skip to main content

Anastomotic leak after bypass — USMLE Step 3 MCQ

Instant feedback + full explanation. One question, done properly.

HardSurgery (Post-operative / Follow-up)Anastomotic leak after bypassUSMLE Step 3

A traveler returning from Sierra Leone has Plasmodium falciparum parasitemia of 7%, confusion and acute kidney injury. After IV artesunate 2.4 mg/kg at 0, 12 and 24 hours, a smear obtained 4 hours after the third dose shows 1.8% parasitemia; consciousness is improving, but vomiting prevents oral therapy. What is the next antimalarial step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Continue IV artesunate 2.4 mg/kg daily while reassessing parasitemia and oral tolerance

The best answer is “Continue IV artesunate 2.4 mg/kg daily while reassessing parasitemia and oral tolerance”. CDC guidance uses IV artesunate 2.4 mg/kg at 0, 12 and 24 hours for severe malaria. When the post-third-dose parasite density remains above 1%, continue the same dose once daily, for no more than seven total days, until density is 1% or less and the patient can receive a complete oral follow-on regimen. Persistent vomiting prevents an immediate oral transition, and residual parasitemia does not by itself establish artesunate failure.

Reference: CDC Clinical Guidance: Treatment of Severe Malaria: https://www.cdc.gov/malaria/hcp/clinical-guidance/treatment-of-severe-malaria.html