Dengue fever: management of complications and supportive care MCQs With Answer

Dengue fever: management of complications and supportive care MCQs With Answer

This quiz set is designed specifically for M.Pharm students studying Pharmacotherapeutics II (MPP 202T) to deepen understanding of evidence-based supportive care and complication management in dengue fever. Questions cover fluid resuscitation strategies in dengue shock, indications and thresholds for blood component therapy, pharmacologic and non-pharmacologic measures for bleeding and organ dysfunction, monitoring parameters, and controversies such as the role of colloids, corticosteroids, tranexamic acid and N‑acetylcysteine. Each item emphasizes clinical decision points, drug dosing considerations and guideline-aligned practices, aiming to prepare students for advanced clinical pharmacotherapy roles and rational medication use in dengue management.

Q1. In dengue shock syndrome (DSS), what is the recommended initial fluid resuscitation for an adult according to WHO guidelines?

• Rapid infusion of 20 mL/kg isotonic crystalloid bolus, repeat as needed while monitoring response
• Immediate infusion of hypertonic saline 3% at 10 mL/kg
• Give a single bolus of colloid (e.g., 6% HES) 10 mL/kg only
• No fluids; start vasopressors immediately

Correct Answer: Rapid infusion of 20 mL/kg isotonic crystalloid bolus, repeat as needed while monitoring response

Q2. Which bedside sign is most useful to detect plasma leakage indicating progression to severe dengue?

• Progressive rise in hematocrit relative to baseline
• Rapid increase in platelet count
• Marked leukocytosis with left shift
• New onset hyperglycemia

Correct Answer: Progressive rise in hematocrit relative to baseline

Q3. Which analgesic/antipyretic is recommended for fever in dengue patients?

• Paracetamol (acetaminophen), within safe dosing limits
• Aspirin, single high dose to reduce fever
• Ibuprofen or other NSAIDs to reduce inflammation
• Diclofenac suppository as first-line

Correct Answer: Paracetamol (acetaminophen), within safe dosing limits

Q4. Regarding platelet transfusion in dengue, which statement aligns with best practice?

• Transfuse platelets only for active clinically significant bleeding or very severe thrombocytopenia with bleeding risk
• Prophylactic platelet transfusion is recommended for all patients with platelet count <100,000/µL
• Transfuse platelets routinely to prevent progression to severe dengue
• Platelet transfusion should be given to all febrile dengue patients

Correct Answer: Transfuse platelets only for active clinically significant bleeding or very severe thrombocytopenia with bleeding risk

Q5. Which laboratory threshold commonly prompts consideration of platelet transfusion in the absence of bleeding in many guidelines?

• Platelet count <10,000/µL (10 x10^9/L) or <20,000/µL with additional risk factors
• Platelet count <150,000/µL
• Platelet count <50,000/µL regardless of bleeding
• Platelet count <100,000/µL with no other issues

Correct Answer: Platelet count <10,000/µL (10 x10^9/L) or <20,000/µL with additional risk factors

Q6. In a dengue patient with severe gastrointestinal bleeding and coagulopathy, which blood product is most appropriate to correct clotting factors?

• Fresh frozen plasma (FFP) to replace clotting factors
• Platelet concentrate only
• Albumin 20% as first-line correction of coagulopathy
• Iron infusion to correct anemia immediately

Correct Answer: Fresh frozen plasma (FFP) to replace clotting factors

Q7. When is red blood cell transfusion indicated in dengue management?

• Significant, symptomatic blood loss causing hemodynamic instability or severe anemia
• Any hematocrit reduction even without symptoms
• Only when platelet count is low
• For prophylaxis in all severe dengue cases

Correct Answer: Significant, symptomatic blood loss causing hemodynamic instability or severe anemia

Q8. Which fluid strategy is recommended if a patient with dengue shock does not respond to initial crystalloid boluses?

• Consider a colloid bolus (e.g., 5–10 mL/kg of starch or gelatin) while continuing monitoring
• Immediately stop all fluids and observe
• Switch to hypotonic saline to reduce plasma leakage
• Administer high-dose loop diuretics

Correct Answer: Consider a colloid bolus (e.g., 5–10 mL/kg of starch or gelatin) while continuing monitoring

Q9. Which of the following is true about corticosteroid use in dengue?

• Corticosteroids are not routinely recommended for treating dengue or preventing shock
• High-dose steroids are recommended to prevent bleeding
• Short-course steroids reduce viral replication and improve outcomes
• Steroids should be given to all severe dengue patients

Correct Answer: Corticosteroids are not routinely recommended for treating dengue or preventing shock

Q10. Which monitoring parameter is most critical during the critical phase (days 3–7) of dengue illness?

• Frequent measurement of hematocrit, vital signs and urine output to detect plasma leakage
• Serum cholesterol levels daily
• Weekly liver enzymes only
• Random blood glucose once on admission

Correct Answer: Frequent measurement of hematocrit, vital signs and urine output to detect plasma leakage

Q11. In dengue-associated acute liver injury with rising transaminases and encephalopathy, which pharmacologic agent has been used as a supportive therapy though evidence is limited?

• N-acetylcysteine (NAC) as hepatoprotective supportive therapy
• High-dose acetylsalicylic acid to reduce inflammation
• Oral metronidazole for presumed infection
• Intravenous iron to correct transaminase levels

Correct Answer: N-acetylcysteine (NAC) as hepatoprotective supportive therapy

Q12. Which statement regarding prophylactic platelet transfusion before invasive procedures in dengue is correct?

• Consider transfusion if platelet count is very low and the procedure cannot be delayed; individualize decision
• Never transfuse platelets before any procedure regardless of count
• Always transfuse platelets for any minor procedure in dengue patients
• Prophylactic platelet transfusion is mandatory at platelet <150,000/µL

Correct Answer: Consider transfusion if platelet count is very low and the procedure cannot be delayed; individualize decision

Q13. Regarding the use of tranexamic acid (TXA) in dengue-related bleeding, current evidence supports which position?

• Evidence is limited; TXA is not routinely recommended but may be considered in selected severe bleeding with institutional protocols
• Routine TXA for all dengue patients prevents hemorrhage
• TXA is contraindicated in all dengue cases
• TXA replaces the need for platelet transfusion

Correct Answer: Evidence is limited; TXA is not routinely recommended but may be considered in selected severe bleeding with institutional protocols

Q14. Which of the following best describes pulse pressure changes in dengue shock?

• Narrowing of pulse pressure (≤20 mmHg) is a sign of circulatory compromise in dengue
• Widened pulse pressure (>60 mmHg) is typical of early dengue
• Pulse pressure remains unchanged and is not useful
• Pulsus paradoxus is the defining feature of dengue shock

Correct Answer: Narrowing of pulse pressure (≤20 mmHg) is a sign of circulatory compromise in dengue

Q15. For pediatric patients with DSS, the recommended initial crystalloid bolus is:

• 20 mL/kg isotonic crystalloid bolus over 15–30 minutes, repeat as needed
• 5 mL/kg of isotonic saline over 1 hour only
• Hypertonic saline 5 mL/kg as initial choice
• No fluid bolus due to risk of overload

Correct Answer: 20 mL/kg isotonic crystalloid bolus over 15–30 minutes, repeat as needed

Q16. Which intervention is most appropriate for a dengue patient who develops pulmonary edema from aggressive fluid therapy?

• Reduce/stop fluids, provide oxygen, consider cautious diuretic and ventilatory support if needed
• Increase fluid rate to overcome leak
• Immediately transfuse platelets to resolve fluid overload
• Administer routine high-dose steroids to mobilize fluid

Correct Answer: Reduce/stop fluids, provide oxygen, consider cautious diuretic and ventilatory support if needed

Q17. Which of the following is TRUE about the role of antibiotics in dengue management?

• Antibiotics are not indicated for uncomplicated dengue unless there is documented secondary bacterial infection
• Broad-spectrum antibiotics should be started routinely in all dengue cases
• Antibiotics reduce plasma leakage and should be used early
• Antibiotic prophylaxis prevents hemorrhagic complications

Correct Answer: Antibiotics are not indicated for uncomplicated dengue unless there is documented secondary bacterial infection

Q18. Monitoring which of the following helps to time the critical transition from the febrile to the critical phase?

• Trends in platelet count decline and rising hematocrit around days 3–7
• Immediate normalization of liver enzymes
• Rapid rise in lymphocyte count the first day
• Stable platelet count throughout illness

Correct Answer: Trends in platelet count decline and rising hematocrit around days 3–7

Q19. In pregnant women with dengue, which statement about management is correct?

• Management principles are similar but require multidisciplinary care, fetal monitoring and cautious transfusion decisions
• All pregnant dengue patients should be delivered immediately
• No special monitoring is necessary beyond routine outpatient care
• Use of NSAIDs is preferred for analgesia in pregnancy

Correct Answer: Management principles are similar but require multidisciplinary care, fetal monitoring and cautious transfusion decisions

Q20. Which factor is most associated with progression to severe dengue and warrants closer supportive intervention?

• Rapid rise in hematocrit with falling platelet count and clinical warning signs (persistent vomiting, abdominal pain, mucosal bleeding)
• Isolated mild sore throat without other signs
• Stable hematocrit with mild thrombocytopenia and normal urine output
• Early defervescence with improving appetite only

Correct Answer: Rapid rise in hematocrit with falling platelet count and clinical warning signs (persistent vomiting, abdominal pain, mucosal bleeding)

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