AANP Family Nurse Practitioner (FNP) Certification ExamDiagnosisMedium
A 4-year-old child is brought to the clinic by her parents due to a 3-day history of high fever (up to 103°F/39.4°C), bilateral conjunctivitis without exudate, a diffuse erythematous rash on her trunk, and a 'strawberry tongue.' The parents also note swelling and redness of her hands and feet. Which of the following is the most critical diagnostic consideration due to potential cardiac complications?
- AScarlet fever
- BMeasles
- CKawasaki disease
- DFifth disease (Erythema infectiosum)
Show answer & explanationAnswer & explanation
Correct answer: C. Kawasaki disease
The child's symptoms—prolonged high fever, bilateral non-exudative conjunctivitis, rash, 'strawberry tongue', and swelling/redness of extremities—are the classic diagnostic criteria for Kawasaki disease. This condition is a vasculitis that can lead to serious cardiac complications, particularly coronary artery aneurysms, making its diagnosis and timely treatment critical.
Why the other options are wrong
- A. Scarlet fever presents with a rash, 'strawberry tongue,' and fever, but typically also includes pharyngitis and is caused by Streptococcus pyogenes, usually without the prominent extremity changes or non-exudative conjunctivitis.
- B. Measles presents with fever, cough, coryza, conjunctivitis (often with exudate), and a maculopapular rash that starts on the face, but lacks the extremity changes and 'strawberry tongue' of Kawasaki disease.
- D. Fifth disease typically presents with a 'slapped cheek' rash and a lacy rash on the trunk and extremities, often without high fever or the other specific features of Kawasaki disease.
Kawasaki Disease Diagnosis
Kawasaki disease is an acute systemic vasculitis of childhood, diagnosed by prolonged fever and at least four of five principal clinical criteria, with a critical risk of coronary artery aneurysms.
- Fever for ≥5 days (must-have).
- Four of five principal criteria: conjunctivitis, oral changes, extremity changes, rash, lymphadenopathy.
- Leading cause of acquired heart disease in children in developed countries.
- Requires prompt treatment with IVIG and aspirin.
Memory trick: Kawasaki: Fever, CRASH, and Burn (hands/feet).