Viral Exanthems
A child develops a high fever, cough, coryza, and conjunctivitis followed by an erythematous maculopapular rash that begins on the face and spreads downward. What is the diagnosis?
Measles (rubeola)
Rubella infection is especially concerning during pregnancy because it can cause what fetal condition?
Congenital rubella syndrome
A child develops fever and malaise followed by an intensely pruritic rash with macules, papules, vesicles, and crusted lesions present simultaneously. What is the diagnosis?
Varicella (chickenpox)
A child presents with fever, headache, malaise, and painful swelling of the parotid glands that causes the cheeks and jaw to appear swollen. What is the most likely diagnosis?
Mumps
What virus is the most common cause of infectious mononucleosis?
Epstein-Barr virus (EBV)
What small blue-white lesions on an erythematous base inside the buccal mucosa are characteristic of measles?
Koplik spots
A child develops intensely erythematous cheeks followed by a lacy, reticular rash on the trunk and extremities. What is the diagnosis?
Fifth disease (erythema infectiosum)
The presence of skin lesions in multiple stages of development at the same time is a classic finding of what viral exanthem?
Varicella
A patient develops an expanding erythematous skin lesion with central clearing several days after a tick bite. What characteristic lesion should make the NP suspect Lyme disease?
Erythema migrans
A patient with infectious mononucleosis develops a diffuse maculopapular rash after being treated for presumed streptococcal pharyngitis. What antibiotic commonly produces this reaction?
Amoxicillin (or ampicillin
What is the primary treatment for uncomplicated measles, in addition to recommended vitamin A administration in children?
Supportive care
What virus causes fifth disease?
Parvovirus B19
What virus causes both chickenpox and shingles?
Varicella-zoster virus (VZV)
What organism causes Lyme disease?
Borrelia burgdorferi
Because splenomegaly can occur with infectious mononucleosis, what activity should patients avoid during the period of increased splenic rupture risk?
Contact or collision sports
A child develops a mild fever and lymphadenopathy followed by a fine pink maculopapular rash that begins on the face and rapidly spreads to the trunk and extremities. What is the diagnosis?
Rubella
An infant has several days of high fever but otherwise appears relatively well. The fever abruptly resolves, followed by a pink maculopapular rash beginning on the trunk. What is the diagnosis?
Roseola infantum (exanthem subitum)
A child presents with a vesicular eruption concentrated on the hands, feet, and buttocks along with painful oral lesions. What physical finding helps distinguish this illness from many other childhood exanthems?
Lesions involving the palms and soles
What oral antibiotic is commonly used as first-line treatment for uncomplicated early localized Lyme disease?
Doxy
A child presents with fever, sore throat, and a fine, erythematous “sandpaper” rash that begins on the trunk and spreads outward. What diagnosis should the NP suspect?
Scarlet fever
Enlargement of which lymph nodes is particularly characteristic of rubella?
Posterior auricular and suboccipital lymph nodes
A young child presents with fever, painful oral vesicles and ulcers, and vesicular lesions on the palms and soles. What is the diagnosis?
Hand-foot-and-mouth disease
A child with a viral exanthem develops petechiae or purpura that do not blanch with pressure and appears acutely ill. What should the NP recognize about this finding?
It is a red flag requiring urgent evaluation for serious infection, including meningococcal disease.
An adolescent presents with fever, severe pharyngitis, fatigue, and posterior cervical lymphadenopathy. What diagnosis should the NP suspect?
Infectious mononucleosis
A child with fever and a rash develops a nonblanching petechial or purpuric eruption and appears acutely ill. What life-threatening infection should the NP immediately consider?
Meningococcal disease (meningococcemia)