Kawasaki Disease - MEDIUM CELL

Question 1

Kawasaki disease is a type of vasculitis that commonly affects the medium size vessels. Does this commonly affect adults or children?

Answer 1

• children
• typically 1-5 year olds, peaks at 2-3 years

Leading cause of acquired heart disease in children affecting around 300/year in the UK

Question 2

What is the incidence of Kawasaki disease in the UK?

1 - 0.8 : 100,000
2 - 8 : 100,000
3 - 800 : 100,000
4 - 8000 : 100,000

Answer 2

2 - 8 : 100,000

2nd most common vasculitis in children

Question 3

Which nationality is most commonly affected by Kawasaki disease?

1 - Caucasians
2 - African Americans
3 - Europeans
4 - Southeast asians

Answer 3

4 - Southeast asians

Least common in black ethnicities

Question 4

Does Kawasaki disease typically affect men or women more?

Answer 4

• women
• 1.3 :1

However in children this is more common in boys

Question 5

Kawasaki arteritis is a form of medium vessel vasculitis. Which vessels are particularly affected in this condition?

1 - blood vessels of the brain
2 - respiratory blood vessels
3 - coronary blood vessels
4 - renal blood vessels

Answer 5

3 - coronary blood vessels

Question 6

Kawasaki arteritis is a form of medium vessel vasculitis that predominantly affects the coronary blood vessels. All of the following can be caused EXCEPT which one?

1 - increased risk of coagulation and cardiac ischaemia
2 - weak artery walls due to fibrin deposits increasing aneurysms
3 - thickened blood vessels walls and narrowing lumen inducing a heart attack
4 - valves become dysfunctional due to reduced blood flow

Answer 6

4 - valves become dysfunctional due to reduced blood flow

Question 7

Patients with Kawasaki arteritis can present with a fever for how long typically?

1 - >24h
2 - >48h
3 - >5 days
4 - >2 weeks

Answer 7

3 - >5 days

Question 8

Patients with Kawasaki arteritis can cause present in an acute phase with sudden onset, but no specific focus. Changes in the tongue and lips. What typically occurs?

1 - ulcers on tongue and lips
2 - strawberry tongue and red cracked lips
3 - dry tongue, mucus membranes and lips
4 - all of the above

Answer 8

2 - strawberry tongue and red cracked lips

Question 9

Patients with Kawasaki arteritis can cause present in an acute phase with sudden onset, but no specific focus. Which of the following typically occur?

1 - inguinal lymphadenopathy
2 - axillary lymphadenopathy
3 - occipital lymphadenopathy
4 - cervical lymphadenopathy

Answer 9

4 - cervical lymphadenopathy

Question 10

Patients with Kawasaki arteritis can cause present in an acute phase with sudden onset, but no specific focus. Patients with Kawasaki arteritis can develop red lips and a strawberry tongue. Which other body parts can become red and swollen?

1 - face and neck
2 - red palms and soles of feet
3 - torso
4 - upper and lower limbs

Answer 10

2 - red palms and soles of feet

Widespread erythematous maculopapular rash and desquamation

This typically occurs in the sub-acute phase

Question 11

Although Kawasaki arteritis is self-limiting, meaning it can correct itself, which of the following is not a typical presentation?

1 - aortic dissection
2 - conjunctivitis injection (red eyes)
3 - polymorphic rash affecting most of the body
4 - lymphadenopathy (cervical)
5 - strawberry tongue
6 - swollen hands and feet
7 - fever
8 - carditis/giant coronary aneurysms

Answer 11

1 - aortic dissection

• CRASHS - burn is the mnemonic

Question 12

Although Kawasaki arteritis is self-limiting, meaning it can correct itself. All of the following can occur and remembered using the mnemonic CRASH. But how many of these are required to confirm a diagnosis?

• bilateral conjunctivitis
• rash
• adenopathy (cervical)
• strawberry tongue
• hands and feet become swollen+red
• fever >5days

1 - all of them
2 - >4 with a fever for 5 days
3 - >3
4 - >2 with a fever for 3 days

Answer 12

2 - >4 with a fever for 5 days

Question 13

Kawasaki arteritis can cause all of the following except which one?

1 - anaemia
2 - raised WBC
3 - low ESR and CRP
4 - raised LFTs and low albumin
5 - thrombocytosis (raised platelets)
6 - mononuclear white blood cells in the urine without evidence of bacteria

Answer 13

3 - low ESR and CRP
- these are both typically HIGH as there is inflammation

Thrombocytosis (raised platelets) typically signifies the onset of coronary artery aneurysms

Question 14

Which of the following is most effective for diagnosing Kawasaki disease?

1 - echocardiogram
2 - chest X-ray
3 - clinical diagnosis
4 - biochemistry

Answer 14

3 - clinical diagnosis

A good history and examination

Question 15

Which imaging modality can be useful in Kawasaki arteritis?

1 - X-ray
2 - MRI
3 - CT
4 - echocardiogram

Answer 15

4 - echocardiogram
- as Kawasaki arteritis mainly effects coronary blood vessels its important to check the heart

Following the 1st echo, need to repeat after 4-6 weeks for risk of coronary arteries

Question 16

Typically which 2 are used to treat Kawasaki arteritis?

1 - aspirin
2 - strong dose of steroids given immediately
3 - IV immunoglobulins (donor antibodies)
4 - biologics given immediately

Answer 16

1 - aspirin (reduces blood clot risk)
3 - IV immunoglobulins (donor antibodies)
- form of passive immunity

Question 17

Typically Kawasaki disease is treated using IV immunoglobulins (donor antibodies) and aspirin. In which of the following cases can corticosteroids and infliximab be used?

1 - older patients
2 - in females
3 - in young children due to risk of reyes syndrome
4 - if patient resistant to aspirin and immunoglobulins

Answer 17

4 - if patient resistant to aspirin and immunoglobulins

Question 18

Kawasaki arteritis is typically treated using aspirin and IV immunoglobulins (donor antibodies). Why does the patient need to be monitored very closely during treatment?

1 - reyes syndrome
2 - hypersensitivity reaction
3 - anaphylaxis
4 - heart attack

Answer 18

1 - reyes syndrome
- children taking aspirin are at risk of reyes syndrome

Question 19

What is the most common complication of Kawasaki arteritis?

1 - coronary artery aneurysm
2 - ruptured aorta
3 - aortic dissection
4 - subdural haemorrhage

Answer 19

1 - coronary artery aneurysm