Viruses & Sepsis

Question 1

What is the pathognomonic signs of measles?

Answer 1

Warthin-finkeldey giant cells = multinucleated cells
Kopliks spots

Question 2

What is the period of communicability in measles virus?

Answer 2

3 days before up to 4-6 days after the onset of rash

Question 3

What aer the 4 phases of measles infetion?

Answer 3

Incubation (8-12days)
Prodrome
Exanthema
Recovery

Question 4

What are the significant clinical presentaion during prodrome phase of measles infection?

Answer 4

Cough, Coryza, Conjunctivitis

Question 5

What are significant skin lesions seen in measles?

Answer 5

Confluence rash = map-like, coalescing rash
Fades in order of appearance
Hyperpigmented before diapperance -> brawny desquamation

Question 6

What are important complications to take note of in px with measles?

Answer 6

Blindness - children with VIt A def & corneal aberrations

Severe diarrhea & dehdyration
Acute otitis media = most common
Severe respiratory infections (Pneumonia)
Encephalitis
Immune amnesia
Subacute Sclerosing Panencephalitis = chronic

Question 7

When can you suspect that measles has a bacterial complication/

Answer 7

Persistence of fever after the 4th day of rash OR
Rash on the soles of the feet

Question 8

How many doses of MMR vaccine should be taken?

Answer 8

2 doses

Question 9

What is the vax sched for filipino infants for MMR?

Answer 9

1st dose = early as 6 months to 9 months
2nd dose = 15 months (“true first dose”)
3rd dose = 4-6 years old (“true 2nd dose”)

Question 10

In patients who have active immunization with live, attenuated mesales vaccine, when should post-exposure prophylaxis be given?

Answer 10

Within 3 days of exposure
CIs: Malignancies, immunodeficiencies, chronic corticosteroid tx

Question 11

In px with passive immunization with Igs, when should post-exposure prophylaxis be given?

Answer 11

Within 6 days of exposure

Question 12

What are the clinical feature of Rubella?

Answer 12

Incubatio = 14-21 days post exposure
Prodrome: headache, malaise, anorexia, low grade fever, sore throat, red eyes (w or wo pain), lymphadenopathy

Question 13

During Prodrome stage of Rubella, what is a pathognomonic sign for rubella?

Answer 13

Lymphadenopathy

Question 14

Druing Enanthem in Rubella, what are petechial hemorrgages in soft palate with tiny rose-colored lesions, Koplik’s spots?

Answer 14

Forchheimer spots

Question 15

What are the type of rashes seen in Exanthem of Rubella?

Answer 15

Rash = does not desquamate & Pruritic, 3 days

Question 16

What are the complications of Rubella?

Answer 16

Thrombocytopenia
Arthralgia/arthritis
Encephalitis
Hemorrhagic Manifestations
Orchitis & or neuritis

Question 17

What is the most seriou complication of Rubella?

Answer 17

Encephalitis

Question 18

What are the classical triad of Congenital Rubella Syndrome?

Answer 18

Bulag
Bingi
Butas

Ocular abnormalities= catact, infantile glaucoma, pigmented retinopathy
Sensorineural hearing loss = most common
Congenital heart disease = patent ducctus arteriosys

Question 19

What is the gold standard in Rubella dx?

Answer 19

Isolation of rubella virus (urine/nasopharync)

Question 20

Can wpmen of childbearing age who intend to become pregnant within 4 weeks receive Rubella vaccine (MMR)?

Answer 20

No, they should not

Question 21

What is the common childhood disease that is caused by HHV-6 aka Sixth Disease?

Answer 21

Roseola/Exanthem Subitum/Baby measles

Question 22

What are the clinical presentation of sixth disease?

Answer 22

9-12 mons old
Febrile seizure
Fussiness
Acute high grade fever up to 40C

After 3 days rapid defervesncence (fever disappears) occurs & morbiliform rash appears

Question 23

What is a pathognomic sign of sixth disease in infants from asian countries?

Answer 23

Nagayama spots
- ulcers at uvulopalatoglossal junction

Question 24

What is the first manifestation of Varicella in children?

Answer 24

Exanthem = generalized vesicular rash with few systemic effects, classic exanthem is a vesicular tear-drop shaped lesion

Question 25

When is the most contagious period of VZV?

Answer 25

1-2 days before and shortly after onset of rash

Question 26

What is the hallmark of Varicella rash?

Answer 26

Vesicular lesions Macules > Maculopapular > Vesicular > Crusting > Scab formation

Question 27

When should u administre VZ Ig?

Answer 27

Within 96 hrs but rarely found in PH Chemoprophylaxis

Question 28

What should be prescribed as post-exposure prophylaxis to VZV 7-10 days after exposure?

Answer 28

Acyclovir (4x a day for 7 days) Max dose = 800mg 4x a day

Question 29

What is the routine vax of VZ in children?

Answer 29

12-15 months

Question 30

What causes erythema infectious/fifth diseas?

Answer 30

Parvovirus or B19 infection - low grade fever

Question 31

When is the highest viral load of SARS COV2?

Answer 31

Onset & up to 3 days after symptoms onset

Question 32

What is the diff betw antigenic shift and antigenic draft?

Answer 32

Antigenic drift - minor change (epidemic) Antigenic shift = major change (pandemic)

Question 33

What are the clinical presentations of Chikungunya?

Answer 33

Night time biting (A aegypti) or daytime biting mosquitos Polyarthralgia Backache Headache

Question 34

What is the diff betw Chikungunya & Dengue?

Answer 34

Polyarthralgia, Arthritis = chikungunya Dengue - none of these

Question 35

Out of the 4 dengue serotypes, what are the most common in PH?

Answer 35

DEN-1 & DEN-2

Question 36

What is the vector that causes dengue?

Answer 36

Aedes aegypti

Question 37

What serotype is dengue hermorhagic fever more likely to develop?

Answer 37

DEN-2

Question 38

Why is protein malnutrition a protective factor in reducing risk of DHF/DSS?

Answer 38

Suppresses cellular immune response

Question 39

How do you classify probable dengue case?

Answer 39

Lives in or traveled to dengue endemic area Fever and 2 of the ff - nausea - vimiting - rashes - aches 7 pain - (+) tourniquet test - leukopenia - any warning sign

Question 40

What are the diff warning signs of dengue?

Answer 40

Requires strict observation & medical itnervention Abdominal pain or tenderness Persistent vomiting Clinical fluid accumulation Lethargy or restlessness Liver enlargement >2cm INC in HCT concurrent with rapid dec in plt ct

Question 41

What are parameters to say that there is severe organ involvement?

Answer 41

AST or ALT > 1000 Impaired consciouness Heart and other organs

Question 42

What are the 3 phases of dengue?

Answer 42

Febrile phase = mild hemorrhagic manifestations Critical phase = defervescence & improvement fter defervescence or deterioration Recovery phase = 48-72 hrs

Question 43

What virus affects children <5 yo and characterized by erythematous-based macules which ulcerate centrally creating an ERYTHEMATOUS HALO?

Answer 43

Hand,foot, & mouth disease

Question 44

What are the diff Enteroviruses causing HFMD?

Answer 44

Coxsackievirus A16 = mild, self-limiting Enterovirus-71 = serious: meningitis, encephalitis

Question 45

What is a pathognomonic sign of HFMD?

Answer 45

Oral lesions: Herpangina (transmissible by saliva) Rash: papulovesicular affecting the palms & soles of the feet

Question 46

What is the leading cause of death in pedia px worldwide?

Answer 46

Sepsis

Question 47

What characterizes SIRS?

Answer 47

>2 of the ff criteria: - abnormal core temp (<36C or >38.5C) - abnormal HR (>2 standard deviations above normal for age, or <10th percentile for ag if child is <1yr) - INC RR (>2 SD above normal for age, or mechanical ventilation for acute lung disease) - abnormal WBC ct (> or < normal ange or >10% immature WBC)

Question 48

What characterizes severe sepsis?

Answer 48

1. > or equal to 2 age based SIRS criteria 2. Confirmed or suspected invasive infeciton 3. Cardiovascular dysfunction, acute respiratory distress syndrome, or >2 non-cardiovascular organ system dysfunctions

Question 49

What is the most useful diagnosis and monitoring of sepsis and septic shock?

Answer 49

Serum procalcitonin

Question 50

What are the 2 key points in the tx of sepsis?

Answer 50

1. Timely recognition & institution of therapy (<1hr) = most crucial 2. Early & aggressive source control (drainage, debridement, surgical intervention)