Malaria

Question 1

How is malaria transmitted.

Answer 1

Via mosquito bites.

Question 2

What is the name given to the parasite that causes malaria.

Answer 2

Plasmodium.

Question 3

How many plasmodium species are there.

Answer 3

4.

Question 4

What are the plasmodium species. (4)

Answer 4

Falciparum.
Vivax.
Ovale.
Malariae.

Question 5

Which two plasmodium species can remain dormant and cause recurrent infections. (2)

Answer 5

Ovale.

Vivax.

Question 6

Where does malaria occur.

Answer 6

In tropical areas.

Question 7

What are the symptoms of malaria. (6)

Answer 7

Fever. 
Fatigue. 
Myalgia. 
Headache. 
Nausea. 
Vomiting.

Question 8

What are the physical signs of malaria. (4)

Answer 8

Tachycardia.
Anaemia.
Jaundice.
Splenomegaly.

Question 9

What tests should be carried out in a patient with malaria. (10)

Answer 9

FBC (anaemia, thrombocytopenia). 
Clotting (DIC). 
Glucose (hypoglycaemia). 
ABG/lactate (lactic acidosis).
UandEs (renal failure). 
LFTs. 
CRP/ESR.
Urinalysis (haemoglubinuria, proteinuria, casts). 
Blood smears.

Question 10

What is seen on the blood results of a patient with malaria. (3)

Answer 10

Anaemia.
Raised ESR.
Raised CRP.

Question 11

What is the main subspecies that can cause complications in malaria.

Answer 11

Falciparum malaria.

Question 12

What are the clinical manifestations of falciparum malaria. (3)

Answer 12

Renal impairment.
Hypoglycaemia.
Cerebral malaria.

Question 13

What are the symptoms of falciparum malaria. (6)

Answer 13

Prodromal headache. 
Malaise. 
Myalgia. 
Possible faints. 
Fever.

Question 14

What are the main physical signs of falciparum malaria. (3)

Answer 14

Anaemia.
Jaundice.
Hepatosplenomegaly.

Question 15

What is not seen in falciparum malaria. (2)

Answer 15

No rash or lymphadenopathy.

Question 16

What are the complications of falciparum malaria. (2)

Answer 16

Anaemia.

Thrombocytopenia.

Question 17

What are the ‘5 grim signs’ associated with survival rate in falciparum malaria. (5)

Answer 17

Reduced consciousness/coma (cerebral malaria).
Convulsions. 
Co-existing chronic illness. 
Acidosis. 
Renal failure.

Question 18

What blood test is done to diagnose malaria.

Answer 18

Thick and thin blood films.

Question 19

What is the most dangerous form of malaria.

Answer 19

Falciparum malaria.

Question 20

What is the mortality rate for falciparum malaria. (2)

Answer 20

100% if left untreated.

15-20% with treatment.

Question 21

What are some protective factors against malaria. (4)

Answer 21

G6PD deficiency.
Sickle cell trait.
Melanaesian ovalocytosis.
Some HLAB53 alleles enable T cells to kill parasite infected hepatocytes in non-Europeans.

Question 22

What is the newest form of malaria.

Answer 22

Plasmodium knowlesi.

Question 23

Who is the primary carrier of p.knowlesi malaria.

Answer 23

Common in monkeys.

Question 24

Who is susceptible to malaria in the West.

Answer 24

Travellers.

Question 25

How many malaria cases are reported in the UK due to travelling.

Answer 25

2,000 per annum.

Question 26

What occurs to RBCs infected with malaria.

Answer 26

Haemolysis.

Question 27

What is seen on a blood film in a patient infected with malaria. (3)

Answer 27

Ring form on RBCs. Trophozoite in RBCs. Schizont in RBCs.

Question 28

What are the neurological signs of malaria. (5)

Answer 28

``` Coma. Hypoglycaemia. Seizures. Cranial nerve palsies. Opisthotonus. ```

Question 29

What are the features of the FBC in a patient with malaria. (4)

Answer 29

Parasitaemia. Anaemia. Thrombocytopenia. Colagulopathy.

Question 30

What are the respiratory features of malaria infection. (2)

Answer 30

Pulmonary oedema. | Secondary bacterial pneumonia.

Question 31

What are the CVS features of malaria infection. (3)

Answer 31

Shock. Cardiac failure ('algid malaria'). Dysrhythmias with quinine.

Question 32

What are the renal features of malaria infection. (2)

Answer 32

Acute renal failure. | Severe haemolysis resulting in haemoglobinuria ('blackwater fever').

Question 33

What are the abdominal features of malaria infection. (3)

Answer 33

Jaundice. Tender liver edge with hepatitis. Pain in LUQ with splenomegaly.

Question 34

What optic sign can malaria cause.

Answer 34

Retinopathy with roth spots.

Question 35

What is the most important diagnostic features of malaria.

Answer 35

Fevers in any patient who has a travel history - very important to diagnose and direct investigations according to risk status.

Question 36

Who is most at risk of complications of a malaria infection.

Answer 36

Pregnant women.