February Week 1

Fimbres AM and Shulman ST. Kawasaki Disease. Peds in Review. 2008; 29(9).

Freeman AF and Shulman ST. Kawasaki Disease: Summary of the AHA
Guidelines.  Amer Fam Phys. 2006. (pdf or html)

An 18-month-old boy is brought to the clinic with fever and
irritability. His mother explains that he has had a fever for the past
week and a red rash on his extremities. On physical examination, he
has a temperature of 39.2°C; he is irritable; his eyes are injected
without discharge; his lips are dry, red, and cracked.  All other
findings are WNL.

1.  What are the criteria for diagnosing Kawasaki Disease?
2.  Other febrile illnesses of childhood can mimic KD.  Discuss the
differential diagnosis and what clinical features are more suggestive
of KD.
3.  Why is it important to diagnose KD as quickly and accurately as
possible?  What are the consequences of missed diagnosis/treatment?
4.  When should echocardiograms be performed in a patient with KD?
5.  Identify the cardiac complications of KD.  How can you use risk
stratification to determine which patients require longer
pharmacologic treatment, more frequent follow up, and/or more invasive

6.   PREP:  Of the following, the MOST appropriate next step in the
case above is to:
A. Administer IV abx
B. Administer IVIG
C. Obtain blood cultures
D. Obtain electrocardiography
E. Perform an LP and ctx CSF

7.  PREP:  The child’s parents are surprised that the recommended
therapy includes aspirin because of lay press reports to avoid aspirin
in children younger than 16 years of age. You explain to them that
there are some adverse effects to aspirin therapy for which they
should be alert.  Of the following, the MOST likely adverse effect is:
A. Gastric toxicity with nausea
B. Interstitial nephritis
C. Liver toxicity
D. Reye syndrome
E. Tinnitus