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Quiz

1. Of the four species of malaria parasites that infect humans, which one can cause severe, potentially fatal malaria?

• Plasmodium falciparum
• Plasmodium vivax
• Plasmodium ovale
• Plasmodium malariae

2. A tourist who plans to visit Cap-Haitien (Haiti) should:

• Not take any chemoprophylaxis to prevent malaria
• Take chemoprophylaxis with doxycycline
• Take chemoprophylaxis with mefloquine
• Take chemoprophylaxis with chloroquine

3. Which one of the following countries is most likely to have Plasmodium ovale?

• Pakistan
• Thailand
• Peru
• Nigeria
• Ethiopia

4. Which one of the following countries is most likely to have chloroquine-resistant Plasmodium vivax?

• India
• Thailand
• Guatemala
• Liberia
• Papua New Guinea

5. Which drug is contraindicated in a person with G6PD deficiency?

• Chloroquine
• Primaquine
• Sulfadoxine-primethamine
• Mefloquine
• Atovaquone-proguanil (Malarone®)

6. Which one of the following is most indicated to treat a 25-year-old man with fever, disorientation, thrombocytopenia, and a blood smear reported as positive for Plasmodium vivax?

• Chloroquine then primaquine
• Chloroquine and primaquine simultaneously
• Sulfadoxine-pyrimethamine
• Atovaquone-proguanil (Malarone®)
• Quinidine-doxycycline

7. In a patient with Plasmodium falciparum malaria, which one of the following is not a reason for considering exchange transfusion?

• Hypoglycemia
• Parasitemia 15%
• Coma
• Non-overload pulmonary edema
• Renal failure

8. Which one of the following drugs is the least desirable in the treatment of malaria in a pregnant woman?

• Quinine/quinidine
• Doxycycline
• Clindamycin
• Sulfadoxine-pyrimethamine
• Chloroquine

9. Regarding microscopic diagnosis of malaria, all the statements below are correct, except which one:

• In the United States, if microscopic diagnosis is not readily available, a patient with suspected malaria can be treated for malaria as long as a blood smear is collected for delayed microscopic examination (within 24 hours)
• The optimal staining technique is the Giemsa stain
• Thick smears are more sensitive for detecting parasites and thin smears are better for determining parasite species
• Microscopic diagnosis is the standard, approved diagnostic technique in most countries including the United States
• CDC may provide telediagnosis assistance to those laboratories that have the necessary equipment

10. Among the 1,332 cases of imported malaria in the United States in 2002, the region of acquisition was known in 1,252 cases. All the following statements are correct, except:

• 72.1% were acquired in Africa; 13.7% in Asia; 11.3% in the Americas; and 3.0% in Oceania
• 69.7% of the cases acquired in Africa came from countries in West Africa
• 52.6% of the cases acquired in Asia came from the Indian subcontinent
• 68.1% of the cases acquired in the Americas came from Central America and the Caribbean
• Compared with 2001, the number of reported cases acquired in the Americas increased by 41.2%

11. Regarding malaria prevention in endemic countries, which one of the following statements is not correct?

• Insecticide-treated bed nets (ITNs) have been shown to decrease general mortality in children in different epidemiologic settings in Africa
• Insecticide-treated bed nets (ITNs) have proven very popular in Africa and are reaching rapidly in many countries the target coverage (60%) proposed by the Abuja Declaration
• The cost of an insecticide-treated bet net (ITN)is around US$ 5
• Pregnant women should be receiving intermittent preventive treatment (IPT) because they are at increased risk of malaria
• Malaria in a pregnant woman increases the risk of adverse outcomes of the pregnancy (low birth weight, stillbirth, prematurity, and abortion)

12. Which of the following drugs is not recommended for use by CDC?

• Chloroquine
• Hydroxychloroquine
• Quinine
• Mefloquine
• Halofantrine (Halfan®)

13. Regarding malaria during pregnancy in endemic countries, which one of the following statements is not correct?

• Pregnant women, particularly during their first and second pregnancies, are at increased risk of malaria
• Malaria in a pregnant woman increases the risk of adverse outcomes of the pregnancy (low birth weight, stillbirth, prematurity, and abortion)
• To prevent and control malaria during pregnancy, pregnant women in endemic areas should use insecticide-treated bed nets (ITNs)
• To prevent and control malaria during pregnancy, pregnant women in endemic areas should receive prophylaxis with weekly chloroquine
• To prevent and control malaria during pregnancy, pregnant women in endemic areas should receive intermittent preventive treatment with sulfadoxine-pyrimethamine (IPT/SP)

14. Which one of these tourist destinations in Mexico has a malaria risk?

• Cabo San Lucas (State of Baja California Sur)
• Tijuana (State of Baja California Norte)
• Mexico City (Distrito Federal)
• Playa del Carmen (State of Quintana Roo)
• Cancun (State of Quintana Roo)

15. A woman in her 16 th week of pregnancy develops Plasmodium vivax malaria after a travel to Guatemala . Which one of the following courses of treatment would be the most desirable?

• Chloroquine treatment (3 days) followed immediately by primaquine treatment (14 days)
• Chloroquine treatment (3 days) and then, after delivery, primaquine treatment (14 days)
• Chloroquine treatment (3 days) followed by weekly chloroquine prophylaxis until delivery
• Chloroquine treatment (3 days), followed by weekly chloroquine prophylaxis until delivery and then, after delivery, primaquine treatment (14 days)
• Quinine (3 days) plus doxycycline (7 days) treatment followed immediately by primaquine treatment (14 days)

16. About malaria transmitted through blood transfusion, which one of the following statements is incorrect:

• Exclusion criteria used by blood banks in the United States (based on history) will not identify all donors infected with malaria parasites
• Serologic screening will identify all donors/blood units infected with malaria parasites
• A history of travel to a malaria-endemic area results in a substantial number of potential blood donors being deferred in the United States
• Transfusion of platelets can transmit malaria parasites because platelet preparations can be contaminated with erythrocytes
• When a case of transfusion-transmitted malaria occurs, epidemiologic investigations can often identify the infected donor and prevent further episodes

17. Babesia microti causes in the United States a febrile illness (babesiosis) that may be difficult to distinguish from malaria. On microscopic examination, Babesia microti:

• Is sometimes difficult to distinguish from Plasmodium falciparum
• Is sometimes difficult to distinguish from Plasmodium vivax
• Is sometimes difficult to distinguish from Plasmodium ovale
• Is sometimes difficult to distinguish from Plasmodium malariae
• Is easily distinguishable from all four species of human malaria parasites

18. Which of the following chemoprophylaxis regimens is most suitable for a 20-year-old woman who will spend 2 weeks in New Delhi ( India )?

• No prophylaxis needed
• Chloroquine
• Chloroquine followed by terminal prophylaxis with primaquine
• Mefloquine
• Mefloquine followed by terminal prophylaxis with primaquine

19. About malaria in the United States , which one of the following statement is correct?

• Malaria has never been a major health problem in the United States
• Malaria was eradicated in the United States the 1960’s
• Eradication of malaria in the United States was achieved mainly through insecticide spraying
• All Anopheles species capable of transmitting malaria were eliminated in the United States during the eradication campaign
• There is a constant risk of reintroduction of malaria in the United States

20. Regarding treatment of severe Plasmodium falciparum malaria with intravenous quinidine gluconate, which one of the following statements is incorrect?

• Most patients should receive a loading dose of 6.25 mg/kg base (=10 mg salt/kg) IV over 1-2 hours followed by 0.0125 mg/kg/min base (=0.02 mg salt/kg/min) by continuous infusion for at least 24 hours
• The intravenous infusion should be continued for 4 to 7 days, depending on the area where the infection was acquired
• No loading dose should be given to patients who have received more than 40 mg/kg quinine within the preceding 48 hours
• No loading dose should be given to patients who have received mefloquine within the preceding 12 hours
• During intravenous administration of quinidine, the patient’s blood pressure, EKG, and blood glucose should be monitored