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Malaria & tropical infections flashcards

16 high-yield MRCP Part 1 cards from the Intellect Medicos Infectious Diseases course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.

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1. How many negative blood films are needed before malaria is considered unlikely?

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   Three (thick and thin films, repeated over about 48–72 hours).

   Why? Parasitaemia can be low or sequestered, so one negative film does not exclude malaria. Rapid antigen tests are used alongside films.

2. What is the first-line treatment for uncomplicated falciparum malaria in UK adults?

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   An artemisinin combination therapy, usually oral artemether–lumefantrine (Riamet).

   Why? Alternatives: dihydroartemisinin–piperaquine; if no ACT is available, atovaquone–proguanil or quinine plus doxycycline (clindamycin in pregnancy).

3. What is the first-line treatment for severe falciparum malaria?

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   IV artesunate (IV quinine if artesunate is not available).

   Why? Artesunate clears parasites faster and lowers mortality compared with quinine. Give at least 24 h IV, then complete a full oral ACT course.

4. Above what parasitaemia should falciparum malaria be treated with IV therapy (as severe) under UK guidelines?

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   More than 2% of red cells parasitised.

   Why? Above 2% the risk of severe disease rises even if the patient looks well; 10% parasitaemia counts as severe disease in its own right. Other severe features: hypoglycaemia, metabolic acidosis, AKI, ARDS, DIC, impaired consciousness, haemoglobinuria ("blackwater fever").

5. Which two malaria species form liver hypnozoites that cause relapse?

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   Plasmodium vivax and Plasmodium ovale.

   Why? Blood-stage drugs do not kill hypnozoites, so primaquine (or tafenoquine) is given for radical cure.

6. What blood test is essential before giving primaquine?

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   G6PD activity.

   Why? Primaquine is an oxidant drug that causes severe haemolysis in G6PD deficiency. It is also avoided in pregnancy and breastfeeding.

7. P. falciparum, vivax and ovale give a ______ (tertian) fever cycle, P. malariae a ______ (quartan) cycle, and P. knowlesi a ______ cycle.

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   48-hour; 72-hour; 24-hour

   Why? P. knowlesi (South-East Asia, from macaques) multiplies daily, so parasitaemia can rise fast.

8. How long before and after travel is atovaquone–proguanil (Malarone) taken for malaria prophylaxis?

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   Start 1–2 days before travel and continue for 7 days after return.

   Why? It acts on liver stages (causal prophylaxis), so only a short post-travel course is needed.

9. Which malaria prophylaxis drugs are contraindicated in epilepsy?

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   Mefloquine and chloroquine.

   Why? Both lower the seizure threshold. Mefloquine also causes neuropsychiatric effects and is avoided with a psychiatric history.

10. What incubation window should raise suspicion of a viral haemorrhagic fever in a traveller from Africa?

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    Fever within 21 days of return.

    Why? Lassa, Ebola and Marburg have incubation up to 21 days; these patients need urgent risk assessment and isolation (after malaria is excluded).

11. Which antiviral is used for Lassa fever?

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    Ribavirin.

    Why? Lassa (an arenavirus) is caught from excreta of Mastomys rats in West Africa; early ribavirin reduces mortality.

12. What is the best test for dengue in the first days of fever?

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    NS1 antigen (with dengue PCR); IgM serology becomes positive later.

    Why? Dengue (Aedes mosquito, flavivirus) causes fever, retro-orbital pain, "breakbone" myalgia, rash and thrombocytopenia.

13. A man returns from Sudan with months of fever, weight loss, massive splenomegaly, pancytopenia and darkening skin. What is the first-line treatment (UK practice)?

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    Liposomal amphotericin B.

    Why? This is visceral leishmaniasis (kala-azar), spread by the sandfly. Diagnose by bone marrow, spleen or lymph node aspirate showing amastigotes.

14. Which vector transmits leishmaniasis?

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    The female sandfly (Phlebotomus / Lutzomyia).

    Why? Cutaneous leishmaniasis gives a painless "volcano" ulcer; L. braziliensis causes mucocutaneous destruction of the nasal septum.

15. What is the first-line treatment for acute Chagas disease?

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    Benznidazole (nifurtimox is an alternative).

    Why? Trypanosoma cruzi (kissing bug, Latin America). Romaña sign acutely; chronic disease causes dilated cardiomyopathy, megaoesophagus and megacolon.

16. What is Winterbottom's sign, and which disease is it seen in?

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    Enlarged posterior cervical lymph nodes — African trypanosomiasis (sleeping sickness).

    Why? Spread by the tsetse fly; late CNS stage causes daytime somnolence and behavioural change.