WorksheetsMalaysian CPG Dengue in Adults '15 Quiz
Total questions: 25
Worksheet time: 21mins
Pick false statement regarding dengue virus and serotype trends in Malaysia.
Dengue infection is caused by dengue virus which is mosquito-borne flavivirus.
Four distinct serotype in dengue, DENV 1,2,3,4.
Each episode of infection induces life-long protective immunity to all serotype.
Secondary infection is major risk factor to severe dengue due to antibody-dependent enhancement.
Pick false symptoms according to its clinical course.
febrile phase - high grade fever 2-7 days
febrile phase - isles of white in sea of red
critical phase - mucosal bleed
critical phase - injected pharynx, conjuctiva pallor
recovery/ reabsorption phase - return of appetite, resolved diarrhea
Based on image above, pls select the clinical phase of dengue and its recommended serology test.
Incubation period (4-7 days): rapid combo test
Febrile phase (2-7days): NS1
Critical phase (24-48hours): IgG
Recovery phase (life-long): IgM
Mrs.F, 43 y/o malay lady presented with fever for 3 days. It was associated with lethargy and altralgia. She went to KK Seksyen 7 for further treatment. What are other hx that need to be asked that is specific to this pt?
"Any history of sick contact?"
"Any abdominal pain, persistent vomiting, persistent diarrhea?"
"Any history of travelling/swimming/jungle trekking recently?"
"Any nose bleed, gum bleed, bruising, increased menstrual bleed?"
"Any reduced urine output?"
What are the indicators of deterioration of compensated shock patient to decompensated state?
cool extremities
weak peripheral pulse
change of mental state
metabolic acidosis
oliguria/anuria
The primary pathophysiological abnormality seen in dengue infection is acute increase in vascular permeability that lead to plasma leakage into extravascular compartment resulting in haemoconcentration and hypovolaemia or shock.
Which is false?
Hypovolemia leads to reflex tachycardia and vasoconstriction
Inadequate perfusion of tissue leads to increased aerobic glycolysis and lactic acidosis.
In refractory shock state, bolus injection of vasopressor will restore tissue perfussion, BP and intravascular volume.
Secondary infection with a heterotypic dengue is a/w increased risk of developing severe dengue infection due to antibody-dependent enhancement phenomenon.
The common late complication of prolonged shock are massive bleeding, DIVC and multiorgan failure.
True
False
Mrs.F, 43 y/o malay lady presented with fever for 6 days. It was associated with lethargy and altralgia. She also had persistent vomiting > 6 times/day. She is living in dengue prone area. Day 3, she went to Klinik Kesihatan and NS1 test done is +ve. She had dengue follow up until 3 days later noted low platelet and was referred to nearest hospital. She vomited 4 times that day. No evidence of mucosal bleeding.
What is her diagnosis now?
Dengue Fever in Febrile Phase
Dengue Fever in Febrile Phase with warning sign
Dengue Fever Day 6 in Febrile phase
Dengue Fever Day 6 in Febrile Phase with warning sign
These criterias for severe dengue are true except
severe dengue leading to shock
severe dengue leading to fluid accumulation with respiratory distress
raised ALT/AST
impaired consciousness
Dengue serology test:
NS1 -ve
IgM -ve
IgG +ve low titers
interpret?
past infection
secondary dengue
current infection
Dengue serology test:
NS1 -ve
IgM +ve
IgG +ve high titers
interpret?
current dengue infection
secondary dengue infection
past dengue infection
43y/o malay male presented with fever for 4 days a/w myalgia and hx of living in dengue prone area. No mucosal bleeding. Oral intake good. Urine output moderate. Upon PE, CCTVR, bp, pulse pressure normal. Hydration status normal. NS1 test +ve. Which is false plan of outpatient management?
Fill up dengue assessment checklist
notify district health office within 24hours
stabilized pt before transfer
no need admission, daily follow up fbc
Dengue pt with warning sign in outpatient clinic. Refer to hospital or not?
Refer
Daily dengue monitoring chart
Dengue pt with rising HCT accompanied by reducing platelet count in outptient clinic. Refer to hosp or not?
Refer
No refer
Pregnant dengue pt in outpatient clinic. Refer hospital or not?
Refer
Dont refer
Ultrasound can be done in the ED for patients requiring admission to _____ except
look for evidence of third space fluid loss
see the collapsibility of IVC -adequacy of IV fluid compartment & response to IV fluids
look for evidence of heart failure
Choose false fluid management in non-shock patient.
in non-shock, haemodynamically stable, not vomiting pt, increased oral fluid intake is sufficient (2-3L daily)
IV fluid is indicated in pt with raised HCT with evidence of plasma leakage, despite increased oral intake.
in pt with persistent warning sign with increased high HCT, graded bolus may started with caution.
Colloid solution should be fluid of choice for non-shock dengue pt.
Graded fluid bolus regime in non-shock pt except
obtain baseline HCT before fluid therapy
give crystalloid solution
start with 5ml/kg/h for 1-2hours --> 3 --> 2 according to clinical response
if the clinical parameters are worsening and HCT is rising, change to colloid.
How to know if pt responds to fluid therapy?
improving urine output
crt<2sec
bp stable
appropriate decrease in HCT
all of above
You are attending dengue pt in compensated shock. You already gave 5ml/kg/hr 0.9%NS for 1 hour. You see there is improvement in HCT. What's the next plan?
reduce IV fluid 5-7ml/kg/hr for 1-2 hours
monitor HCT 4-6hourly
Administer 2nd bolus of fluid
consider stop IV fluid
You are attending dengue pt in compensated shock. You already gave 5ml/kg/hr 0.9%NS for 1 hour. You see there is increase in HCT. What's the next plan?
administer 2nd bolus of colloid
transfuse packed cell
You are attending dengue pt in compensated shock. You already gave 20ml/kg/hr colloid for 15 minutes. You see there is improvement in vs crt and warm peripheries. What's the next plan?
reduced colloid to 10ml/kg/hr and monitor HCT 4 hourly.
start routine maintanance IV fluid therapy
You are attending dengue pt in compensated shock. You already gave 20ml/kg/hr colloid for 15 minutes. You see there is no improvement in vs crt and warm peripheries.
You then administered 2nd bolus of fluid. HCT is still increased. What's the next plan?
repeat administration of bolus colloid
packed cell transfusion
What can be another reason of unchanged haematocrit after fluid resuscitation that cause shock?
cardiac failure
bleeding and leaking at the same time
septic shock
liver + multiorgan failure
all of above
Match the other cause of shock in dengue pt and its management.
bleeding ang leaking at same time - packed cell transfusion
cardiac dysfuction - ionotrope
septic shock - norad
all of above
