Malaria

Front 1

the cause of most cases of severe disease and most deaths, predominates in Africa, New Guinea, and Hispaniola

Back 1

P. falciparum

Front 2

is more common in Central America

Back 2

P. vivax

Front 3

both are equally prevalent in South America, the Indian subcontinent, eastern Asia, and Oceania.

Back 3

P. falciparum and P. vivax

Front 4

is unusual outside of Africa, where it makes up ~1% of isolates.

Back 4

P. ovale

Front 5

is found in most areas (especially throughout sub-Saharan Africa) but is less common

Back 5

P. malariae

Front 6

(the monkey parasite) can reliably be identified only by molecular techniques and is present in Borneo and Southeast Asia.

Back 6

P. knowlesi

Front 7

Malaria is the most important parasitic disease in humans, causing about ____ deaths each year.

Back 7

1 million

Front 8

After introduction of ____ into the bloodstream by female anopheline mosquitoes, the parasite travels to the liver.

Back 8

sporozoites

Front 9

After introduction of sporozoites into the bloodstream by female anopheline mosquitoes, the parasite travels to the liver and reproduces to form _____ that infect the RBCs.

Back 9

merozoites

Front 10

The merozoites transform into ______, feed on intracellular proteins (principally hemoglobin), multiply 6-20 fold every 48-72 h, and cause the RBCs to rupture

Back 10

trophozoites

Front 11

Some parasites develop into long-lived sexual forms called ___, which can be taken up by another female anopheline mosquito allowing transmission

Back 11

gametocytes

Front 12

in P vivax or P ovale infection, dormant forms called _____ remain in liver cells and may cause disease 3 weeks to more than 1 year later

Back 12

hypnozoites

Front 13

RBCs infected with P falciparum may exhibit ______ (attachment to venular and capillary endothelium), ______ (adherence to uninfected RBCs), and agglutination (adherence to other infected RBCs)

Back 13

cytoadherence, rosetting

Front 14

adherence to uninfected RBCs

Back 14

rosetting

Front 15

adherence to other infected RBCs

Back 15

agglutination

Front 16

Cytoadherence, rosetting and agglutination causes sequestration of P. falciparum in vital organs, with consequent underestimation of ____ numbers in the body

Back 16

parasite

Front 17

_____ is central to the pathogenesis of falciparum malaria but is not evident in the other three "benign" forms

Back 17

Sequestration

Front 18

In ______ individuals, infection triggers nonspecific host defense mechanisms such as increased splenic filtration

Back 18

nonimmune

Front 19

with repeated exposure to malaria, patients develop ____ to high-level _______ and disease but not to infection

Back 19

resistance, parasitemia

Front 20

______ (eg sickle cell disease, ovalocytosis, thalassemia) and G6PD deficiency are more common in endemic areas and protect death from malaria.

Back 20

Hemoglobinopathies

Front 21

Pts initially develop nonspecific symptoms (e.g., headache, fatigue, myalgias) that are followed by _____

Back 21

fever

Front 22

Febrile paroxysms at regular intervals are unusual and suggest infection with _____ or ______.

Back 22

P vivax or P ovale

Front 23

The diagnosis of severe falciparum malria requires more than one or one of the following:

Back 23

impaired consciousness/coma, severe normocytic anemia, renal failure, pulmonary edema, ARDS, circulatory shock, DIC, spontaneous bleeding, acidosis, hemoglobinuria, jaundice, repeated generalized convulsions, and a parasitemia level of more than 5%

Front 24

_____ malaria manifests as diffuse symmetric encephalopathy, typically without focal neurologic signs

Back 24

Cerebral

Front 25

_____ is an ominous sign associated with mortality rates of ~20%

Back 25

Coma

Front 26

______ women have unusuall severe illness.

Back 26

Pregnant women.

Front 27

Premature labor, fetal distress, stillbirth and delivery of low-birth-weight infants are common.

Back 27

Pregnant women

Front 28

_______ (hyperreactive malarial splenomegaly) may result as a chronic complication of malaria and is characterized by massive splenomegaly, hepatomegaly, and an abnormal immunologic response to infection.

Back 28

Tropical splenomegaly

Front 29

Although antibody-based diagnostic tests are being used with increasing frequency, demonstration of ______ forms of the parasite on __________ is required for diagnosis.

Back 29

asexual; peripheral blood smears

Front 30

______ and the less sensitive thin smears detect parasitemia levels as low as 0.001% and ~0.05%, respectively

Back 30

Thick

Front 31

If the level of clinical suspicion is high and smears are initially negative, they should be repeated _________ for 2 days.

Back 31

every 12-24 hours

Front 32

Other laboratory findings generally include ______,______ anemia; elevated ________ markers, and thrombocytopenia.

Back 32

normochromic, normocytic and inflammatory

Front 33

Treatment for uncomplicated malaria

Back 33

chloroquine-sensitive strains of P vivax, P malariae, P ovale, P knowlesi, P falciparum - the treatment is Chloroquine (10mg of base/kg stat followed by 5mg/kg at 12, 24, and 36 h or by 10 mg/kg at 24 h and 5 mg/kg at 48 hours) OR
Amodiaquine (10-12 mg of base/kg qd for 3 days)

Front 34

Radical treatment for P vivax or P ovale infection

Back 34

chloroquine , amodiaquine,
primaquine should be given (0.5mg of base/kg qd) for 14 days to prevent relapse. In mild G6PD deficiency, 0.75,g of base /kg should be given once weekly for 6-8 weeks.

Front 35

This drug should NOT be given in severe G6PD deficiency

Back 35

Primaquine

Front 36

Treatment for sensitive P. falciparum malaria

Back 36

Front 37

Treatment for multidrug-resistant P falciparum malaria

Back 37

Either artemether-lumefantrine (1.5/9 mg/kg bid for 3 days with food) or Artesunate (4 mg/kg qd for 3 days) PLUS mefloquine (25 mg of base/kg - either 8 mg/kg qd for 3 days or 15 mg/kg on day 2 and then 10 mg/kg on day 3)

Front 38

Second-line treatment/treatment of imported malaria

Back 38

Front 39

Treatment for severe falciparum malaria

Back 39

Front 40

Pts receiving _______ should undergo cardiac monitoring;

Back 40

quinidine

Front 41

Pts receiving quinidine should undergo cardiac monitoring; a total plasma level of more than 8ug/mL, increased QT intervals, or QRS widening by more than 25% is an indication for _____ the infusion rate.

Back 41

slowing

Front 42

______ is the drug of choice when available.

Back 42

Artesunate

Front 43

The WHO now recommends artemisinin combination regiments as first line therapy for _______ malaria in all tropical countries and advocates use of fixed-dose combinations.

Back 43

falciparum

Front 44

_____ and ____ should NOT be given to pregnant women or to children below 8 years of age.

Back 44

Tetracycline ; doxycycline

Front 45

Infusion rates for _____ and ______ should be carefully controlled.

Back 45

quinine, quinidine

Front 46

All pts with severe malaria should receive a continuous infusion of _____.

Back 46

dextrose

Front 47

Unconscious pts should have blood glucose levels measured every _____ hours

Back 47

4-6

Front 48

Parasite counts and hematocrits for pts with severe malria and pts with uncomplicated disease should be measured every ______ and ____ respectively.

Back 48

6-12, 24

Front 49

_______ (0.5 mg of base/kg for 14 days) eradicates persistent liver stages and prevents relapse in P vivas or P ovale infection. G6PD deficiency must be ruled out before treatment.

Back 49

Primaquine

Front 50

Peak feeding times

Back 50

dusk and dawn

Front 51

____ is the only drug advised for pregnant women traveling to areas with drug-resistant malaria and is generally safe in the 2-3 trimesters.

Back 51

Mefloquine

Front 52

Back 52

Atovaquone/ proguanil (Malarone)

Front 53

____ is contraindicated in persons with severe renal impairment. And should be taken with food or a milky drink.

Back 53

Atovaquone/proguanil

Front 54

_____ may exacerbate psoriasis.

Back 54

Chloroquine phosphate

Front 55

Back 55

Chloroquine phosphate

Front 56

Back 56

Doxycycline

Front 57

____ is contraindicated for children less than 8 years of age and for pregnant women.

Back 57

Doxycycline

Front 58

Back 58

Hydroxychloroquine sulfate

Front 59

Back 59

Mefloquine

Front 60

____ may exacerbate psoriasis

Back 60

Hydroxychloroquine

Front 61

Contraindicated in persons allergic to this drug or related compounds (eg quinine and quinidine) and in persons with active or recent depression, generalized anxiety disorder , psychosis, schizophrenia, other major psychiatric disorders or seizures.

Back 61

Mefloquine

Front 62

Use with caution in persons with psychiatric disturbances or a history of depression

Back 62

Mefloquine

Front 63

_____ is not recommended for persons with cardiac conduction abnormalities

Back 63

Mefloquine

Front 64

_________ is contraindicated in persons with G6PD deficiency.

Back 64

Primaquine

Front 65

_____ is also contraindicated during pregnancy and in lactation unless the infant being breast fed has documented normal G6PD level.

Back 65

Primaquine

Front 66

This therapy is indicated for persons who have had prolonged exposure to P vivax and/or P ovale. It is contraindicated in persons with G6PD deficiency as well as during pregnancy and in lactation unless the infant being breast-fed has a documented normal G6PD level.

Back 66

Primaquine

Front 67

Back 67

primaquine

Front 68

The process of reproduction of sporozoites in the hepatocytes of humans leading to production of merozoites.

Back 68

Merogony/Schizogony

Front 69

The dormant forms of P. vivax and P. ovale which cause relapse in people who are infected with these malarial species.

Back 69

Hypnozoites

Front 70

The arthropod host of plasmodium species.

Back 70

Anopheles sp.

Front 71

Aside from cytoadherence and agglutination, which other process plays a role in the sequestration of RBCs with mature P. falciparum parasites in the human vital organs?

Back 71

Rosetting

Front 72

Aside from failure of hepatic gluconeogenesis, what other mechanism is responsible for the hypoglycaemia seen in malaria?

Back 72

Increased glucose consumption

Front 73

Type of smear used in performing parasite count.

Back 73

Thick blood smear

Front 74

Type of smear used in identifying the malarial parasite species.

Back 74

Thin blood smear

Front 75

The drug of choice for severe falciparum malaria.

Back 75

Artesunate

Front 76

In patients with P. ovale or P. vivax, which agents address the hepatic stage of the parasite thereby preventing relapse?

Back 76

Primaquine

Front 77

The only antimalarial drug that can be given to a pregnant patient.

Back 77

Mefloquine

Front 78

Hepatic form of P. ovale and p. vivax
responsible for relapse.

Back 78

HYPNOZOITES

Front 79

Give 1 principal Determinant of malarial
transmissibility:

Back 79

NUMBER/ DENSITY, HUMANBITING
HABITS, LONGEVITY OF ANOPHELINE
MOSQUITO

Front 80

Sequestration of RBC with malarial parasite can
occur in all plasmodium species:

Back 80

False

Front 81

Signs of severe malaria:

Back 81

CEREBRAL MALARIA,
ACIDOSIS, RENAL FAILURE, ARDS/
PULMONARY FAILURE, SEIZURES OR
CONVULSIONS, IMPAIRED CONSCIOUSNESS

Front 82

Tetracycline used in combination with
antimalarial.

Back 82

Doxycycline

Front 83

DOC for radical cure of malaria.

Back 83

Primaquine

Front 84

What is the infective form of Plasmodium species to humans from the mosquitos

Back 84

Sporozoites

Front 85

What Plasmodium species causes relapse of malaria

Back 85

P. vivax (in Philippines), P. ovale

Front 86

For public health reason, what is the primary rationale why primaquine (which we actually for relapse), why do we give primaquine to patients with Plasmodium falciparum malaria

Back 86

To eradicate gametocytes and to stop transmission from man to mosquito

Front 87

In terms of proper clinical management, why primaquine is not given to patients with transfusion related malaria

Back 87

No hypnozoites and no gametocytes in transmission-related malaria; No liver stage, no extraerythrocytic/ pre-erythrocytic cycle

Front 88

What antimalarial drug causes worsening of hypoglycemia in severe malaria

Back 88

Quinine or Quinidine

Front 89

Complete name of the vector that transmits malaria:

Back 89

female Anopheles minimus flavirostris mosquito

Front 90

stage in the life cycle of plasmodium that is infective to
man

Back 90

sporozoite

Front 91

Antibodies attach to __ to block cytoadherence

Back 91

infected RBC or parasite antigen

Front 92

Disease produced by this mode of transmission of
malaria does not have a pre-erythrocytic stage of
development

Back 92

transfusion

Front 93

Why does falciparum malaria have very high
parasitemia?

Back 93

Because it attacks all ages of RBC

Front 94

Lab test that determines prognosis

Back 94

thin blood smear

Front 95

Drug for radical cure

Back 95

primaquine

Front 96

Drug that can produce a neuropsychiatric rxn

Back 96

Mefloquine

Front 97

yes/no: chemoprophylaxis for malaria is 100% effective

Back 97

NO