• What will be your differential diagnoses for this patient?
My differential diagnosis for this child would be:
1. Kawasaki disease.
2. Infectious disease such as rubeola, streptococcal scarlet fever, Lyme disease, Rocky mountain spotted fever, infectious mononucleosis.
3. Drug reaction; Stevens-Johnson syndrome
4. Juvenile rheumatoid arthritis.
• What specific physical exam findings support these differential diagnoses?
I will quickly assess this child overall appearance for distress, signs of dehydration by checking for the capillary refill, poor skin turgor, and dry mucous membrane. Measures the vitals signs- carefully determine the temperature. Then, inspect the skin for erythema, edema, induration, rashes, drying, cracking, and desquamation. Perform a complete eye examination- check for bilateral bulbar conjunctiva injection without exudate. Assess ears, nose, and throat for any signs of infection, the neck for lymphadenopathy and nuchal rigidity. Perform a complete heart and cardiovascular exams-check for gallop rhythm or distant heart sounds. Auscultate the lungs. Palpate the abdomen for organomegaly and tenderness. Assess the joints for swelling, erythema, and tenderness. Perform a neurological exam; take note of irritability, changes in mental
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Kawasaki is an acute febrile illness, erythematous, multi-system vasculitis with unknown etiology and incubation period. It is the leading cause of acquired heart disease in children in the US, and approximately 80% of the cases occur in children < 5 years of age with peak occurrence of 18 -24 months. The long-term fever does not respond to antibiotics. Cardiac problems are the primary cause of morbidity and mortality from pericardial effusion, myocarditis, coronary artery aneurysms, ectasia, and myocardial infarction is the major cause of death with the mortality rate of