DENGUE FEVER

Question 1

This acute febrile phase usually lasts 2−7 days and is often accompanied by facial flushing, skin erythema, generalized body ache, myalgia, arthralgia, retro-orbital eye pain, photophobia, rubeliform exanthema and headache (1).

Answer 1

Dengue fever

Question 2

Dermatological manifestation in DF

Answer 2

rubeliform exanthema

Question 3

when the temperature drops to 37.5−38°C or less and remains below this level, usually on days 3–8 Day of illness.

Answer 3

time of defervescence

Question 4

The period of clinically significant plasma leakage usually last

Answer 4

24−48 hours.

Question 5

may be the earliest sign of plasma leakage.

Answer 5

A rapid and progressive decrease in platelet count to about 100 000 cells/mm3
and a rising haematocrit above the baseline that is usually preceded by leukopenia (≤ 5000 cells/mm3) (4).

Question 6

As the patient survives the 24−48 hour critical phase, a gradual reabsorption of extravascular compartment fluid takes place in the following

Answer 6

48−72 hours

Recovery phase

Question 7

A case of severe dengue is defined as a suspected dengue patient with one or more of the following

Answer 7

i) severe plasma leakage that leads to shock (dengue shock) and/or fluid accumulation with respiratory distress;
(ii) severe bleeding;
(iii) severe organ impairment.

Question 8

is a form of hypovolaemic shock and results from continued vascular permeability and plasma leakage.

Answer 8

Dengue shock syndrome (DSS)

Question 9

Severe organ involvement in dengue fever

Answer 9

• Liver: AST or ALT>=1000 • CNS: Impaired consciousness

* Heart and other organs

Question 10

incubation period of

Answer 10

4–10 days

Question 11

is the best marker of a recent dengue infection.

Answer 11

Specific IgM

Question 12

True or false

Primary infections are characterized by high levels of IgM and low levels of IgG, while low levels of IgM with high levels of IgG characterize secondary infections

Answer 12

True

Question 13

is the method of choice for determination of specific serotype

Answer 13

Neutralization Test

Question 14

Discharge criteria:

-> all of the following criteria must be present

Answer 14

o No fever for 48 hours
o Increasing trend of platelet count
o Stable haematocrit without intravenous fluids
o Improvement in clinical picture
o No respiratory distress

Question 15

intravenous fluid therapy

Answer 15

0.9% saline or

Ringer Lactate at maintenance rate

Question 16

Group b fluid management : Give only isotonic solutions such as 0.9% saline, Ringer’s lactate or Hartmann’s solution

Answer 16

start with 5-7 ml/kg/hr for 1-2 hours,

then reduce to 3- 5 ml/kg/hr for 2-4 hr, and then reduce to 2-3 ml/kg/hr or less according to clinical response

Question 17

I f Hct remains the same or rises only minimally ->

Answer 17

continue with 2-3 ml/kg/hr for another 2-4 hours

Question 18

I f worsening of vital signs and rapidly rising Hct ->

Answer 18

increase rate to 5-10 ml/kg/hr for 1-2 hours

Question 19

Reduce intravenous fluids gradually when the rate of plasma leakage decreases towards the end of the critical phase.
This is indicated by:

Answer 19

o Adequate urine output and/or fluid intake
o Hct decreases below the baseline value in
a stable patient

Question 20

Treatment of compensated shock:

o Start I.V. fluid resuscitation with isotonic crystalloid solutions at

Answer 20

5-10 ml/kg/hr over 1 hr

Question 21

Treatment of hypotensive shock: Initiate I.V. fluid resuscitation with crystalloid or colloid solution at

Answer 21

o 20 ml/kg as a bolus for 15 min

Question 22

Treatment of haemorrhagic complications:

Answer 22

o G i v e
5-10 ml/kg of fresh packed red cells or
10-20 ml/kg fresh whole blood

Question 23

True or false:
Note that a haematocrit of < 30% as a trigger for blood transfusion, as recommended in the Surviving Sepsis Campaign Guideline (10), is not applicable to dengue

Answer 23

True

Question 24

True or false

There is no evidence that supports the practice of transfusing platelet concentrates and/or fresh-frozen plasma for severe bleeding in dengue

Answer 24

True

Question 25

The recommended choice of vasopressor which should be titrated to maintain mean arterial BP of 65 mmHg in adults. Vasopressor therapy should be weaned off as intravascular volume is restored and end-organ perfusion re-established.

Answer 25

dopamine

Question 26

Evidence of cardiogenic shock due to myocarditis or ischemic heart disease.what is the recommended choice of inotrope?

Answer 26

Dobutamine

Question 27

In concomitant septic shock,what are the vasopressors of choice.

Answer 27

dopamine or norepinephrine

Question 28

The preferred choice of renal replacement therapy is

Answer 28

continuous veno-venous haemodialysis (CVVH)

Question 29

In DM px, validated protocol for insulin dose adjustments to a target glucose level of ___ should be used

Answer 29

< 150 mg/dl (8.3 mmol/L)