Kawasaki’s Disease – A high-yield topic on the Step 2 CK exam

by / Tuesday, 01 June 2010 / Published in Internal Medicine, Pediatrics
There is always at least 1 question on the USMLE CK exam that requires you to recognize and be able to manage the patient with Kawasaki’s disease.  This post contains everything you will need to know in order to answer these Kawasaki disease questions with 100% confidence.
 
  • A mucocutaneous lymph node syndrome
  • Affects large and medium vessel vasculitis in children <5yr of age
  • More commonly seen in children of Japanese heritage

Picture – NOTE: red eyes, dry cracked lips, red tongue

Diagnosis:

Diagnosis requires the presence of a FEVER > 104F or 40C for more than 5 days that is unresponsive to antibiotics + 4/5 of the following criteria:
 
Using the mnemonic CRASH to remember the criteria

  1. Conjunctivitis
  2. Rash (truncal)
  3. Aneurysms of the coronary arteries
  4. Strawberry tongue
  5. Hand and foot induration (erythema of the palms and soles)

     

Complications:
 

  • 10%-40% of untreated cases show dilation/aneurysm of the coronary arteries

     

Treatment:

  • IVIG to prevent coronary vasculitis + high-dose aspirin
  • Do not give steroids as this will exacerbate the condition

     

Prognosis:

  • With response to IVIG + aspirin is rapid and 2/3 become afebrile within 1 day.
  • Always re-evaluate in 1 week, repeat ECHO at 3-6wk post illness
  • If no further abn on ECHO then no further imaging is necessary

 

THIS IS THE INFORMATION THAT IS MOST COMMONLY TESTED ON THE USMLE STEP 2 CK EXAM.  ATTENTION TO THE 5 CRITERIA (CRASH) SHOULD BE PAID, AS WELL AS MANAGEMENT AND TREATMENT.  

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