Kawasaki Disease — MCQs
Best treatment for Kawasaki disease is:
A child with fever for 6 days, strawberry tongue, conjunctival congestion with peeling of skin. What will be the treatment option for this child?
A 2-year-old presents with fever, cervical lymphadenopathy, strawberry tongue, and desquamating rash on fingers. What is the cardiac complication?
The most dreadful complication of Kawasaki disease is
Which one of the following is a criterion of Kawasaki disease?
Kawasaki disease is associated with all of the following clinical features except -
In Kawasaki disease, desquamation and denudation of skin from fingers and toes occurs in:
Kawasaki disease is associated with all of the following clinical features except
Which of the following vasculitides is predominantly seen in children?
What is the treatment of choice for Kawasaki Disease?
Kawasaki Disease Indian Medical PG Practice Questions and MCQs
Question 1: Best treatment for Kawasaki disease is:
- A. Aspirin
- B. Corticosteroids
- C. Methotrexate
- D. I.V. immunoglobulins (Correct Answer)
Explanation: ***I.V. immunoglobulins (IVIG)*** - **IVIG** is the cornerstone of treatment for **Kawasaki disease**, significantly reducing the risk of **coronary artery aneurysms**. - It is typically administered in conjunction with **aspirin** to reduce inflammation and prevent thrombosis. *Aspirin* - **Aspirin** is an important part of Kawasaki disease treatment, initially used at a high dose for its **anti-inflammatory** effects, then at a low dose for its **anti-platelet** effects. - However, it is generally used *in combination* with IVIG and is not considered the *sole best treatment* for preventing severe complications like coronary aneurysms. *Corticosteroids* - **Corticosteroids** may be considered in refractory cases of **Kawasaki disease** or in patients at high risk for IVIG treatment failure. - They are not a first-line treatment due to potential side effects and the superior efficacy of IVIG in most cases. *Methotrexate* - **Methotrexate** is an **immunosuppressant** often used in long-term management of certain **autoimmune diseases** and some forms of vasculitis. - It is not indicated for the acute treatment of Kawasaki disease, which requires rapid **anti-inflammatory** and **immunomodulatory** intervention.
Question 2: A child with fever for 6 days, strawberry tongue, conjunctival congestion with peeling of skin. What will be the treatment option for this child?
- A. Antibiotics
- B. Steroids
- C. Antipyretics
- D. IVIG (Correct Answer)
Explanation: ***IVIG*** - The constellation of **fever for 6 days (prolonged fever)**, **strawberry tongue**, **conjunctival congestion**, and **peeling skin** is highly indicative of **Kawasaki disease**. - **Intravenous immunoglobulin (IVIG) 2 g/kg as a single infusion** is the cornerstone of treatment for Kawasaki disease to reduce the risk of **coronary artery aneurysms** (from ~25% to <5%). - IVIG should be administered within **10 days of fever onset** for maximum efficacy. - **High-dose aspirin** (80-100 mg/kg/day) is given concurrently until the fever subsides, then switched to low-dose aspirin (3-5 mg/kg/day) for antiplatelet effect. *Antibiotics* - Kawasaki disease is a **vasculitis**, not a bacterial infection, so antibiotics are ineffective. - While other conditions like scarlet fever can present with strawberry tongue, the prolonged fever and other classic Kawasaki features differentiate it. *Steroids* - While steroids can reduce inflammation, they are **not the primary treatment** for Kawasaki disease and are typically used in conjunction with IVIG in **refractory cases** or for IVIG-resistant disease. - **Monotherapy with steroids** is not recommended for acute Kawasaki disease due to potential for increased aneurysm risk. *Antipyretics* - **Antipyretics** like acetaminophen can help manage the fever symptomatically. - However, they **do not treat the underlying vasculitis** or prevent the serious cardiac complications of Kawasaki disease. - Note: **NSAIDs like ibuprofen should be avoided** when high-dose aspirin is being used due to risk of drug interactions.
Question 3: A 2-year-old presents with fever, cervical lymphadenopathy, strawberry tongue, and desquamating rash on fingers. What is the cardiac complication?
- A. Pericarditis
- B. Coronary artery aneurysm (Correct Answer)
- C. Endocarditis
- D. Myocarditis
Explanation: ***Coronary artery aneurysm*** - The constellation of **fever**, **cervical lymphadenopathy**, **strawberry tongue**, and **desquamating rash** is highly suggestive of **Kawasaki disease**. - **Coronary artery aneurysm** is the most significant and *life-threatening cardiac complication* of untreated or severe Kawasaki disease, leading to long-term morbidity and mortality. *Pericarditis* - While pericarditis can occur in some systemic inflammatory conditions, it is **not the hallmark cardiac complication** of Kawasaki disease. - Pericarditis is characterized by **chest pain** and **pericardial friction rub**, which are not typically the primary concerns in Kawasaki disease management. *Endocarditis* - **Infective endocarditis** involves inflammation of the *inner lining of the heart and heart valves*, often caused by bacterial or fungal infections. - It is **not a typical complication of Kawasaki disease**, which is a vasculitis, not primarily an endocardial infection. *Myocarditis* - Myocarditis (inflammation of the heart muscle) can occur in various viral infections, and mild myocarditis can be present in Kawasaki disease. - However, **coronary artery aneurysms** represent the most *specific and critical cardiac complication* that requires careful monitoring and treatment to prevent rupture or thrombosis.
Question 4: The most dreadful complication of Kawasaki disease is
- A. Cardiac involvement (Correct Answer)
- B. Rash
- C. Thrombocytosis
- D. Lymphadenopathy
Explanation: ***Cardiac involvement*** - **Cardiac complications**, particularly **coronary artery aneurysms**, are the most serious and potentially fatal sequelae of Kawasaki disease. - If untreated, these can lead to **myocardial infarction**, **sudden death**, or chronic ischemic heart disease. *Rash* - A rash is a common and often an early sign of Kawasaki disease, but it is a **benign symptom** and not life-threatening. - It resolves with the other acute symptoms and does not contribute to long-term morbidity or mortality. *Thrombocytosis* - **Thrombocytosis** is a characteristic laboratory finding in the subacute phase of Kawasaki disease but is rarely a direct cause of dreadful complications. - While it may increase the risk of **thrombus formation** in already damaged coronary arteries, it's not the primary "dreadful complication" itself. *Lymphadenopathy* - **Cervical lymphadenopathy** is one of the diagnostic criteria for Kawasaki disease and is a common, but not life-threatening, symptom. - It generally resolves without specific treatment for the lymph nodes and does not lead to serious long-term sequelae.
Question 5: Which one of the following is a criterion of Kawasaki disease?
- A. Edema
- B. Rash (Correct Answer)
- C. Purulent conjunctivitis
- D. Strawberry tongue
Explanation: ***Rash*** - A **polymorphous rash**, which can be macular, papular, or scarlatiniform, is one of the **five principal diagnostic criteria** for **Kawasaki disease**. - This rash typically appears early in the course of the illness and can affect any part of the body, often involving the trunk and extremities. *Edema* - **Edema of the hands and feet**, especially when accompanied by **erythema** (redness), is actually one of the **principal diagnostic criteria** for Kawasaki disease under "extremity changes." - This finding typically occurs in the acute phase, followed by **desquamation** (peeling) in the convalescent phase, particularly in the periungual region. - Note: While edema is a valid criterion, **rash** is considered the most characteristic and commonly used criterion among the options listed. *Purulent conjunctivitis* - **Kawasaki disease** characteristically presents with **bilateral non-purulent (non-exudative) conjunctival injection** - red eyes without discharge or exudate. - **Purulent conjunctivitis** (conjunctivitis with pus/discharge) indicates a bacterial infection and actually argues **against** the diagnosis of Kawasaki disease. - This is the only option that is definitively **not** a criterion. *Strawberry tongue* - **Strawberry tongue** (red, swollen tongue with prominent papillae) is part of the **oral changes criterion** in Kawasaki disease, which includes red cracked lips, strawberry tongue, and erythema of the oropharyngeal mucosa. - While also seen in scarlet fever and toxic shock syndrome, strawberry tongue is a **recognized feature** of Kawasaki disease. - Note: This is technically a valid criterion, though less specific than the polymorphous rash.
Question 6: Kawasaki disease is associated with all of the following clinical features except -
- A. Posterior cervical lymphadenopathy
- B. Truncal rash
- C. Conjunctivitis
- D. Thrombocytopenia (Correct Answer)
Explanation: ***Thrombocytopenia*** - **Thrombocytopenia** (low platelet count) is **not** a feature of Kawasaki disease; instead, patients characteristically present with **thrombocytosis** (elevated platelet count) in the subacute phase. - An elevated platelet count (often >450,000/μL) is a common laboratory finding in Kawasaki disease, especially in the second to third week of illness. - Thrombocytopenia would suggest an alternative diagnosis. *Posterior cervical lymphadenopathy* - **Cervical lymphadenopathy** is a recognized diagnostic criterion for Kawasaki disease (unilateral, non-tender, >1.5 cm). - However, the lymphadenopathy is **most commonly anterior cervical**, not posterior cervical. - While posterior cervical nodes can occasionally be involved, this is **less typical** than anterior involvement, making it a less specific finding. - Despite this, cervical lymphadenopathy (regardless of exact location) can occur in Kawasaki disease, making thrombocytopenia the more definitively incorrect option. *Truncal rash* - A **polymorphous rash**, which frequently involves the **trunk**, is a characteristic diagnostic criterion for Kawasaki disease. - This rash can take various forms, including maculopapular, scarlatiniform, or erythema multiforme-like patterns. - The rash typically appears in the first week of illness. *Conjunctivitis* - **Bilateral bulbar conjunctival injection** (redness of the white part of the eyes) without exudate is a hallmark clinical feature of Kawasaki disease. - It is one of the principal diagnostic criteria, distinguishing it from bacterial conjunctivitis with purulent discharge. - The conjunctival injection is typically non-purulent and painless.
Question 7: In Kawasaki disease, desquamation and denudation of skin from fingers and toes occurs in:
- A. After 6 weeks
- B. 2nd and 3rd week (Correct Answer)
- C. After 1st week
- D. 3-6 weeks
Explanation: ***2nd and 3rd week*** - Desquamation and denudation of skin, particularly affecting the **fingers and toes**, is a characteristic late-subacute phase finding in **Kawasaki disease**. - This typically occurs during the **subacute stage** of the illness (around days 10-21), as the acute inflammatory symptoms begin to subside. - Periungual desquamation is one of the hallmark clinical features that helps confirm the diagnosis. *After 6 weeks* - By 6 weeks, most of the acute and subacute symptoms of Kawasaki disease would have fully resolved. - This represents the late convalescent phase where desquamation has typically already occurred and resolved. *After 1st week* - While technically desquamation begins after the first week, this option is too vague and non-specific. - The more precise timing is the **2nd and 3rd weeks**, which better characterizes the subacute phase. *3-6 weeks* - While some desquamation may persist into the early part of this period, the **onset and peak** of desquamation occurs earlier, in the **2nd and 3rd weeks**. - This time frame represents primarily the late subacute to convalescent stage, where desquamation is resolving rather than beginning.
Question 8: Kawasaki disease is associated with all of the following clinical features except
- A. Thrombocytopenia (Correct Answer)
- B. Pericarditis
- C. Posterior cervical lymphadenopathy
- D. Truncal rash
Explanation: ***Thrombocytopenia*** - While **thrombocytosis** (elevated platelet count) is a characteristic feature of Kawasaki disease, especially in the subacute phase, **thrombocytopenia** (low platelet count) is not typically observed and would make the diagnosis less likely. - Initial presentation may show normal or slightly elevated platelet counts, but a significant drop is not a hallmark. *Pericarditis* - **Pericarditis** is a recognized cardiac manifestation of Kawasaki disease, occurring due to the systemic inflammatory response. - Other cardiac complications include myocarditis, valvulitis, and coronary artery aneurysms. *Posterior cervical lymphadenopathy* - **Cervical lymphadenopathy** is a common diagnostic criterion for Kawasaki disease, typically involving a single lymph node greater than 1.5 cm in diameter. - This lymphadenopathy is often **unilateral** and commonly affects the anterior cervical chain, but can occur in posterior regions as well. *Truncal rash* - Kawasaki disease often presents with a **polymorphous rash**, which can be macular, papular, or scarlatiniform, and commonly affects the **trunk** and extremities. - Other mucocutaneous manifestations include bilateral conjunctival injection, oral changes (strawberry tongue, red cracked lips), and extremity changes (redness and swelling of hands/feet).
Question 9: Which of the following vasculitides is predominantly seen in children?
- A. Takayasu arteritis
- B. Susac syndrome
- C. Kawasaki disease (Correct Answer)
- D. Henoch-Schonlein purpura
Explanation: ***Kawasaki disease*** - This is the **most common vasculitis in children**, with approximately 90% of cases occurring in children **under 5 years of age**. - It is **predominantly a pediatric condition** and rarely occurs in adults. - Characterized by fever lasting more than 5 days, along with conjunctivitis, oral changes (strawberry tongue, cracked lips), rash, cervical lymphadenopathy, and extremity changes. - The major complication is **coronary artery aneurysms**, which can lead to myocardial infarction if untreated. - Treatment with **IVIG and aspirin** reduces the risk of coronary complications. *Henoch-Schönlein purpura (HSP)* - While this is a **common vasculitis in children** (peak age 4-6 years), it also occurs in adults. - Presents with palpable purpura, arthritis, abdominal pain, and glomerulonephritis. - Caused by **IgA-mediated immune complex deposition** in small vessels. - However, it is not as **exclusively pediatric** as Kawasaki disease. *Takayasu arteritis* - A **large vessel vasculitis** affecting the aorta and its major branches. - Predominantly affects **young women** between 10-40 years of age, not specifically children. - Presents with absent pulses, hypertension, and vascular bruits. *Susac syndrome* - A rare microangiopathy affecting the brain, retina, and inner ear. - Typically occurs in **young adults** (mean age 30-40 years), not in children. - Characterized by encephalopathy, branch retinal artery occlusions, and sensorineural hearing loss.
Question 10: What is the treatment of choice for Kawasaki Disease?
- A. IV Immunoglobulins (Correct Answer)
- B. Steroids
- C. Dapsone
- D. Methotrexate
Explanation: ***IV Immunoglobulins*** - **Intravenous immunoglobulin (IVIG)** administered with **aspirin** is the primary treatment for Kawasaki disease to reduce inflammation and prevent **coronary artery aneurysms**. - Treatment should ideally be initiated within **10 days of fever onset** to achieve maximal benefit in preventing cardiac complications. *Steroids* - **Corticosteroids** may be considered in cases of IVIG-resistant Kawasaki disease or in specific high-risk patients, but they are not the first-line treatment. - Their primary role is in modulating the inflammatory response when standard therapies are insufficient. *Dapsone* - **Dapsone** is an antibiotic and anti-inflammatory agent primarily used in the treatment of **leprosy** and certain **dermatological conditions**, such as dermatitis herpetiformis. - It has no established role in the treatment of Kawasaki disease. *Methotrexate* - **Methotrexate** is a **folate antagonist** used as an immunosuppressant and chemotherapy agent for conditions like rheumatoid arthritis, psoriasis, and certain cancers. - It is not indicated for the acute management of Kawasaki disease.
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