Clipp 11: 4 y/o with fever and lymphadenopathy

Question 1

Derm term for flat, discolored spot

Answer 1

macular

Question 2

Small, well defined solid palpable bump

Answer 2

papular

Question 3

Small, well-defined, fluid containing bump

Answer 3

vesicle

Question 4

Small, well-defined bump containing purulent material

Answer 4

pustle

Question 5

Small, raised, differentiated patch or area on a body surface

Answer 5

plaque

Question 6

Shedding of the outer layer of skin surface

Answer 6

Desquamation

Question 7

Another name for meningiococcemia?

Answer 7

Meningitis with Nisseria Meningiditis

Question 8

May cause upper respiratory tract infection, pharyngitis, conjunctivitis, tonsillitis, or otitis media

Potential for more severe infections in immunocompromised hosts

Answer 8

Adenovirus Infection

Question 9

Fever > 5 days
Cervical adenopathy
Nonpurulent conjunctivitis
Nonspecific ("polymorphic") rash
Swelling and erythema of extremities
Mucosal inflammation

Answer 9

Kawasaki disease

Vasculitis

Question 10

Fever
Chills, malaise
Rash (often petechial)
May lead to shock and DIC (often rapidly progressing)

Answer 10

Meningococcemia
Bacterial infection (Neisseria meningitidis)

Question 11

After a prodrome of fever (over 38.3 C, or 101 F), cough, coryza, and conjunctivitis, this maculopapular rash starts on the neck, behind the ears, and along the hairline.

The rash spreads downward, reaching the feet in two or three days.

The initial rash appears on the buccal mucosa as red lesions with bluish white spots in the center (known as Koplik spots). These have frequently disappeared by the time the patient presents to medical attention.

Answer 11

Measles

Question 12

Fever

Headache

Rash (typically starts on ankles and wrists and progresses centrally and to palms and soles; may be macular or papular at first, quickly becoming petechial; in 5% of cases, there may be no rash)

Myalgias

Answer 12

Rocky Mountain spotted fever (RMSF)

Tick-borne bacterial infection (Rickettsia rickettsii)

Question 13

Fever

A diffuse, erythematous, finely papular rash (described as having a “sandpaper” texture) is pathognomonic

Rash often begins at neck, axillae, and groin and then spreads over trunk and extremities, typically resolving within four or five days

Answer 13

Scarlet fever

Group A strep

Question 14

Severe, pruritic rash (erythema multiforme)
Fever
Mucosal changes (e.g., stomatitis)
Conjunctivitis

Answer 14

SJS

Question 15

Fever lasting 3-5 days

Nonspecific rash (which may include the palms and soles)

May also cause conjunctivitis, oral ulcers, diarrhea, aseptic meningitis

Answer 15

Enteroviral infection

Coxsackievirus, echovirus, enterovirus

Question 16

“Chicken pox:” rash starts on trunk and spreads to extremities and head

Each lesion starts as an erythematous macule, then forms a papule followed by a vesicle before crusting over

Lesions at various stages of development are seen in the same area of the body

Immunization is effective in preventing this infection

Answer 16

Varicella

Question 17

Also called 5th disease

Low grade fever followed by a rash, which starts as a facial erythema to the face (“slapped cheek” appearance), which can spread to the trunk and extremities and appears lacy

Can lead to pain and swelling of the extremities, as well as development of aplastic anemia

Answer 17

Erythema Infectiosum
Viral infection (parvovirus B19)

Question 18

“Exanthem subitum:” erythematous macules start on trunk and spreads to arms and neck (less commonly face and legs)

Rash is typically preceded by 3-4 days of high fevers, which end as the rash appears

Usually occurs in children under age 2 years

Answer 18

Roseola
Viral infection (human herpesvirus 6)

Question 19

Causes of unilateral cervical lymphadenopahty

Answer 19

Reactive cervical adenitis (with oral infection)
Kawasaki Disease
Bacterial Cervical Adenitis
Cat Scratch Disease
Mycobacterial Infection

Question 20

Ddx for strawberry tongue? (3)

Answer 20

Strep Pharyngitis
Kawasaki Disease
Toxic Shock Syndrome

Question 21

3 phases of Kawasaki Disease

Answer 21

Acute phase: onset through ~10 days. Fever and clinical findings are present, with serologic evidence of systemic inflammation (elevated acute phase reactants).
Subacute phase: 10 days through ~3 weeks. Fever resolves and clinical findings largely subside (often with peeling of hands and feet). Serologic evidence of inflammation continues.
Convalescent phase: 3 weeks through 6-8 weeks. All clinical findings have resolved. Continued serologic evidence of inflammation.

Question 22

Although Kawasaki Disease is a panvasculitis, it has a predilection for what sized vessels?

Answer 22

Small and medium –> affects coronary vasculature

Question 23

At what phase of Kawasaki Disease do coronary aneurysms develop?

Answer 23

The greatest risk for the development of CA aneurysms is in the subacute phase of illness (beyond 10 days), and aneurysms almost always develop within four weeks of the onset of the disease. Aneurysms that form during this time are at risk for thrombosis due to the concurrent thrombocytosis.

Question 24

What monitoring should be done on patients with kawasaki disease?

Answer 24

Cardiac echo

Question 25

Standard tx for Kawasaki Disease?

Answer 25

Aspirin and IVIG

Question 26

What antipyretic should be used in the tx of Kawasaki?

Answer 26

Ibuprofen- because it antagonizes the irreversible platelet inhibition of aspirin

Question 27

Follow up care for Kawasaki?

Answer 27

Cardiology in 1-2 weeks

Low dose aspirin for 6-8 weeks

Question 28

What are children taking aspirin at risk for if they are infected with a virus?

Answer 28

Reye’s syndrome

Question 29

A 5-year-old female, previously healthy, presents with an erythematous, vesicular rash on the palms and soles and a high fever for several days. Upon examination, she is also found to have ulcers in her mouth. A few days later, the fever and rash resolve. What is the most likely pathogen?

Answer 29

Enterovirus- cocksackie A