AANP Family Nurse Practitioner (FNP) Certification ExamDiagnosisHard
A 5-year-old child is brought to the clinic by his mother due to a 3-day history of high fever (up to 104°F), irritability, and a confluent, blanching erythematous rash that started on his trunk and spread to his extremities. He also has bilateral non-exudative conjunctivitis, 'strawberry tongue,' and cervical lymphadenopathy. His hands and feet are swollen. Which of the following conditions is the most urgent diagnostic concern?
- AScarlet fever
- BKawasaki disease
- CFifth disease (Erythema Infectiosum)
- DMeasles
Show answer & explanationAnswer & explanation
Correct answer: B. Kawasaki disease
The patient's presentation with prolonged high fever, bilateral non-exudative conjunctivitis, strawberry tongue, rash, cervical lymphadenopathy, and swollen hands/feet, especially in a child, is highly indicative of Kawasaki disease. This is an urgent concern due to the risk of coronary artery aneurysms.
Why the other options are wrong
- A. Scarlet fever presents with a fever, pharyngitis, and a 'sandpaper' rash, often followed by desquamation, but typically lacks the specific conjunctivitis, strawberry tongue, and extremity changes of Kawasaki.
- C. Fifth disease typically presents with a 'slapped cheek' rash and a lacy, reticular rash on the body, usually without high fever, strawberry tongue, or extremity swelling.
- D. Measles (rubeola) involves a maculopapular rash, cough, coryza, conjunctivitis, and Koplik spots, but does not present with strawberry tongue, swollen extremities, or the same pattern of lymphadenopathy.
Kawasaki Disease
An acute systemic vasculitis affecting medium-sized arteries, primarily in young children, with a significant risk of coronary artery aneurysms.
- Prolonged fever (>5 days) plus at least 4 of 5 criteria: Conjunctivitis, Rash, Adenopathy, Strawberry tongue/oral changes, Extremity changes (CRASH and burn).
- Peak incidence 6 months to 5 years.
- Requires urgent diagnosis and treatment (IVIG) to prevent cardiac complications.
Memory trick: Kawasaki's 'CRASH' is a 'Cardiac' emergency in kids.