KFP – Travel medicine

Emily Watson, aged 27, presents for a pre-travel consultation. She is planning a three-month backpacking trip through Southeast Asia, including rural parts of Thailand, Laos, Cambodia, and Vietnam. She will be staying in hostels, doing volunteer work in local communities, and consuming local food and water. She reports being in good health, with no chronic illnesses, and takes no regular medications. She has completed her primary childhood immunisations, including MMR, polio, and DTP.

Medications: None

Allergies: Nil known

Past history: Nil significant

Travel history: First time travelling to tropical countries

Social history: Non-smoker, drinks alcohol occasionally, vegetarian

Examination findings: Normal vital signs and examination

What are the most appropriate vaccinations and prophylactic measures to recommend for Emily’s trip? Select four (4) from the following list:

Michael D’Souza, aged 34, presents after returning from a four-week business trip to Nigeria. He complains of fever, myalgia, and headaches for the past two days. He feels generally unwell and has had intermittent chills. He denies cough or urinary symptoms. He did not take any malaria prophylaxis before departure, believing the trip would be brief and mainly in urban areas. He stayed in air-conditioned hotels but did travel for three days to rural areas to visit local suppliers. He recalls being bitten by mosquitoes despite precautions.

Medications: None

Allergies: Nil known

Past history: Unremarkable

Social history: Lives in Melbourne, works in logistics, non-smoker, occasional alcohol

Examination findings: Temperature 38.9°C, HR 102 bpm, BP 122/78 mmHg, appears flushed but otherwise unremarkable examination

Investigations: FBC shows mild thrombocytopenia and elevated LDH. LFTs mildly deranged. Rapid antigen test for malaria: pending.

What are the most appropriate next steps in Michael’s care? Select three (3) from the following list:

Alana Petrovic, aged 19, presents one week after returning from a two-week schoolies trip to Bali. She reports a three-day history of profuse watery diarrhoea, abdominal cramping, and mild fever. She denies blood in the stool or vomiting. She has had no previous episodes and has not sought medical attention overseas. She has no significant medical history and is on the oral contraceptive pill. She drank bottled water but consumed street food daily.

Medications: Ethinylestradiol/levonorgestrel (OCP)

Allergies: Nil known

Past history: Nil significant

Travel history: Indonesia (Bali), two weeks, returned 7 days ago

Examination findings: BP 110/70 mmHg, HR 86 bpm, T 37.8°C. Mild diffuse abdominal tenderness. No signs of dehydration.

What are the most appropriate management steps at this time? Select three (3) from the following list:

Dr. Sanjay Mehta, aged 46, presents for advice prior to a two-week surgical volunteer mission to Papua New Guinea. He will be based in a rural hospital and expects to be involved in theatre and inpatient care. He has received standard childhood immunisations and had a tetanus booster ten years ago. He had hepatitis A and typhoid vaccines before a trip to India five years ago. He has no other travel plans and no known chronic illnesses.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Married, three children, lives in Sydney, non-smoker, occasional alcohol

Occupational history: General surgeon

What are the most appropriate health and safety considerations for Sanjay? Select four (4) from the following list:

Harinder Singh, aged 62, presents after returning from a four-week pilgrimage to northern India. He reports feeling increasingly tired, with low-grade fevers and a dry cough. He has also noticed some unintentional weight loss and night sweats. He has no significant past medical history and is on no regular medications. He reports staying in crowded communal accommodations and visiting hospitals during the pilgrimage. He denies smoking or alcohol use.

Medications: None

Allergies: Nil known

Past history: Nil significant

Social history: Retired school teacher, lives with wife, no recent sick contacts

Travel history: India, 4 weeks, returned 10 days ago

Examination findings: Mildly cachectic, T 37.8°C, no lymphadenopathy, chest clear to auscultation, mild hepatomegaly

What are the most appropriate next investigations or management steps? Select four (4) from the following list:

Julia Martinez, aged 31, presents for pre-travel advice. She is 24 weeks pregnant and plans to visit her husband’s family in El Salvador for four weeks. The trip includes urban and rural locations, and she will be staying with extended family members. She is generally well and this is her first pregnancy. She has no medical conditions and her antenatal checks have been normal to date. She is up to date with routine vaccinations but has not received any travel-specific vaccines in the past.

Medications: Pregnancy multivitamins

Allergies: Nil known

Past history: Nil significant

Obstetric history: First pregnancy, progressing normally

What are the most appropriate travel health recommendations for Julia? Select four (4) from the following list:

David Ko, aged 45, presents for pre-travel medical advice before an upcoming business trip to Kenya. He will be in Nairobi for three days before spending a week in a remote area assisting with a construction project. He has type 2 diabetes managed with oral hypoglycaemics. He has not travelled to Africa before. He is concerned about malaria and whether any vaccines are needed. He also has a history of needle phobia and prefers to avoid unnecessary injections.

Medications: Metformin XR 1g daily, gliclazide MR 30mg daily

Allergies: Nil known

Past history: Type 2 diabetes, diagnosed 3 years ago

Social history: Office worker, non-smoker, occasional alcohol, no recreational drug use

What are the most appropriate recommendations for David’s travel health preparation? Select four (4) from the following list:

Thomas Bell, aged 25, presents one week after returning from a backpacking trip to Peru. He reports a painless genital ulcer that developed three days ago, followed by a non-itchy rash on his palms and soles. He had unprotected sexual intercourse with two partners during his trip. He is otherwise well and has no past history of STIs. He did not seek any medical care while overseas.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Works in hospitality, smokes socially, moderate alcohol intake, not currently in a relationship

What are the most appropriate next steps in managing Thomas? Select four (4) from the following list:

Sophie Chan, aged 29, presents for pre-travel counselling prior to a six-month posting as a schoolteacher in rural Laos. She will be living in a small community with limited access to medical care. She is generally healthy, with no chronic illnesses. She has previously travelled to Thailand for short holidays. She is seeking advice about vaccinations, malaria, and general precautions. She has not received any recent vaccinations apart from COVID-19.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Non-smoker, drinks alcohol socially, vegetarian

Travel history: Short trips to urban Thailand; this is her first long-term rural placement

What are the most appropriate pre-travel recommendations for Sophie? Select four (4) from the following list:

James O’Neill, aged 52, presents three days after returning from a fishing trip to the Northern Territory where he camped in remote bushland and swam in freshwater rivers. He now reports fevers, muscle aches, and a severe headache. He also has conjunctival suffusion and mild jaundice. He recalls cutting his foot on a rock while wading through a river. He has no chronic illnesses and is not on any medications.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Works as an electrician, non-smoker, moderate alcohol use

Examination findings: T 38.9°C, HR 96 bpm, BP 118/72 mmHg, scleral icterus, no rash, tender calves, no meningism

What are the most appropriate next investigations or management steps? Select three (3) from the following list:

Markus Novak, aged 38, presents with fever, retro-orbital headache, myalgia, and a widespread maculopapular rash. He returned to Brisbane two days ago after visiting family in Jakarta, Indonesia, where he spent three weeks during the rainy season. He reports being bitten by mosquitoes despite using repellents. He did not take any pre-travel prophylaxis or seek medical advice prior to his trip.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Examination findings: T 39.4°C, HR 92 bpm, BP 118/74 mmHg, blanching rash across trunk and limbs, mild conjunctival injection, no meningism

What are the most appropriate immediate investigations or management steps? Select four (4) from the following list:

Emma Whitfield, aged 43, presents for travel advice. She is planning to visit her extended family in Pakistan for eight weeks, including a four-week stay in a rural village. She has type 1 diabetes managed with an insulin pump. She has received all routine childhood vaccinations but has not had any adult boosters. She is particularly concerned about water safety, insulin storage, and infectious diseases in the region.

Medications: Rapid-acting insulin via insulin pump

Allergies: Nil known

Past history: Type 1 diabetes since age 15

Social history: Lives with husband and two children, non-smoker, no alcohol use

What are the most appropriate travel health recommendations for Emma? Select four (4) from the following list:

Alex Zhang, aged 26, presents with fever, fatigue, and cervical lymphadenopathy. He returned five days ago from a one-month trekking trip through rural Nepal. During his trip, he drank untreated stream water on multiple occasions and stayed in basic lodges. He reports a sore throat, mild jaundice, and abdominal discomfort. He has no past medical history and is not on any medications.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Works in finance, non-smoker, occasional alcohol

Examination findings: T 38.6°C, HR 84 bpm, BP 122/76 mmHg, scleral icterus, tender cervical nodes, hepatomegaly

What are the most appropriate investigations or initial management steps? Select four (4) from the following list:

Rachel Green, aged 34, presents for advice before travelling to Morocco for a three-week desert trekking tour. She will be camping in remote areas with limited access to clean water or medical care. She has a history of generalised anxiety disorder, well managed on sertraline. She expresses concern about developing illness while overseas and asks about traveller’s diarrhoea, hydration, and psychological preparedness.

Medications: Sertraline 50 mg daily

Allergies: Nil known

Past history: Generalised anxiety disorder, stable

Social history: Non-smoker, drinks alcohol rarely, lives alone

What are the most appropriate pre-travel recommendations for Rachel? Select four (4) from the following list:

Liam Byrne, aged 48, presents with a non-healing ulcer on his lower leg three weeks after returning from a hiking and photography trip to the Amazon rainforest in Brazil. He recalls being bitten multiple times by insects and developed a small papule at the site of one bite, which slowly enlarged and ulcerated. He denies systemic symptoms but reports local tenderness and increasing redness. He has not seen a doctor since returning and was otherwise well during his travels.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Freelance photographer, non-smoker, drinks socially

Examination findings: 2.5 cm ulcer with raised edges, clean base, surrounding erythema, no regional lymphadenopathy, afebrile, vital signs normal

What are the most appropriate next steps in Liam’s care? Select four (4) from the following list:

Gabrielle Thomas, aged 57, presents after returning from a Mediterranean cruise where she experienced a two-day episode of vomiting and diarrhoea midway through the trip. She now complains of ongoing fatigue and occasional loose stools one week later. Several other passengers had similar symptoms at the time. She did not seek medical care onboard and self-managed with fluids. She is now afebrile and hemodynamically stable.

Medications: Amlodipine 5 mg daily

Allergies: Nil known

Past history: Hypertension, well controlled

Social history: Retired teacher, non-smoker, no alcohol

Examination findings: BP 128/72 mmHg, HR 76 bpm, T 36.7°C, abdomen soft, non-tender, mild bowel sounds, no dehydration

What are the most appropriate next steps in management? Select three (3) from the following list:

Andre Ferreira, aged 30, presents with fever, chills, and dry cough five days after returning from a two-week safari holiday in South Africa. He camped in national parks and recalls multiple tick bites. He developed symptoms two days after returning and has also noticed a small dark scab (eschar) on his upper thigh. He has no past medical history and is not on any medications.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Engineer, non-smoker, drinks socially

Examination findings: T 39.1°C, HR 88 bpm, BP 124/78 mmHg, maculopapular rash on trunk, black eschar on thigh, mild hepatomegaly, lungs clear

What are the most appropriate steps in his investigation and management? Select four (4) from the following list:

Sarah Williamson, aged 33, presents for pre-travel advice prior to undertaking a six-month humanitarian aid deployment to Papua New Guinea (PNG). She will be living and working in a rural area with limited sanitation and healthcare access. She has no significant past medical history and is up to date with routine childhood immunisations. She has never travelled to a tropical country before.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Non-smoker, minimal alcohol, nurse

What are the most appropriate pre-travel health measures to recommend for Sarah? Select four (4) from the following list:

Tom Hargreaves, aged 44, presents with fatigue, low-grade fever, and a dry cough. He returned from the Middle East (Saudi Arabia) 6 days ago, where he was attending a religious pilgrimage involving close contact with large crowds. He reports mild shortness of breath and denies gastrointestinal symptoms. He is concerned about possible respiratory infections acquired during travel.

Medications: Ramipril 5 mg daily

Allergies: Nil known

Past history: Hypertension

Social history: Works in finance, non-smoker, no alcohol use

Examination findings: T 38.3°C, HR 88 bpm, RR 18, SpO₂ 97% on room air, lungs clear

What are the most appropriate next steps in assessment and management? Select four (4) from the following list:

Isabelle Martin, aged 62, presents with persistent fever, arthralgia, and a maculopapular rash on her limbs. She returned from Fiji two weeks ago, where she spent ten days visiting family and swimming in coastal areas. She reports mosquito bites despite using repellents. She also complains of fatigue and bilateral wrist and ankle joint pain that started five days ago. No significant past medical history is noted.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Retired, non-smoker, no alcohol

Examination findings: T 38.2°C, HR 84 bpm, symmetrical wrist and ankle joint tenderness, maculopapular rash on arms and legs, no lymphadenopathy

What are the most appropriate next investigations and management steps? Select four (4) from the following list:

Daniel Lee, aged 22, presents one week after returning from a school volunteering trip to Cambodia. He complains of right upper quadrant abdominal pain, low-grade fever, and anorexia. He recalls being unwell with self-limiting diarrhoea during the trip, which resolved. He now reports fatigue and discomfort in the upper abdomen. He has no past medical history and took no malaria prophylaxis. He drank bottled water but ate local street food regularly.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: University student, non-smoker, no alcohol use

Examination findings: T 37.9°C, HR 80 bpm, tender hepatomegaly, no jaundice, no rash

What are the most appropriate next investigations and initial management steps? Select four (4) from the following list:

Natalie Ho, aged 36, presents two weeks after returning from a surfing holiday in Sri Lanka. She reports a persistent non-healing skin lesion on her left foot. It began as a small itchy red papule that has slowly progressed into a serpiginous, raised track beneath the skin. It is mildly tender but not purulent. She walked barefoot frequently on the beach and in her accommodation. She has no systemic symptoms.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Surf instructor, non-smoker, occasional alcohol

Examination findings: Linear, raised, erythematous track on the plantar surface of the left foot, approximately 6 cm long; no signs of cellulitis; afebrile and haemodynamically stable

What are the most appropriate next steps in diagnosis and management? Select three (3) from the following list:

Ravi Patel, aged 40, presents with night sweats, intermittent low-grade fever, and a persistent dry cough two months after returning from a six-month teaching placement in rural India. He stayed in shared accommodation with local teachers and students. He had a BCG vaccination as a child but has never been screened for tuberculosis. He denies haemoptysis or chest pain but feels increasingly fatigued. No recent travel since returning to Australia.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Lives with partner, non-smoker, no alcohol use

Examination findings: T 37.8°C, HR 78 bpm, lungs clear to auscultation, mild weight loss noted

What are the most appropriate investigations and management steps? Select four (4) from the following list:

Jessica Miles, aged 28, presents with fever, headache, retro-orbital pain, and generalised myalgia. She returned from Thailand five days ago where she spent two weeks backpacking through urban and rural areas during the rainy season. She reports numerous mosquito bites and did not take any malaria prophylaxis. She denies any respiratory symptoms or gastrointestinal upset.

Medications: Oral contraceptive pill

Allergies: Nil known

Past history: Nil significant

Social history: Lives with partner, non-smoker, drinks socially

Examination findings: T 38.9°C, HR 92 bpm, BP 110/70 mmHg, petechial rash on lower limbs, no lymphadenopathy, mild tenderness in calf muscles

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Samuel Briggs, aged 50, presents three weeks after returning from a business trip to Nigeria. He reports a gradual onset of fever, malaise, and abdominal discomfort. He also describes constipation and a dull headache. He did not receive any pre-travel vaccinations and reports eating at local restaurants. He is concerned as his symptoms have persisted despite taking paracetamol regularly. He has no other significant medical history.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Works in international logistics, non-smoker, drinks socially

Examination findings: T 38.5°C, HR 86 bpm, BP 122/74 mmHg, mild abdominal tenderness in the right lower quadrant, relative bradycardia noted, no rash

What are the most appropriate investigations and initial management steps? Select four (4) from the following list:

Amira Al-Sayeed, aged 31, presents for travel advice prior to undertaking the Hajj pilgrimage to Saudi Arabia. She has asthma, managed with salbutamol and budesonide/formoterol. She is concerned about infectious diseases, medication access, and the large crowds. She has never travelled to the Middle East before and has not received any travel-specific vaccinations.

Medications: Salbutamol inhaler PRN, budesonide/formoterol inhaler BD

Allergies: Nil known

Past history: Asthma (mild to moderate)

Social history: Lives with husband and two children, non-smoker

What are the most appropriate pre-travel health recommendations for Amira? Select four (4) from the following list:

Lina Huang, aged 35, presents one week after returning from a two-month stay in rural Vietnam, where she worked with a local non-governmental organisation. She reports low-grade fever, fatigue, and painful swelling in the right inguinal region. She denies gastrointestinal or respiratory symptoms. She reports numerous mosquito bites and recalls swimming in freshwater lakes. She is otherwise healthy with no known medical conditions.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Social worker, non-smoker, no alcohol use

Examination findings: T 37.8°C, HR 84 bpm, tender enlarged right inguinal lymph node (~3 cm), mild oedema of the right lower leg, no rash, lungs and abdomen normal

What are the most appropriate next investigations or management steps? Select four (4) from the following list:

Elena Petrova, aged 46, presents with abdominal bloating, intermittent diarrhoea, and fatigue three weeks after returning from a trekking holiday in the Andes Mountains in Peru. She drank from mountain streams after running out of bottled water. She denies fever or vomiting but reports foul-smelling, greasy stools and weight loss of approximately 3 kg since returning. She is otherwise healthy and not on any regular medications.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Teacher, non-smoker, no alcohol

Examination findings: Vital signs normal, mild epigastric tenderness, no fever, no hepatosplenomegaly

What are the most appropriate investigations and initial management steps? Select four (4) from the following list:

Michael Russo, aged 64, presents with low-grade fever, malaise, and a painless ulcer on his tongue. He returned from a four-week wildlife photography trip to northern Brazil three weeks ago. He spent time camping and trekking in forested areas and reports multiple insect bites. The tongue ulcer appeared about a week ago and has not healed. He also reports some cervical lymphadenopathy and mild fatigue. He is otherwise healthy.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Retired, non-smoker, no alcohol

Examination findings: T 37.6°C, HR 78 bpm, 1.5 cm ulcer on lateral tongue with raised edge, non-tender, enlarged right cervical lymph node, no rash or hepatosplenomegaly

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Lucas Nguyen, aged 27, presents with fever, severe muscle aches, and red eyes three days after returning from a white-water rafting holiday in northern Thailand. He also reports headaches and chills but no gastrointestinal or respiratory symptoms. He swam and fell into freshwater rivers multiple times. He is otherwise healthy and not on any medications.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Adventure tourism guide, non-smoker, occasional alcohol

Examination findings: T 38.7°C, HR 88 bpm, BP 118/76 mmHg, conjunctival suffusion, mild diffuse muscle tenderness, no rash, no jaundice

What are the most appropriate investigations and initial management steps? Select four (4) from the following list:

Priya Menon, aged 30, presents for pre-travel advice before embarking on a six-week backpacking trip through sub-Saharan Africa, including Kenya, Uganda, and Tanzania. She plans to visit national parks, participate in rural volunteer work, and go on a safari. She is generally healthy, has completed routine childhood vaccinations, and has not travelled to Africa previously.

Medications: Ethinylestradiol/levonorgestrel (oral contraceptive pill)

Allergies: Nil known

Past history: Nil significant

Social history: Primary school teacher, non-smoker, social alcohol use

What are the most appropriate pre-travel recommendations for Priya? Select four (4) from the following list:

Benjamin O’Connor, aged 38, presents with a painless genital ulcer and generalised fatigue two weeks after returning from a business trip to Manila, Philippines. He had unprotected sexual contact during the trip. He denies dysuria or penile discharge. He has no previous history of sexually transmitted infections and is otherwise well. No fevers, rashes, or gastrointestinal symptoms.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Accountant, single, drinks socially, non-smoker

Examination findings: Single clean-based ulcer on the penile shaft, non-tender inguinal lymphadenopathy, afebrile, no skin rash

What are the most appropriate next steps in management? Select four (4) from the following list:

Anna Wright, aged 41, presents with severe watery diarrhoea and dehydration two days after returning from a humanitarian mission in Bangladesh. She reports more than 10 loose stools per day and has noticed that the stools are rice-water in appearance. She has no fever or vomiting. She drank tap water during her stay, assuming it was treated. She is otherwise healthy with no comorbidities.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: School administrator, non-smoker, occasional alcohol

Examination findings: T 36.8°C, HR 108 bpm, BP 92/58 mmHg, dry mucous membranes, sunken eyes, reduced skin turgor

What are the most appropriate immediate management steps? Select four (4) from the following list:

David Kim, aged 29, presents four weeks after returning from a remote village placement in Papua New Guinea with intermittent low-grade fevers, abdominal bloating, and mild diarrhoea. He also reports perianal itching at night. He is otherwise well and has no known medical history. During his trip, he worked in a local school and often walked barefoot.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Teacher, non-smoker, no alcohol use

Examination findings: Vital signs normal. Mild abdominal distension, no hepatosplenomegaly, no rash

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Nadia El-Amin, aged 33, presents two weeks after returning from a month-long backpacking trip through Indonesia. She reports low-grade fever, fatigue, and a new onset of dry cough. She also noticed a tender swelling in her right axilla. She recalls removing a tick from her leg while hiking in a national park but did not seek medical attention at the time. She denies rash, diarrhoea, or urinary symptoms.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Travel blogger, non-smoker, occasional alcohol

Examination findings: T 38.4°C, HR 82 bpm, BP 118/72 mmHg, 2 cm tender lymph node in right axilla, no rash, lungs clear, no hepatosplenomegaly

What are the most appropriate investigations and initial management steps? Select four (4) from the following list:

Matthew Doyle, aged 47, presents with a persistent non-productive cough and fatigue six weeks after returning from a two-month backpacking trip through southern Africa, including Zimbabwe and Mozambique. He reports visiting caves and bat-infested areas while hiking. He is otherwise well, with no known medical conditions. He denies fever, haemoptysis, or weight loss. Symptoms began gradually about three weeks after returning.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Outdoor enthusiast, non-smoker, occasional alcohol

Examination findings: Normal vital signs, scattered crackles in both lung bases, no clubbing, no lymphadenopathy

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Emily Foster, aged 26, presents with an intensely itchy rash on her feet and lower legs five days after returning from a beach holiday in northern Queensland. She reports walking barefoot on the sand and sleeping in a hammock outside. The rash began as small red bumps and has progressed into serpiginous, raised tracks. She is otherwise well, with no systemic symptoms.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Marketing professional, non-smoker, drinks socially

Examination findings: Multiple serpiginous, raised erythematous tracks on the soles and dorsum of both feet, no swelling or signs of secondary infection

What are the most appropriate next steps in investigation and management? Select three (3) from the following list:

John Price, aged 54, presents with persistent dry cough and mild shortness of breath two weeks after returning from a business trip to Dubai. He reports attending a camel market and drinking unpasteurised camel milk. He has no fever, chest pain, or gastrointestinal symptoms. He has mild hypertension controlled with medication. He is concerned about the risk of ‘that Middle East virus’ he has heard about in the news.

Medications: Perindopril 5 mg daily

Allergies: Nil known

Past history: Hypertension

Social history: Works in finance, non-smoker, occasional alcohol

Examination findings: T 37.4°C, HR 80 bpm, RR 16, SpO₂ 98%, chest clear on auscultation

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Sophie Lau, aged 32, presents one week after returning from a yoga retreat in Bali with generalised fatigue, low-grade fever, and jaundice. She has dark urine and pale stools but no abdominal pain or vomiting. She ate local food, drank bottled water, and did not receive any travel vaccinations prior to departure. She is otherwise well and takes no regular medications.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Yoga instructor, non-smoker, vegetarian

Examination findings: T 37.9°C, HR 84 bpm, scleral icterus, non-tender hepatomegaly, no rash

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Tomás Alvarez, aged 36, presents with fever, myalgia, and a widespread maculopapular rash after returning from a trip to Brazil where he visited friends and attended local festivals. He reports mosquito bites and mild joint pain. He is sexually active and notes some conjunctival redness. He is concerned about Zika virus, as his partner is planning pregnancy in the next few months.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Works in hospitality, non-smoker, sexually active with female partner

Examination findings: T 38.2°C, HR 82 bpm, non-purulent conjunctivitis, diffuse maculopapular rash, no lymphadenopathy, no neurological signs

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Rachel Tan, aged 58, presents with a three-day history of fevers, chills, and headaches. She returned from a two-week trip to Papua New Guinea (PNG) six days ago, where she visited both urban and remote areas. She did not take malaria prophylaxis. She has no gastrointestinal or respiratory symptoms. She is concerned because a colleague on the same trip was recently diagnosed with malaria.

Medications: Ramipril 5 mg daily

Allergies: Nil known

Past history: Hypertension

Social history: Consultant engineer, non-smoker, occasional alcohol

Examination findings: T 39.1°C, HR 92 bpm, BP 130/76 mmHg, mild pallor, no rash, chest and abdomen unremarkable

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Alison Murray, aged 37, presents for pre-travel advice before departing for a four-week solo trekking trip through rural Peru and Bolivia. She will be staying in hostels and hiking through mountainous and jungle regions. She has a history of well-controlled epilepsy and is concerned about altitude sickness, insect bites, and access to medical care in remote areas. She has not travelled to South America before.

Medications: Sodium valproate 500 mg BD

Allergies: Nil known

Past history: Epilepsy (well controlled, seizure-free for 5 years)

Social history: Works in IT, non-smoker, no alcohol

What are the most appropriate pre-travel health recommendations for Alison? Select four (4) from the following list:

Daniela Costa, aged 45, presents four weeks after returning from Ethiopia with persistent eosinophilia noted on routine blood tests. She is asymptomatic but mentions having swum in freshwater lakes and walked barefoot in rural areas. She had no pre-travel consultation and took no prophylactic medications. She is otherwise well and has no fever, rash, or gastrointestinal symptoms.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: University lecturer, non-smoker, vegetarian

Investigations: FBC shows eosinophils 1.3 x10⁹/L (reference: 0.0–0.5 x10⁹/L), other parameters normal

What are the most appropriate next steps in management? Select four (4) from the following list:

Leon Wu, aged 31, presents with persistent fever, headache, and malaise four days after returning from a two-week business trip to India. He reports eating a variety of local street food and recalls drinking water from a jug provided in a restaurant. He did not receive typhoid vaccination before travel. He has no respiratory or urinary symptoms but reports feeling increasingly unwell. No gastrointestinal symptoms are currently reported.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Business analyst, non-smoker, drinks socially

Examination findings: T 38.6°C, HR 82 bpm, BP 120/70 mmHg, no rash, mild right lower quadrant abdominal tenderness, no hepatosplenomegaly

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Isaac Morrison, aged 61, presents with fever, confusion, and severe headache five days after returning from a two-week bird-watching trip in northern Thailand. He reports being bitten by mosquitoes and staying in rural areas near rice paddies. His partner states he became progressively drowsy over the past 24 hours. He had no pre-travel vaccinations and is not on any medications.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Retired teacher, non-smoker, no alcohol

Examination findings: T 39.3°C, HR 96 bpm, GCS 13/15, no focal neurological signs, neck stiffness present

What are the most appropriate immediate investigations and management steps? Select four (4) from the following list:

Amelia Zhang, aged 34, presents for pre-travel health advice before a three-month work placement in Bangladesh with an international aid organisation. She will be living in a rural village with limited sanitation and healthcare access. She is generally healthy and up to date with routine immunisations. She has never travelled to South Asia previously and expresses concern about water safety, vaccinations, and mosquito-borne diseases.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Aid worker, non-smoker, occasional alcohol

What are the most appropriate pre-travel health measures for Amelia? Select four (4) from the following list:

Marcus Bell, aged 40, presents with profuse watery diarrhoea, abdominal cramping, and bloating two weeks after returning from a hiking trip in Nepal. He reports drinking untreated water from mountain streams and eating locally prepared vegetarian food. He denies fever or vomiting but notes significant flatulence and fatigue. His symptoms have persisted for over a week without improvement.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Fitness coach, non-smoker, vegetarian

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Olivia Reed, aged 39, presents with fever, malaise, and arthralgia two weeks after returning from a three-week visit to family in Samoa. She reports mosquito bites during the trip and developed a rash and conjunctival redness in the first few days of her illness. Her symptoms have mostly resolved, except for ongoing joint pain, particularly in her wrists and knees.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: HR consultant, non-smoker, drinks socially

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

George Peters, aged 70, presents for a pre-travel consultation. He is planning to attend a five-week eco-tour in Kenya, including visits to national parks, rural villages, and the coast. He has hypertension and type 2 diabetes, both well controlled. He has not travelled to Africa before and is concerned about vaccines, food safety, and medical access while abroad.

Medications: Perindopril 5 mg daily, Metformin XR 1 g daily

Allergies: Nil known

Past history: Hypertension, Type 2 diabetes

Social history: Retired, non-smoker, occasional wine

What are the most appropriate travel health recommendations for George? Select four (4) from the following list:

Emily Davis, aged 25, presents two weeks after returning from a backpacking trip across Central America, including Guatemala and Honduras. She reports a three-day history of painful urination, increased urinary frequency, and low back discomfort. She is sexually active and had a new partner during the trip. She denies fever, vaginal discharge, or abdominal pain. She is concerned this may be related to something she caught overseas.

Medications: Levonorgestrel oral contraceptive

Allergies: Nil known

Past history: Nil significant

Social history: Student, non-smoker, sexually active with men

What are the most appropriate next steps in investigation and management? Select four (4) from the following list: