A five year old is brought in by mother, with a new onset rash
A 5 year old child is brought in by mum with a rash to the torso. (See photo)
You are required to take a history from the mother who is a nurse.
You will then be given the examination findings by the examiner.
You will then be required to present your findings to the mother including a likely diagnosis, differential diagnoses and your intended management.
You are the mother of a five year old child who has developed a rash today.
You are working part time as a nurse. You live with your husband who is an ofice worker and this is your first child.
Your child spends time in pre-school on days when you are at work.
Immunisations as per schedule.
no medication, no allergy, previously well apart from usual URTIs.
Child was well yesterday but today developed a fever and a rash. Temp at home 38.0
The child has had a mild headache but no vomiting or neck stiffness.
Slight runny nose, slight cough, but not dyspnoeic or tachypnoeic. Mild conjunctivitis.
Fine erythematous macular rash covering the face, chest abdomen and back.
No petechiae or ecchymoses.
Child looks reasonably well but is irritable. Fever has improved with paracetamol.
No history of overseas travel, no apparent exposure to other sick children.
Tolerating fluids well but has decreased food intake today. Apparently normal urine output.
Examination findings. T 37.4, P 120, Well perfused, active but irritable
RR 14, Pharynx sl red with no tonsillar exudate
A few cervical lymph nodes, no neck stiffness or photophobia
chest clear, abdo soft
The rash blanches, with no petechiae.
You are to observe the candidate as they take a history from the mother.
The candidate will then explain to the mother the likely diagnosis, differential diagnosis, intended investigations and disposition.
The image used comes from DermNet NZ. Published online at: http://www.dermnetnz.org/common/image.php?path=/viral/img/exanthem1.jpg