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Severe falciparum malaria — SCE Acute Medicine MCQ

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ModerateSepsis and Infectious EmergenciesSevere falciparum malariaSCE Acute Medicine

A 55-year-old woman presents with fever, systemic upset and acute deterioration. Relevant history includes a plausible infectious exposure or immunocompromising context. On assessment, NEWS2 is elevated and there are features of organ dysfunction. Investigations show parasitaemia 8 percent with confusion, jaundice and renal impairment. What is the most appropriate next step in management?

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Correct answer: A — Start intravenous artesunate and involve infectious diseases

The key discriminator is that parasitaemia 8 percent with confusion, jaundice and renal impairment, which makes Start intravenous artesunate and involve infectious diseases the single best answer. Give controlled oxygen and senior review is less appropriate because it does not address the dominant acute risk in the vignette; Start anticoagulation after assessing bleeding risk would fit a different presentation or later stage of care. Arrange urgent specialist referral and Call critical care for escalation are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: UK malaria treatment guideline; BNF