AANP Family Nurse Practitioner (FNP) Certification ExamDiagnosisMedium
A 3-year-old child presents with a 2-day history of high fever (up to 103°F/39.4°C), bilateral conjunctival injection without exudate, a diffuse erythematous rash on the trunk, and swollen, erythematous hands and feet. The mother also notes cracked lips and a 'strawberry tongue.' What is the most likely diagnosis?
- AHand-foot-and-mouth disease
- BScarlet fever
- CKawasaki Disease
- DMeasles
Show answer & explanationAnswer & explanation
Correct answer: C. Kawasaki Disease
The clinical picture of a young child with prolonged high fever, bilateral conjunctival injection, rash, swollen/erythematous extremities, cracked lips, and strawberry tongue are the classic diagnostic criteria for Kawasaki Disease.
Why the other options are wrong
- A. Hand-foot-and-mouth disease typically presents with fever, oral sores, and a rash with vesicles on the hands, feet, and sometimes buttocks, which is different from the described rash and extremity swelling.
- B. Scarlet fever presents with a 'sandpaper' rash, strawberry tongue, and pharyngitis, but typically lacks conjunctivitis, swollen extremities, or cracked lips.
- D. Measles presents with fever, cough, coryza, conjunctivitis, and Koplik spots, followed by a maculopapular rash, but does not include swollen extremities, cracked lips, or strawberry tongue as primary features.
Kawasaki Disease
An acute systemic vasculitis of unknown etiology that primarily affects young children, characterized by fever and mucocutaneous lymph node syndrome, with a significant risk of coronary artery aneurysms.
- Diagnostic criteria include fever for 5+ days and at least 4 of 5 specific clinical features.
- Key features: bilateral conjunctivitis, oral mucosal changes, peripheral extremity changes, rash, cervical lymphadenopathy.
- Untreated, it can lead to coronary artery aneurysms, requiring urgent treatment with IVIG and aspirin.
Memory trick: Kawasaki: Kids Always Want A Strawberry Kiss.