Q24: October 2020-2026 PLAB- UKMLA Exam-style question
A mother takes her 4-year-old boy to the pediatric emergency department. He's got a fever and she found raised nodes on his neck. She gave him paracetamol and ibuprofen, but there is no drop in his temperature. His lips looks extremely dry and cracked, his tongue is red and swollen slightly. She's noticed that his feet are now red and puffy as well, and he is developing a widespread fine rash. What is the single most likely diagnosis?
A. Scarlet Fever
B. Parvovirus B19
C. Measles
D. Kawasaki’s disease
E. Hand, foot and mouth disease
Try to answer this question in 50 seconds. Comment your answer below . The answer to this question is given below
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The correct answer is D. Kawasaki's disease
This presentation is typical of Kawasaki's disease. It presents with a high fever that is not very responsive to paracetamol or ibuprofen. The patient then develops a 'strawberry tongue,' dry cracked lips and inflamed mucosa. Erythema and oedema are followed by desquamation of the extremities.
Why not Scarlet fever?
Scarlet fever presents with an inflamed tongue also, but, would not explain the red and puffy feet which later desquamate. The primary complaint of scarlet fever is usually sore throat. follow our instagram @medrevisions for PLAB clinchers in this topic
Why not Measles?
Measles presents with a fever and coryzal symptoms. Koplick's spots can develop on the oral mucosa however these are bright red with a bluish-white speck at the centre. A maculopapular rash arrives 3-5 days later.
Why not Hand, foot and mouth disease?
Hand, foot and mouth disease starts with general malaise and pyrexia, but, skin lesions in the form of vesicles appear in the mouth. 75% develop an eruption on the hands and feet with tender papule and vesicles.
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