Q 1:
A17-year-old girl comes to the clinic with several weeks of joint pain and rash. The joint pain is most prominent in the hands. She states that the pain is most severe in the morning and tends to improve over the day. She has noted some swelling of her fingers. She has also had a rash on her face that becomes more prominent when she is outdoors. She states that sunlight tends to bother her eyes. On further questioning, she states that she has not felt well for several months. She has had intermittent fever, has been more tired than usual, and has lost weight although she has not been restricting her diet. On physical examination, she looks tired. She has lost 5 lbs since her last visit 1 year ago. She has an erythematous rash on her cheeks. She has several shallow ulcers in her mouth. She has fusiform swelling of her fingers and pain with movement of her fingers. Which of the following is the most likely diagnosis?
(A) systemic lupus erythematosus (SLE)
(B) dermatomyositis
(C) juvenile rheumatoid arthritis
(D) rheumatic fever
(E) Lyme disease
Answer
(A)
SLE is an autoimmune disorder that affects multiple organs. The diagnosis is based on the presence of four or more major criteria. These include malar rash, oral ulcers, arthritis, and photosensitivity. This patient has all of these symptoms, as well as the systemic symptoms often seen at presentation. The disorder is predominately a disease of women and, in the pediatric population, is a disease of adolescence.
Chronic renal disease is an important and common cause of morbidity and mortality among patients with SLE.
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Q 2:
A 3-year-old boy has had fever for 4 days. On physical examination he has bilateral cervical lymphadenopathy, injected pharynx, and dry cracked lips. A throat swab is done and the rapid strep test is negative. The child is sent home and advised to follow-up if symptoms worsen. The child is brought back 2 days later with all previous findings including a maculopapular rash, swollen hands, and conjunctivitis.
Which of the following is the most likely diagnosis?
(A) Scarlett fever
(B) Kawasaki disease
(C) toxic shock syndrome
(D) infectious mononucleosis
(E) erythema infectiosum
B
Criteria require fever of at least 5 days’ duration for a clinical diagnosis of Kawasaki disease.
According to these criteria, patients also must have at least four of five other findings, including bilateral conjunctival infection, one or more changes of the oral mucous membranes (e.g., pharyngeal erythema; dry, fissured, and erythematous lips; and strawberry tongue), one or more changes of the extremities (e.g.,
erythema, edema, and desquamation), rash, and cervical lymphadenopathy. Kawasaki disease occurs most commonly during the first 2 years of life. Thrombocytosis, rather than thrombocytopenia, is an almost invariable feature late in the course of illness. The most common serious complication of Kawasaki disease is coronary artery aneurysm formation which can result in thrombosis, aneurysmal rupture, or other cardiac effects.
Answer
(A)
SLE is an autoimmune disorder that affects multiple organs. The diagnosis is based on the presence of four or more major criteria. These include malar rash, oral ulcers, arthritis, and photosensitivity. This patient has all of these symptoms, as well as the systemic symptoms often seen at presentation. The disorder is predominately a disease of women and, in the pediatric population, is a disease of adolescence.
Chronic renal disease is an important and common cause of morbidity and mortality among patients with SLE.
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Q 2:
A 3-year-old boy has had fever for 4 days. On physical examination he has bilateral cervical lymphadenopathy, injected pharynx, and dry cracked lips. A throat swab is done and the rapid strep test is negative. The child is sent home and advised to follow-up if symptoms worsen. The child is brought back 2 days later with all previous findings including a maculopapular rash, swollen hands, and conjunctivitis.
Which of the following is the most likely diagnosis?
(A) Scarlett fever
(B) Kawasaki disease
(C) toxic shock syndrome
(D) infectious mononucleosis
(E) erythema infectiosum
B
Criteria require fever of at least 5 days’ duration for a clinical diagnosis of Kawasaki disease.
According to these criteria, patients also must have at least four of five other findings, including bilateral conjunctival infection, one or more changes of the oral mucous membranes (e.g., pharyngeal erythema; dry, fissured, and erythematous lips; and strawberry tongue), one or more changes of the extremities (e.g.,
erythema, edema, and desquamation), rash, and cervical lymphadenopathy. Kawasaki disease occurs most commonly during the first 2 years of life. Thrombocytosis, rather than thrombocytopenia, is an almost invariable feature late in the course of illness. The most common serious complication of Kawasaki disease is coronary artery aneurysm formation which can result in thrombosis, aneurysmal rupture, or other cardiac effects.
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