1. Plasmodium falciparum is summarized as: - It is the most virulent species and can cause severe complications like cerebral malaria. - It infects red blood cells of all ages. - Rapid antigen detection tests can detect HRP2 which is specific to P. falciparum.

1. -DR.AKIF A.B

3. 1) There is no liver stage since parasite directly enters blood
2) Hypnozoites are not found
3) Hence there is no relapse
4) No need for Primaquine

4. 1) Infective form to man = Sporozoites present in salivary glands of
Mosquito
2) Infective form to man in case of
blood transfusion
3) Infective form to mosquito = Gametocytes
- To infect mosquito, Gametocyte must be mature, viable, count >12per cubic mm.
merozoites

5. P.Vivax P.Falciparu
m
P.Malariae P.Ovale
Relapse(Hypn
ozoites)
seen Not seen Not seen Seen
Recrudescene
ce
Not seen seen seen Not seen
Incubation
period
14days 12days 28days 17days
Erythrocytic
cycle
48hrs 48hrs 72hrs 48hrs

6. Recrudescence is due to persistence of drug resistant parasite.
In Falciparum : Disease appears after 2-3weeks of completion of treatment
In Malariae ; Disease appears very late almost after 60yrs.
-due to hypnozoites
-May reappear after2-3yrs
-Seen in P.vivax and ovale.

7. Species Disease Periodicity
P.Vivax Benign tertian 48hrs
P.Falciparum Malignant tertian 48hrs
P.Ovale Ovale tertian 48hrs
P.Malariae Quartian 72hrs
P.Knowlesi Quotidian 24hrs

10. Plasmodium spcies Type of RBC
P.Vivax Young RBCs
P.Falciparum RBCs of all age
P.Ovale Reticulocytes /Young RBCs
P.Malariae Old RBCs

11. Sickle cell trait Protective from P.falciparum
Thallasemia trait Protective from P.falciparum
Fetal Hb Protective from P.falciparum
G6PD deficiency Protective from P.falciparum
Ovalocytosis Protective from P.falciparum
Duffy negative RBCs Protective from P.vivax

12. -It is a parasite of monkey but can also affect humans
-Early trophozoite resembles to P.falciparum
-Late trophozoite resembles to P.malariae
-Quotidian malariae

13. P.Vivax P.Falciparu
m
P.Malariae P.ovale
Forms seen
in
peripheral
blood smear
Early and late
trophozoites,
gametocytes
and schizonts
Ring forms
(early
trophozoites)
and
gametocytes
Similar to that
of vivax
Ring forms are
known as
Band forms.
Similar to that
of vivax
Gametocye Spherical,
almost
occupies RBC
Banana
shape, larger
than RBC
Similar to that
of vivax
Similar to that
of vivax
RBC size Enlarged Normal Normal enlarged
Stippling Schuffner’s
dots ( small
red dots)
Maurer’s
cleft( large
red spots)
Ziemann’s
dots
James dots

16. Gameto
cytes

17. Thin smear = for species identification
Thick smear = for quantification

18. -pLDH and Aldolase = common to all plasmodium species
-HRP-2 Ag detection = specific for P.falciparum

19. -Not found in INDIA
-Vector : Tick borne
-Zoonotic
-Diagnostic form:
Maltese cross : Ring forms are arranged in Tetrads

22. 1) Man is intermediate host for: (DNB June 2011)
A Brugia malayi
B W. Bancrofti
C Plasmodium
D Echinococcus

23. Ans. C & D
Humans act as intermediate host for
Plasmodium,
Toxoplasma,
Babesia and
Echinococcus,
T. Solium.
Intermediate host for W. Bancrofti and Brugia malayi is mosquito

24. 2) In malaria, infective stage injected into human subjects by the mosquito is:
A Sporozoite
B Merozoite
C Cryptozoite
D Gametocyte

25. Ans. A Sporozoite
Man: intermediate host
a. Female anopheles mosquito: definitive host
b. In malaria infective stage for humans is sporozoites.
c. Human cycle (Schizogony/ asexual cycle):
female anopheline mosquito bites→ sporozoites injected→ general
circulation→ invade hepatocytes→ preerythrocytic schizogony→
merozoites→ invade rbcs→ erythrocytic schizogony→ some merozoites
develop into gametocytes
d. Mosquito cycle (Sporogony/ sexual cycle): female anopheline mosquito
bites→ picks macrogametocyte & microgametocyte→ exflagellation of
microgametocyte→ penetrates one macrogamete→ zygote→ ookinete→
penetrates the epithelial lining & muscular wall & lies below the outer limiting
membrane of the stomach→ oocyst→ sporocyst containing sporozoites→
rupture, sporozoites liberated in the body cavity→ reach salivary gland

26. 3. Duration of pre-erythrocytic schizogony in Plasmodium falciparum
is: (AIIMS Nov 2011)
A 2 days
B 5 days
C 9 days
D 13 days

27. Ans. B 5 days
Duration of Pre-erythrocytic (exo-erythrocytic) schizogony:
P. Falciparum-5.5 days,
P. Vivax-8 days,
P. Ovale- 9 days,
P. Malariae- 15days.

28. 4. What is the site of pre-erythrocytic cycle of malaria?
A Anopheles
B Paranchymal cells of liver
C Kupfer cells of liver
D Spleen

29. Ans. B Parenchymal cells of liver.
Pre-erythrocytic stage occurs in the hepatocytes

30. 5. Blackwater fever results from: (DNB Dec 2011)
A Intravascular haemolysis
B Nephrotic syndrome
C Alkaptonuria
D Paroxysmal nocturnal hemoglobinuria

31. Ans. A Intravascular haemolysis
a. Black water fever is because of intravascular hemolysis.
b. It is caused by rapid and massive destruction of red blood cells with the
production of hemoglobinemia, hemoglobinuria, intense jaundice, anuria,
and finally death
c. In the majority of cases. The most probable explanation for blackwater
fever is an autoimmune reaction apparently caused by the interaction of the
malaria and quinine

32. 6. In falciparum malaria, all the following states are seen except:.
A Ring stage
B Gametocyte
C Schizont
D Sporozoite

33. Ans. C Schizont
a. Erythrocytic schizogony occurs in the capillaries of internal organs and only
the early ring forms and the gametocytes are seen in the peripheral smear.
b. Late trophozoite and schizont are not seen in peripheral blood in falciparum
malaria.

34. 7. Banana shaped gametocytes in peripheral smear are seen
in infection with: (AIIMS May 2011)
A Plasmodium vivax
B Plasmodium malaria
C Plasmodium falciparum
D Plasmodium ovale

35. Ans. C Plasmodium falciparum
Banana shaped or crescent shaped gametocytes
are seen in P. Falciparum.

36. 8. All are seen in Plasmodium falciparum infection except:
A Hemoglobinuria
B Cerebral malaria
C Relapses
D Malignant malaria

37. Ans. C Relapses
Relapses are due to hypnozoites in liver. These are seen in case of P.vivax and
P.ovale. P. Falciparum is not associated with relapses.

38. 9. Microscopic examination of a thin blood smear from a patient suspected
of having malaria reveals numerous normal size erythrocytes without
stippling but with ring stages, many with multiple ring stages and applique
forms. Several erythrocytes show developing trophozoites that are spread
across the erythrocytes in a band fashion. Which of the following is the
most likely cause of infection? (AIPG 2011)
A Plasmodium vivax
B Plasmodium malariae
C Plasmodium falciparum
D A mixed infection with two plasmodium species

39. Ans. D A mixed infection with two plasmodium species
a. Multiple ring stages and applique forms are indicative of P. Falciparum;
several erythrocytes show developing trophozoites that are spread across
the erythrocytes in a band fashion that is indicative of P. Malariae infection.
b. Normal size erythrocytes without stippling (Schuffner dots) would exclude P.
Vivax and P. Ovale.

40. 10. A patient in the city of Pune was diagnosed with malaria acquired
through a blood transfusion. A discussion of this case by physicians
included the following statements. Which statement is correct?
A The infected blood contained sporozoites.
B The patient should be treated with chloroquine and primaquine.
C The patient should be treated to eradicate the stages responsible for
symptoms.
D The blood donor had chloroquine-resistant malaria.

41. Ans. C The patient should be treated to eradicate the stages
responsible for symptoms.
a. The primary goal should be to treat the patient to eliminate the erythrocytic cycle
that is the cause of symptoms.
b. This would constitute a radical cure because the liver phase only occurs if infection
is initiated by sporozoites. Thus, treating with primaquine (B) is not necessary
because the patient will not harbor hypnozoites.
c. Likewise, (A) is not correct because sporozoites are only acquired from
mosquitoes. Transfusion malaria is caused by schizonts and merozoites present in
the transferred blood.
d. There is no way to know that the malaria is chloroquine resistant until after
treatment with chloroquine (D)

42. 11. Cerebral malaria most commonly attends infection with which of the following?
A Plasmodium vivax
B Plasmodium malariae
C Plasmodium falciparum
D Plasmodium ovale

43. Ans. C Plasmodium falciparum
a. Cerebral malaria involves the clinical manifestations of Plasmodium
falciparum malaria that induce changes in mental status and coma and is
accompanied by fever.
b. Without treatment, cerebral malaria is fatal in 24-72 hours and the mortality
ratio is between 25-50 percent.
c. The common histopathological finding is the sequestration of parasitized and
nonparasitized red blood cells in cerebral capillaries and venules.

44. 12. A 29-year-old man feels tired and has sore muscles, so he consults a physician,
who examines him, but decides not to admit him to the hospital. The man
subsequently develops a disabling illness complicated by severe anemia, pulmonary
edema, renal failure, and shock. Which of the following organisms is the most likely
pathogen? (AIPG 2012)
A Babesia microti
B Plasmodium falciparum
C Plasmodium malariae
D Plasmodium ovale

45. Ans. B Plasmodium falciparum
a.This is the history of complicated P. Falciparum infection.
b. The complications associated with P. Falciparum include: pernicious malaria,
black water fever, algid malaria, cerebral malaria, pulmonary edema, ARDS and
metabolic acidosis.

46. 13. Which of the following species of Plasmodium has
special affinity for reticulocytes: (AIIMS Nov 2012)
A P ovale
B P vivax
C P malariae
D P falciparum

47. Ans. A P ovale
P. Falciparum infects RBC’s of all ages
P. Vivax infects RBC’s < 14 d
P. Malariae infects old RBC’s
P. Ovale selectively infect reticulocytes

48. 14. All of the following are complication of Plasmodium falciparum infection except
A Blackwater fever
B Cerebral malaria
C Recrudescent malaria
D Nephropathy

49. Ans. D Nephropathy
a. Nephropathy is seen in Plasmodium malariae.
b. Recrudescence result from persistent erythrocytic infection, which re-emerges
within a defined period -usually taken as 28 days following antimalarial
treatment in endemic areas.
c. Relapse occurs due to reactivation of hypnozoites in the liver.
d. Blackwater fever results due to severe intravascular hemolysis.
e. Cerebral malaria occurs due to sequestration, rosetting and cytoadherence in
cerebral capillaries.

50. 15. Which species of malaria causes nephrotic syndrome
A Plasmodium ovale
B Plasmodium falciparum
C Plasmodium vivax
D Plasmodium malariae

51. D Plasmodium malariae

52. 16. Which one of the following is detected by the
antigen detection test for the diagnosis of P.
Falciparum malaria (AIIMS Nov 2012)
A CSP
B MSA
C HRP1
D HRP2

53. Ans. D HRP2
Malaria rapid diagnostic tests detect the presence of malarial antigens in the blood
of the patient. Malarial HRP-II, LDH and aldolase are detected. These are immune-
chromatographic tests.

54. 17. Infection with Babesia is most commonly observed in which of the following?
A AIDS patient
B Foresters
C Patients without a spleen
D Transfusion recipients

55. Ans. C Patients without a spleen
a. Babesia is a tick-borne organism transmitted by I. Scaputaris, the same tick
that transmits Lyrne disease.
b. Babesia is often mistaken for Plasmodia (causative organism of malaria) on a
blood smear. Patients become anemic and develop hepatosplenomegaly, but
patients who are asplenic are at a much greater risk.
c. Transfusion recipients, foresters, and immunosuppressed patients may be at
risk of acquiring disease but not to the same extent as those patients who have
been splenectomized.

56. 18. Maltese cross is associated with (DNB June 2012)
A Candida albicans
B Penicillium marneffii
C Babesia microti
D Cryptococcus

57. Ans. C Babesia microti
Tetrad forms in RBC’s which represent budding merozoites are called Maltese cross.