Viral Exanthems

Chapter 112 Viral Exanthems




Clinical Case Problem 1: A 3-Year-Old with a Rash and Fever


A 3-year-old comes to your office with fatigue and irritability and a low-grade fever that he has had for 3   days. The father relates to you that the child attends daycare, where a virus is “going around.” The father used acetaminophen, which has helped decrease irritability; although the child’s appetite is suppressed, he is still taking a good amount of fluids.


On physical examination, the child does not look ill. His temperature is 38° C. His skin examination shows scattered, small vesicles on an erythematous base. The rash was seen first on the face and seems to be spreading to the trunk.



Select the best answer to the following questions




1. What is the most likely diagnosis in this child at this time?


a. rubella (German measles)

b. adenoviral exanthem

c. varicella-zoster

d. mumps

e. rubeola

2. What is the most outstanding feature of this illness?


a. constitutional symptoms

b. the appearance of a rash at the same time as the temperature falls

c. the description of the lesion as a “dewdrop on a rose petal”

d. recurrence of the rash in adulthood

e. benign nature of this infection

3. What is the causative agent of this infection?


a. human parvovirus

b. adenovirus

c. rhinovirus

d. human herpesvirus

e. Epstein-Barr virus

4. This infection can occur in adulthood. Which of the following is a unique feature in this recurrence?


a. incidence varies with gender and race

b. there are no long-term sequelae with the recurrence

c. there is dermatomal distribution of the lesions

d. diagnosis is usually made on clinical findings

e. these lesions are not seen in immunocompromised patients

5. What is the current recommendation for the treatment and prevention of this condition?


a. no antibiotics, no vaccinations

b. no antibiotics, an antiviral agent to prevent complications

c. no antibiotics, one vaccination in childhood

d. antibiotics, no vaccinations in childhood

e. no antiviral, no antibiotics, two vaccinations in childhood

6. The father is concerned that his 5-year-old child will contract the disease. What do you tell him?


a. there is no cause for concern

b. the child will get herpes zoster infection

c. the child is exposed and will get severe varicella infection

d. all of the above

e. none of the above

7. What is (are) a complication(s) associated with varicella infection?


a. scarring

b. secondary bacterial infection with Staphylococcus and Streptococcus

c. pneumonia

d. encephalitis and cerebellar ataxia

e. all of the above


Clinical Case Problem 2: A 5-Year-Old with Cough, Coryza, and Conjunctivitis


A 5-year-old whose family believes that immunizations can cause autism is brought to the office with a 3-day history of fever, nonproductive cough, coryza, and conjunctivitis. This morning, a rash appeared on his forehead and behind the ears, and it appears to be spreading to his upper arms and chest.


On physical examination, you note a fine maculopapular rash over the face that appears to be spreading to the back and thighs.



8. What is the most likely diagnosis in this patient?


a. roseola infantum

b. scarlet fever

c. meningococcemia

d. rubeola

e. rubella

9. What is (are) the hallmark sign(s) symptom(s) of this infection?


a. Koplik spots

b. coalescing erythematous maculopapular rash

c. suboccipital and postauricular lymph node enlargement

d. conjunctivitis

e. all of the above

10. Which of the following is a relatively common complication of this infection?


a. encephalomyelitis

b. myocarditis

c. pneumonia

d. thrombocytopenic purpura

e. keratoconjunctivitis

11. What treatment recommendations will you make to the father?


a. amoxicillin

b. erythromycin

c. supportive care

d. vitamin A

e. ribavirin

12. What is the recommended immunization schedule for the prevention of this infection?


a. four doses at 2, 4, and 6   months with a booster at 15 months

b. three doses at 2, 4, and 6 months

c. two doses at 12 to 15   months and 4 to 6 years

d. three doses at 0, 1, and 6 months

e. two doses at 1   year and 15 months

13. What would be the recommendations for the exposed members of the family?


a. none

b. administration of immune globulin and measles vaccine

c. immune globulin only

d. measles vaccine

e. vitamin A


Clinical Case Problem 3: A 4-Year-Old with a Bright Red Rash on Both Cheeks


A 4-year-old is brought to the office by his mother. The child has had a low-grade fever, headache, and sore throat for the past week. Four days ago, he suddenly developed a bright red rash on his cheeks, which during the past 2   days has spread to the trunk, arms, and legs.


On physical examination, the child has erythema of the cheeks and a maculopapular rash with central clearing on the trunk spreading to the extremities. There are no other significant findings.



14. What is the most likely diagnosis in this child?


a. rubella

b. scarlet fever

c. human herpesvirus 6

d. erythema infectiosum

e. measles

15. What is the causative agent of this infection?


a. human herpesvirus 6

b. human papillomavirus

c. rhinovirus

d. human parvovirus B19

e. adenovirus

16. What are the cardinal features of this infection?


a. circumoral pallor and sandpaper-like appearance of the trunk

b. fine pustular appearance and a bright red macular- papular rash with central clearing

c. erythematous cheeks with a lacy reticular pattern

d. coalesced lesions in various stages (vesicles, bullae, and papules)

e. none of the above

17. The mother asks you what she can do about the “slapped cheek” appearance. People are staring at her as though she has been abusing her child.


a. tell her to tell them to stop staring; it is none of their business

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Viral Exanthems

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