Medical history 15-year-old male patient seeks for health service complaining of pain in oropharynx, fever of 38 to 39 °C, abdominal pain and exhaustion for the past nine days. He took dipyrone, with improvement of the fever. Denies cough, comorbidities or continuous medication. Physical examination reveals pharyngitis, bilateral cervical lymphadenopathy and painful hepatosplenomegaly. Amoxicillin and symptomatic treatment were prescribed. Returned after two days reporting appearance of skin lesions on trunk and upper limbs (picture aside). Image 1: Photograph of anterior chest and abdominal area. Question: Considering the medical history and the image (lesion photograph) provided, which complication is associated with the disease presented by the patient? A) Rheumatic fever B) Papular-purpuric gloves and socks syndrome C) Coronary artery aneurysm D) Splenic rupture Test question (Medical Residency - HSJC) Eight-year-old male, seeks for health service with history of high fever for 8 days. He was attended on the first day of illness and physical examination revealed generalized lymphadenopathy and enlarged tonsils with exudate. The diagnosis hipotesis was tonsillitis and it was prescribed amoxicillin (50 mg/kg/day oral medication in every 8 hours). After seven days using the antibiotic the patient developed erythematous maculopapular rash. On the eighth day of the disease, he was attended and remained with fever and pain in the upper left quadrant of the abdomen radiating to the shoulder. The rash persisted and after 6 hours of observation, the patient died of hypovolemic shock. Question:What is the main diagnosis and the probable cause of death? A) Infectious mononucleosis / hypovolemic shock by splenic rupture B) Bacterial pharyngitis / severe anaphylaxis caused by antibiotic use C) Diphtheria / severe anaphylaxis caused by antibiotic use D) Acute lymphocytic leukemia / sepsis due to marrow aplasia. E) Kawasaki Disease / acute myocardial infarction secondary to coronary aneurysm Time is Up! Time's up
