Kawasaki disease US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Kawasaki disease. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Kawasaki disease US Medical PG Question 1: A 6-year-old boy presents to his pediatrician accompanied by his mother for evaluation of a rash. The rash appeared a little over a week ago, and since that time the boy has felt tired. He is less interested in playing outside, preferring to remain indoors because his knees and stomach hurt. His past medical history is significant for an upper respiratory infection that resolved uneventfully without treatment 2 weeks ago. Temperature is 99.5°F (37.5°C), blood pressure is 115/70 mmHg, pulse is 90/min, and respirations are 18/min. Physical exam shows scattered maroon macules and papules on the lower extremities. The abdomen is diffusely tender to palpation. There is no cervical lymphadenopathy or conjunctival injection. Which of the following will most likely be found in this patient?
- A. Coronary artery aneurysms
- B. Leukocytoclastic vasculitis (Correct Answer)
- C. Thrombocytopenia
- D. Mitral regurgitation
- E. Occult malignancy
Kawasaki disease Explanation: ***Leukocytoclastic vasculitis***
- This patient presents with symptoms highly suggestive of **Henoch-Schönlein Purpura (HSP)**, including a preceding URI, fatigue, low-grade fever, **abdominal pain**, and a **palpable purpura** primarily on the lower extremities.
- HSP is characterized by IgA-mediated **small-vessel vasculitis**, which histologically presents as leukocytoclastic vasculitis with IgA deposition on immunofluorescence.
*Coronary artery aneurysms*
- **Coronary artery aneurysms** are a classic complication of **Kawasaki disease**, not Henoch-Schönlein Purpura.
- Kawasaki disease presents with different clinical features, including prolonged fever, conjunctival injection, oral changes, and cervical lymphadenopathy.
*Thrombocytopenia*
- **Thrombocytopenia** is characterized by a low platelet count and often presents with petechiae, purpura, and bleeding, but the rash in HSP is due to inflammation and extravasation of red blood cells, not low platelets.
- Platelet counts in HSP are typically **normal** or can be slightly elevated as an acute phase reactant.
*Mitral regurgitation*
- **Mitral regurgitation** is a common manifestation of **rheumatic fever**, particularly after recurrent episodes, caused by valvular damage.
- Rheumatic fever is also preceded by infection (Group A Strep) but involves different symptoms like migratory polyarthritis, carditis, chorea, erythema marginatum, and subcutaneous nodules, which are not described here.
*Occult malignancy*
- While an **occult malignancy** can cause paraneoplastic syndromes or constitutional symptoms, the specific constellation of symptoms, including the migratory rash, abdominal pain, and preceding URI, points much more strongly to **HSP** in a 6-year-old.
- The presentation is more consistent with an acute, inflammatory process rather than a chronic, insidious malignant one.
Kawasaki disease US Medical PG Question 2: A 9-year-old boy is brought to the emergency department because of progressively worsening shortness of breath for 3 days. He has had fever and malaise for the past 5 days. He had a sore throat 3 weeks ago that resolved without treatment. He appears ill. His temperature is 38.6°C (101.5°F), pulse is 98/min and blood pressure is 84/62 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 93%. Examination shows jugular venous distension and bilateral ankle edema. There are erythematous, ring-shaped macules and patches over his trunk that are well-demarcated. Auscultation of the chest shows crackles at the lung bases bilaterally. An S3 is heard on cardiac auscultation. His hemoglobin concentration is 12.2 g/dL, leukocyte count is 13,600/mm3, and platelet count is 280,000/mm3. A urinalysis is normal. An x-ray of the chest shows cardiac silhouette enlargement with prominent vascular markings in both the lung fields. Which of the following is the most likely etiology of this patient's symptoms?
- A. Systemic lupus erythematosus
- B. Acute rheumatic fever (Correct Answer)
- C. Kawasaki disease
- D. Viral myocarditis
- E. Infection with Borrelia burgdorferi
Kawasaki disease Explanation: ***Acute rheumatic fever***
- This patient presents with signs of cardiac involvement (**shortness of breath**, **S3 gallop**, **cardiomegaly**, **pulmonary edema**), a history of a recent **strep throat infection**, and **erythema marginatum** (the ring-shaped rash), all consistent with **acute rheumatic fever**.
- **Acute rheumatic fever** is a delayed, non-suppurative complication of Group A Streptococcus pharyngitis, leading to systemic inflammation, particularly affecting the heart, joints, brain, and skin.
*Systemic lupus erythematosus*
- SLE can cause cardiac complications like pericarditis or myocarditis, but the characteristic rash of SLE (malar or discoid) differs from the described **erythema marginatum**.
- While SLE can cause systemic symptoms, the clear history of a preceding **sore throat** and the specific rash point away from SLE.
*Kawasaki disease*
- Kawasaki disease primarily affects **children under 5 years old** and is characterized by fever, conjunctivitis, oral changes, rash, lymphadenopathy, and extreme irritability.
- The patient's age (9 years) and the specific rash described (erythema marginatum) are not typical for Kawasaki disease.
*Viral myocarditis*
- Viral myocarditis can cause **heart failure** symptoms (shortness of breath, S3, cardiomegaly), but it typically lacks the preceding **sore throat** and the specific skin findings of **erythema marginatum** seen in this patient.
- While a viral infection could cause myocarditis, the constellation of symptoms points strongly to a specific post-streptococcal etiology.
*Infection with Borrelia burgdorferi*
- *Borrelia burgdorferi* (Lyme disease) can cause cardiac manifestations like **carditis** (often AV block) and a characteristic rash called **erythema migrans**.
- However, **erythema migrans** is typically a single, expanding bull's-eye rash, which is different from the described **erythematous, ring-shaped macules and patches** of erythema marginatum.
Kawasaki disease US Medical PG Question 3: 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?
- A. Mitral valve
- B. Kidneys
- C. Gallbladder
- D. Coronary artery (Correct Answer)
- E. Pylorus
Kawasaki disease Explanation: ***Coronary artery***
- The constellation of symptoms, including prolonged fever, rash on trunk, palms, and soles, cracked lips, cervical lymphadenopathy, and perianal desquamation, is highly indicative of **Kawasaki disease**.
- **Coronary artery aneurysms** are the most serious complication of Kawasaki disease, occurring in 15-25% of untreated children, necessitating close monitoring and screening.
*Mitral valve*
- While other forms of vasculitis or rheumatic fever can affect heart valves, **mitral valve** involvement is not a primary or characteristic complication of Kawasaki disease.
- The main cardiac concern in Kawasaki disease is direct arterial inflammation, not valvular dysfunction.
*Kidneys*
- **Renal involvement**, such as acute kidney injury, is not a typical or prominent feature of Kawasaki disease.
- Kawasaki disease primarily targets medium-sized muscular arteries throughout the body, with a predilection for the coronary arteries.
*Gallbladder*
- **Hydrops of the gallbladder** can occur in Kawasaki disease, leading to acute cholecystitis-like symptoms, but it is generally a self-limiting complication.
- While it's a potential finding, it is not as life-threatening or essential to screen for as coronary artery complications.
*Pylorus*
- There is no direct association between Kawasaki disease and primary involvement or complications of the **pylorus**.
- Gastrointestinal symptoms can occur, but these are typically non-specific and do not involve anatomical changes to the pylorus.
Kawasaki disease US Medical PG Question 4: 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?" (Correct Answer)
Kawasaki disease Explanation: ***Can you tell me more about the symptoms you have been experiencing?***
- This **open-ended question** encourages the patient to provide a **comprehensive narrative** of their symptoms, including details about onset, frequency, duration, alleviating/aggravating factors, and associated symptoms, which is crucial for diagnosis.
- In a patient presenting with vague, intermittent symptoms like alternating constipation and diarrhea, allowing them to elaborate freely can reveal important clues that might not be captured by more targeted questions.
*Does the diarrhea typically precede the constipation, or vice-versa?*
- While knowing the sequence of symptoms can be helpful in understanding the **pattern of bowel dysfunction**, it is a very specific question that might overlook other important aspects of the patient's experience.
- It prematurely narrows the focus without first obtaining a broad understanding of the patient's overall symptomatic picture.
*Is the diarrhea foul-smelling?*
- Foul-smelling diarrhea can indicate **malabsorption** or **bacterial overgrowth**, which are important to consider in some gastrointestinal conditions.
- However, this is a **specific symptom inquiry** that should follow a more general exploration of the patient's symptoms, as it may not be relevant if other crucial details are missed.
*Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life*
- Quantifying pain intensity is useful for assessing the **severity of discomfort** and monitoring changes over time.
- However, for a patient with intermittent rather than acute, severe pain, understanding the **character, location, and triggers** of the pain is often more diagnostically valuable than just a numerical rating initially.
*Are the symptoms worse in the morning or at night?*
- Diurnal variation can be relevant in certain conditions, such as inflammatory bowel diseases where nocturnal symptoms might be more concerning, or functional disorders whose symptoms might be stress-related.
- This is another **specific question** that should come after gathering a more complete initial picture of the patient's symptoms to ensure no key information is overlooked.
Kawasaki disease US Medical PG Question 5: A 7-year-old boy comes to the physician because of a generalized rash for 3 days. Over the past 5 days, he has also had a high fever and a sore throat. His 16-year-old sister was treated for infectious mononucleosis 2 weeks ago. He returned from a summer camp a week ago. His immunizations are up-to-date. Three years ago, he required intubation after an allergic reaction to dicloxacillin. The patient appears ill. His temperature is 38.2°C (100.8°F). Examination shows circumferential oral pallor. Cervical lymphadenopathy is present. There is tonsillar erythema and exudate. A confluent, blanching, punctate erythematous rash with a rough texture is spread over his trunk and extremities. His hemoglobin concentration is 13.3 g/dL, leukocyte count is 12,000/mm3, and erythrocyte sedimentation rate is 43 mm/h. Which of the following is the most appropriate next step in management?
- A. Amoxicillin therapy
- B. Doxycycline therapy
- C. Azithromycin therapy (Correct Answer)
- D. Cephalexin therapy
- E. Acyclovir therapy
Kawasaki disease Explanation: ***Azithromycin therapy***
- This patient presents with symptoms highly suggestive of **streptococcal pharyngitis** (sore throat, fever, tonsillar exudates, cervical lymphadenopathy) complicated by **scarlet fever** (confluent, blanching, punctate erythematous rash with a rough texture, circumferential oral pallor).
- Given his **history of severe allergic reaction (intubation) to dicloxacillin**, a penicillin-class antibiotic, azithromycin (a macrolide) is the appropriate choice for treating **Group A Streptococcus** (GAS) infection in a penicillin-allergic patient.
*Amoxicillin therapy*
- **Amoxicillin** is a penicillin-class antibiotic and is **contraindicated** due to the patient's severe allergic reaction (intubation) to dicloxacillin, another penicillin.
- Cross-reactivity between penicillins, especially in severe allergic reactions, is a significant concern, making this an unsafe choice.
*Doxycycline therapy*
- **Doxycycline**, a tetracycline, is not a first-line treatment for **streptococcal pharyngitis** and is primarily used for atypical bacterial infections or in specific cases of penicillin allergy where other agents are not suitable.
- While it has some activity against GAS, macrolides like azithromycin are preferred alternatives for penicillin-allergic patients.
*Cephalexin therapy*
- **Cephalexin** is a first-generation cephalosporin, and while it can be used for GAS, roughly 5-10% of patients with a penicillin allergy may have a **cross-reaction** to cephalosporins, especially with a history of severe reactions.
- Therefore, it is generally avoided in patients with a history of anaphylaxis or other severe reactions to penicillin.
*Acyclovir therapy*
- **Acyclovir** is an antiviral medication used to treat herpes simplex and varicella-zoster virus infections.
- The patient's symptoms (pharyngitis, rash consistent with scarlet fever) are indicative of a **bacterial infection (GAS)**, not a viral infection that would respond to acyclovir.
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