| Malaria | Traveler's Diarrhea | Vaccines | Misc | Infants & Pregnant Patients |
|---|---|---|---|---|
|
B. Plasmodium falciparum
Chemoprophylaxis is 80-90% effective at preventing episodes of primary malaria, if taken correctly
The primary goal of malaria chemoprophylaxis is to prevent death from this strain__________
a. Plasmodium vivax b. Plasmodium falciparum c. Plasmodium ovale d. Plasmodium malariae |
C. Ecoli enterotoxigenic (50% in LA & Africa; 33% in Asia) Shigella/Salmonella/Camplobacter (20%)
Norovirus – 10-20%. Giardia - less common, has a 1-2 week incubation period
Name the most common causes of Traveler’s Diarrhea?
a. Norovirus b. Shigella c. E.coli d. Salmonella e. Giardia |
D. No limit.
- Most vaccines can be given on same day at separate sites without impairing antibody responses or increasing rates of adverse reactions. Review timing between doses and PPD
How many vaccines can be given at one time?
a. Three b. Four c. Five d. No limit |
B. Descent - High Altitude Related Illness - Includes Acute Mountain Sickness, High Altitude Pulmonary Edema (HAPE) and High Altitude Cerebral Edema (HACE). Most effective treatment for all is descent. Only effective treatment for HAPE and HACE- others are only temporizing measures.
A 32 y/o man from RI is on a trek to Machu Picchu. On the 2nd day, he starts to develop headache, nausea, fatigue, and lightheadedness. What is the most effective way to treat his condition?
a. Stopping, resting, and using Tylenol/anti-nausea medication prior to descending b. Descending c. Diamox d. Fluids |
C. 2 Months -DEET concentration up to 30% should be applied every 4 hours. Picaridin needs to be applied Q2 hours. When is most important time?
At what age can you start using DEET in children?
a. 2 wks b. 1 month c. 2 months d. 6 months e. 1 year |
|
D. Chloroquine can be used in all trimesters. Very small amounts secreted in milk
- Mefloquine – for chloroquine resistant malaria, does enter milk, unclear data on 1st trimester - Atovaquone/proguanil– not recommended for pregnancy, do not use if infant is <5kg (11lbs) - Doxycycline and Tafenoquine - not safe in either
Which Malarial chemoprophylaxis is safe both during pregnancy and lactation?
a. doxycycline b. atovaquone/proguanil (Malarone) c. mefloquine d. chloroquine e. Tafenoquine (Arakoda) |
A. Bactrim due to widespread resistance, emerging resistance to Flourquinolones esp in SEA
- Best evidence for Azithro
Which of the following should not be given for the treatment of moderate or severe travelers’ diarrhea?
a. Bactrim DS b. Azithromycin c. Cipro d. Rifaximin e. Rifamycin SV |
C. Meningococcal Vaccine - Covers A,C,Y, W-135
- Most common strain in Africa ___. High risk time of the year is ____
Which vaccine is required before going to the Hajj?
a. Yellow Fever b. Tdap c. Menactra d. Hep B |
D. Mefloquin - It can prolong QTc intervals and decrease levels of anticonvulsants
Which of the following does not cause an increase in INR in patients taking coumadin?
a. Doxycycline b. Ciprofloxacin c. Azithromycin d. Mefloquine |
B. Between 14-28 wk GA. Most common obstetric emergencies occur in 1st and 3rd trimesters. Available information suggests that noise, vibration, and cosmic radiation present a negligible risk for the occasional pregnant air traveler. Travel is not recommended > 36wk GA but is airline dependent.
What is the safest time to travel when pregnant?
a. 4-13 weeks b. 14-28 weeks c. 28-36 weeks d. > 36 weeks |
|
Standby Emergency Self Treatment
- a supply of antimalarial meds for use in case of infection. Consider in if traveling to remote area where medical attention is not readily available but risk of malaria is low. Or if refuse or require or choose a suboptimal prophylaxis regimen
What does SBET stand for and when is it indicated?
|
D. Bismuth subsalicylate (pepto bismal, kayopectate) is not safe in children (F) Concern for Reyes syndrome in children <12yrs.
Which of the following are false about feeding in infants/children with travelers’ diarrhea?
a. There is no advantage to lactose free formula b. Breastfed infants should continue breast feeding after rehydration c. Bottle fed infants should continue bottle feeding after rehydration d. Bismuth subsalicylate (pepto bismal, kayopectate) is safe in children |
6 months (will need to get 2 more doses after turning 1, 28 days apart) . If infant >12 months, give 2 doses 28 days apart
The parents and their 6 month old are traveling to Thailand. When is the earliest an MMR can be given?
|
D. Long bone fracture, if <48 hrs need to place in bivalve cast as air can be trapped
Which of the following does not require a wait prior to flying…
a. NSTEMI b. Acute Heart Failure c. CVA d. Long bone fracture e. Skull fracture |
starting at 40lbs can use the aircraft seat belt.
At what weight can children use the aircraft seat belt?
|
|
P. Vivax and P. Ovale - Both cause latent infection in liver --not killed by most chemoprophylaxis mainly active against ‘blood’ stage. Relapse can occur > year after infection. Hard to detect as less parasitemia.
Primaquine effective against liver stage - can give as Post Exposure Contraindicated if G6PD deficiency - causes hemolytic anemia
What 2 strains of malaria cause relapsing infection? Why?
a. Plasmodium vivax b. Plasmodium falciparum c. Plasmodium ovale d. Plasmodium malariae |
C. Anti motility drugs can be used as monotherapy for those who have dysentery (diarrhea and fever.)
Which of the following is false:
a. Loperamide may be used as monotherapy for moderate travelers’ diarrhea. b. Anti motility drugs should not be used alone for patients with bloody diarrhea c. Anti motility drugs can be used as monotherapy for those who have diarrhea and fever. d. Loperamide has antisecretory properties. |
2 doses, at 0 to 24 hours post bite and day 3, no Rabies IG. If no PEP, 4 doses at day 0, 3, 7, 14 and Rabies IG on day 0
A veterinary student received pre-exposure rabies prophylaxis prior to an international rotation. If bitten by a rabid dog how many doses of vaccine are needed?
|
Parasite: Chagas (Treponema cruzi), Malaria. Bacteria: Typhoid (Salmonella enterica). Virus: Chikungunya (Alphavirus), Dengue (Flavivirus)
Classify the following as bacteria, parasite, virus illnesses?
a. Chagas b. Chikungunya c. Dengue d. Malaria e. Typhoid |
A. 1-2 week old, if necessary. Better if wait 6 -12wks if traveling internationally since that’s the earliest immunizations can be started on an accelerated schedule. Place in car safety seat (FAA approved) seat appropriate for the age, weight and height of the child.
At what age can a newborn travel by airplane?
a. 1 wk b. 4 wks c. 6 wks d. 8 wks |
|
C. Mefloquine and E. Tafenoquine (Arakoda) - Contraindicated if history of seizure, manic depression, depression may cause anxiety, sleep disturbance, acute psychosis
Which 2 malaria prophylaxis are associated with neuropsychiatric side effects?
a. doxycycline b. atovaquone/proguanil (Malarone) c. mefloquine d. hydroxychloroquine e. Tafenoquine (Arakoda) |
All the above
Which of the following is true about antibiotic prophylaxis for traveler's diarrhea
a. It is no longer recommended b. It increases the risk of microbial resistance and ESBL c. Campylobacter and Shigella resistance has emerge to Fluoroquinolones d. They may be considered for short-term travelers who are high-risk hosts |
A. It takes 2 weeks for most inactivated vaccines (meningitis, influenza, typhoid-IM, Cholera-oral). For multi-dose series often 2 wks after dose 2
A patient at your travel clinic got a Hepatitis A shot. How long after vaccination does partial protection begin?
a. 2 weeks b. 4 weeks c. 2 months d. 6 months |
C. Dengue.Tourniquet Test. Inflate bp cuff ½ way between SBP & DBP for 5 minutes. Positive if >= 10 or petechiae/per square inch below cuff
You are in Brazil evaluating a patient with a severe febrile illness, myalgia, and a rash, you have no lab near you, what test can you perform to distinguish between the following? Which one does it identify?
a. Chagas b. Chikungunya c. Dengue d. Malaria e. Typhoid |
C. Yellow Fever Vaccine - Infants are at high risk for developing encephalitis from this live virus vaccine. Travelers with infants and pregnant travelers should be discouraged from traveling to endemic areas. It is unknown whether or not vaccine virus is transmitted in breast milk.
Which vaccine (and why) is unsafe in infants under 9 months, pregnant people and should only be given during lactation if traveler is at very high risk for exposure to mosquitos in endemic countries?
a. Varicella vaccine b. Measles vaccine c. Yellow Fever vaccine d. Japanese Encephalitis vaccine |
Support Us on Ko-fi