kaplan Q 3

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kaplan Q 3

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drduck
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01/08/08 - 08:37 AM

A 35 yr old man comes to the physician because of recurrent bouts of fever and shaking chills for 1 week. He was on a safari trip in sub saharan africa 1 month ago.
Each attack begins with shaking chills and lasting a few hrs, followed by fever up to 41 degree C, which resolves with profuse sweating. The attacks have occoured every other day.
The patient feels slightly tired between the episodesof feverbut otherwise is well. Examination reveales spleenomegaly. The liver is not palpable. A blood smear at this time is negative for parasites.
Which of the following is most appropriate next step in diagnosis

A) Blood cultures

B) Repeat blood smear every 8 hrs for 3 days

C) Repeat blood smear during an attack

D) Repeat blood smear once more

E) Start treatment with chloroquine

neurom
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01/08/08 - 08:45 AM

e

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Ivonne
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01/08/08 - 09:17 AM

I will go with E , not sure because of high resistance to chloroquine then B

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multifactorial
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01/08/08 - 09:45 AM

sub-saharan africa has predominantly chloroquine-resistant malaria,so i would think that it should be C as that is the time the merozoites are released in the blood.

cool doctor
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01/08/08 - 11:28 AM

milestogo
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01/08/08 - 12:08 PM

first c then e

diagnosis of malaria by ps taken durin attack of chills and fever then treatment

bax
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01/08/08 - 12:39 PM

anastamosis
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01/08/08 - 01:35 PM

E

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drduck
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01/08/08 - 09:29 PM

very bad Q...i felt...
i dont know what is the protocol for diagnosis of malaria or when someone is suspected to suffer from the same.

usually if smear of a suspected case of malaria comes negative...u try for a blood smear during the attack of high fever or chills.....as this is the time when parasite burst out of RBCs and can easily be found on examination under microscope.

i went for the option C.

but, but......the answer is B....
i just want to know whether this is the protocol for malaria.
and if we go for smear 8 hrly, shud patient be instituted any admission or treatment??
not clear....someone plz help...

mildus
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01/09/08 - 01:49 PM

#10

I also think it is C, are you sure it is B?

milestogo
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01/10/08 - 12:06 PM

#11

dianosis of malaria is definitively done by a periphral smear made during an attack of chills and fever as already said in an earlier post the reason is the release of merozoites is responsible for the febrile episode, there r more sophisticated methods of diagnosing malaria in endemic countries but since the choice is not given then c is the appropriate response.
i am from india where malaria is fairly common and am not familiar with 8 hrly samplesbeing taken for 3 days....... sounds like a waste of valuable time.....th enext best choice is to give empirical treatment for malaria based on symptoms and history.

pls kindly quote the ques source?

dr_gladiator
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01/10/08 - 02:14 PM

#12

C... merozoits release during attack of fever..

drduck
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01/12/08 - 12:42 AM

#13

i dont know what was the logic behind this, i mean 8 hrly blood smears.
and asked u guys about this.
this Q is from kaplan Q bank internal med.
and answer was again by the same guys...i wasnt convinced.
just wanted to know whether there is any protocol for diagnosis of malaria in non endemic states.

really difficult one to answer.
if anyone has any idea regarding this plz share...
thank you.

neurom
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01/12/08 - 04:28 AM

#14

drduck wrote:
i dont know what was the logic behind this, i mean 8 hrly blood smears.
and asked u guys about this.
this Q is from kaplan Q bank internal med.
and answer was again by the same guys...i wasnt convinced.
just wanted to know whether there is any protocol for diagnosis of malaria in non endemic states.

really difficult one to answer.
if anyone has any idea regarding this plz share...
thank you.

Why parasites are not detected at times in peripheral smear?
1. sequestration in deep vascular bed
2. partially treated patients
3. prophylactic antimalarial treatment
4. inexperiensed microscopist
5. poor quality stainig

and yes this is a standart protocol - repeat blood test every 8 hours for 2-3 days to ascertain the presence or absence of infection.

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drduck
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01/13/08 - 10:04 AM

#15

thanks a lot friend.

neurom
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01/13/08 - 11:20 AM

#16

[quote=drduck]thanks a lot friend.[/quo
you're welcome wink

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