2012 Dengue Fever

Question 1

What is the typical characteristic of Aedes Aegypti mosquito, carrier of Dengue virus 1-4?

Answer 1

Bites during the day

Question 2

Protective in Dengue fever

Answer 2

Malnutrition

Question 3

How is tourniquet test done

Answer 3

1. Take BP
2. Add 10-20 mmHg to SBP
3. Inflate for 15 minutes
4. Check appearance of petechaie in antecubital space

Question 4

What is a positive tourniquet test

Answer 4

More than 20 petechaie in 1 sq. Inch

Question 5

When do you say there is hematoconcentration

Answer 5

Rise of 15% from baseline hematocrit

Question 6

True or false. Malnourished individuals are more likely to suffer from shock

Answer 6

False. Malnutrition is protective.

Question 7

Warning signs in Dengue

Answer 7

Abdominal pain or tenderness
Persistent vomiting
Clinical fluid accumulation
Mucosal bleeding
Lethargy, restlessness
Liver enlargement more than 2 cm
Concurrent rapid decrease in platelet count

Question 8

Criteria for severe dengue

Answer 8

Severe plasma leakage leading to shock or fluid accumulation with respiratory distress
Severe bleeding
Severe organ involvement with liver AST/SGPT more than 1000, impaired consciousness, impairment in heart and other organs

Question 9

True or false. Degree of platelet decrease reflect the severity of plasma leakage

Answer 9

False. Increase above baseline hematocrit reflects severity of plasma leakage

Question 10

Earliest abnormality in dengue

Answer 10

Decrease in total WBC count

Question 11

Reflect severity of plasma leakage

Answer 11

Increase above the baseline hematocrit

Question 12

Expected laboratory changes in Day 3-7 of illness

Answer 12

Increase in capillary permeability in parallel with increasing hematocrit levels

Question 13

Precedes plasma leakage

Answer 13

Progressive leukopenia followed by rapid decrease in platelet count

Question 14

True or false. Bradycardia is common during the recovery phase of dengue

Answer 14

True

Question 15

True or false. Recovery of platelet count is typically later than that of WBC count

Answer 15

True.

Question 16

When does WBC count start to rise in Dengue

Answer 16

Soon after defervescence

Question 17

True or false. Hematocrit stabilises or may lower due to the dilutional effect of reabsorbed fluid

Answer 17

True.

Question 18

True or false. During the critical and or recovery phase, excessive fluid therapy is associated with pulmonary edema or congestive heart failure

Answer 18

True.

Question 19

In the DOH Revised Dengue Clinical Case Management Guidelines, when is Dengue confirmed

Answer 19

Viral culture isolation or PCR

Question 20

Which Dengue patient requires in-hospital admission

Answer 20

Coexisting conditions such as pregnancy, infancy, old age, diabetes mellitus, renal failure
Living alone

Question 21

Which Dengue patient may be sent home

Answer 21

Able to tolerate adequate volumes of oral fluids

Pass urine at least once every 6 hours

Question 22

What is the initial fluid management in Dengue patients with compensated shock

Answer 22

Isotonic crystalloid rate of 5-10 ml/kg/hour

Question 23

How is IV infusion adjusted in Dengue fever

Answer 23

If clinical with clinical improvement,
5-7 ml/kg/hr for 1-2 hours
3-5 ml/kg/hr for 2-4 hours
2-3 ml/kg/hr for 2-4 hours
If patient continues to improve, fluid can be reduced even further

Question 24

Algorithm in fluid management of compensated shock in Dengue. After 5-10 ml/kg/hr over 1 hour, no improvement. What to do next?

Answer 24

Check hematocrit.

Question 25

Algorithm in fluid management of compensated shock in Dengue. After 5-10 ml/kg/hr over 1 hour, no improvement. Hematocrit is low

Answer 25

Consider occult or overt bleeding. Initiate transfusion with fresh whole blood

Question 26

Algorithm in fluid management of compensated shock in Dengue. After 5-10 ml/kg/hr over 1 hour, no improvement. Hematocrit is high.

Answer 26

Administer 2nd bolus of fluid 10-20 ml/kg/hr for 1 hour.

Question 27

Algorithm in fluid management of compensated shock in Dengue. After 5-10 ml/kg/hr over 1 hour, no improvement. Hematocrit high. No improvement after 2nd IV fluid bolus. What to do next?

Answer 27

Re check hematocrit

Question 28

Algorithm in fluid management of compensated shock in Dengue. After 5-10 ml/kg/hr over 1 hour, no improvement. Hematocrit high. With improvement after 2nd IV fluid bolus.

Answer 28

Reduce IVF to 7-10 ml/kg for 1-2 hours then reduce further

Question 29

True or false. Persistent or worsening metabolic acidosis with or without well maintained systolic blood pressure esp whose wiht severe abdominal tenderness or distention is a sign or severe bleeding

Answer 29

True.