A 23-year-old student returns from India and develops a febrile illness. Following investigation he is diagnosed as having Plasmodium vivax malaria.
What is the most appropriate treatment?
Correct Answer A: Non-falciparum malarias are almost always chloroquine sensitive.
Malaria: non-falciparum:
The most common cause of non-falciparum malaria is Plasmodium vivax, with Plasmodiumovale and Plasmodium malariae accounting for the other cases. Plasmodium vivax is often found in Central America and the Indian Subcontinent whilst Plasmodium ovale typically comes from Africa.
Benign malarias have a hypnozoite stage and may therefore relapse following treatment.
Treatment:
A nurse undergoes primary immunization against hepatitis B. Levels of which one of the following should be checked four months later to ensure an adequate response to immunization?
Correct Answer A: It is preferable to achieve anti-HBs levels above 100 mIU/ml, although levels of 10 mIU/ml or more are generally accepted as enough to protect against infection.
Hepatitis B serology:
Interpreting hepatitis B serology is a dying art form which still occurs at regular intervals in medical exams. It is important to remember a few key facts:
Example results:
A 45-year-old female presents to the Emergency Department three days after returning from Thailand complaining of severe muscle ache, fever and headache. On examination she has a widespread maculopapular rash. Results show:
What is the most likely diagnosis?
Correct Answer E: The low platelet count and raised transaminase level is typical of dengue fever.
Dengue fever: Dengue fever is a type of viral haemorrhagic fever (also yellow fever, Lassa fever, Ebola).
Basics:
Features:
Treatment is entirely symptomatic e.g. fluid resuscitation, blood transfusion etc.
A 65-year-old man with a history of type 2 diabetes mellitus and peripheral arterial disease is investigated for fatigue and pyrexia of unknown origin. He recently had an amputation of a toe on his left foot. A diagnosis of osteomyelitis is suspected in the left foot.
What is the most appropriate investigation?
Correct Answer A: Osteomyelitis: MRI is the imaging modality of choice.
Osteomyelitis:
Osteomyelitis describes an infection of the bone.
Staph. aureus is the most common cause except in patients with sickle-cell anaemia where Salmonella species predominate.
Predisposing conditions:
Investigations:
Management:
What is the mechanism of action of the antiviral agent amantadine?
Correct Answer D:
Antiviral agents:
Aciclovir:
Ribavirin:
Interferons:
Amantadine:
Anti-retroviral agent used in HIV: 1- Nucleoside analogue reverse transcriptase inhibitors (NRTI)
2- Protease inhibitors (PI):
3- Non-nucleoside reverse transcriptase inhibitors (NNRTI):
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