Chapter·PediatricsKawasaki disease

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1

A 4-year-old boy is brought to the emergency department by his parents after 10 days of fever, varying from 38.0–40.0°C (100.4–104.0°F). On physical examination, the child is ill-looking with an extensive rash over his trunk with patchy desquamation. His hands are swollen, and he also shows signs of a bilateral conjunctivitis. The laboratory test results are as follows: Hemoglobin 12.9 g/dL Hematocrit 37.7% Mean corpuscular volume 82.2 μm3 Leukocyte count 10,500/mm3 Neutrophils 65% Lymphocytes 30% Monocytes 5% Platelet count 290,000/mm3 Erythrocyte sedimentation rate (ESR) 35 mm/h What is the next best step in the management of this patient’s condition?

AHigh-dose aspirin

BInfluenza vaccine

CEchocardiography

DLow-dose aspirin

ECorticosteroids

2

A 4-year-old boy is brought to the emergency department by his mother with a rash on his trunk, malaise, and fever with spikes up to 38.5°C (101.3°F) for the past 2 weeks. The patient's mother says she tried giving him Tylenol with little improvement. Past medical history includes a spontaneous vaginal delivery at full term. The patient's vaccines are up-to-date and he has met all developmental milestones. On physical examination, his lips are cracking, and he has painful cervical lymphadenopathy. The rash is morbilliform and involves his trunk, palms, and the soles of his feet. There is fine desquamation of the skin of the perianal region. Which of the following anatomical structures is most important to screen for possible complications in this patient?

AMitral valve

BKidneys

CGallbladder

DCoronary artery

EPylorus

3

A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?

A"Does the diarrhea typically precede the constipation, or vice-versa?"

B"Is the diarrhea foul-smelling?"

C"Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"

D"Are the symptoms worse in the morning or at night?"

E"Can you tell me more about the symptoms you have been experiencing?"

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