Travel Medicine — MCQs
The only certificate of vaccination required for international travel is
Which drug is given to prevent acute mountain sickness?
A person wants to visit a malaria endemic area of low level chloroquine resistant falciparum malaria. The best chemoprophylaxis is -
For yellow fever control, the distance around an airport to be kept free of Aedes breeding is
According to standard guidelines, post-exposure prophylaxis is routinely recommended after ANY potential exposure for which of the following infections?
All are features of yellow fever except?
Which fungus is commonly known as golden yellow jelly fungus?
What is the active ingredient of the marking nut (Semecarpus anacardium)?
A 26-year-old pregnant woman presents with arthritis and a malar rash that worsens with sun exposure. She has a low-grade fever and is admitted to the hospital. What is the likely diagnosis?
A young male develops fever, followed by headache, confusional state, focal seizures and a right hemiparesis. The MRI performed shows bilateral frontotemporal hyperintense lesion. The most likely diagnosis is
Travel Medicine Indian Medical PG Practice Questions and MCQs
Question 1: The only certificate of vaccination required for international travel is
- A. BCG
- B. Yellow fever (Correct Answer)
- C. Tetanus
- D. Hepatitis B
Explanation: ***Yellow fever*** - **Yellow fever vaccination certificate** is required for entry into certain countries, particularly in sub-Saharan Africa and parts of South America, to prevent the international spread of the disease. - The **International Health Regulations (IHR)** specify yellow fever as one of the few diseases for which proof of vaccination can be mandated for international travel. *BCG* - **BCG vaccination** protects against **tuberculosis** but is generally not a mandatory requirement for international travel, although some countries may recommend it for long-term stays. - While tuberculosis can spread globally, a certificate of BCG vaccination is not an internationally regulated requirement for entry into most countries. *Tetanus* - **Tetanus vaccination** is crucial for individual health protection but is **not a mandatory certificate** for international travel. - Tetanus is typically acquired through contact with spores in the environment, not through person-to-person transmission, so it doesn't pose a risk for international spread. *Hepatitis B* - **Hepatitis B vaccination** is recommended for personal protection, especially for travelers visiting endemic areas or those at risk of exposure, but it is **not a universal requirement** for international entry. - While Hepatitis B can be a serious infection, a vaccination certificate is not specified in the International Health Regulations for cross-border travel.
Question 2: Which drug is given to prevent acute mountain sickness?
- A. Acetazolamide (Correct Answer)
- B. Diltiazem
- C. Digoxin
- D. Dexamethasone
Explanation: ***Acetazolamide*** - This drug is a **carbonic anhydrase inhibitor** that acidifies the blood and causes compensatory hyperventilation, increasing oxygenation. - It is the **first-line prophylactic agent** for acute mountain sickness (AMS) and is best started 24-48 hours before ascent. - Most effective and widely recommended for AMS prevention. *Digoxin* - This is a **cardiac glycoside** used to treat heart failure and irregular heartbeats. - Its mechanism of action is unrelated to the physiological changes that cause acute mountain sickness. *Diltiazem* - This is a **calcium channel blocker** primarily used for hypertension, angina, and certain arrhythmias. - It has no known role in the prevention or treatment of acute mountain sickness. *Dexamethasone* - While **dexamethasone** can be used for AMS prophylaxis, it is typically reserved as an **alternative agent** when acetazolamide is contraindicated or not tolerated. - It is more commonly used for **treatment** of severe altitude illness including **High Altitude Cerebral Edema (HACE)** and **High Altitude Pulmonary Edema (HAPE)**. - **Acetazolamide remains the preferred first-line prophylactic agent** due to its mechanism of action that directly addresses the underlying pathophysiology of AMS.
Question 3: A person wants to visit a malaria endemic area of low level chloroquine resistant falciparum malaria. The best chemoprophylaxis is -
- A. Sulfadoxine + Pyrimethamine
- B. Mefloquine
- C. Atovaquone + Proguanil (Correct Answer)
- D. Chloroquine
Explanation: ***Atovaquone + Proguanil*** - **Atovaquone + Proguanil (Malarone)** is the **preferred first-line chemoprophylaxis** for areas with **chloroquine-resistant *P. falciparum***, including low-level resistance. - It has **excellent efficacy** against resistant strains with minimal documented resistance, and is **well-tolerated** with fewer side effects compared to mefloquine. - Approved by WHO and CDC as a **primary option** for travelers to chloroquine-resistant malaria areas. - The daily dosing regimen, while requiring more frequent administration, actually allows for a **shorter pre-travel start time** (1-2 days before vs. 1-2 weeks for mefloquine) and **shorter post-travel duration** (7 days vs. 4 weeks). *Mefloquine* - While **effective against chloroquine-resistant *P. falciparum***, mefloquine is increasingly used as a **second-line option** due to significant **neuropsychiatric side effects** (anxiety, depression, vivid dreams, rarely psychosis). - It requires weekly dosing starting 2 weeks before travel and continuing 4 weeks after, making the total prophylaxis period longer. - **Contraindicated** in individuals with psychiatric disorders, seizure disorders, or cardiac conduction abnormalities. *Sulfadoxine + Pyrimethamine* - This combination is primarily used for **intermittent preventive treatment (IPT)** in pregnant women and infants in endemic areas, **not for travel prophylaxis**. - Widespread **parasitic resistance** to both components has made it unreliable for chemoprophylaxis in most regions. - Not recommended by international guidelines for routine traveler prophylaxis. *Chloroquine* - **Completely ineffective** in areas with **chloroquine-resistant *P. falciparum*** as stated in the question. - Would provide **no protection** and lead to treatment failure if infection occurs.
Question 4: For yellow fever control, the distance around an airport to be kept free of Aedes breeding is
- A. 450m
- B. 400m (Correct Answer)
- C. 250m
- D. 200m
Explanation: ***400m*** - The **International Health Regulations (IHR)** mandate that an area within **400 meters** of an airport in a yellow fever endemic zone must be kept free of *Aedes* breeding sites. - This distance is based on the flight range of the mosquito vector, *Aedes aegypti*, which is approximately **400 meters**. *450m* - This distance is **greater than the recommended** safe zone for *Aedes* breeding site control around airports. - While it would increase safety, it is **not the officially specified** requirement by international health organizations. *250m* - This distance is **insufficient** to ensure an adequate buffer zone against the spread of *Aedes* mosquitoes from breeding sites to aircraft or personnel. - The typical flight range of *Aedes aegypti* extends beyond **250 meters**, making this option unsafe. *200m* - A **200-meter radius** is significantly **too small** to effectively prevent the transmission of yellow fever via *Aedes* mosquitoes around airports. - This limited range would leave a large portion of the mosquito's flight range uncovered, posing a high risk.
Question 5: According to standard guidelines, post-exposure prophylaxis is routinely recommended after ANY potential exposure for which of the following infections?
- A. HBV
- B. Diphtheria
- C. Measles
- D. Rabies (Correct Answer)
Explanation: ***Rabies*** - **Rabies post-exposure prophylaxis (PEP) is ALWAYS recommended** after any potential exposure (Category II/III wounds) **regardless of vaccination status** due to the near 100% fatality rate once symptoms appear. - PEP is initiated immediately and involves **wound care**, administration of **rabies immune globulin (RIG)** for previously unvaccinated individuals, and a series of **rabies vaccines**. - Unlike other infections, there is **no screening or assessment of immune status required** - exposure alone mandates PEP. *HBV* - Hepatitis B post-exposure prophylaxis is **conditional** - recommended only for unvaccinated individuals or those with unknown vaccination status after significant exposure. - Those with documented immunity (anti-HBs >10 mIU/mL) do **not require PEP**. - Not routine for all exposures. *Diphtheria* - Diphtheria post-exposure prophylaxis is recommended **only for close contacts** of confirmed cases, particularly if unvaccinated or uncertain vaccination history. - Fully vaccinated individuals with recent boosters may not require prophylaxis. - Not routine for all potential exposures. *Measles* - Measles post-exposure prophylaxis is recommended **only for susceptible individuals** (unvaccinated or no evidence of immunity). - Those with documented immunity do not require PEP. - Requires assessment of immune status before administration.
Question 6: All are features of yellow fever except?
- A. Caused by vector aedes
- B. IP 3-6 days
- C. 1 attack gives life long immunity
- D. Validity of vaccination begins immediately after vaccination (Correct Answer)
Explanation: ***Validity of vaccination begins immediately after vaccination*** - Yellow fever vaccine is highly effective, but **immunity does not develop immediately**; it typically offers protection starting **10 days after vaccination**. - This delay is crucial for travelers to endemic areas, as they need to be vaccinated well in advance to ensure protection. *IP 3-6 days* - The **incubation period (IP)** for yellow fever is indeed short, usually ranging from **3 to 6 days** after the bite of an infected mosquito. - This brief incubation period contributes to the rapid onset of symptoms once infected. *1 attack gives life long immunity* - Similar to many viral infections, a single bout of yellow fever infection generally provides **lifelong immunity** against future infections. - This is why the vaccine is so effective, as it mimics natural infection to induce comprehensive, long-term protection. *Caused by vector aedes* - Yellow fever is transmitted primarily by **Aedes mosquitoes**, particularly **Aedes aegypti**, which are responsible for urban and jungle cycles of transmission. - These mosquitoes are prevalent in tropical and subtropical regions of Africa and South America.
Question 7: Which fungus is commonly known as golden yellow jelly fungus?
- A. T. tonsurans
- B. Tremella mesenterica (Correct Answer)
- C. Epidermophyton floccosum
- D. T. mentagrophytes
Explanation: ***Tremella mesenterica*** - This fungus is commonly referred to as **golden yellow jelly fungus** or **witch's butter** due to its distinctive golden-yellow, gelatinous, and brain-like appearance. - It is a **jelly fungus** that typically grows on dead hardwood branches, especially after rain, and is known for its pliable, quivering texture. *T. tonsurans* - This refers to **Trichophyton tonsurans**, a dermatophytic fungus primarily known for causing **tinea capitis** (ringworm of the scalp). - Its common name relates to its effect on hair, causing breakage and a "black dot" appearance, rather than a golden yellow, jelly-like form. *Epidermophyton floccosum* - This is a dermatophytic fungus that specifically causes infections of the **skin and nails**, particularly **tinea pedis** (athlete's foot) and **tinea cruris** (jock itch). - It does not produce a fruiting body and is not described as a jelly-like fungus. *T. mentagrophytes* - This refers to **Trichophyton mentagrophytes**, another common dermatophyte responsible for various superficial fungal infections, including **tinea pedis**, **tinea corporis**, and **tinea unguium**. - Its clinical presentation is not that of a golden yellow jelly fungus.
Question 8: What is the active ingredient of the marking nut (Semecarpus anacardium)?
- A. Ricin
- B. Croton
- C. Semecarpol (Correct Answer)
- D. Abrin
Explanation: ***Semecarpol*** - **Semecarpol** is a **phenolic compound** derived from the fruit of the marking nut tree (*Semecarpus anacardium*), which is responsible for its toxic and medicinal properties. - It causes **irritation**, **blistering**, and **allergic contact dermatitis** upon contact with skin. *Ricin* - **Ricin** is a **toxic protein** found in castor beans (*Ricinus communis*), not the marking nut. - It is a **potent ribosome-inactivating protein** that can be lethal if ingested, inhaled, or injected. *Croton* - **Croton** refers to a genus of plants (*Croton*) from which various compounds, including **phorbol esters**, can be extracted. - These compounds are potent **tumor promoters** and vesicants, but they are not the active ingredient of the marking nut. *Abrin* - **Abrin** is a **highly toxic protein** found in the seeds of the jequirity bean (*Abrus precatorius*), which is distinct from the marking nut. - Like ricin, abrin is a **ribosome-inactivating protein** and is extremely toxic upon exposure.
Question 9: A 26-year-old pregnant woman presents with arthritis and a malar rash that worsens with sun exposure. She has a low-grade fever and is admitted to the hospital. What is the likely diagnosis?
- A. Lyme disease
- B. Chloasma
- C. Systemic Lupus Erythematosus (Correct Answer)
- D. Steven Johnsons syndrome
Explanation: ***Systemic Lupus Erythematosus*** - The combination of **arthritis**, **malar rash** that worsens with sun exposure (photosensitivity), and a **low-grade fever** in a young woman is highly characteristic of systemic lupus erythematosus (SLE) [1]. - SLE is an **autoimmune disease** with diverse clinical manifestations affecting multiple organ systems [1]. *Lyme disease* - Characterized by a **target-like rash (erythema migrans)**, which is distinct from a malar rash, and often presents with flu-like symptoms. - While Lyme disease can cause arthritis, the presence of a classic malar rash and photosensitivity points away from this diagnosis. *Chloasma* - Also known as the **"mask of pregnancy,"** chloasma is a common skin condition in pregnant women causing dark, discolored patches on the face. - It is a **pigmentation disorder** and does not involve arthritis, fever, or an associated malar rash that worsens with sun exposure. *Steven Johnsons syndrome* - An infrequent, serious systemic reaction to medication or infection, that triggers severe skin and mucous membrane reactions, typically presenting with **widespread blistering** and epidermal detachment. - This is an **acute, severe mucocutaneous reaction** and does not present with the chronic arthritis and photosensitive malar rash seen in this patient.
Question 10: A young male develops fever, followed by headache, confusional state, focal seizures and a right hemiparesis. The MRI performed shows bilateral frontotemporal hyperintense lesion. The most likely diagnosis is
- A. Acute pyogenic meningitis
- B. Carcinomatous meningitis
- C. Cerebral abscess
- D. Herpes Simplex Encephalitis (Correct Answer)
Explanation: ***Herpes Simplex Encephalitis*** - The constellation of **fever**, **headache**, **confusional state**, **focal seizures**, and **right hemiparesis** points strongly to an encephalitic process [1]. - The MRI finding of **bilateral frontotemporal hyperintense lesions** is highly characteristic of Herpes Simplex Encephalitis (**HSE**) [1]. *Acute pyogenic meningitis* - Typically presents with fever, headache, and **meningeal signs** like nuchal rigidity, which are not explicitly mentioned as predominant features. - While it can cause confusion, focal neurological deficits and seizures are less specific, and the MRI findings would typically show **leptomeningeal enhancement** rather than frontotemporal parenchymal involvement. *Carcinomatous meningitis* - This condition usually develops in patients with a known or occult malignancy and is characterized by a more **insidious onset** of neurological symptoms. - MRI findings would typically show **leptomeningeal enhancement** or nodular seeding, not focal bilateral frontotemporal hyperintensities. *Cerebral abscess* - A cerebral abscess can cause fever, headache, focal deficits, and seizures, but its onset is often more protracted, and the MRI would typically show a **ring-enhancing lesion** with surrounding edema. - The description of bilateral frontotemporal hyperintense lesions is not characteristic of a single or multiple discrete abscesses.
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