Question # 1 (Multiple Answer) Antimalarials: dihydrofolate reductase inhibitors

A) chloroquine (Aralen)
B) chloroguanide
C) pyrimethamine (Daraprim)
D) trimethoprim (generic)
E) primaquine

Question # 2 (Multiple Answer) Characteristics of significant parasitization, i.e. P falciparum:

A) vasoconstriction
B) hemoglobinuria
C) microthrombi formation
D) if > 20% of erythrocytes are parasitized, mortality = 50% (P falciparum)

Question # 3 (Multiple Answer) One cycle of liver invasion and multiplication:

A) P vivax
B) P falciparum
C) P. malariae
D) P ovale

Question # 4 (Multiple Choice) Factors which determine antimalarial agent efficacy:

A) species
B) life-cycle stage-dependencies
C) both
D) neither

Question # 5 (Multiple Choice) Asserting a malarial diagnosis:

A) fever/flu-like symptoms in individual returning from travel (or native to) a malarious geographical region
B) disease ruled out the patient has taken prophylactic drugs during travel
C) both
D) neither

Question # 6 (Multiple Answer) Malaria prophylaxis:for regions with chloroquine (Aralen)-resistant P falciparum malaria

A) preferred: mefloquine (Lariam)
B) alternative #1:doxycycline (Vibramycin, Doryx)
C) alternative #2: chloroquine (Aralen) plus proguanil (Paludrine)

Question # 7 (Multiple Answer) Malaria: etiology --

A) only arthropod vector-byte to the female anopheline mosquito
B) transmission does not occur at < 60 degrees Fahrenheit or at >100 degrees Fahrenheit
C) incubation period: typically three-four weeks

Question # 8 (Multiple Answer) Antimalarials: classification based on site of drug action:

A) gametocides
B) tissue schizonticides
C) blood schizonticides, e.g. chloroquine (Aralen), proguanil (Paludrine), pyrimethamine (Daraprim), mefloquine (Lariam), quinine (Quinamm)
D) gametocides: primaquine (P falciparum; chloroquine (Aralen) (P vivax, P. malariae, P ovale)

Question # 9 (Multiple Answer) Treatment of malaria-all species except chloroquine (Aralen)-resistant P falciparum

A) Oral treatment (P falciparum or P. malariae): chloroquine phosphate (Aralen)
B) Oral treatment (P vivax or P ovale): chloroquine (Aralen) plus primaquine phosphate
C) Parenteral treatment (severe attacks): quinidine gluconate (Quinaglute, Quinalan) followed by oral chloroquine (Aralen) when possible {followed by primaquine if infection is caused by P vivax or P ovalea brace

Question # 10 (Multiple Answer) Malaria: objective clinical presentations

A) orthostatic hypotension
B) faint scleral icterus
C) meningismus
D) during paroxysmal phase: high fever (up to 106 degrees Fahrenheit)

Question # 11 (Multiple Answer) Malaria:

A) about one million deaths per year due to malaria
B) most important parasitic infection
C) most U.S. cases found in transfusion recipients and intravenous drug users
D) increase in incidence secondary to increasing drug- resistance to P falciparum & failure of mosquito eradication programs

Question # 12 (Multiple Answer) Major malarial symptoms:

A) cold phase-patient complains of chills
B) hot phase-associated with high fever, headache, vomiting, nausea, delirium
C) defervescence;profuse sweating and sleep
D) none of the above

Question # 13 (True/False) Treatment of malaria caused by chloroquine (Aralen)-resistant P falciparum:oral:quinine sulfate and clindamycin (Cleocin)

A) True
B) False

Question # 14 (Multiple Answer) Treatment must eliminate parasites from both liver and erythrocytes:

A) P falciparum
B) P. malariae
C) P vivax
D) P ovale

Question # 15 (Multiple Choice) Of the plasmodium species causative for human malaria, the one producing most serious complications:

A) Plasmodium vivax
B) Plasmodium malariae
C) Plasmodium ovale
D) plasmodium falciparum

Question # 16 (Multiple Answer) Concerning definitive malaria diagnosis:

A) if thin blood smear is negative, examine thick smear {may be positive than 20%-25% of patients}
B) examination of blood smear should be done once approximately seven days after initial visit
C) a critical factor is to determine if patient has falciparum malaria which may be fatal due to high-rate of erythrocyte parasitization