Student MCQs – Kawasaki disease and MIS-C

Which of the following medications is considered the first-line treatment for Kawasaki disease?

  - A. Aspirin

  - B. IV immunoglobulin (IVIG)

  - C. Steroids

  - D. Acetaminophen

Correct answer: B

Explanation:

1.     Correct

1.     B: IVIG is used as a first-line medication for managing inflammation and reducing damage in Kawasaki disease

2.     C: Aspirin is used first-line for prevention of thrombosis in coronary arteries

2.     Incorrect

1.     C: Steroids are an alternative to IVIG for managing inflammation.

2.     D: Acetaminophen is not used for thrombosis prophylaxis or inflammation management.

Which of the following is a common adverse effect of corticosteroid use in treating MIS-C?

  - A. Hypertension

  - B. Hyperglycemia

  - C. Osteoporosis

  - D. All of the above

 

Correct answer: D

Explanation:

1.     Correct

1.     D: This choice is correct as corticosteroids can increase the risk of hypertension, hyperglycemia, and osteoporosis

2.     Incorrect

A, B, C are incorrect because they are all side effects of corticosteroids

1.     Which of the following is a first-line medication for Kawasaki disease?

§  A) Ibuprofen: 

§  B) Aspirin

§  C) Prednisone

§  D) Methotrexate

 

 

Aspirin (AI answer) is used first line for its anti-inflammatory, antipyretic and anti-platelet effects. 

Ibuprofen is not correct - it should not be used as it antagonizes the antiplatelet action of aspirin. 

Prednisone is probably more of an adjunct therapy with aspirin and IVIG being first line, but this is debatable; pred is listed as adjunct on UpToDate but at the end of the first-line therapies section in the presentation for class. Prednisone is especially useful for its demonstrated benefit in patients with coronary artery abnormalities. Aspirin and IVIG are more first line than prednisone. 

Methotrexate is not correct - it is anti-inflammatory but is not used in KD.

What is a common adverse effect of intravenous immunoglobulin (IVIG) used in MIS-C?

·       A) Hypertension

·       B) Hyperglycemia

·       C) Headache

·       D) Hypokalemia

 

 

C Headach (AI answer). The adverse effects of IVIG discussed in class were hypersensitivity reactions, signs of which include flushing, hypotension, nausea, vomiting, fever, chills pruritus, malaise, myalgia, and chest tightness. 

Hyperglycemia and hypokalemia are definitely incorrect. Though not discussed in class, headache occurs in > 10% of cases per Lexicomp, so I believe the AI answer is correct. Also, my dad gets headaches when he gets IVIG treatment.

Lexicomp includes hypertension as occurring at a rate > 10%, so I think AI was incorrect in not classifying it as common.

Which of the following clinical features is more commonly associated with Kawasaki Disease compared to MIS-C?

A. Profoundly decreased ejection fraction
B. Gastrointestinal symptoms in most patients
C. Conjunctivitis
D. Highly elevated NT-proBNP levels

 

Correct Answer: C. Conjunctivitis is correct because it is a symptom of Kawasaki Disease, but not MIS-C.)

A is incorrect because a profoundly decreased ejection fraction is associated with MIS-C not Kawasaki Disease.

B is incorrect because gastrointestinal symptoms occur in most patients with MIS-C and few patient with Kawasaki Disease.

D is incorrect because NT-proBNP levels may be normal or mildly elevated in Kawasaki Disease but highly elevated in MIS-C.

Which laboratory finding is more commonly seen in MIS-C compared to Kawasaki Disease?

A. Elevated platelet count
B. Strawberry tongue
C. Decreased lymphocyte count
D. Mildly elevated C-reactive protein (CRP)

Correct Answer: C. Decreased lymphocyte count is correct because it is seen in MIS-C while normal lymphocyte count is seen in Kawasaki Disease.
Incorrect Answers:

A is incorrect because elevated platelet counts are more commonly seen in Kawasaki Disease.

B is incorrect because strawberry tongue is typically seen in Kawasaki Disease, not MIS-C.

D is incorrect because CRP is commonly seen as highly elevated in MIS-C and mildly elevated in Kawasaki Disease.

Which of the following cytokine inhibitors is used to treat Kawasaki disease and MIS-C by blocking the IL-6 receptor? A. Infliximab B. Anakinra C. Tocilizumab D. None of the above

 

Correct Answer: C. Tocilizumab 

Tocilizumab is correct because it is an IL-6 antagonist medication 

A is incorrect because it blocks TNF. B is incorrect because it is an antagonist of the IL-1 receptor. D is incorrect because Tocilizumab is the correct answer. 

The use of cytokine inhibitors in treating Kawasaki disease and MIS-C primarily aims to: A. Reduce fever B. Inhibit pro-inflammatory cytokines C. Improve cardiac function D. Eliminate bacterial infection

Correct Answer: B. inhibit pro-inflammatory cytokines 

B is the correct answer because these medications inhibit cytokines, which reduce inflammation in the body to hopefully reduce future complications from occurring. 

A is incorrect because NSAIDs and/or acetaminophen would be used to reduce fever. C is incorrect because IVIG, ASA, and corticosteroids are typically used to prevent cardiac complications such as reducing inflammation/arterial damage and preventing thrombosis in coronary arteries. D is incorrect because antibiotics would be used to eliminate bacterial infections. 

Which drug is commonly used to reduce inflammation and prevent coronary artery complications in Kawasaki disease?

a. Warfarin

b. Aspirin

c. Metformin

d. Prednisone

explanation:

a. Warfarin - Incorrect, this agent isn't used in Kawasaki's for cardiac complications

b. Aspirin - Correct because the moderate dose is used first to help reduce fever and systemic inflammation. Then the lower dose is used after discharge to prevent coronary artery complications

c. Metformin - Incorrect, this agent is used for high blood glucose

d. Prednisone - Incorrect, prednisolone is used for this indication

What is the primary drug therapy used to manage myocardial dysfunction in patients with MIS-C?

a. Methotrexate

b. Intravenous Immunoglobulin (IVIG)

c. Clopidogrel

d. Amiodarone

 

explanation:

a. Methotrexate - Incorrect, this agent is not used in MIS-C

b. Intravenous Immunoglobulin (IVIG) - Correct because this agent is first-line therapy for MIS-C and reduces inflammation which could cause myocardial dysfunction if not treated right away

c. Clopidogrel - Incorrect, this agent is a second-line adjunct therapy with ASA for mild-moderate disease cardiac prevention in Kawasaki's

d. Amiodarone - Incorrect, this agent is not used in MIS-C 

1.     Which drug is commonly used to treat Kawasaki disease to prevent coronary artery thrombosis?

o   A) Ibuprofen

o   B) Aspirin

o   C) Paracetamol

o   D) Naproxen

 

 

Correct Answer: B) Aspirin

Confirmation: option B is correct because in lecture, it was clearly stated that ASA therapy is appropriate first line treatment for thrombosis in coronary arteries. NSAIDs like Ibuprofen and naproxen are not appropriate as they do not benefit antagonize the irreversible platelet inhibition of ASA. Acetaminophen is not mentioned as a drug for this indication

1.     What is the primary treatment for multisystem inflammatory syndrome in children (MIS-C) to reduce the risk of thrombosis?

o   A) Corticosteroids

o   B) Intravenous immune globulin (IVIG)

o   C) Low-dose aspirin

o   D) Antibiotic

Correct Answer: B) Intravenous immune globulin (IVIG)

Confirmation: Option B is correct as IVIG is first line for prevention of cardiovascular manifestations of MIS-C. Option A, corticosteroids is not correct here as though it has been proven to be effective in combination therapy with IVIG for patients with shock, it is not first-line/primary treatment. Option C, low dose aspirin is appropriate for patient with significant cardiovascular risk, but again, is not primary treatment. Option D, antibiotic is not mentioned as treatment for MIS-C as MIS-C is not a bacterial disease. 

Which of the following signs and symptoms are most commonly associated with Kawasaki disease?

1. High fever lasting more than five days, bilateral non-purulent conjunctivitis, red cracked lips, and swollen lymph nodes 

2. Severe abdominal pain, hypotension or shock, and evidence of cardiac dysfunction 

3. Wheezing, shortness of breath, and severe respiratory distress 

4. Neurological symptoms such as seizures and altered mental status

 

Answer: A. High fever lasting more than five days, bilateral non-purulent conjunctivitis, red cracked lips, and swollen lymph nodes

Confirmation: Option A  is correct because Kawasaki disease is characterized by a persistent high fever lasting more than five days, bilateral non-purulent conjunctivitis, red cracked lips, swollen lymph nodes, and other mucocutaneous changes. These symptoms are distinct and help in diagnosing Kawasaki disease.

Explanation: 

B: This option describes symptoms commonly associated with MIS-C rather than Kawasaki disease.

C: This option describes respiratory symptoms that are not characteristic of Kawasaki disease.

D: Neurological symptoms like seizures and altered mental status are not typically associated with Kawasaki disease.

Which of the following signs and symptoms are most commonly associated with Multisystem Inflammatory Syndrome in Children (MIS-C)?

Options:

1. Persistent high fever lasting more than five days, bilateral non-purulent conjunctivitis, red cracked lips, and swollen lymph nodes 

2. High fever, severe abdominal pain, hypotension or shock, and evidence of cardiac dysfunction

3. Wheezing, shortness of breath, and severe respiratory distress 

4. Neurological symptoms such as seizures and altered mental status

 

 

Answer: B. High fever, severe abdominal pain, hypotension or shock, and evidence of cardiac dysfunction

Confirmation: This option is correct because MIS-C is characterized by a high fever, severe abdominal pain, hypotension or shock, and evidence of cardiac dysfunction. These symptoms are typically seen in patients with MIS-C and help differentiate it from other conditions.

Explanation: 

A: This option describes symptoms characteristic of Kawasaki disease rather than MIS-C.

C: While respiratory symptoms can occur in MIS-C, they are not the primary or most common symptoms.

D: Neurological symptoms are not the primary signs of MIS-C, though they can occur in severe cases.

1.     Which of the following drug therapies is primarily used to prevent or treat cardiovascular complications in Kawasaki disease?

A) Acetaminophen

B) Aspirin

C) Ibuprofen 

D) Diphenhydramine

 

Option B is correct because aspirin is used first line to prevent thrombosis in Kawasaki disease, usually started with a moderate dose until afebrile and then a low dose for 4-6 weeks.

 

Option A is incorrect because acetaminophen does not have antiplatelet properties like aspirin in order to help prevent thrombosis, option C is incorrect because aspirin is the preferred agent and other NSAIDs should be avoided in order to prevent antagonization of the platelet process, option D is incorrect because it does not have any antiplatelet properties and is not a medication used for Kawasaki treatment. 

In the management of MIS-C, which drug is commonly administered to address severe inflammation and prevent cardiovascular sequelae? 

 

A) Methotrexate

B) Amoxicillin 

C) Intravenous immunoglobulin (IVIG) 

D) Ranitidine

 

Option C is correct because it is the first line treatment of MIS-C in patients without shock or refractory disease for the treatment of inflammation.

 

Option A is incorrect because methotrexate is not a therapeutic agent used in MIS-C disease for inflammation, option B is incorrect because antibiotics are not used to treat MIS-C disease or inflammation due to MIS-C, option D is incorrect because it does not have any anti-inflammatory properties and is not used in the management of MIS-C. 

Which cytokine inhibitor is an IL-1 receptor antagonist used in the treatment of MIS-C?

o   A) Infliximab

o   B) Anakinra

o   C) Tocilizumab

o   D) None of the above

 

 

Explanation: Anakinra is the only IL-1 receptor antagonist used to treat MIS-C. Infliximab is a TNF-alpha antagonist, and tocilizumab is an IL-6 receptor antagonist.

Which cytokine inhibitor is most commonly used to treat both Kawasaki disease and MIS-C?

o   A) Infliximab

o   B) Anakinra

o   C) Tocilizumab

o   D) All of the above

 

Explanation: Infliximab is used in both Kawasaki disease and MIS-C. Anakinra is more commonly used in MIS-C, and Tocilizumab is no longer recommended for MIS-c and is not used in Kawasaki disease.

Which of the following is a first-line medication used in Kawasaki disease for reducing inflammation?

A) Ibuprofen

B) Intravenous immunoglobulin (IVIG)

C) Prednisolone

D) Aspirin

B is the correct answer because IVIG decreases the production of inflammatory cytokines, allowing a reduction in inflammation.

A is incorrect because ibuprofen is not primarily used in Kawasaki. C is incorrect because although it may be effective in reducing inflammation, it is not a first-line treatment and is only used in specific cases. D is incorrect because aspirin’s main purpose is to prevent thrombosis in coronary arteries

Which of the following adverse effects is commonly associated with the use of corticosteroids in treating MIS-C?

A) Hyperglycemia

B) Hypotension

C) Bradycardia

D) Weight loss

 

 

A is correct because hyperglycemia is a side effect of corticosteroid use. B is incorrect because hypertension is a side effect of corticosteroids. C is incorrect because tachycardia is a side effect of corticosteroids. D is incorrect because weight gain is a side effect of corticosteroids

1.     Which cytokine inhibitor is commonly used to treat Kawasaki disease?

   - A) Infliximab

   - B) Anakinra

   - C) Tocilizumab

   - D) All of the above

 

Correct Answer:  A) Infliximab

Confirmation: option A is correct because infliximab has been studied and found to be appropriate to treat refractory Kawasaki disease after the use of IVIG and corticosteroids. Dose should be 5 mg/kg IV over 2-3 hours.

Explanation: 

·       option B is incorrect because anakinra may be used as 2nd line therapy for Kawasaki disease after the use of IVIG, corticosteroids and infliximab. It is considered for MIS-C refractory disease.

·       option C is incorrect because Tocilizumab was previously used for MIS-C refractory disease. This is no longer recommended by the ACR.

·       option D is incorrect because Anakinra and Tocilizumab are incorrect.

2.     In the treatment of MIS-C, which cytokine inhibitor targets the IL-6 receptor?

   - A) Infliximab

   - B) Anakinra

   - C) Tocilizumab

   - D) None of the above

 

Correct Answer: C) Tocilizumab

Confirmation: option C is correct because Tocilizumab is a IL-6 receptor antagonist. Note that this is no longer recommended by the ACR for MIS-C refractory disease.

Explanation: 

·       option A is incorrect because infliximab targets TNF-alpha. 

·       option B is incorrect because Anakinra targets IL-1 receptors.

option D is incorrect because Tocilizumab targets IL-6 receptors

Which of the following is the first-line treatment for Kawasaki Disease to reduce the risk of coronary artery aneurysms?

1.     A) High-dose corticosteroids
B) IV immunoglobulin (IVIG)
C) Low-dose aspirin
D) Infliximab

 

Correct Answer: B) IV immunoglobulin (IVIG)

·       The lecture states that IVIG is the first-line treatment for Kawasaki Disease.

·       IVIG reduces inflammation and prevents coronary artery aneurysms

Why the Incorrect Options Are Wrong:

A) High-dose corticosteroids: Corticosteroids are not first-line therapy. They may be considered for IVIG-resistant cases or patients with coronary abnormalities, but IVIG remains the standard treatment​

C) Low-dose aspirin: Aspirin is an adjunct therapy used in Kawasaki Disease but does not replace IVIG as the primary treatment.

D) Infliximab: Infliximab is reserved for refractory KD, meaning it is only used in IVIG-resistant cases. It is not a first-line therapy

A child diagnosed with MIS-C presents with cardiac dysfunction and systemic inflammation. What is the recommended initial treatment approach?

1.     A) IVIG and corticosteroids
B) Heparin and infliximab
C) High-dose aspirin and enoxaparin
D) Anakinra and tocilizumab

 

Correct Answer: A) IVIG and corticosteroids

The lecture said IVIG and corticosteroids as the primary immunomodulatory therapy for MIS-C​.

 

Why the Incorrect Options Are Wrong:

B) Heparin and infliximab: Heparin or enoxaparin is used selectively in high-risk thrombosis cases. Infliximab is not first-line; it is reserved for refractory cases where IVIG and steroids fail​

 

C) High-dose aspirin and enoxaparin: Aspirin is used, but only if platelets are ≥80,000/mm³ and for cardiac protection. Enoxaparin is used only if severe left ventricular dysfunction or documented thrombosis is present​

 

D) Anakinra and tocilizumab: Anakinra and Tocilizumab are used in refractory MIS-C, not first-line therapy​

Which of the following is a distinguishing clinical feature of Kawasaki disease?

        a) High fever lasting more than 5 days

        b) Bilateral conjunctival injection without exudate

        c) Cervical lymphadenopathy

        d) Erythema and cracking of lips

 

B is correct as this is a prevalent presenting feature of Kawasaki disease, but not MIS-C

The rest are incorrect as these can be seen in both Kawasaki disease and MIS-C

 

Which of the following is commonly associated with MIS-C but not typically with Kawasaki disease?

        a) Myocardial dysfunction

        b) Strawberry tongue

        c) Peeling of the skin on hands and feet

        d) Fever lasting more than 5 days

 

A is the correct answer as this is much more prevalent and common in MIS-C, but is rarely seen in Kawasaki disease patients

B is incorrect as this is commonly seen in Kawasaki, C is incorrect for the same reason as B, and D is incorrect as this can be seen in both commonly