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patients who have received measles vaccine within eight days to eight weeks prior to testing. 4 Obtain blood cultures in cases where bacteraemia cannot be excluded clinically.
Kawasaki disease is a systemic vasculitis affecting medium-sized arteries, including coronary arteries. It mainly affects children under five. Diagnosis is based on clinical features. Incomplete Kawasaki disease, where all diagnostic criteria are not met, may also occur. 8 Early recognition is important because of the potential for long-term cardiac complications. Suspected cases require hospital admission.
Without treatment, 25 % of affected patients develop coronary artery aneurysms. 6 Other cardiovascular complications include acute thrombosis, long-term risk of myocardial ischaemia, pericardial effusion, valvular regurgitation, myocarditis and ventricular dysfunction. The condition is treated
Ponder Med Podcast of the Week
IT’ S unclear where Dr Robert Lloyd finds the time for this new podcast.
He’ s a third-year ED trainee from Essex in the UK and already a busy blogger for his site, Pondering EM.
The blog explores various big issues in healthcare with a particular focus on digital technology.
Now Dr Lloyd has started a
podcast to accompany his blog. The first episode involves an interview with a British GP known as‘ the VR doctor’ for his attempts to incorporate virtual reality into everyday practice.
Dr Lloyd says the style of the podcast may evolve based on feedback from listeners, but there are no obvious flaws in his first go
with IVIg. This should ideally be given within 10 days of fever onset to reduce the risk of cardiac complications, especially coronary artery aneurysms. 6
Moderate-to-high-dose aspirin— switched to a lower dose once the patient is afebrile for 48 hours and continued for a minimum of 4-6 weeks following acute phase treatment— is recommended.
However, there is no evidence that aspirin reduces coronary artery aneurysms. 2 High-risk and IVIg-resistant cases may benefit from adjunctive therapies, including corticosteroids and infliximab. 2, 7, 8
For uncomplicated patients, serial echocardiograms are recommended. These are performed at presentation and repeated both within 1-2 weeks and 4-6 weeks after treatment to monitor for coronary sequelae. 2 ● References on request
at it. He’ s an engaging interviewer who will appeal to technology geeks and sceptics equally.
Hopefully, he’ ll find the time to keep this promising podcast going.
Specifications
COST: FREE URL: http:// apple. co / 2nnElXz
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THE QUIZ
Q. Describe the clinical features. a. There is generalised whitening of the vermilion border. b. There is a loss of definition of the vermilion / skin interface. c. The lower lip is dry and fissured, with a deeper midline fissure. d. White striation is present on the lower vermilion border. A. The answers are a, b and c.
Q. What investigations would you recommend? a. Shave biopsy. b. None. c. Excisional biopsy. d. Blood tests to exclude vitamin deficiency. A. The answer is b. Further questioning regarding sun exposure, lip care, previous lip lesions and examination of the lesion are indicated before deciding on management.
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Q. What is your clinical differential diagnosis? a. Solar keratosis. b. Melanoma. c. Chronic lip fissure. d. SCC. A. The answers are c and d. A melanoma typically presents as a rapidly growing mass which may or may not be pigmented. A solar keratosis presents as a more distinct white plaque with or without focal erosion or ulceration. |
Q. What is your initial management? a. Kenacomb ointment. b. Topical corticosteroid. c. Miconazole gel. d. Intralesional corticosteroid injection. A. The answer is a. The clinical features and history are most consistent with a chronic lip fissure.
The fissure is being aggravated by dehydration of the lip
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due to John’ s outdoor working life and also a likely lack of application of lip lubrication and sunscreen. Chronic lip fissures generally respond well to at least a 10-14 day course of Kenacomb ointment used in conjunction with a lip sunscreen and keeping the lip hydrated.
Q. If the initial management is unsuccessful what is the next course of action? a. Laser therapy. b. Cryotherapy. d. Punch biopsy. d. Excisional biopsy. A. The answer is d. An excisional biopsy with a margin of normal tissue is indicated. If the histopathological features are those of a solar keratosis with varying degrees of atypia and / or a squamous cell carcinoma, this will hopefully ensure normal excision margins.
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