Infection Malaria

Question 1

Who should avoid travelling to malaria area?

Answer 1

Asplenic

Preganant

Question 2

Other than antimalarial, what other prevention methods are they?

Answer 2

Nets impregnated with permethrin is most effective

DEET 20-50% spray or lotion
50% provides the longest protection

Long sleeves and trousers after dusk

Question 3

Who can use DEET spray?

Answer 3

On adults and children above 2 months

Question 4

Advice on how to apply DEET?

Answer 4

Apply sunscree first and use at least SPF 30-50

As DEET reduces the SPF

Question 5

Dose and treatment duration of doxycycline for malaria prophylaxis?

Answer 5

100mg OD

Take 1-2 days before entering pandemic area and continued for 4wks after leaving

Question 6

Pt counselling in doxycycline?

Answer 6

Protect skin from sunlight - even on a bright but cloudy day
Do not use sunveds

Do not take indigestion remedies, or meds containing iron or zinc, 2hrs before or after meds

Swallow whole with plenty of fluid during meals while sitting or standing

Question 7

Side effect of mefloquine?

Answer 7

Serious neuropsychiatric reactions

• psychosis, suicidal ideation and suicide
• proderomal symptoms for serious events like abnormal dreams, insomnia, nightmares, depression, anxiety, restlessness, confusion

So contra indicated if history of psychiatric disorders including depression or convulsions

Question 8

Pt counselling on mefloquine?

Answer 8

Makes you dizzy so careful with driving
Mefloquine gas a long half life so side effects can persist up to several months after stopping

Stop and seek medical advice if neuropsychiatric reactions

Question 9

Length of prophylaxis before travelling?

Answer 9

Usually 1 wk

Apart fro mefloquine which is 2-3wks
Malarone and doxycycline 1-2 days

Question 10

Length of prophylaxis after travel?

Answer 10

Usually 4wks after

Except Malarone which is 1wk after

Question 11

How long can you take chloroquine and proguanil as long term prophylaxis?

Answer 11

More than 5yrs

Question 12

How long can you take doxycycline as long term prophylaxis?

Answer 12

2yrs

Question 13

How long can you take mefloquine and Malarone as long term prophylaxis?

Answer 13

1yrs

Question 14

What antimalarial need to be avoided in epileptic pts?

Answer 14

Chloroquine and mefloquine

Question 15

What antimalarial needs to be avoided in renal impairment?

Answer 15

Progianil

Malarone and chloroquine if egft is below 30ml/min

Question 16

What Antimalatials are suitable for pts with renal impairment?

Answer 16

Doxycycline or mefloquine

Question 17

What Antimalatials are recommended for Preganancy?

Answer 17

Chloroquine and proguanil (but a lot of resistance)

5mf folic acid is given with proguanil

Question 18

What Antimalatials should be avoided in pregnancy?

Answer 18

Doxycycline
Mefloquine
Malarone (if there is no alternative, may give in 2nd or 3rd trimester

Question 19

Antimalarial treatment in pts taking warfarin?

Answer 19

Start prophylaxis 2_3wks before
INR should be stable before departure

Monitor INR before, 7days after starting and after completing the course
For prolonged stay, check INR regularly in visiting country

Question 20

What type of mosquito causes malaria?

Answer 20

Anopheles

Question 21

What’s the mosquito that causes the most dangerous malaria?

Answer 21

P. Falciparum

Question 22

Symptoms of malaria?

Answer 22

Rigors
Fever
Profuse sweating
Headache
N and V
Muscle oain
Bloody stools
Seizures

Question 23

When can you experience malaria symptoms?

Answer 23

Within 1yr, especially the first 3 months of return from malarial region

Question 24

Which antimalarial act as causal Prophylactic and prevent parasite from infecting RBC?

Answer 24

Malarobe
Atovaquonr and proguanil

Proguanil has mainly suppressive activity but also has some causal activity

Question 25

Which antimalarial works as a suppressive Prophylactic and destroy any parasite once release into blood?

Answer 25

Mefloquine Chloroquine Doxycycline

Question 26

What antimalarial drug is recommended for epilepsy?

Answer 26

Doxycycline Or Malarone

Question 27

What antimalarial are used for falciparum malaria?

Answer 27

Quinine Malarone Riamet

Question 28

What antimalarial is used for non falciparum malaria?

Answer 28

Chloroquine

Question 29

What antimalarial is used as standby treatment of malaria?

Answer 29

Quinine Take only if you cannot access medical care in 24hrs of fever onset Given with written instructions that urgent help is required if fever is over 38, 7 days or more after arriving in malarious zone

Question 30

What's the normal range of WBCs?

Answer 30

4-10

Question 31

What's the normal range of CRP?

Answer 31

Below 5mg/L

Question 32

What's procalcitonin?

Answer 32

Marker for bacterial infection if increased

Question 33

What's the normal range of procalcitonin?

Answer 33

Below 0.25mcg/L

Question 34

Sepsis symptoms in adults?

Answer 34

``` SEPSIS S=slurred speech or confusion E=extreme shivering or muscle pain P=passing no urine in a day S=severe breathlessness I=it feels like you're going to die S=skin mottled or discoloured ```

Question 35

What the sepsis 6 management plan?

Answer 35

1. Administer oxygen 2. Take blood culture 3. Give IV antibiotic 4. Give IV fluids 5. Check serum lactate and HB (ensure HB OVER 7G/DL) 6. Urine output sk mayve catheterisation

Question 36

What's typically used to treat sepsis?

Answer 36

Tazobactam STAT | and gentamicin