Question 1
Which of the following malarial species is associated with a persistent hypnozoite stage?
(A) P. Vivax
(B) P. falciparum
(C) P. ovale
(D) P. knowlesi
(E) P. malarae
A and C
Question 2
The majority of malarial infections occuring in Australia are caused by which species?
(A) P. Vivax
(B) P. falciparum
(C) P. ovale
(D) P. knowlesi
(E) P. malarae
A
Question 3
Which of the following treatments has the greatest efficacy for the liver stage of P. vivax or P. ovale?
(A) Arthemeter
(B) Artesunate
(C) Quinine
(D) Atovaquone-proguanil
(E) Primaquine
E:
Eliminates liver forms of P. vivax and ovale
Need G6PD screen
6mg/kg total dose
e.g. 70kg: 15mg BD for 14 days
> 70kg: extend > 14 days
Total dose of primaquine received is important
No other alternatives --> PEP lectures 2014
Question 4
A 46 year old male returns from Uganda after visiting his relatives. He presents with diarrhoea and high fevers. On examination he is confused and dyspnoeic. Thick and thin films are ordered, which show a parasitaemia of 10%. He is also mildly hypoglycaemic (BGL 3.8). What is the best management strategy?
(A) Admit and IV quinine + doxycycline
(B) Admit and IV artesunate + doxycycline
(C) Admit and PO arthemeter
(D) Admit and PO atovaquone + proguanil
(E) Admit and PO chloroquine + primaquine
B: This patient has severe malria given he is confused, has hypoglycaemia and a parasitaemia >5%. He needs to be admitted (all malaria patients should be) and given IV therapy. SEAQUAMAT trial (artesunate vs, quinine): 38% less mortality with IV artesunate = Choice of therapy for severe malaria. According to the Australian therapeutic guidelines: Severe malaria: if available, IV artesunate 2.4mg/kg bolus IV 0, 12, 24 hours, daily until can tolerate PO, switch to oral artemether - lumefantrine to complete further 3 days
PEP 2014
Question 5
A 34 year old G1P0 patient requests your advice on malaria prophylaxis prior to travelling to Thailand. She is considering all her options, including melfloquine, malarone and doxycycline. She does not have a seizure disorder. Which of the following agents should be used?
(A) Melfloquine, started 3 weeks prior to travel and continue for 4 weeks post travel
(B) Doxycycline, started 1 day prior to travel and continued for 4 weeks post travel
(C) Melfloquine, started 1 day prior to travel and continue for 4 weeks post travel
(D) Malarone, started 1 day prior to travel and continue for 1 week post travel
(E) Malarone, started 3 weeks prior to travel and continue for 4 weeks post travel
A: Out of all the agents, only melfloquine is safe in pregnancy. Tetracyclines cause teeth staining and malarone doesnt have enough information to guarantee safety. Melfloquine should not be used, however, if there is a history of any type of seizure disorder or cardiac conduction disturbance. PEP 2014
Which of the following malarial species is associated with a persistent hypnozoite stage?
(A) P. Vivax
(B) P. falciparum
(C) P. ovale
(D) P. knowlesi
(E) P. malarae
A and C
Question 2
The majority of malarial infections occuring in Australia are caused by which species?
(A) P. Vivax
(B) P. falciparum
(C) P. ovale
(D) P. knowlesi
(E) P. malarae
A
Question 3
Which of the following treatments has the greatest efficacy for the liver stage of P. vivax or P. ovale?
(A) Arthemeter
(B) Artesunate
(C) Quinine
(D) Atovaquone-proguanil
(E) Primaquine
E:
Eliminates liver forms of P. vivax and ovale
Need G6PD screen
6mg/kg total dose
e.g. 70kg: 15mg BD for 14 days
> 70kg: extend > 14 days
Total dose of primaquine received is important
No other alternatives --> PEP lectures 2014
Question 4
A 46 year old male returns from Uganda after visiting his relatives. He presents with diarrhoea and high fevers. On examination he is confused and dyspnoeic. Thick and thin films are ordered, which show a parasitaemia of 10%. He is also mildly hypoglycaemic (BGL 3.8). What is the best management strategy?
(A) Admit and IV quinine + doxycycline
(B) Admit and IV artesunate + doxycycline
(C) Admit and PO arthemeter
(D) Admit and PO atovaquone + proguanil
(E) Admit and PO chloroquine + primaquine
B: This patient has severe malria given he is confused, has hypoglycaemia and a parasitaemia >5%. He needs to be admitted (all malaria patients should be) and given IV therapy. SEAQUAMAT trial (artesunate vs, quinine): 38% less mortality with IV artesunate = Choice of therapy for severe malaria. According to the Australian therapeutic guidelines: Severe malaria: if available, IV artesunate 2.4mg/kg bolus IV 0, 12, 24 hours, daily until can tolerate PO, switch to oral artemether - lumefantrine to complete further 3 days
PEP 2014
Question 5
A 34 year old G1P0 patient requests your advice on malaria prophylaxis prior to travelling to Thailand. She is considering all her options, including melfloquine, malarone and doxycycline. She does not have a seizure disorder. Which of the following agents should be used?
(A) Melfloquine, started 3 weeks prior to travel and continue for 4 weeks post travel
(B) Doxycycline, started 1 day prior to travel and continued for 4 weeks post travel
(C) Melfloquine, started 1 day prior to travel and continue for 4 weeks post travel
(D) Malarone, started 1 day prior to travel and continue for 1 week post travel
(E) Malarone, started 3 weeks prior to travel and continue for 4 weeks post travel
A: Out of all the agents, only melfloquine is safe in pregnancy. Tetracyclines cause teeth staining and malarone doesnt have enough information to guarantee safety. Melfloquine should not be used, however, if there is a history of any type of seizure disorder or cardiac conduction disturbance. PEP 2014
