Travel Medicine

Question 1

General counselling for motion sickness, jet lag + VTE on flights

Answer 1

Motion sickness: sit in centre of vehicle, take prophylactic antiemetic
Jet lag: active in sunlight on arrival
VTE: fluids, move about

Question 2

What should you have in a travel Health kit?

Answer 2

bandages, gauze, insect repellant, bite treatment, antihistamine, ORS, analgesiic, sunscreen

Question 3

Food + water safety

Answer 3

Avoid tap water, ice from tap water
Unpasteurized foods
Open buffers

Question 4

High risk activities

Answer 4

STI, blood exposure, car safety
Water safety
High altitudes

Question 5

Malaria counselling

Answer 5

Avoid dawn and dusk, full length clothes, insect repellant, inspect for ticks

Question 6

Malaria rx: when to start, SE

Answer 6

Atovaquone/proguanil (Malarone) daily
Start 1 day prior, continue 7d after
Avoid in children <5kg

Mefloquine (Lariam) weekly
Start 3w prior, continue 4w after
AE: Severe intolerance in some patients

Chloroquine 500mg weekly: start 1-2 wks before until 4wks after
Resistant areas: sub-saharan africa, south america except argetina, Asia

Doxycyline 100mg once daily: start 1d before travel until 4wks after

Question 7

Ix for malaria

Answer 7

CBC (anemia, lymphopenia, thrombocytopenia, eosinophilia)
Thick and thin blood smear r/o Malaria (consider repeat q12h until three negative smears as parasitemia is cyclical)

Question 8

Sx, signs + cause of malaria

Answer 8

Plasmodium protozoa
Sx: cough, fatigue, malaise, arthralgia, myalgias, fever
Signs: splenomegaly, jaundice

Question 9

Complications of malaria

Answer 9

Complications: sz, AKI, hypoglycemia, pulmonary edema, lactic acidosis, hemolysis + bleeding

Question 10

Travellers diarrhea rx

Answer 10

Typically lasts 2-4 days
Management: loperamide 4mg then 2mg after each BM, azithromycin 1000mg x1

Question 11

Altitude sickness cause + sx

Answer 11

Pulmonary edema, cerebral edema, usually >2500m
Sx: HA, weakness, fatigue, nausea, insomnia, reduced appetite, SOB, cough, hemoptysis

Question 12

Altitude sickness prevention + rx

Answer 12

Prevention: slow ascent, acetazolamide (diuretic)/ dexamethasone
Rx: dexamethasone, nifedipine, sildenafil, ventolin

Question 13

Causes of Fever based on when travel was:
<10d
<21d
>21d
>30d

Answer 13

<10d: travelers diarrhea, dengue fever, yellow fever, spotted fever, diphtheria, malaria, rabies, typhoid, typhus
<21d: leptospirosis, malaria, typhoid
>21d: viral hepatitis, malaria, acute HIV, schistosomiasis, leishmaniasis
>30d: TB, malaria, hep B or C, HIV, syphilis

Question 14

Travel hx qs

Answer 14

when, where, how long, why, PMH, allergies

Question 15

Vaccines for travellers

Answer 15

hep A, B, rabies, routine vaccinations (flu, shingrix, tetanus, pertussis, covid), typhoid, meningitis, yellow fever, encephalitis depending on country

Question 16

What places would you recommend typhoid vax?

Answer 16

Central and SE Asia

Question 17

Who would you advise NOT to have probiotics to prevent C diff?

Answer 17

Pregnant, ICU, prosthetic heart valves, IBD

Question 18

Bacteria causing travellers diarrhea

Answer 18

campylobacter, salmonella, e coli, shigella

Question 19

What to give before, during and after travel

Answer 19

before (antimalarials, vaccines)
during (antimalarials, antidiarrheals, insect precautions, activities)
after (antimalarials, Zika precautions)

Question 20

1st line antimalarial + key points to remember

Answer 20

malarone (atovaquone + proguanil) - expensive, only need for 7 days after trip

Question 21

2nd line antimalarial + key points to remember

Answer 21

doxycycline, cheap, photosensitivity rash, need for 30d after trip

Question 22

Antimalarial for use in pregnancy

Answer 22

advise not to travel, if they have to use mefloquine - once weekly, SE are wild dreams + psychosis

Question 23

Rx for confirmed malaria

Answer 23

artemisinin combo or quinine combo + prophylaxis drugs

Question 24

Advice for travellers

Answer 24

limit high risk activites (MVA, sex), don’t check meds into luggage

Question 25

Advice for travellers for diarrhea

Answer 25

Pack ORS, loperamide, azithromycin, pepto bismol (can use QID for prevention), boil/ peel/ cook food, avoid ice cubes/ salads, uncooked veggies, use bottled water, wash hands

Question 26

Meds for altitude above 2800m

Answer 26

acetazolamide, dexamethasone, nifedipine, viagra

Question 27

Causes of fever in travelers

Answer 27

malaria, travelers diarrhea, resp infections

Question 28

When should loperamide not be used in travelers diarrhea?

Answer 28

Severe diarrhea w/ dysentry (blood in stool)

Question 29

What can you use to prevent diarrhea when travelling?

Answer 29

Pepto bismol QID

Question 30

SE of pepto bismol

Answer 30

black tongue, black stools, constipation