WBR1099
| Author | PageAuthor::Chetan Lokhande |
|---|---|
| Exam Type | ExamType::USMLE Step 2 CK |
| Main Category | MainCategory::Internal medicine |
| Sub Category | SubCategory::Hematology, SubCategory::Infectious Disease, SubCategory::Respiratory |
| Prompt | [[Prompt::A previously healthy 25-year-old female medical student from India presents with high fever, myalgias and generalized body pain. She also presents with a macular rash all over her body. Her Vitals were stable except for a temperature of 39 degrees and a pulse rate of 102.Her platelet count is 90,000. What is the next best step in the management of the disease?]] |
| Answer A | AnswerA::Platelet transfusion. |
| Answer A Explanation | AnswerAExp::Platelet transfusion should be started when platelets drop below 10,000 IU/ml. |
| Answer B | AnswerB::Follow platelet count. |
| Answer B Explanation | AnswerBExp::This is the correct answer as platelet count is 90,000 and a watchful observation should be done. Serial platelet counts should be ordered once the patient is admitted. One should wait till platelets drop below 10,000 to start transfusion. |
| Answer C | AnswerC::Start antiviral therapy. |
| Answer C Explanation | AnswerCExp::There are no specific antiviral drugs for dengue, however maintaining proper fluid balance is important. Treatment depends on the symptoms. |
| Answer D | AnswerD::Blood culture. |
| Answer D Explanation | [[AnswerDExp::Dengue cannot be cultured in the blood. The diagnosis of dengue fever may be confirmed by microbiological laboratory testing. This can be done by virus isolation in cell cultures, nucleic acid detection by PCR, viral antigen detection (such as for NS1) or specific antibodies (serology)]] |
| Answer E | AnswerE::Liver function test. |
| Answer E Explanation | AnswerEExp::Liver function tests are used to monitor severity or complications of dengue syndrome. As this patient doesn't have any symptoms of jaundice or complications or signs suggestive of liver involvement liver function tests are not indicated. |
| Right Answer | RightAnswer::B |
| Explanation | [[Explanation::Dengue fever, also known as breakbone fever, is an infectious tropical disease caused by the dengue virus. Symptoms include fever, headache, muscle and joint pains, and a characteristic skin rash that is similar to measles. In a small proportion of cases the disease develops into the life-threatening dengue hemorrhagic fever, resulting in bleeding, low levels of blood platelets and blood plasma leakage, or into dengue shock syndrome, where dangerously low blood pressure occurs.
There are no specific antiviral drugs for dengue, however maintaining proper fluid balance is important. Treatment depends on the symptoms. Those who are able to drink, are passing urine, have no "warning signs" and are otherwise healthy can be managed at home with daily follow up and oral rehydration therapy. Those who have other health problems, have "warning signs" or who cannot manage regular follow up should be cared for in hospital. In those with severe dengue cared should be provided in an area where there is access to an intensive care unit. Intravenous hydration, if required, is typically only needed for one or two days. The rate of fluid administration is titrated to a urinary output of 0.5–1 mL/kg/h, stable vital signs and normalization of hematocrit. The smallest amount of fluid required to achieve this is recommended. Invasive medical procedures such as nasogastric intubation, intramuscular injections and arterial punctures are avoided, in view of the bleeding risk. Paracetamol (acetaminophen) is used for fever and discomfort while NSAIDs such as ibuprofen and aspirin are avoided as they might aggravate the risk of bleeding. Blood transfusion is initiated early in people presenting with unstable vital signs in the face of a decreasing hematocrit, rather than waiting for the hemoglobin concentration to decrease to some predetermined "transfusion trigger" level. Packed red blood cells or whole blood are recommended, while platelets and fresh frozen plasma are usually not. Corticosteroids do not appear to affect outcomes and may cause harm, thus are not recommended.
During the recovery phase intravenous fluids are discontinued to prevent a state of fluid overload. If fluid overload occurs and vital signs are stable, stopping further fluid may be all that is needed. If a person is outside of the critical phase, a loop diuretic such as furosemide may be used to eliminate excess fluid from the circulation. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Dengue hemorrhagic fever, WBRKeyword::Dengue hemorrhagic fever, WBRKeyword::Dengue shock syndrome, WBRKeyword::Platelet transfusion |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |