11: 4-year-old male with fever and adenopathy

Question 1

What’s the normal HR for a 4-year-old?

Answer 1

65-135

Question 2

What are 4 causes of unilateral cervical lymphadenopathy?

Answer 2

1. Reactive cervical adenitis
2. Kawasaki disease
3. Bacterial cervical adenitis
4. Cat scratch disease
5. Mycobacterial infection

Question 3

Which cause of unilateral cervical lymphadenopathy causes nonfluctuant lymph node?

Answer 3

Kawasaki disease

Question 4

Which cause of unilateral cervical lymphadenopathy is typically seen in kids age 1-5 with a recent URI and is usually Staph or Strep?

Answer 4

Bacterial cervical adenitis

Question 5

Which cause of unilateral cervical lymphadenopathy causes axillary LAD and is caused by Bartonella and is usually self-limiting?

Answer 5

Cat scratch disease

Question 6

Which cause of unilateral cervical lymphadenopathy causes erythematous and violacious overlying skin, rupture of lymph nodes, and must be treated by surgical excision?

Answer 6

Mycobacterial infection

Question 7

What 3 diseases can result in Strawberry Tongue?

Answer 7

1. Strep pharyngitis
2. Kawasaki disease
3. TSS

Question 8

Four out of what 5 criteria are necessary for a diagnosis of Kawasaki disease?

Answer 8

1. Oral mucosa changes
2. Extremity redness/swelling
3. Unilateral cervical LAD
4. Rash
5. Conjunctivitis

Question 9

What are the 3 phases of Kawasaki disease and how long does each last?

Answer 9

1. Acute (10 days)
2. Subacute (10 days-3 weeks)
3. Convalescent (3 weeks-8 weeks)

Question 10

What are the findings in the acute phase of Kawasaki disease?

Answer 10

Fever, systemic inflammation, acute phase reactants

Question 11

What are the findings in the subacute phase of Kawasaki disease?

Answer 11

Fever and clinical findings subside; feet and hands peel

Question 12

What are the findings in the convalescent phase of Kawasaki disease?

Answer 12

Just serologic evidence of inflammation persists

Question 13

What heart issue can happen as a result of Kawasaki disease?

Answer 13

Coronary artery aneurysm

Question 14

What’s the best treatment for Kawasaki disease?

Answer 14

High dose aspirin (80-100mg/kg/day) divided into 4 doses, plus IVIG (2 g/kg) over 10-12 hours

Question 15

When is the most likely time of coronary artery aneurysm in Kawasaki disease?

Answer 15

4 weeks

Question 16

Would a negative ESR indicate Kawasaki disease?

Answer 16

No, ESR is usually elevated in Kawasaki disease

Question 17

What are the liver enzyme and albumin levels in Kawasaki disease?

Answer 17

Liver enzymes: high

Albumin: low

Question 18

What’s the progression of Measles rash?

Answer 18

Starts on neck behind ears, spreads downward

Question 19

What’s the progression of the RMSF rash?

Answer 19

Starts on ankles and wrists and progresses centrally and to palms and soles

Question 20

What’s the progression of the Scarlet fever rash

Answer 20

Begins at neck, axillae, and groin, and then spreads over trunk and extremities

Question 21

What’s the progression of the Varicella rash?

Answer 21

Starts on trunk and spreads to extremities and head

Question 22

What’s the progression of Erythema infectiosum rash?

Answer 22

Starts as slapped cheeks and spreads to the trunk and extremities

Question 23

What’s the progression of Roseola rash?

Answer 23

Starts on trunk and spreads to arms and neck; less commonly face and legs

Question 24

Erythema infectiosum vs. Roseola?

Answer 24

Roseola has a high fever, erythema infectiosum has a low fever

Question 25

What group of strep causes Scarlet fever?

Answer 25

GAS

Question 26

How long does Kawasaki fever have to be minimum?

Answer 26

5 days