Thread by @Dr_Hempenstall

1/ Primary Care Case of the Week 5

Each week I’d like to share a case for #MedStudents to continue developing their clinical reasoning, even though not on clinical placement at present.

All cases are fictitious, but inspired by those seen in #PrimaryCare

#MedEd #MedTwitter

2/ 5yo F presents to the general practice clinic with a fever & a rash. Mum has been giving her paracetamol & ibuprofen, but it hasn’t seemed to really help.

🤦🏻‍♀️Oh no! Not a fever & a rash!

🤷🏼What are your differentials?

🤷🏽‍♂️What additional info would you like on history & exam?

@am_baker @lucierobson @AlisonBoast would you like to play along?

3/ Kawasaki Disease

🌡Acute self limiting illness

🌡Unknown cause

🌡Clinical diagnosis

🌡Most common in children with Japanese ethnicity/ancestry
dontforgetthebubbles.com/kawasaki-disea…

4/ Diagnostic criteria:
Fever for 5+ days, PLUS 4/5 criteria:
1 Conjunctival injection
2 Lymphadenopathy
3 Polymorphous rash
4 Mucous membrane changes (red cracked lips/ strawberry tongue)
5 Peripheral erythema/ oedema

Irritability is frequently present, although not diagnostic

5/ Investigations include:

✅FBE, CRP, ESR, UEC, LFTs
✅Blood culture
✅Urine MCS
✅ECG
✅Echocardiogram

💊Treat with IV immunoglobulin, aspirin & chat with your local paediatric team for consideration of steroids

rch.org.au/clinicalguide/…

6/ Higher rates of Kawasaki-like disease have been described during this #COVID19 pandemic, you can read more here: thelancet.com/journals/lance…

Thanks @lucierobson @jacobacla @am_baker for playing along!