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Kawasaki Disease

I am a third-year medical student, and I use VisualDx a lot both during my study time and on the wards. VisualDx helped me shine last month when I was on pediatrics.

It was my first week on the pediatric rotation when I was paged for a new consult in the emergency room. The patient was a 5-year-old boy presenting with fever and rash and appeared quite ill. I did the history and physical exam, and by the time I finished talking to the family I had less than 10 minutes before the start of rounds with my attending. I knew I needed to have at least a couple of ideas for my differential diagnosis, most likely diagnosis, what test I would do, and treatment options.

As this was my first week on pediatrics, I couldn't come up with any of this information, so I quickly pulled out my phone and launched the VisualDx Mobile app to help me with ideas. I used the Differential Builder – I selected pediatric, selected the type of rash and its location and distribution, and answered keys questions, which included fever and the degree of distress the baby was in. As soon as the information was submitted, VisualDx gave me a differential list with the most likely diagnosis being Kawasaki disease. I clicked on Kawasaki disease and read the synopsis, diagnostic pearls, and pitfalls.

On attending rounds I presented the patient, and for my assessment I stated that I was concerned that this child may have Kawasaki disease. My attending then asked for the diagnostic criteria for Kawasaki disease, which I answered very easily because I had just read it on VisualDx. That day, I was confident on rounds and contributed to the treatment plans simply because I did a quick look up on VisualDx that took me less than 5 minutes.

That is one of the many occasions VisualDx has come to my rescue in medical school. Yes my attendings expect us to use all these tools to enhance and complement our education. They focus on teaching us the foundation/basics upon which we as students can build. They understand that medicine is a highly evolving field where things today will be obsolete tomorrow. To that respect, they focus on teaching us to be life-long students. They expect us to use technology to our advantage, but they do emphasize to a great extent the importance of learning and understanding the foundations/basic information. It is because of this philosophy that my attendings expect us to look up information on topics we are not very familiar with before rounds – the obvious caveat being time, since one can not go to the computer every time a patient is seen. This is where having mobile versions of software like VisualDx come in handy.

Many of my attendings don't see these tools as crutches as long as they are used appropriately. Trying to look up the answer to a question asked during rounds is obviously not accepted. At the same time, I've had two attendings that have pulled up pictures on their iPads to clarify a teaching point. The beauty of VisualDx is that you have a wealth of information at your finger tips when you need it. I have also had an attending on rounds specifically ask me to look up a picture of the port-wine stain seen in Sturge-Weber syndrome.

In regards to my case, the child did have Kawasaki disease, but his presentation was not classic. Since he did not meet the classic clinical criteria, we diagnosed him with incomplete (atypical) Kawasaki. Our differential included Rocky Mountain spotted fever, scarlet fever, viral infection (adenovirus, Epstein-Barr virus, enterovirus), and drug reaction.

My classmates and I have studied with Wikipedia to look up images of diseases. Now that I know of VisualDx, I use it exclusively because of its vast database of pictures. If students are exposed to VisualDx and its features, I guarantee you they will use it on a daily basis.

– MS-3, Pediatric Rotation, UT Southwestern