Ivonne
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73.-You are notified that one of your patients, a 3 -year-old previously healthy girl, is admitted to the hospital because of 6-day history of fever, irritability, and erythema of the hands and feet. Her physical examination on admission showed a temperature of 39.7 C (103.4 F), bilateral conjunctival injection, an enlarged left-sided cervical lymph node (2.0 cm), fissured lips, a red tongue with red papillae, pharyngeal hyperemia, erythematous and edematous palms and soles, and a confluent, blanching erythematous rash on the trunk. The mother told the emergency department physician that she had been giving her daughter aspirin for the past week to reduce her fever. In the emergency department, intravenous fluids were started, the aspirin therapy was continued, and laboratory studies were ordered. These laboratory studies just returned and show an erythrocyte sedimentation rate of 28mm/h and a platelet count of 490,000/mm3. The patient is extremely uncomfortable and now shows desquamation of the fingers and toes. The mother is very concerned about her daughter's condition. At this time the most correct statement about her condition is:
A. Corticosteroids are necessary to decrease the risk of aneurysms within 10 days of the onset of fever
B. Influenza vaccination is necessary if this patient requires long-term salicylate therapy
C. MMR vaccination should be given within a month if this patient receives intravenous gamma globulin
D. Nasopharyngeal cultures will help to establish the diagnosis
E. There is a 40% risk of death associated with her disease
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| Eagle_303
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This is Kawasaaki Disease = mucocutaneous lymph node disease
Option B is correct ;to prevent Reye syndrome
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| nightflight1945
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Agree,
Good one!
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| ngaybinhyen
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While awaiting for the patient to respond to the flu shot, alternative antiplatelet treatment is recommended
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| Ivonne
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Explanation:
The correct answer is B. This patient most likely has Kawasaki disease, which is treated with aspirin and intravenous gamma globulin. The disease is characterized by a high fever for longer than 5 days, bilateral conjunctival injection, fissured lips, a "strawberry tongue", mucosal change in the oral pharynx, erythematous and edematous palms and soles with desquamation, a polymorphous rash, cervical lymphadenopathy, an elevated erythrocyte sedimentation rate, and thrombocytosis. The most important complication is coronary artery aneurysms, which may be prevented by early treatment with aspirin and intravenous gamma globulin. An echocardiogram is necessary to evaluate cardiac involvement. The influenza vaccine is necessary if this patient requires long-term salicylate therapy because of the possible increased risk of Reye syndrome. Reye syndrome may develop in patients with influenza who receive salicylates.
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| ngaybinhyen
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Good luck, Ivonne
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| Ivonne
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Thank you ngaybinhyen!
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| ngaybinhyen
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| lampard
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chicken pox immunization should be initiated too
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| ngaybinhyen
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can you tell us why it is recommended, lampard?
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| lampard
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Having an influenza / chicken pox infection predisposes the patient to Reyes' syndrome
Not sure about the pathophysiology though...
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