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KD coronary aneurysm – aspirin — RACP Paediatrics MCQ

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HardCardiologyKD coronary aneurysm – aspirinRACP Paediatrics

A 5-month-old meets criteria for Kawasaki disease on day 7 of fever. Echocardiography shows a left-anterior-descending coronary Z-score of 2.8. Which initial anti-inflammatory and antithrombotic plan best follows the current RCH pathway?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Give IVIg 2 g/kg once, aspirin 5 mg/kg/day and specialist-guided corticosteroids

Explanation lettering: B = shown as A · D = shown as B · E = shown as C · A = shown as D · C = shown as E

A is correct. All children with Kawasaki disease receive IVIg 2 g/kg as a single infusion plus aspirin 5 mg/kg daily in the RCH pathway. Age six months or younger and a coronary Z-score at least 2.5 confer high aneurysm risk, so corticosteroid intensification should be discussed under local specialist protocols. B omits IVIg, the treatment that improves coronary outcomes. C misclassifies a Z-score of 2.8; giant aneurysm is a much higher-risk category and anticoagulation is specialist-directed. D omits the recommended aspirin. E gives a second IVIg dose before establishing resistance, defined by persistent fever at least 36 hours after completion. Serial cardiology imaging remains essential.

Reference: Royal Children’s Hospital Melbourne: Kawasaki disease: https://www.rch.org.au/clinicalguide/guideline_index/kawasaki_disease_guideline/