Antimalaria & Antiparasitology (Lam)

1. A patient is diagnosed with malaria caused by Plasmodium vivax. The physician is concerned about the possibility of future relapse due to dormant liver stages (hypnozoites). Which two Plasmodium species are known for causing this phenomenon? 

a) P. falciparum and P. malariae 

b) P. vivax and P. ovale 

c) P. knowlesi and P. falciparum 

d) P. malariae and P. ovale

B

2. A 35-year-old traveler returns from a trip to East Africa with a high fever, chills, and headache. A blood smear confirms malaria with a parasitemia of 7% and the patient is showing signs of renal failure. He is diagnosed with severe malaria based on his symptoms and the lab results. What is the immediate treatment for this patient? 

a) Oral artemether-lumefantrine 

b) IV artesunate therapy 

c) Oral chloroquine 

d) Oral atovaquone-proguanil

B

3. A patient is diagnosed with uncomplicated P. falciparum malaria acquired in a region of South America known for chloroquine resistance. What is the first-line treatment recommended in the US for this infection? 

a) Chloroquine phosphate 

b) IV artesunate 

c) Artemether-lumefantrine (Coartem®) 

d) Primaquine phosphate

C

4. A physician plans to prescribe primaquine to a patient to eradicate the liver stages of a P. ovale infection. What critical laboratory test MUST be performed before initiating this therapy to prevent a potentially fatal side effect? 

a) Liver function tests (LFTs) 

b) Complete blood count (CBC) 

c) G6PD deficiency test 

d) PCR for species confirmation

C

5. A patient with a fever returns from a trip to the Dominican Republic and is diagnosed with uncomplicated malaria. Based on the CDC guidelines presented, what is the first-line treatment for this patient? 

a) Artemether-lumefantrine (Coartem®) 

b) Chloroquine phosphate (Aralen™) 

c) Atovaquone-proguanil (Malarone™) 

d) IV artesunate

B

6. A traveler took chloroquine for prophylaxis during a trip to Haiti but still developed symptoms of uncomplicated malaria. Which statement is true regarding their treatment? 

a) They should be treated with a higher dose of chloroquine since the infection broke through. 

b) They should be treated with hydroxychloroquine, as it is a stronger alternative. 

c) They should not be treated with chloroquine, as prophylaxis failure suggests resistance. 

d) They should be immediately started on IV artesunate for prophylaxis failure.

C

7. A 25-year-old patient who is 15 weeks pregnant is diagnosed with uncomplicated P. falciparum malaria from a chloroquine-resistant region. Which medication is recommended as the first-line treatment for her? 

a) Doxycycline 

b) Primaquine 

c) Artemether-lumefantrine (Coartem®) 

d) Tafenoquine (Krintafel™)

C

8. A 30-year-old patient who is 20 weeks pregnant is diagnosed with uncomplicated malaria after a trip to a chloroquine-resistant area. Which of the following treatments is recommended for her condition? 

a) Doxycycline + Quinine 

b) Primaquine 

c) Artemether-lumefantrine 

d) Tafenoquine

C

9. A 32-year-old patient who is 34 weeks pregnant is hospitalized with severe malaria, including neurological symptoms. What is the immediate, standard-of-care treatment? 

a) Withhold treatment until after delivery to protect the fetus. 

b) Administer oral artemether-lumefantrine. 

c) Treat immediately with IV artesunate. 

d) Treat with quinine plus clindamycin.

C

10. Which of the following statements reflects a key principle in the treatment of pediatric malaria? 

a) Dosing for all antimalarials should be strictly based on the child's body weight. 

b) Tetracyclines like doxycycline are a safe alternative for children under 8 years old. 

c) Children are less vulnerable to rapid deterioration than adults. 

d) Treatment can be safely delayed until PCR confirmation is available.

A

11. Which of the following is considered the "gold standard" for diagnosing malaria, as it can identify the specific Plasmodium species and calculate the parasitemia percentage? 

a) Rapid diagnostic tests (RDTs) 

b) Polymerase chain reaction (PCR) 

c) Thick and thin blood smears (Microscopy) 

d) Clinical suspicion based on travel history and fever

C

12. A 4-year-old child weighing 18 kg requires treatment for uncomplicated malaria. Which of the following medications is specifically listed as a preferred and approved option for a child of this age and size? 

a) Artemether-lumefantrine (Coartem®) 

b) Doxycycline

c) Mefloquine

d) Tafenoquine

A

13. A 5-year-old child weighing 20 kg is being treated for malaria. Which of the following medications should be avoided in this patient due to age-related contraindications? 

a) Artemether-lumefantrine 

b) Atovaquone-proguanil 

c) Doxycycline 

d) IV artesunate

C

1. A patient who recently went on a hiking trip and drank unfiltered stream water presents to the ED with foul-smelling, fatty diarrhea (steatorrhea) and bloating. What is the most likely causative organism and the preferred diagnostic method? 

a) Entamoeba histolytica; stool microscopy for trophozoites 

b) Enterobius vermicularis; paddle (cellophane tape) test 

c) Giardia lamblia; PCR or antigen detection assays 

d) Schistosoma mansoni; serologic tests

C

2. A 26-year-old pregnant patient is diagnosed with a mild-to-moderate intestinal infection with Entamoeba histolytica. Which medication is the preferred treatment for her condition? 

a) Metronidazole 

b) Paromomycin 

c) Tinidazole 

d) Praziquantel

B

3. The treatment regimen for Enterobius vermicularis (pinworm) is unique because it requires a specific follow-up action to prevent reinfection from eggs that hatch after the initial treatment. What is this critical step? 

a) A 7-day course of antibiotics must be completed. 

b) The initial dose must be repeated in 2 weeks. 

c) The patient must be re-tested with a paddle test after 3 days. 

d) All household members must be treated with a different medication.

B

4. A patient is diagnosed with schistosomiasis after swimming in a freshwater lake in sub-Saharan Africa. What is the preferred first-line treatment for this parasitic blood fluke? 

a) Albendazole 

b) Metronidazole 

c) Praziquantel 
d) Nitazoxanide

C

5. According to the life cycle of Schistosoma species, how do humans become infected? 

a) By ingesting infectious cysts from contaminated food or water. 

b) Through the bite of an infected snail. 

c) By inhaling eggs from contaminated surfaces. 

d) When cercariae larvae in freshwater penetrate the skin.

D

6. A public health official is advising a community on preventing the spread of Entamoeba histolytica. They note that standard chlorination of water supplies may not be sufficient. What is a more effective method for disinfecting water against amebic cysts? 

a) Disinfection with iodine 

b) Adding salt to the water 

c) Using alcohol-based sanitizers 

d) Standard filtration under 10 microns

A

7. A child is brought to a clinic with significant perianal itching, especially at night. A "paddle test" is performed by pressing an adhesive surface to the perianal region first thing in the morning. This sample is examined under a microscope for what diagnostic feature? 

a) Motile trophozoites 

b) Enterobius vermicularis (pinworm) eggs 

c) Giardia cysts 

d) Schistosome cercariae

B

8. Which of the following parasitic infections is primarily transmitted through the ingestion of cysts via the fecal-oral route? (Select all that apply)

a) Giardiasis 

b) Amebiasis (Entamoeba histolytica) 

c) Schistosomiasis 

d) Pinworm (Enterobius vermicularis)

A,B

first line treatment for uncomplicated malaria in Dominican Republic

• chloroquine phosphate (aralen)

• hydroxychloroquine (plaquenil)

if patient took chloroquine for prophylaxis and still got sick, do not use it for treatment (t/f) —> uncomplicated malaria

true

first line treatment for uncomplicated malaria in US

artemether-lumefantrine (Coartem)

treatment for severe malaria

IV artesunate

radical cure (preventing relapse) treatment for P.vivax & P.ovale

primaquine phosphate

Tafenoquine (krintafel)

patients must be tested for what in primaquine phosphate and tafenoquine

G6PD deficiency

treatment for uncomplicated malaria in pregnancy

artemether-lumefantrine (Coartem)

treatment for severe malaria in pregnancy

IV artesunate

what is contraindicated in pregnancy for malaria

doxycycline & tetracyclines

treatment for pediatric in malaria

• artemether-lumefantrine (Coartem)

• atovaquone-proguanil (Malarone)

doxycycline & tetracyclines should be avoided in children <8 (t/f)

true

what is used for chloroquine resistance in malaria

coartem

if treating P.vivax or P.ovale what drugs should be used

primaquine

tafenoquine

treatment for entamoeba histolytic in children and adults

metronidazole (flagyl)

paromomycin (humantin)

tinidazole (Tindamax)

treatment for entamoeba histolytic in pregnancy

paromomycin for mild-moderate

metronidazole for severe

treatment for giardaiasis

tinidazole (tindamax)

nitazoxanide (alinia)

enterobius vermicularis treatment in adults and children

albendazole (Albenza)

mebendazole (vermox)

pyrantel pamoate(ascarel)

enterobius vermicularis treatment in pregnancy

pyrantel pamoate

treatment for schistosomiasis

praziquantel (biltricide)