Examkin

Soru

Zorluk: OrtaPediatric Cardiovascular Disorders

A 2-year-old boy is evaluated in the emergency department for a persistent fever of 39.6∘C39.6^\circ\text{C} (103.3∘F103.3^\circ\text{F}) that has lasted for 6 days despite regular use of acetaminophen. His mother notes he has been unusually irritable, has poor oral intake, and developed a mild cough today. On physical examination, the child has bilateral bulbar conjunctival injection without purulent discharge. His lips are noticeably erythematous, dry, and fissured. A 2.5 cm2.5\text{ cm} firm, tender lymph node is palpated in the right anterior cervical chain. A diffuse, polymorphous maculopapular rash is visible across his trunk and perineum. His hands and feet exhibit non-pitting edema and distinct erythema. Respiratory rate is 42/min, and oxygen saturation is 97% on room air. Lungs are clear to auscultation bilaterally. Cardiac examination reveals tachycardia but a regular rhythm with no murmurs. What is the most appropriate next step in the management of this patient's condition?

  1. A
    Reassure the parents that the cutaneous findings represent a benign viral exanthem and prescribe topical corticosteroids
  2. B
    Obtain throat cultures and prescribe empiric broad-spectrum intravenous antibiotics for bacterial lymphadenitis
  3. Admit for intravenous immunoglobulin and high-dose aspirin therapy, and order an echocardiogramCevap
  4. D
    Obtain a chest radiograph and initiate nebulized albuterol therapy to treat viral bronchiolitis
  5. E
    Administer his overdue live-attenuated measles-mumps-rubella vaccine and discharge with oral antipyretics

Cevap

The most appropriate management is to admit the patient for intravenous immunoglobulin and high-dose aspirin therapy, and order an echocardiogram.
The patient's presentation of a fever lasting at least 5 days combined with four classic signs (bilateral non-exudative conjunctivitis, mucositis, cervical lymphadenopathy, and extremity edema/erythema) establishes the diagnosis of Kawasaki disease. Kawasaki disease is an acute, systemic medium-vessel vasculitis that primarily affects young children. The most feared complication is the formation of coronary artery aneurysms. To mitigate this risk, standard of care dictates immediate hospitalization for the administration of intravenous immunoglobulin (IVIG) and high-dose aspirin. Additionally, a baseline transthoracic echocardiogram is essential at the time of diagnosis to evaluate for pre-existing coronary artery dilation or aneurysms, and must be repeated subsequently.

Adım Adım Çözüm

1
Evaluate the clinical presentation against diagnostic criteria.
The patient has ≥\geq 5 days of fever plus 4 classic criteria: non-exudative conjunctivitis, mucosal changes (cracked lips), cervical lymphadenopathy, and extremity changes (edema/erythema).
Identifying these 5 clinical findings confirms the diagnosis of classic Kawasaki disease, a medium-vessel vasculitis.
2
Identify the primary complication associated with this diagnosis.
The most severe complication of Kawasaki disease is the development of coronary artery aneurysms.
Without treatment, up to 25% of affected children develop coronary artery aneurysms, which can lead to myocardial infarction or sudden death.
3
Select the correct acute management to prevent this complication.
Intravenous immunoglobulin (IVIG) and high-dose aspirin should be administered immediately, and a baseline echocardiogram must be obtained.
IVIG significantly reduces the risk of coronary artery aneurysms if given within the first 10 days of illness, while an echocardiogram evaluates baseline cardiac anatomy.

Anahtar Kavram

Kawasaki disease requires prompt diagnosis based on clinical criteria and immediate treatment with IVIG and aspirin to prevent coronary artery aneurysms.
Bu soruyu puanla

Konular

Pediatric Cardiovascular Disorders

Bu konudan daha fazla soru