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How to Spot and Manage Kawasaki Disease in a Feverish Child: PLAB 2 Mock Scenario

Updated: Jun 24


Summary:

This scenario involves a parent presenting with a febrile child who has developed a rash and other systemic symptoms. The candidate is expected to recognize red flags, rule out serious differentials, and provide urgent referral due to a likely diagnosis of Kawasaki Disease.



Key Points:


Presenting Complaint:

  • Fever persisting for 5 days

  • Rash (polymorphous, different sizes and shapes)

  • Red eyes (bilateral conjunctivitis)

  • Neck swelling (suggestive of lymphadenopathy)


History and Symptom Exploration:

  • Rash spread from trunk to back

  • No relief with paracetamol (only administered once)

  • Contact with cousin with chickenpox (raises initial concern)

  • Associated symptoms: reduced oral intake, red eyes, and neck swelling


Differential Diagnoses:

  • Chickenpox (contact history)

  • Meningococcal infection (rash + fever → must rule out)

  • Infectious mononucleosis

  • Scarlet fever

  • Kawasaki Disease (most likely based on symptoms)


Important Considerations:

  • Always rule out life-threatening conditions like meningitis with questions about photophobia, neck stiffness, etc.

  • Rash description: polymorphous, non-vesicular, non-itchy = suggestive of Kawasaki Disease

  • Use “CRASH and BURN” mnemonic to remember Kawasaki criteria:

    • C: Conjunctivitis

    • R: Rash

    • A: Adenopathy (cervical lymphadenopathy)

    • S: Strawberry tongue

    • H: Hands/feet desquamation

    • BURN: Fever for ≥5 days


Diagnostic Approach:

  1. Focused History:

    • Duration and pattern of fever

    • Rash characteristics and progression

    • Systemic symptoms (eye redness, lymph node swelling)

    • Contact history and vaccination status

    • Rule out signs of meningitis

  2. Physical Examination:

    • Vitals

    • Rash inspection

    • Cervical lymph nodes

    • Check for conjunctivitis, oral mucosa, hand/feet desquamation


Management:

  • Urgent hospital referral: Kawasaki is a medical emergency due to risk of coronary artery aneurysms

  • Explain diagnosis: Use clear, layman’s language; explain vasculitis and its implications

  • Hospital treatment: IVIG and high-dose aspirin

  • Safety netting: Educate on red flag symptoms – lethargy, dehydration, grunting, cyanosis, etc.

  • Leaflets and Pamphlets: Provide trusted information sources to parents

  • Follow-up Plan: Ensure ongoing monitoring with GP/pediatrician


Communication Skills:

  • Elicit ICE (Ideas, Concerns, Expectations) – Parent believed it might be chickenpox

  • Empathetic and clear explanation of serious diagnosis

  • Address concerns about symptom persistence

  • Build rapport and validate parental concerns


Ethical Considerations:

  • Recognize and respect parental anxiety

  • Provide clear rationale for urgent referral

  • Ensure consent for examination

  • Communicate in a culturally sensitive and non-alarming manner


Additional Resources:

  • NICE Guidelines on Kawasaki Disease

  • RCPCH guidance on pediatric febrile illness

  • GMC's "Good Medical Practice" (communication, diagnosis, and management principles)

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