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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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