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MC > Travel Medicine > Flashcards

Travel Medicine Flashcards

1
Q

_____the science of travel

medicine

A

Emporiatics

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2
Q

The main diseases facing the international
traveller are _____ and _____ especially the potentially lethal
______

A

traveller’s diarrhoea (relatively mild) and malaria,

Plasmodium falciparum malaria

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3
Q

Most cases of traveller’s diarrhoea are caused

by enterotoxigenic_____ and _____

A

Escherichia coli and

Campylobacter species

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4
Q

Enteroinvasive E. coli (a different serotype)

produces a dysentery-like illness similar to ______

A

Shigella

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5
Q

____ is contracted mainly from
contaminated water and ice used for beverages,
washing food or utensils, or cleaning teeth

A

Traveller’s diarrhoea

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6
Q

_____is endemic in at least 20 countries and thus immunisation for polio is still important.

A

Poliomyelitis

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7
Q

Infections transmitted by mosquitoes include:

A

malaria, yellow fever, Rift Valley fever, Japanese

B encephalitis, chikungunya and dengue fever

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8
Q

Malaria is a dusk-till-dawn risk only, but bites from

daytime mosquitoes can cause _____

A

dengue

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9
Q

It is important for GPs to consult a _____to obtain specific information about ‘at
risk’ countries

A

travel medicine database

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10
Q

The commonest causes of death in travellers
overseas are ____ (26%), particularly traffic
accidents, and _____ (16.9%).

A

trauma

homicide

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11
Q

Other diseases caused by poor santitation

A

hepatitis A,
and worm infestations such as hookworm and
schistosomiasis.

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12
Q

Reputable soft drinks, such as ____should be recommended for drinking.

A

Coca-Cola,

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13
Q

Traveller’s diarrhoea is a special problem in which countries:

A

Mexico, Nepal, India, Pakistan, South-East Asia,

Latin America, the Middle East and Central Africa

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14
Q

Duration of Travellers diarrhea

A

2 or 3 days. It is unusual for it to last longer than 5 days

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15
Q

Very severe diarrhoea, especially if

associated with the passing of blood or mucus, may bea feature of

A

Shigella sp or Campylobacter sp infections

and amoebiasis.

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16
Q

Most traveller’s diarrhoea is caused by:

A

enterotoxigenic E. coli (ETEC), Campylobacter sp, Shigella sp and Salmonella sp

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17
Q

The key factor in treatment of TD is

A

rehydration

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18
Q

Tx of mild diarrhea

A
  • Maintain fluid intake—Gastrolyte.

* Antimotility agent

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19
Q

Examples of antimotility agents

loperamide (Imodium) ____
or

______ (Lomotil) 2 tablets
statim then 1–2 (o) 8 hourly

___is the preferred agent.

A

2 caps statim then 1 after each unformed stool (max. 8 caps/day)

diphenoxylate with atropine

Imodium

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20
Q

Shigella species

A

Dysentery

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21
Q

Salmonella species

A

Typhoid

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22
Q

Moderate diarrhoea Tx

  • Attend to hydration.
  • Patient can self-administer antibiotic—e.g. single dose____
  • Loperamide in adults.
A

norfloxacin or azithromycin (especially in

India, Nepal and Thailand).

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23
Q 
Severe diarrhoea (patient toxic
and febrile) TX
• ? Admit to hospital.
• Attend to hydration—use an oral hydrate
solution (e.g. Gastrolyte).
• Loperamide in adults.
• Antibiotic: \_\_\_\_\_
A

norfloxacin, ciprofloxacin or

azithromycin (usually 3 days

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24
Q

There is increasing resistance to ____ and _____, especially in South-East Asia

A

doxycycline

and cotrimoxazole

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25
Q

Any travellers with persistent diarrhoea after visiting less-developed countries, especially India and China,may have a protozoal infection such as ____ and __

A

amoebiasis

or giardiasis.

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26
Q

______ is characterised by abdominal cramps, flatulence, and bubbly, foul-smelling diarrhoea persisting beyond 2 to
4 days

A

Giardiasis

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27
Q

Treatment
• Giardiasis: _____
• Amoebiasis: _____

A

tinidazole or metronidazole

metronidazole or tinidazole

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28
Q

Preventive advice for TD

Purify all water by boiling for 10 minutes.

Adding purifying tablets is not so reliable, but
if the water cannot be boiled some protection is provided by adding _____

A

Puratabs (chlorine) or iodine (2% tincture of iodine), which is more effective than chlorine—

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29
Q

Avoid fresh salads or raw vegetables (including watercress).

Salads or uncooked vegetables are
often washed in ______

A

contaminated water

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30
Q

Malaria:

The risk is very low in the major cities of ______ and _________
can be high in some African cities

A

Central and Southern America and South-East Asia but

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31
Q 
• In humans malaria is caused by four species of
plasmodium:
— Plasmodium vivax and P. ovale \_\_\_\_\_\_\_
— P. falciparum —\_\_\_\_\_\_\_
— P. malariae —\_\_\_\_\_\_\_\_\_
— P. knowlesi —\_\_\_\_\_\_\_\_
A

tertian malaria

malignant tertian malaria

quartian malaria

presents like vivax and
falciparum

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32
Q

The lethal ______ is developing
resistance to chloroquine and the antifolate
malarials (Fansidar and Maloprim).

A

P. falciparum

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33
Q

Resistance is common in _____

A

South-East Asia,
Papua New Guinea (PNG), northern South
America and parts of Africa

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34
Q

Patients who have had _____ are at grave

risk from P. falciparum malaria (PFM).

A

splenectomies

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35
Q

It is recommended that _____ and _____do not travel to malarious areas
(if possible).

A

pregnant women and

young children

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36
Q

Travellers should be advised that malaria may be

prevented by following two simple rules:

A

1 avoid mosquito bites

2 take antimalarial medicines regularly

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37
Q

In order to avoid mosquito bites, travellers are advised to:

impregnate nets with ___ or ____

A

permethrin (Ambush) or

deltamethrin

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38
Q

Important considerations in malaria
prophylaxis:

Know areas of widespread chloroquine resistance:

A

• Asia, tropical South America (rare north of

Panama Canal), sub-Sahara, East Africa

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39
Q

WHO Guidelines in drug prophylaxis:

What prophylaxis:

• Accommodation in large, air-conditioned hotels in most cities of South-East Asia (dusk–dawn) for <2 weeks: ______

A

no prophylaxis required

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40
Q

WHO Guidelines in drug prophylaxis:

What prophylaxis

For low-risk travel (urban: dusk–dawn) in areas of high resistance for <2 weeks: chloroquine adequate; ______

A

use a treatment course of Malarone if

necessary

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41
Q

WHO Guidelines in drug prophylaxis:

What prophylaxis

For short- and long-term travel to rural areas of high resistance (e.g. South-East Asia including Thailand, Kenya, Tanzania, Ecuador, Venezuela, Brazil): ______

A

doxycycline daily alone or mefloquine (once

a week).

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42
Q

WHO Guidelines in drug prophylaxis:

What prophylaxis

For short- and long-term travel to rural areas of high resistance (e.g. South-East Asia including Thailand, Kenya, Tanzania, Ecuador, Venezuela, Brazil):

______) is
also very useful for short-term travel

A

Atovaquone and proguanil (Malarone

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43
Q

Drugs for Malarial Prophylaxis:

Chloroquine:

Dose (Adult)___________

Dose (Children): __________

A

300 mg base (2 tabs) same
day each week 1 week
before, during, 4 weeks
after exposure

5 mg base/kg up to
maximum adult dose

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44
Q

Only antimalarial approved for
pregnancy, Aggravates psoriasis,
Beware of retinopathy

A

Chloroquine

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45
Q

Drugs for Malarial Prophylaxis:

Doxycycline*

Dose (Adult)___________

Dose (Children): __________

A

100 mg each day, 2 days before, during, 4 weeks after

> 8 years only 2 mg/kg/day up to
100 m

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46
Q

SE: Photosensitivity reactions

A

Doxycycline*

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47
Q

Drugs for Malarial Prophylaxis:

Mefloquine
(Lariam)*

Dose (Adult)___________

Dose (Children): __________

A

250 mg (1 tab) same day each week, 1 week before, during, 4 weeks after

Not recommended <45 kg; >45 kg as for
adults

48
Q

SE of Mefloquine:

A

Side effects: dizziness, ‘fuzzy’ head, blurred vision, neuropsychiatric

Beware of beta blockers

49
Q

Drugs for Malarial Prophylaxis

Atovaquone+ proguanil
(Malarone)*

Dose (Adult)___________

Dose (Children): __________

A

250 mg / 100 mg (1 tab) with food same day each week 2 days before, during, 7 days later

Junior tablets 62.5 mg/
25 mg

11–20 kg: 1 tablet/day
21–30 kg: 2 tablets/day
31–40 kg: 3 tablets/day
>40 kg: 1 adult tab/day

50
Q

Avoid in pregnant women or
women breastfeeding infants
<11 kg
Avoid in severe kidney impairment

A

Atovaquone+ proguanil

(Malarone)*

51
Q

Drugs used for uncomplicated chloroquineresistant
malaria (presumptive breakthrough
where professional medical care
unavailable, i.e. emergency self-treatment

A

Artemether/ lumefantrine (Riamet)

Atovaquone/ proguanil (Malarone
if not used for prophylaxis)

52
Q

All travellers should be immunised against :

A

tetanus, polio and diphtheria and

measles.

53
Q

Protection against tetanus requires an initial
course of three injections followed by a booster every
______

A

10 years.

54
Q

___vaccination is a legal requirement for any

travellers returning from a endemic area.

A

Yellow fever

55
Q

______has now been eradicated from the world and therefore is no longer required
for any traveller.

A

smallpox vaccination

56
Q

The two vaccinations that may be required

before visiting ‘at risk’ areas are____ and _______

A

yellow fever and

meningococcus.

57
Q

Yellow fever is a serious viral infection spread by ______ mosquitoes and, like malaria, is a tropical disease

A

Aedes

58
Q

Yellow fever vaccination, which is the only WHOrequired vaccine, is essential for travel to or through

A

equatorial Africa and northern parts of South America, and for re-entry to Australia from those countries

59
Q

fever + bradycardia + jaundice

A

yellow fever

60
Q

Yellow fever

One injection only is required and the
immunisation is valid for______ years

A

10

61
Q

T or F

Yellow fever

Children aged less than 9 months should not be given this vaccine

A

T

62
Q

It should not be given within 3 weeks of cholera vaccine.

A

Yellow fever

63
Q

T or F

According to the WHO a certificate against yellow fever is the only certificate that should be required for international travel

A

T

64
Q

Travellers trekking through the
Kathmandu valley of Nepal and those attending the Haj pilgrimage to Saudi Arabia are at special risk and
should have the vaccine

A

Meningococcal infection

65
Q

There is a declining level of

antibodies to _____ in developed countries and adults are at special risk

A

hepatitis A

66
Q

How many doses of Hep A should be givem?

A

1-2

67
Q

________is endemic in South-East Asia, South America and other developing countries.

Vaccination is recommended, especially for people working in such countries, particularly those in the health care area or
those who may expect to have sexual or drug contact

A

Hepatitis B

68
Q

If patients have a ‘negative’ HBV core IgG titre, then vaccination would be worthwhile : what vax?

A

(three doses: 0, 1

and 6 months).

69
Q

______ has a high mortality rate

in pregnant women.

A

Hepatitis E

70
Q

Hepa vax:

The usual approach for non-immunised people is to give _____ and _____

A

the combined hepatitis A and B vaccine (Twinrix) as a course of three injections

71
Q

_________ is not required for entry into any country but is recommended for travel to third world countries where the standards of sanitation are low

A

Typhoid immunisation

72
Q

Typhoid immunisation:

It should be considered for travellers to
smaller cities, and village and rural areas in

A

Africa,
Asia, Central and South America and Southern
Europe.

73
Q

The parenteral (subcutaneous) vaccine can be used but the _______, which have fewer side effects, are generally preferred

A

single dose typhi Vi vaccine or the oral vaccine

74
Q 
Cholera is given as an
oral vaccine (Dukoral) over\_\_\_\_\_\_\_prior to exposure. It is not recommended in children under \_\_\_\_ or \_\_\_\_\_
A

1 week

5 years or pregnant women.

75
Q

Routine vaccination for all Australians

A 
Tetanus, diphtheria, pertussis
Hepatitis B
Haemophilus influenzae
Measles, mumps, rubella
Influenza
Pneumococcal disease
Poliomyelitis
Rotavirus
Varic
76
Q

This mosquito-borne ______infection presents a real dilemma to the traveller and doctor because it is a very severe infection (mortality rate 20–40%) with high infectivity and high prevalence in endemic
countries

A

flavivirus

77
Q

febrile illness + vomiting + stupor

A

Japanese B encephalitis

78
Q

__________is recommended for some
international aid workers or travellers going to
rabies-endemic areas for periods of more than 1 month or even for short periods of working with affected animals in those areas.

A

Rabies vaccination

79
Q

T or F

The prebite vaccination does not remove the need for postexposure vaccination

A

T

80
Q

painful bite + paraesthesia +

hydrophobia ( pain with drinking)

A

rabies

81
Q

_______ is still prevalent in rodents in countries
such as Vietnam, Brazil, Peru, Ecuador and
Kenya.

A

Plague

82
Q

Vaccination for plague

A

Two doses are given to adults (three to children <12 years) and a booster
every 6 months

83
Q

The common STIs, especially prevalent in South-East Asia and Africa, are

A

non-specific urethritis (NSU), gonorrhoea

(especially penicillin-resistant strains), hepatitis B and syphilis

84
Q

Unusual STIs such as _____, ______, ____ are more common in tropical developing
countries.

A

lymphogranuloma venereum, chancroid and

donovanosis

85
Q

If a patient has had unprotected intercourse and is at definite risk of acquiring an STI, such as penicillin resistant gonorrhoea or NSU, the following may be appropriate:

A

• ceftriaxone 250 mg IM (as a single dose)
• doxycycline 100 mg (o) for 10 days or
azithromycin 1 g (o) statim

86
Q

Most international airlines do not allow passengers to travel after the____ week of pregnancy and may require a doctor’s certificate after ______ weeks

A

36th

28

87
Q

Air travel is contraindicated in the last month of pregnancy and until
the ______ day after delivery.

A

7th

88
Q

Administration of killed or inactivated ______, _______, ________is permitted during pregnancy.

A

vaccines, toxoids and polysaccharides

89
Q

Yellow fever vaccine is considered safe after the ____

A

6th month

90
Q

______ is important as protection

is passed on to the child during early infancy.

A

Tetanus immunisation

91
Q

______ can be safely given as prevention against hepatitis in pregnant women

A

Immunoglobin

92
Q

The antimalarial drugs _____, ______, ______ may be given to pregnant women

A

chloroquine, quinine and proguanil

93
Q

Air travel is not recommended for _______

A

infants of less than 7 days or premature infants.

94
Q

Most vaccines__________) can safely be given in the first few weeks of life.

A

(diphtheria, tetanus, poliomyelitis, BCG

95
Q

______ is common overseas and it is worthwhile considering it even under 12 months

A

Measles

96
Q

____ should not be given under 12 months.

A

Yellow fever

vaccine

97
Q

____, ___, _____may be given safely to
infants. However, as a rule young children should be
discouraged from trave

A

Chloroquine,

proguanil and quinine

98
Q

This is the uncomfortable aftermath of a long flight in which the person feels exhausted and disoriented, and has poor concentration, insomnia and anxiety

A

Jet lag

99
Q

On Jet lag:

The worst cases appear to be in those travelling eastbound from ______
It can occur with travel
in any direction, but the north–south flights are not so bothersome.

A

England to Australia.

100
Q

Specific factors affecting jet lag

A

Duration of the flight, time of
departure, and changes in climate and culture at the
destination affect the severity of jet lag

101
Q

Oral medication in a 5 mg dose close to the desired or usual bedtime decreased jet lag

A

Melatonin

102
Q

Patients with these problems should avoid flying
or be assessed for fitness:

• upper airways congested by infection, including
_______, e.g. within 6 weeks of severe acute
respiratory illness
• acute gastroenteritis
• severe respiratory disease______
• recent_________ surgery

A

influenza

(COPD, chronic bronchitis, pneumothorax)

thoracic

103
Q

Patients with these problems should avoid flying
or be assessed for fitness:

• cystic fibrosis
• \_\_\_\_\_\_\_\_\_(people should not fly
until rendered non-infective)
• past history of respiratory problems while flying
(dyspnoea, chest pain, confusion)
• unstable heart failure
• severe anaemia \_\_\_\_\_\_\_\_
A

pulmonary tuberculosis

below 7.5 g/dL

104
Q

Patients with these problems should avoid flying
or be assessed for fitness:

  • pregnancy beyond ____
  • previous violent or unpredictable behaviour
  • within _______days of a myocardial infarction
  • within 3 days of a cerebrovascular accident
  • within_____ days of major surgery
A

200 days (28 weeks) (up to 36 weeks if necessary)

7

5–10

105
Q

Special precautions are required by travellers with
the following problems:

• Colostomy. Patients should wear a large colostomy
bag and take extra bags.
• __________. Such patients should wear
supportive stockings and exercise frequently.
__________Those with broken limbs in plaster
should be careful of swelling

A

Varicose veins

• Plaster casts.

106
Q

Special precautions are required by travellers with
the following problems:

Those with _______ may have a
problem with X-rays at some overseas airports.
Mention it to security officials before passing
through security equipment.

________. Medication should be increased on the
day of travel.

________should discuss their therapy
and control with their doctor. They should carry
sweets.

A

pacemakers

  • Epilepsy
  • Diabetics.
107
Q

Risk factors for DVT

A

increasing
age, clotting tendency, i.e. thrombophilia, past history
of DVT, family history of DVT, smoking, obesity,
varicose veins, dehydration, significant illness, recent
major surgery and oestrogen therapy

108
Q

The main symptoms of_______ are nausea,
vomiting, dizziness, weakness and lethargy. Early
signs are pallor and drowsiness, and sudden silence
from an active, talkative child

A

travel sickness

109
Q

Many medicines are available for travel sickness.

They include ________, ________, _______ derivatives, all of which can cause drowsiness

A

hyoscine, various antihistamines and

other phenothiazine

110
Q

Phenothiazine derivatives that provide appropriate
anti-labyrinthine activity include

1.
2.
3`

A

prochlorperazine
(Stemetil), promethazine hydrochloride (Phenergan)
and promethazine theoclate (Avomine

111
Q

Travel sickness:

These preventive oral preparations should ideally
be taken ______ minutes before the trip and can be
repeated _______hourly during the trip (maximum
4 tablets in 24 hours).

A

30–60

4–6

112
Q

________ generally poses no special problems apart
from motion sickness and the possibility of injuries
in the aged

A

Sea travel

113
Q

Those prone to sea sickness are advised to
take anti-emetics _______ minutes before sailing and for
the first _______ days at sea until they obtain their ‘sea legs

A

60

2

114
Q

The Chief Surgeon on P & O’s
flagship recommends that elderly people should
bring the following:

A 
• a letter from their doctor stating diagnosis and
medication
• a spare set of spectacles
• a spare set of dentures
• a walking stick (if appropriate
115
Q

Forms of Altitude sickness:

1.
2.
3.

A

1 Acute mountain sickness (mild to severe)
2 High-altitude pulmonary oedema
3 High-altitude cerebral oedema

MC (90 decks)

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