Travel Medicine

Question 1

Define traveller’s diarrhea

Answer 1

3 or more loose stools/day

Question 2

How do most cases resolve?

Answer 2

Self-limiting

Question 3

After how many days do most cases resolve?

Answer 3

1-2 days even without treatment

Question 4

What is the commonest cause of acute TD

Answer 4

ETEC

Question 5

When you have bloody TD what organism is causing it?

Answer 5

Salmonella
Campylobacter
Entamoeba histolytica

Question 6

What is the commonest cause of watery TD?

Answer 6

ETEC
Viral
Cholera

Question 7

What investigations do you do post travel in TD?

Answer 7

Stool microscopy and culture

Question 8

Which organisms are water born in traveler and can be vaccinated for?

Answer 8

HepA
Thyphoid
Cholera

Question 9

Which organisms are vector born in traveler and can be vaccinated for?

Answer 9

Yellow fever

Japanese Encephalitis

Question 10

Which organisms are Respiratory born in traveler and can be vaccinated for?

Answer 10

Meningococcal

Influenza

Question 11

Which organism is blood/body fluid born in traveler and can be vaccinated for?

Answer 11

HBV

Question 12

Which organisms are environmentally caught in traveler and can be vaccinated for

Answer 12

Rabies

Tetanus

Question 13

Does HepA cause a chronic infection?

Answer 13

No

Question 14

How is HepA vaccine scheduled?

Answer 14

2 doses at least 6 months apart
No booster recommended

Available alone or in combo wit HBV and typhoid

Question 15

Which organism causes typhoid?

Answer 15

Salmonella Typhi

S. paratyphi

Question 16

What is the name of the typhoid vaccine?

Answer 16

Polysaccharid vaccine Typherix

Allows 3 year protection

Question 17

What are the symptoms of cholera?

Answer 17

profuse watery diarrhea

Question 18

what is the cholera vaccine composed of?

Answer 18

V. Cholerae O1 organism +

non-toxic B subunit of cholera toxin

Question 19

What is yellow fever?

Answer 19

viral disease spread by mosquitoes

Question 20

what does yellow fever cause?

Answer 20

hepatitis and encephalitis

Question 21

what are c/i for yellow fever vaccine?

Answer 21

severe egg allergy
immunodeficiency
pregnancy
infants

Question 22

How many doses are there of HepB vaccine?

Answer 22

2

0, 1, 6 months

Question 23

What is the post- exposure treatment of rabies?

Answer 23

BEST GIVEN WITHIN 48 hours

• provide wound care (tetanus)
• 4 doses of vaccine: 0, 3, 7, 14
• human rabies immune globulin

Question 24

What is the incubation period of malaria?

Answer 24

7-10 days

Question 25

What does an incubation period of more than 3 weeks exclude?

Answer 25

Arboviruses (dengue) and viral hemorrhagic fevers

Question 26

most common health problems following travel?

Answer 26

TD RTI Skin problems

Question 27

what are the most life treatening traveler illnesses?

Answer 27

Falciparum malaria Bacterial sepsis Viral hemorrhagic fever

Question 28

How do you diagnose enteric fever?

Answer 28

FBE - normal WCC with left shift LFT - commonly abnormal Blood culture - gram negative bacilli, stool culture

Question 29

How do you treat enteric fever?

Answer 29

Ceftriaxone | Quinolone

Question 30

Where is Malaria endemic?

Answer 30

PNG India/Pakistan Africa Indonesia

Question 31

How is malaria transmitted?

Answer 31

Anopheles mosquitoes

Question 32

Which plasmodia infect humans?

Answer 32

P. falciparum P. vivax, P. ovale P. malariae

Question 33

Why is P. falciparum dangerous?

Answer 33

Causes almost all deaths/severe disease No dormant liver stage, no late relapse Often drug resistant MEDICAL EMERGENCY

Question 34

What is important about P. vivax?

Answer 34

Produce hypnozoites | Cause late relapse because has a liver phase?

Question 35

What are the symptoms of malaria?

Answer 35

- Not specific - Flu-like illness, fever, chills - Pain (headache, muscle, back) - Fatigue, malaise - Nausea, vomiting, diarrhea, - Cough

Question 36

what is the mortality of malaria?

Answer 36

15-25%

Question 37

Factors responsible for death:

Answer 37

``` Parasitaemia Delayed presentation, missed diagnosis No prophylaxis Extreme of age Splenectomy Pregnancy ```

Question 38

How do you diagnose malaria?

Answer 38

FBE: might see hemolytic anemia, thromocytopenia Thick blood smear Thin blood smear and do parasite count Antigen capture test: finger prick blood sample.

Question 39

What is the treatment of malaria for vivax and ovale?

Answer 39

chloroquine when in blood stage primaquine for liver stage

Question 40

What is the treatment of malaria for vivax when it is resistant to chloroquine?

Answer 40

treat like falciparum

Question 41

What is the first line treatment of P. falciparum?

Answer 41

Riamet | Malarone

Question 42

what are the indications for malaria iv therapy?

Answer 42

- cannot tolerate oral therapy - altered consciousness - > 5% parasitemia - Jaundice, oliguria, severe anemia, hypoglycemia, acidosis, ARDS

Question 43

what agents are used for malaria prophylaxis?

Answer 43

Chloroquine Mefloquine Doxycycline Malarone

Question 44

How do you catch Dengue?

Answer 44

Mosquitoe Flavivirus

Question 45

what are the symptoms of dengue?

Answer 45

fever | classic rash

Question 46

how to diagnose?

Answer 46

Neutropenia with lymphocytosis Thrombocytopenia Mildly raised ALT and AST 4 fold rise in Ab over 2 weeks Flavivirus PCR

Question 47

What is the management of dengue?

Answer 47

symptomatic | supportive

Question 48

Fever + rash? Cause?

Answer 48

Dengue Typhoid Ricketssia

Question 49

Fever+ diarrhea

Answer 49

TD Malaria Typhoid