Debbie is a young girl planning to go on a trip to Africa.

She is given a typhoid

vaccination (which she has not taken before) and a polio vaccine as a booster.

Describe the changes in terms of cellular and time frame and the
difference in the response to the two vaccines (8 marks).

As part of the consultation, the doctor finds out that Debbie is “on pill”.

What advice would you give on

i. contraception (3 marks)
ii. safe sex (3 marks)
during her holiday trip.

The doctor gives her malarial prophylaxis. She advises her to keep taking the
prophylaxis up to 4 weeks after returning from the trip.

Using the malarial life cycle, explain why the prophylaxis is needed (4
marks)

During her trip, she kept getting bitten by mosquitoes. She kills the mosquitoes
while they were feeding off her and noticed that the blood is not clotted.

What are the possible reasons that the blood in mosquito is liquid? (6
marks)

The areas bitten are red, itchy and swollen.

Why is the area red, itchy and swollen?

She got back, fallen ill badly and admitted to the A&E.

What is the role of triage nurse? (2 marks)

List four other people involved in her care during her stay in the A&E. (4
marks)

She has a blood pressure of 96/60mmHg, heart rate of 125 beats per minute,
and a temperature of 39.6oC. She is also confused.

What is the normal blood pressure and heart rate for a young female? (1
mark)

Relate these clinical findings to the circulation and cardiac output. (3

marks)

List the possible reasons for her confusion (4 marks)

Blood sample is obtained and sent to lab. Blood film is shown. Blood film
(imagine a picture with 3 normal red blood cells and 3 red blood cells with the
ring stage of malarial infection).

Describe what you see and what is your diagnosis? (4 marks)

Palpation on her abdomen is made. A diagram of thoracoabdominal region is

given.

Draw the liver, spleen, and appendix in the diagram. (3 marks)

What region is the spleen in? (2 marks)

The spleen is found to be enlarged and tender.

What are the 2 functions of spleen? (2 marks)

List 3 reasons why the spleen is enlarged and tender. (3 marks)

She needs to be admitted to hospital but she is unconscious. The doctor needs
to get consent.

What is informed consent? (2 marks)

What should the doctor do in this case? (2 marks)