Ease Into Prep with a USMLE^® Step 2 CK Question of the Day

The correct answer is D. This child has Kawasaki disease, the most common vasculitic condition of childhood. This condition causes widespread inflammation of medium-sized vessels, and diagnosis is based upon signs of mucocutaneous inflammation (bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, rash, cervical lymphadenopathy, and swelling of the extremities) in association with fever. The fever typically remains high during the entire course of the illness and does not usually respond to antipyretics. It is a self-limiting condition which lasts for approximately 12 days without treatment. However, possible complications include coronary arteritis and aneurysm, and ECG and echocardiogram are usually part of the diagnostic work-up. Prompt treatment with intravenous immunoglobin (IVIG), in conjunction with high-dose aspirin, dramatically reduces the morbidity and mortality related to this condition. Although aspirin is not usually used in children due to the risk of Reye syndrome, in the case of Kawasaki disease it is recommended. The benefit of IVIG and aspirin appears to be through a generalized anti-inflammatory effect.

Acetaminophen, good hydration, and observation (choice A) will not prevent the complications associated with Kawasaki disease.

Amoxicillin (choice B) will not help this child, as there is no identified bacterial agent. The etiology of Kawasaki disease remains unknown.

Ibuprofen, good hydration, and observation (choice C) will not be sufficient to prevent the complications associated with Kawasaki disease. Ibuprofen has not been shown to be as effective as aspirin in treating the inflammation, and IVIG is critical in the treatment of Kawasaki disease, which is missing in this answer choice.

Oseltamivir and isolation from other children (choice E) is the treatment for influenza which would not present with the red tongue, desquamating rash, and swollen hands and feet.