Paediatric infections: relapse in vivax malaria: practice question

A Pediatrics 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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Pediatrics · Paediatric infections: relapse in vivax malaria

Sample item

A 9-year-old is treated with chloroquine for P. vivax malaria and clears the parasitaemia. Six weeks later fever and parasitaemia recur, with no new travel or exposure. What explains the recurrence?

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

The answer and the reasoning

A. Dormant hypnozoites in the liver

P. vivax and P. ovale form hypnozoites in hepatocytes that are not killed by chloroquine and can reactivate weeks to months later. Radical cure needs primaquine to kill them. Blood-stage drugs clear only the erythrocytic parasites.

Option by option

  • A. Dormant hypnozoites in the liver (correct)

    Correct. Liver hypnozoites cause relapse after blood schizonticide therapy.

  • B. Co-infection with P. malariae

    Co-infection would not explain the vivax recurrence after clearance.

  • C. Chloroquine-resistant gametocytes in the blood

    Gametocytes cause transmission to mosquitoes and do not cause new fever.

  • D. Persistent schizonts in the spleen

    Spleen schizonts are not the cause of vivax 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 Pediatrics question

What is the answer to this Pediatrics question?

The best answer is A, Dormant hypnozoites in the liver. P.

Why is "Co-infection with P. malariae" not the answer?

Co-infection would not explain the vivax recurrence after clearance.

Why is "Chloroquine-resistant gametocytes in the blood" not the answer?

Gametocytes cause transmission to mosquitoes and do not cause new fever.

Why is "Persistent schizonts in the spleen" not the answer?

Spleen schizonts are not the cause of vivax relapse.

What concept does this question test?

It tests Paediatric infections: relapse in vivax malaria in Pediatrics. vivax and P. ovale form hypnozoites in hepatocytes that are not killed by chloroquine and can reactivate weeks to months later. Radical cure needs primaquine to kill them. Blood-stage drugs clear only the erythrocytic parasites.

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 Paediatric infections: relapse in vivax malaria?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics 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.