Rheumatic Hd, Kawasaki Disease (Self-Study)

Front 1

The most common clinical manifestations
of ARF in recent outbreaks
in the United States

Back 1

arthritis; carditis

Front 2

It is important to
remember that the throat culture
frequently is (positive, negative) by the time
rheumatic fever develops.

Back 2

negative

Front 3

These
facts emphasize the need to consider
ARF in the appropriate clinical
setting and use the _______
tests to establish a diagnosis.

Back 3

streptococcal enzyme

Front 4

How is cardiac involvement in ARF often established?

Back 4

By finding a new murmur, often of mitral or aortic insufficiency.

Front 5

Where is mitral regurgitation best heard?

Back 5

apex

Front 6

T/F The classic migratory polyarthritis
of ARF often involves the
extremities (elbows, wrists, knees,
and ankles) and is extremely painful.

Back 6

T

Front 7

When do the chorea symptoms of rheumatic fever present>

Back 7

Later, months usually.

Front 8

What are the Jones criteria for dx of ARF?

Back 8

1. Evidence of a preceding group A streptococcal infection:
Elevated or rising ASO titer or
Positive throat culture or
Positive rapid antigen test.
Plus

2. Either two major or one major and two minor manifestations:
Major manifestations: Carditis, polyarthritis, Sydenham chorea,
erythema marginatum, subcutaneous nodules.
Minor manifestations: Arthralgia, fever, elevated acute-phase
reactants (ESR, C-reactive protein), prolonged PR interval.

Front 9

What type of titer is used to see if there's been a strep infection?

Back 9

ASO titer

Front 10

Recommendations for the primary
prevention of rheumatic fever
(treatment of streptococcal pharyngitis):

Back 10

intramuscular
penicillin G and oral penicillin V
or erythromycin estolate/ethylsuccinate.
Other alternatives include
azithromycin and the oral cephalosporins

Front 11

What is prophylaxis for patients at extremely high risk?

Back 11

an every 3-week regimen of intramuscular
penicillin prophylaxis is

Front 12

generalized, acute vasculitis of
unknown cause that occurs predominantly in infants and
young children

Back 12

Kawasaki disease

Front 13

What is the leading
cause of acquired heart disease among children in the
United States?

Back 13

Kawasaki disease (surpassed rheumatic fever)

Front 14

What racial group is affected by Kawasaki disease the most?

Back 14

Asians, although all are affected.

Front 15

What %age of children develop cardiac involvement from Kawasaki disease?

Back 15

20-25%

Front 16

T/F Kawasaki disease occurs more often in boys than in girls

Back 16

T

Front 17

The vasculitis in Kawasaki disease primarily involves
the ____-size blood vessels

Back 17

medium

Front 18

Inflammation in Kawasaki's involves what layers of the
blood vessel?

Back 18

all three

Front 19

T/F Kawasaki disease is a clinical diagnosis; There is no definitive test.

Back 19

T

Front 20

What is the criteria for a diagnosis of Kawasaki disease?

Back 20

Fever lasting at least 5 days.

At least 4 of the following criteria:
1) Bilateral, nonexudative conjunctival injection

2) At least one of the following mucous membrane
changes: injected or fissured lips, injected pharynx, or
strawberry tongue

3) At least one of the following extremity changes: erythema
of palms or soles, edema of hands or feet, or
periungual desquamation

4) Polymorphous exanthem

5) Acute, nonsuppurative cervical lymphadenopathy

Front 21

polymorphic exanthem: defn

Back 21

widespread rash usually occurring in children. Differing in shape.

Front 22

What is atypical/incomplete Kawasaki disease? What are diagnostic implications?

Back 22

More frequent occurrence of cardiac manifestations.

Atypical
disease, defined by compatible illness with at least 5 days
of fever and fewer than five criteria met, seems to be more
common in infants.

Front 23

3 clinical phases of Kawasaki disease

Back 23

acute febrile, subacute, and convalescent.

Front 24

What happens in the acute febrile clinical phase of Kawasaki disease?

Back 24

The
acute febrile phase generally lasts 1 to 2 weeks, during
which the typical signs of fever, rash, mucous membrane
inflammation, edema, and lymphadenopathy develop.

Front 25

What happens in the subacute phase of Kawasaki disease?

Back 25

The subacute phase begins as initial clinical signs resolve
and desquamation of the skin, thrombocytosis, and coronary
aneurysms develop. The subacute phase generally
occurs 2 to 4 weeks after the onset of fever.

Front 26

What happens in the convalescent phase of Kawasaki disease?

Back 26

all clinical signs and laboratory evidence
for inflammation (eg, elevated erythrocyte sedimentation
rate, C-reactive protein) resolve, usually 6 to
8 weeks after the onset of illness.

Front 27

What other diseases are considered in the Kawasaki differential diagnosis?

Back 27

Measles

Scarlet fever

Toxic Shock

Drug reaction/Allergy

Stevens Johnson Syndrome

Rocky Mountain spotted fever

juvenile rheumatoid
arthritis.

Front 28

Common laboratory findings in Kawasaki disease

Back 28

Elevated ESR

Sterile pyuria

Leukocytosis

Thrombocytosis

Elevated
serum liver transaminase levels are common, as are
elevated serum bilirubin and alkaline phosphatase levels.

Front 29

The management of acute Kawasaki disease focuses on what?

Back 29

limiting inflammation and preventing coronary artery
dilatation and aneurysm formation.

Front 30

What are the current recommendations of initial therapy for Kawasaki disease?

Back 30

IV Immunoglobulin

Oral aspirin

Front 31

T/F Patients who develop coronary disease generally fulfill the classic clinical criteria for Kawasaki disease

Back 31

F

Front 32

What are the cardiac manifestations of Kawasaki disease?

Back 32

coronary artery aneurysms, myocarditis, CHF, dysrhythmias.

Front 33

What test can often detect coronary artery aneurysm and ventricular dilation in children?

Back 33

Echocardiography

Front 34

T/F Kawasaki disease should be Suspected in any child with mucocutanous inflammation and persistent fever.

Back 34

T