Peds 11 Flashcards
Jason is a 4-year-old male with a 7-day history of fever and increased irritability, recently treated for presumptive strep pharyngitis. He now presents with a diffuse, erythematous, blanching macular rash; bilateral conjunctival injection, red/cracked lips, and erythematous tongue with prominent papillae. Palpation of neck reveals a single, enlarged R anterior cervical lymph node about 2cm in diameter. What is your leading dx?
Kawasaki disease
Based on your understanding of the pathophysiology of Kawasaki disease, which studies should be performed to screen for complications related to the disease?
Echocardiogram
What is the initial management for Kawasaki disease?
IVIG 2g/kg single infusion over 10-12 hours
Aspirin high dose 80-100mg/kg/day in 4 divided doses (switch to low dose when fever subsides)
What’s the discharge plan for somebody with Kawasaki disease?
- F/u with cardiology in 1-2 weeks
- Prescription for low dose aspirin (3-5mg/kg/day)
- Influenza vaccine
A 5-year-old female, previously healthy, presents with an erythematous, vesicular rash on her 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?
A. Enterovirus B. Group A strep C. Herpes simplex virus 1 (HSV-1) D. Human herpesvirus 6 (HHV-6) E. HIV
A. Enterovirus
This patient’s presentation is consistent with infection by cocksackie A, an enterovirus. This is commonly known as hand, foot, and mouth disease (HFMD). Following an incubation period of three to five days, patients have fever, tender vesicles on their hands and feet, and oral ulcers. Sometimes the rash also occurs on the buttocks and the genitals. The infection resolves spontaneously and is spread from person to person via saliva, fluid from the vesicles, stool, or nasal discharge.
A 2-year-old female presents to the urgent care clinic with a 7-day history of high fever to 38.5 C, a maculopapular rash that began on the palms and soles of her feet, red eyes without discharge, and unilateral cervical adenopathy. What other symptom/sign might you discover on further history and exam?
A. Costovertebral angle tenderness B. Erythematous and edematous feet C. Rhinorrhea D. Tonsillar exudates E. White spots on buccal mucosa
B. Erythematous and edematous feet
A 3-year-old male presents with fever to 39.4 C for the past week, injected eyes, and a refusal to walk for the past two days. On physical exam, you note conjunctival injection without exudates bilaterally, prominent papillae of his tongue with redness as well as redness of his hands and feet. He also has a new diffuse maculopapular rash on his torso that becomes more prominent with fever. On examination of the swollen extremities, you are unable to elicit any tenderness or effusions in any joints. Which of the following is the most likely diagnosis?
A. Bone or joint infection B. Kawasaki disease (KD) C. Rocky Mountain Spotted Fever (RMSF) D. Scarlet fever E. Systemic onset juvenile idiopathic arthritis
B. Kawasaki disease (KD)
A 5-year-old male comes to the clinic with a chief complaint of four days of progressively worsening fever that has been minimally responsive to acetaminophen. The patient complains of sore throat and decreased appetite. His sister had a positive rapid strep test and is now being treated with amoxicillin. Your concern is for Group A strep. What is the next best step in management?
A. Advise parents to give patient acetaminophen with return precautions
B. Chest x-ray
C. Rapid strep test with back-up culture if negative
D. Send blood cultures
E. Start antibiotic treatment
C. Rapid strep test with back-up culture if negative
A 3-year-old female comes to the clinic with a chief complaint of fever (40 C) for over a week. Her mother reports that she has been fussy and inconsolable since she became febrile. She has a red tongue with large papillae, conjunctivitis, a palmar rash, unilateral cervical adenopathy, and swollen feet. Given the most likely diagnosis, what is the most important follow-up for this girl over the next few weeks?
A. Cardiology follow-up to rule out presence of rheumatic fever
B. Echocardiogram to look for coronary artery aneurysm
C. Neurology follow-up to evaluate partial paralysis of lower extremities
D. Ophthalmology follow-up to determine extent of eye damage
E. Physical therapy follow-up to help prevent long-term joint deformities
B. Echocardiogram to look for coronary artery aneurysm
How would you describe a rash that consists of red non-raised blanching spots?
Erythematous, macular
What labs would you order if you suspect Kawasaki disease and what findings would support the dx?
CBC w/ diff - WBC elevated, anemia (low h/h), thrombocytosis (high plt)
Liver enzymes elevated, albumin low
ESR/CRP high
UA - presence of WBC w/o bacteria/leukocytes
Can you use other antipyretics during treatment of Kawasaki disease?
They are usually not effective for fever control. DO NOT give ibuprofen in those w/ coronary aneurysms taking aspirin for antiplatelet effects (low dose aspirin?)
