(Featured image credit: Wikimedia commons, Øyvind Holmstad CC license)
I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.
You can find more things on the FRCEM on this site here.
Describe some typical features and characteristics of VZV?
- primary disease Chicken Pox
- then remains latent in dorsal root ganglion
- reactivation as shingles
- Infectivity starts 3 days before the rash appears and lasts until the last lesion has crusted.
- Incubation = 10-20 days
- pneumonia in kids – usually Staph, in adults usually viral
What are the role of anti-virals?
- in shingles reduced post herpetic pain if used in first 72 hrs
- often used in immune suppression and eye disease
- for chicken pox it is often considered in adolescents and adults
When would you consider using varicella immunoglobulin?
- cystic fibrosis
How would you manage exposures in pregnancy?
(From the RCOG guideline)
- if exposed and no known immunity then:
- test for immunity
- offer VZV IG within 10 days of exposure if no immunity confirmed
- this seems to apply to all gestational ages even though the main risk seems to be before 28 weeks.
- if develops chicken pox then:
- aciclovir if >20 weeks and within 24 hrs of rash onset
- “consider” aciclovir if <20 weeks
- do not use IG if rash already present
- Fetal varciella syndrome is the concern in the first 28 weeks of pregnancy but it is rare
I think you are doing a wonderful job here. Your work has always inspired me. Could you share your resources and notes on the FRCEM Intermediate exam?
Thanks a lot!
Hi Sang these little posts are my notes. Hope they’re helpful