Kawasaki disease and coronary complications — branching viva

Examiner opening (Examiner)

You are the general paediatric registrar in the emergency department. An eighteen-month-old child is brought in febrile and irritable, on day six of fever, with bilateral red eyes without discharge, cracked bleeding lips, a strawberry tongue, a widespread rash, and swollen red palms and soles. Talk me through your assessment and immediate management. ^[1]

Exemplar opening (Candidate)

This child has a clinical picture strongly suggestive of Kawasaki disease, and because we are on day six of fever the ten-day treatment window is open but narrowing, so I will move quickly. I will confirm the fever duration and the five principal features — bilateral non-purulent conjunctivitis, oral changes, polymorphous rash, extremity changes, and cervical lymphadenopathy — and he already has four of five with the fever, which is complete Kawasaki disease. I will take blood for a full blood count, C-reactive protein, erythrocyte sedimentation rate, albumin and liver function, send a urine for microscopy, and arrange a baseline echocardiogram. While those are running I will start intravenous immunoglobulin at 2 g/kg as a single infusion over ten to twelve hours with high-dose aspirin, because treating within ten days is the single biggest factor preventing coronary aneurysms. ^[1]