4.11 U) Infectious Diseases Fever In Returned Traveller (Dunn)

Front 1

List the DDx for Tropical Causes of fever

in the returned traveller . (5)

Back 1

1. MALARIA
2. Dengue fever
3. Typhoid fever
4. Hepatitis
5. Viral Haemorrhagic Fever

Front 2

List the DDx for Non-tropical

causes of fever in the returned traveller (8)

Back 2

1. Gastroenteritis - Diarrhoeal disease
2. Respiratory tract infections - influenza / pneumonia
3. Meningococcal disease
4. Sexually transmitted diseases
5. Gram negative sepsis
6. HIV
7. Infective endocarditis
8. Drug-induced / related

Front 3

In regards to incubation periods and aetiology for fever, which of the

following is not typically seen in

the < 7-10 day period?
A. Dengue fever
B. Hepatitis A
C. Malaria
D. Yellow fever

Back 3

B. Hepatitis A : 15-45 days

Front 4

In regards to incubation periods, Which of the following is not seen in the < 7 day period in the returned traveller?
A. Typhoid fever
B. Dengue fever
C. Viral haemorrhagic fever
D. Meningococcal disease

Back 4

A. Typhoid fever 7-14 days

Front 5

In regards to incubation periods,

which of the following is not typically

seen in the 7-30 day period?

A. Malaria
B. Dengue fever
C. Hepatitis A
D. Typhoid fever

Back 5

B. Dengue fever 5-8 days

HAV: 15-45 days
Malaria : < 7 days to 6 months
Typhoid fever : 7-14 days

Front 6

In regards to Malaria, which of the following is incorrect?
A. It can present with headache, cough and GIT symptoms.
B. Thrombocytopenia and anaemia can occur.
C. On the thick and thin blood film, a RBC with > 1 parasite usually = falciparum.
D. The Classic Clinical Triad = Fever + splenomegaly + Anaemia.

Back 6

D. Malaria Triad = Fever + splenomegaly + THROMBOCYTOPENIA

Front 7

In regards to Typhoid, which of the following is incorrect?
A. It is a bacterial illness, caused by Salmonella typhi and parathyphi.
B. LFT can be deranged.
C. Most patients present with diarrhoea and fever.
D. Bradycardia with fever is Classical for Typhoid.

Back 7

C. Most patients present with constipation.

Front 8

In regards to Typhoid fever, which of the

following is incorrect?
A. Rose spots can be seen on the trunk as a macular rash.
B. Anaemia + thrombocytopenia can occur.
C. Acute renal failure (ARF) ,LFT derangements and DIC can occur.
D. Transmission is via fecal-oral route.

Back 8

B. Typhoid Fever = Anaemia + neutropenia +

lymphocytosis

Front 9

In regards to Dengue fever, which of the

following is incorrect?
A. It should be suspected in the patient who has fever within 2 weeks of travel ( incubation period 5-8 days).
B. Transmission is by fecal oral route.
C. = "Breakbone fever" : severe myalgias plus retro-orbital pain.
D. Thrombocytopenia can occur.

Back 9

B. Mosquito transmission

Front 10

Which out of Malaria, Dengue fever and Typhoid does not typically have thrombocytopenia?

Back 10

They all can.

Front 11

Link the main test(s) with the Disease process.
A. Malaria - PCR serology
B. Typhoid - Blood / urine cultures
C. Dengue Fever - Rapid ICT Antigen test
D. Typhoid - IgM Ab.

Back 11

D. is wrong

Malaria = Thick + Thin films and Rapid Ag ICT test
Typhoid = Blood and urine cultures
Dengue = PCR serology and IgM Ab.

Front 12

Which is incorrect regarding Fever in the

Traveller?
A. Large blood and PMN in stool samples suggests Shigella.
B. Eosinophilia usually suggests parasitic infection
C. The positive tourniquet test is performed for typhoid fever.
D. The typhoid vaccination is only 75% effective.

Back 12

C. Positive tourniquet test for Dengue :

20 petechiae / square inch.

Front 13

List the main investigations in the returned

traveller with fever.

Back 13

1. FBC / U+E / LFT / COAGS

2. Blood cultures
3. Thick +Thin film AND Rapid Antigen test (ICT) for Malaria

4. Urine m/c/s

5. Stool o/c/p culture
6. CXR
7. Other serology : Dengue: PCR and IgM Ab
8. Hepatitis HIV
9. Other: LP for meningo-encephalitis