Disease which does not present as shock is:

Ans: b (Erythema infectiosum)Ref Harrison, 17 ed. pg. 128, 877, 878; Davidson, 21ed. Pg. 3261. Erythema infectiosum - by parvovirus B19, affecting children (3-12 yrs)C/F - slapped cheek > trunkal rash > lacy reticular pattern that wax and wane over 3 weeks Adults - arthritis Pregnancy - fetal hydrops2. Streptococcal toxic shock syndrome - usually Group A (occasionally Group C/G)Pyrogenic exotoxin A - acts like a superantigen Erythematous rash over chest - circulatory shockStaphylococcal toxic shock syndrome:Due to toxic shock syndrome toxin (TSST1) Seen in women using vaginal tampons C/F: Fever, systemic symptoms, generalized erythematous blnching rash, hypotension Rx iv antistaphylococcal antibiotics (flucloxacillin/vancomycin + protein synthesis inhibitors like clindamycin)3. Meningococcal sepsis: Usually presents with rapid onset of obtundation due to cerebral oedema resulting from (a) endotoxin (b) cytokine release (c) circulatory collapse.Adverse prognostic features include hypotensic shock, rapidly developing rash, haemorrhagic diasthesis, and multisystem failure. Age >60 years.4. Staphylooccal scalded skin syndrome: In children especially neonates. Child usually presents with fever, irritability, skin tenderness, erythema, blister, superficial erosions that can rapidly involve large areas of skin, significant amount of fluid lost in most extensive cases.