Quiz: Fever And Adenopathy

Front 1

A 5-year-old female, previously healthy, presents with an erythematous, vesicular rash on the palms and soles and a high fever for several days. Upon examination, she is also found to have ulcers in her mouth. A few days later, the fever and rash resolve. What is the most likely pathogen?

Back 1

Enterovirus

Front 2

HSV-1

Back 2

• fever
  
• malaise
  
• gingivostomatitis
  

Front 3

HIV infection

Back 3

oral lesions

Front 4

Enterovirus

Back 4

• (e.g. cocksacki A)
  
• fever
  
• tender vesicles on hands and feet
  
• buttocks/genital rash
  
• resolves within three days
  
• spread via saliva, fluid from vesicles, stool, or nasal discharge
  

Front 5

HHV-6 virus

Back 5

• roseola
  
• fever
  
• macular or maculopapular rash
  
• begins on trunk, spreads to extremities
  

Front 6

Group A Strep (GAS)

Back 6

• fever
  
• rash
  
• scarlet fever
  
• "sandpaperlike" rash with small papules
  

Front 7

A 2-year-old girl presents to the urgent care clinic with a 7-day history of high fever to 38.5 C, a maculopapular rash that began on the palms and soles of her feet, red eyes without discharge, and unilateral cervical adenopathy. What other symptom/sign might you discover on further history and exam?

Back 7

Erythematous and edematous feet

(Kawasaki's disease)

Front 8

What are tonsillar exudates present in?

Back 8

Strep pharyngitis

Tonsillitis

Front 9

Headache found in what?

Back 9

Rocky Mountain Spotted Fever

Front 10

Kawasaki disease?

Back 10

• Erythematous and edematous feet
  
• Strawberry tongue
  
• Maculopapular rash began on palms and soles of feet
  
• red eyes without discharge
  
• unilateral cervical adenopathy
  

Front 11

White spots on buccal mucosa

Back 11

Measles (pathognmonic for this)

(also cough, coryza)

(rash starts at head and moves downwards)

Front 12

A 3-year-old male presents with fever to 103 F for the past week, injected eyes, and a refusal to walk for the past two days. On physical exam, you note conjunctival injection without pus or exudates bilaterally, prominent papillae of his tongue with redness as well as redness of his hands, and feet. He also has a new non-diffuse maculopapular rash on his torso that gets worse with fever. On examination of the swollen extremities, you are unable to elicit any tenderness or effusions in any joints. Which of the following is the most likely diagnosis?

Back 12

Kawasaki disease (KD)

Front 13

Cause of RMSF?

Back 13

Rickettsia rickettsii

Front 14

Bone or joint infection signs?

Back 14

Patient refuses to walk

fever assoc with septic arthritis or osteomyleitis

localized symptoms

warmth and tenderness and swelling

Front 15

Symptoms of scarlet fever?

Back 15

Cause: s pyogenes

• sore throat
  
• fever
  
• strawberry tongue
  
• blanching, erythematous rash with desquamation of affected areas
  

Front 16

Systemic onset juvenile idiopathic arthritis

Back 16

Still's disease

intermittent rash, fever, and arthritis

spiking fevers

salmon rash

Front 17

A 5-year-old male comes to the clinic with a chief complaint of four days of progressively worsening fever and that has been minimally responsive to acetaminophen. The patient complains of sore throat and decreased appetite. His sister had a positive rapid strep test and is now being treated with amoxicillin. Your concern is for Group A strep. What is the next best step in management?

Back 17

Rapid strep test with back-up culture if negative

Front 18

T/F: you should diagnose strep infection before treating it

Back 18

True

Front 19

A 3-year old girl comes to the clinic with a chief complaint of fever (104F) for over a week. Her mom reports that she has been fussy and inconsolable since she became febrile. She has a red tongue, with large papillae, conjunctivitis, a palmar rash, unilateral cervical adenopathy, as well as swollen feet. Given the most likely diagnosis, what is the most important follow-up for this patient over the next few weeks?

Back 19

Echocardiogram to look for coronary artery aneurysm

Front 20

What disease are children with Kawasaki disease at high risk of developing?

Back 20

coronary artery aneurysm

Front 21

What is a treatment of Kawasaki that has decreased risk of coronary artery anuerysms?

Back 21

IVIG

Front 22

When to do the following: Ophthalmology follow-up to determine extent of eye damage and determine need for corticosteroids

Back 22

• Steven Johnson syndrome
• juvenile idiopathic arthritis (uveitis)

Front 23

When to do the following: Physical therapy follow-up to help prevent long-term joint deformities and ensure long-term functionality

Back 23

• systemic juvenile idiopathic arthritis
• (prevent joint deformities and improve long term functionality)

Front 24

When to do Cardiology follow-up to rule out presence of rheumatic fever

Back 24

Of scarlet fever

"erythematous, blanching, sandpaper-like rash” with very fine papules secondary to infection with Group A streptococcus."

Front 25

When to do the following: Neurology follow-up to evaluate partial paralysis of lower extremities

Back 25

• Rocky Mountain Spotted fever