Communicable diseases: malaria radical cure: practice question

A PSM question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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PSM · Communicable diseases: malaria radical cure

Sample item

A 25-year-old man from an endemic district has completed chloroquine for microscopically confirmed Plasmodium vivax malaria. His G6PD status is normal. Which drug is added to prevent later relapses, and why?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Primaquine for 14 days, because it kills the dormant hypnozoites in the liver

P. vivax and P. ovale form hypnozoites in hepatocytes that cause relapses weeks to months after the blood stage is cured. Primaquine, an 8-aminoquinoline, is the radical-cure drug and is given at 0.25 mg/kg daily for 14 days in India after confirming normal G6PD status. It is contraindicated in pregnancy and in infants.

Option by option

  • A. Doxycycline for 7 days, because it clears persistent blood-stage parasites

    Doxycycline is used as an adjunct or for prophylaxis and does not eradicate hypnozoites.

  • B. Primaquine for 14 days, because it kills the dormant hypnozoites in the liver (correct)

    Correct. Primaquine acts on hypnozoites and therefore prevents vivax relapse.

  • C. Artesunate plus sulfadoxine-pyrimethamine, because it kills circulating gametocytes

    Artesunate-based combination is for falciparum malaria and has no action against vivax hypnozoites.

  • D. A second course of chloroquine, because chloroquine eliminates liver hypnozoites

    Chloroquine is a blood schizonticide and has no effect on the liver stage, so repeating it does not prevent relapse.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this PSM question

What is the answer to this PSM question?

The best answer is B, Primaquine for 14 days, because it kills the dormant hypnozoites in the liver. P.

Why is "Doxycycline for 7 days, because it clears persistent blood-stage para…" not the answer?

Doxycycline is used as an adjunct or for prophylaxis and does not eradicate hypnozoites.

Why is "Artesunate plus sulfadoxine-pyrimethamine, because it kills circulati…" not the answer?

Artesunate-based combination is for falciparum malaria and has no action against vivax hypnozoites.

Why is "A second course of chloroquine, because chloroquine eliminates liver…" not the answer?

Chloroquine is a blood schizonticide and has no effect on the liver stage, so repeating it does not prevent relapse.

What concept does this question test?

It tests Communicable diseases: malaria radical cure in PSM. vivax and P. ovale form hypnozoites in hepatocytes that cause relapses weeks to months after the blood stage is cured. Primaquine, an 8-aminoquinoline, is the radical-cure drug and is given at 0.25 mg/kg daily for 14 days in India after confirming normal G6PD status. It is contraindicated in pregnancy and in infants.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Communicable diseases: malaria radical cure?

Practise biostatistics with small calculations until sensitivity, predictive values and risk measures are automatic. Then use the flashcards and the other PSM questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.