

What are the risk factors for malaria?

Answer 3

African/SE asian countries
Pregnancy
Elderly
Travellers
Foreign aid workers

Question 4

What are protective factors for malaria?

Answer 4

G6PD deficiency

Sickle-cell trait

Question 5

What are the Sx of malaria?

Answer 5

Fever paroxysms
PHASE 1: Shivering
PHASE 2: ↑↑Fever, flushing, dry skin, N&V, headache
PHASE 3: Cold sweats
Hepatosplenomegaly
Abdo pain
Jaundice
Myalgia

Question 6

How is malaria investigated?

Answer 6

Blood Films x3: SERIAL thick & thin films stained w/Giemsa
-ve >2films over 48hours to exclude
Schizonts = Falciparum
Bloods: FBC (↓Hb, ↓Plt), Clotting, ↓Glucose, U+E (AKI - ↓Na, ↑Urea ↑↑Creat), deranged LFTs Cultures
ABG: Lactic acidosis
Urinalysis: ↑Protein casts, Blood

Question 7

How is non-falciparum malaria managed?

Answer 7

1) PO Chloroquine
2) PO Quinine
3) Primaquine

Question 8

What is given as prophylaxis for malaria in travellers?

Answer 8

Chloroquine +/- Proguanil

Question 9

What are the complications of malaria?

Answer 9

Drug resistance
Complicated Falciparum infection
DIC
Blackwater fever

Question 10

How does complicated Falciparum infection present?

Answer 10

Prodrome: Headache, malaise/myalgia, anorexia
Fever
Dyspnoea, ARDS
Jaundice, AKI, Nephrotic syndrome
5 worrying signs:
-↓GCS 
-Convulsions
-Co-existing chronic illness
-Acidosis
-Renal failure (ATN)

Question 11

How is complicated Falciparum infection treated?

Answer 11

ICU

IV Artesunate

Question 12

What is blackwater fever?

Answer 12

Severe form of malaria resulting in massive intravascular haemolysis = haemoglobinuria (dark urine)

Question 13

What are the Sx of E.Coli GE?

Answer 13

Travellers
Watery stools
Abdominal cramps
Nausea

Question 14

What are the Sx of Giardiasis GE?

Answer 14

Prolonged diarrhoea (NO blood)
Abdo pain

Question 15

What are the Sx of Cholera?

Answer 15

Profuse, watery diarrhoea

Severe dehydration = ↓weight

Question 16

What are the Sx of Shigella GE?

Answer 16

Bloody diarrhoea
Vomiting
Abdo pain

Question 17

What are the Sx of Amoebiasis?

Answer 17

Gradual onset bloody diarrhoea
Abdo pain & tenderness
Lasts for several weeks

Question 18

What are the Sx of campylobacter GE?

Answer 18

Flu-like prodrome
Crampy abdo pain
Fever
Diarrhoea (may be bloody)

Question 19

What causes Typhoid and what are the Sx?

Answer 19

Salmonella Typhi
FEVER
Arthralgia
Headache
Constipation
Abdo pain
Macpap rose spots on trunk

Question 20

How is GE investigated?

Answer 20

Stool MC&S

Bloods: FBC, U&E, Culture

Question 21

When is stool MC&S indicated?

Answer 21

Blood/mucous in stools
Foreign travel
Septicaemia
ImmunoC
Diarrhoea not improved in 7d
Diagnosis uncertain

Question 22

How is GE treated?

Answer 22

ORS: 50ml/kg over 4hours + maintenance fluids
Cholera: Tetracycline
Salmon/Shigella: Cipro
Campylo: Clarithromycin

Question 23

How is pyrexia of unknown origin defined?

Answer 23

Fever >38.3 for >3weeks with no identifiable cause after 3days of hospital admission/tests

Question 24

What are the common causes of pyrexia of unknown origin?

Answer 24

Infection
Malignancy
CT disorder