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Questions and Answers
Which of the following is NOT considered a crucial epidemiologic factor when evaluating a patient with fever and rash?
Which of the following is NOT considered a crucial epidemiologic factor when evaluating a patient with fever and rash?
- Exposures to animals and ill contacts
- Recent travel history
- Patient's social media activity (correct)
- Age of the patient
What is a key aspect to consider regarding the rash itself when assessing a patient with fever?
What is a key aspect to consider regarding the rash itself when assessing a patient with fever?
- The patient's preferred clothing style
- The patient's favorite colors
- The type of soap used by the patient
- The distribution and progression of the rash (correct)
Which of these is NOT specifically mentioned as a possible non-infectious cause of fever and rash?
Which of these is NOT specifically mentioned as a possible non-infectious cause of fever and rash?
- Common cold (correct)
- Erythema nodosum
- Drug reactions
- Deep venous thrombosis
What should be the initial approach for a clinician when confronted by a patient with fever and rash?
What should be the initial approach for a clinician when confronted by a patient with fever and rash?
Which of the following skin manifestations is important for a clinician to note in a patient with fever?
Which of the following skin manifestations is important for a clinician to note in a patient with fever?
What is the importance of considering the timing of the onset of a rash in relation to fever?
What is the importance of considering the timing of the onset of a rash in relation to fever?
Why is it important for clinicians to consider the immune status of the host when evaluating fever and rash?
Why is it important for clinicians to consider the immune status of the host when evaluating fever and rash?
What are clinicians advised to do, if needed, concerning a patient with fever and rash, after establishing a probable etiology?
What are clinicians advised to do, if needed, concerning a patient with fever and rash, after establishing a probable etiology?
A patient presents with a 'brick-red' maculopapular rash starting on their head and neck, along with fever, cough, and Koplik's spots. Which of the following is the most likely diagnosis?
A patient presents with a 'brick-red' maculopapular rash starting on their head and neck, along with fever, cough, and Koplik's spots. Which of the following is the most likely diagnosis?
Which illness is characterized by vesicular lesions at different stages (papules, vesicles, and crusting) on an erythematous base?
Which illness is characterized by vesicular lesions at different stages (papules, vesicles, and crusting) on an erythematous base?
Postauricular, posterior cervical, and suboccipital adenopathy, along with a rash resembling measles but without the patient appearing very sick, is most indicative of:
Postauricular, posterior cervical, and suboccipital adenopathy, along with a rash resembling measles but without the patient appearing very sick, is most indicative of:
A child presents with a 'slapped cheeks' appearance followed by a reticular rash. Which condition is the most likely cause?
A child presents with a 'slapped cheeks' appearance followed by a reticular rash. Which condition is the most likely cause?
Which of the following conditions is characterized by a high fever for 3-4 days followed by a maculopapular rash starting on the neck and trunk?
Which of the following conditions is characterized by a high fever for 3-4 days followed by a maculopapular rash starting on the neck and trunk?
A sandpaper-like rash, circumoral pallor, and a strawberry tongue are classic signs of which disease?
A sandpaper-like rash, circumoral pallor, and a strawberry tongue are classic signs of which disease?
Erythema marginatum and subcutaneous nodules are dermatologic manifestations associated with which condition?
Erythema marginatum and subcutaneous nodules are dermatologic manifestations associated with which condition?
A child less than four years old presents with fever, conjunctival injection, a strawberry tongue, and a rash. Which of the following is the most likely diagnosis?
A child less than four years old presents with fever, conjunctival injection, a strawberry tongue, and a rash. Which of the following is the most likely diagnosis?
Which group of viruses is known to cause various rashes and should be considered in the differential diagnosis of a young child with fever and rash of undetermined origin?
Which group of viruses is known to cause various rashes and should be considered in the differential diagnosis of a young child with fever and rash of undetermined origin?
An older child presents with fever, malaise, sore throat, posterior cervical lymphadenopathy, and a rash, especially after the administration of ampicillin. The most likely cause is:
An older child presents with fever, malaise, sore throat, posterior cervical lymphadenopathy, and a rash, especially after the administration of ampicillin. The most likely cause is:
An adolescent presents with pharyngitis, fever, and a maculopapular rash that is pruritic, starting on the extensor surfaces and sparing the face. The most likely cause is:
An adolescent presents with pharyngitis, fever, and a maculopapular rash that is pruritic, starting on the extensor surfaces and sparing the face. The most likely cause is:
A mild erythematous maculopapular or vesicular rash, erythema multiforme, or Stevens-Johnson syndrome may be associated with which infection?
A mild erythematous maculopapular or vesicular rash, erythema multiforme, or Stevens-Johnson syndrome may be associated with which infection?
Which of these is NOT a typical symptom associated with Measles?
Which of these is NOT a typical symptom associated with Measles?
Forchheimer spots are a helpful diagnostic clue for which condition?
Forchheimer spots are a helpful diagnostic clue for which condition?
Which condition's rash is described as 'sandpaper-like'?
Which condition's rash is described as 'sandpaper-like'?
What is the characteristic rash seen in toxic shock syndrome (TSS)?
What is the characteristic rash seen in toxic shock syndrome (TSS)?
What is a common symptom associated with streptococcal toxic shock syndrome (GAS TSS)?
What is a common symptom associated with streptococcal toxic shock syndrome (GAS TSS)?
Which demographic is most likely to exhibit miliary tuberculosis manifestations?
Which demographic is most likely to exhibit miliary tuberculosis manifestations?
What is a classic cutaneous manifestation of miliary tuberculosis?
What is a classic cutaneous manifestation of miliary tuberculosis?
In diagnosing patients with fever and rash, which characteristic of the rash is most important to assess?
In diagnosing patients with fever and rash, which characteristic of the rash is most important to assess?
Which statement differentiates GAS TSS from S. aureus TSS?
Which statement differentiates GAS TSS from S. aureus TSS?
What type of lesions are typically found in miliary tuberculosis biopsy samples?
What type of lesions are typically found in miliary tuberculosis biopsy samples?
Which of the following is NOT a useful question to ask when assessing the history of a rash?
Which of the following is NOT a useful question to ask when assessing the history of a rash?
What typically occurs one to three weeks after the initial rash in toxic shock syndrome?
What typically occurs one to three weeks after the initial rash in toxic shock syndrome?
Which of the following describes a macule?
Which of the following describes a macule?
What infection is specifically associated with individuals working with plants and soil?
What infection is specifically associated with individuals working with plants and soil?
Which arthropod is associated with onchocerciasis?
Which arthropod is associated with onchocerciasis?
What classic skin lesion is associated with Lyme disease?
What classic skin lesion is associated with Lyme disease?
Which statement is true regarding hypersensitivity skin reactions due to drugs?
Which statement is true regarding hypersensitivity skin reactions due to drugs?
What is the key characteristic of Southern tick-associated rash illness (STARI)?
What is the key characteristic of Southern tick-associated rash illness (STARI)?
Which drug class has a high likelihood of causing allergic skin reactions?
Which drug class has a high likelihood of causing allergic skin reactions?
Which condition is linked to Rickettsia rickettsii?
Which condition is linked to Rickettsia rickettsii?
Immunizations are recommended for which of the following groups?
Immunizations are recommended for which of the following groups?
Which condition may present with a generalized maculopapular rash and is associated with West Nile virus?
Which condition may present with a generalized maculopapular rash and is associated with West Nile virus?
What is a common misconception regarding drug fever and rash?
What is a common misconception regarding drug fever and rash?
Which of the following infections is typically not presented with fever?
Which of the following infections is typically not presented with fever?
Which organism is responsible for causing human granulocytic anaplasmosis?
Which organism is responsible for causing human granulocytic anaplasmosis?
What important aspect should be evaluated in patients presenting with a rash of unknown etiology?
What important aspect should be evaluated in patients presenting with a rash of unknown etiology?
What are Janeway lesions primarily characterized by?
What are Janeway lesions primarily characterized by?
Which type of necrotizing fasciitis is usually due to polymicrobial infection?
Which type of necrotizing fasciitis is usually due to polymicrobial infection?
Which lesion is typically found in the retina and is considered rare?
Which lesion is typically found in the retina and is considered rare?
What is a significant clinical clue for diagnosing Rocky Mountain spotted fever?
What is a significant clinical clue for diagnosing Rocky Mountain spotted fever?
Which factor is commonly associated with the development of necrotizing fasciitis?
Which factor is commonly associated with the development of necrotizing fasciitis?
Which syndrome was first described in relation to young menstruating women?
Which syndrome was first described in relation to young menstruating women?
Which infectious condition is primarily associated with exposure to cats and kittens?
Which infectious condition is primarily associated with exposure to cats and kittens?
What is a common cause of infective endocarditis that has been reported worldwide?
What is a common cause of infective endocarditis that has been reported worldwide?
In which region is Lyme disease primarily reported?
In which region is Lyme disease primarily reported?
Which symptom is a key criterion for diagnosing toxic shock syndrome?
Which symptom is a key criterion for diagnosing toxic shock syndrome?
What causes relapsing fever, predominantly found in mountainous areas of the western United States?
What causes relapsing fever, predominantly found in mountainous areas of the western United States?
What characterizes Osler's nodes?
What characterizes Osler's nodes?
Which fungal infection is endemic to the Mississippi and Ohio River valleys?
Which fungal infection is endemic to the Mississippi and Ohio River valleys?
Which of the following is a major complication of group A streptococcal necrotizing fasciitis?
Which of the following is a major complication of group A streptococcal necrotizing fasciitis?
Exposure to which animal is specifically associated with the risk of contracting psittacosis?
Exposure to which animal is specifically associated with the risk of contracting psittacosis?
How does the rash associated with Rocky Mountain spotted fever progress?
How does the rash associated with Rocky Mountain spotted fever progress?
What is the primary host for Erysipelothrix rhusiopathiae infections?
What is the primary host for Erysipelothrix rhusiopathiae infections?
Which of the following conditions would least likely trigger necrotizing fasciitis?
Which of the following conditions would least likely trigger necrotizing fasciitis?
What is a common result of handling fish species like tilapia?
What is a common result of handling fish species like tilapia?
What is one of the minor criteria for the diagnosis of infective endocarditis?
What is one of the minor criteria for the diagnosis of infective endocarditis?
Which condition is known to develop after exposure to contaminated water in hot tubs?
Which condition is known to develop after exposure to contaminated water in hot tubs?
What is a possible explanation for the unchanged incidence of infective endocarditis over the past 20 years?
What is a possible explanation for the unchanged incidence of infective endocarditis over the past 20 years?
Which tick-borne illness is primarily found in the South-central and Atlantic states?
Which tick-borne illness is primarily found in the South-central and Atlantic states?
What type of infection can be caused by exposure to cat and dog bites?
What type of infection can be caused by exposure to cat and dog bites?
Which infectious disease can be linked to working as a dental worker due to exposure to human secretions?
Which infectious disease can be linked to working as a dental worker due to exposure to human secretions?
Which of the following is NOT a cause of skin lesions associated with aquatic environments?
Which of the following is NOT a cause of skin lesions associated with aquatic environments?
What is a major risk factor for developing tularemia?
What is a major risk factor for developing tularemia?
Herpes gladiatorum is primarily associated with which type of activity?
Herpes gladiatorum is primarily associated with which type of activity?
What characterizes the rash associated with measles?
What characterizes the rash associated with measles?
Which pathogen is most commonly associated with infectious mononucleosis?
Which pathogen is most commonly associated with infectious mononucleosis?
What type of rash is commonly associated with the acute retroviral syndrome following primary HIV infection?
What type of rash is commonly associated with the acute retroviral syndrome following primary HIV infection?
In adolescents presenting with pharyngitis and rash, which organism is likely if group A Streptococcus and viral causes are negative?
In adolescents presenting with pharyngitis and rash, which organism is likely if group A Streptococcus and viral causes are negative?
What is a common feature of the rash seen in erythema infectiosum in adults?
What is a common feature of the rash seen in erythema infectiosum in adults?
Which condition is characterized by vesicular lesions distributed along a dermatome?
Which condition is characterized by vesicular lesions distributed along a dermatome?
Which skin manifestation is NOT typically associated with COVID-19?
Which skin manifestation is NOT typically associated with COVID-19?
What is the typical rash pattern seen in infections with nonpolio enteroviruses?
What is the typical rash pattern seen in infections with nonpolio enteroviruses?
Which of the following is most characteristic of Mycoplasma pneumoniae infections?
Which of the following is most characteristic of Mycoplasma pneumoniae infections?
During which season are measles and rubella infections more frequently seen?
During which season are measles and rubella infections more frequently seen?
What is the likely rash pattern for an individual with herpes zoster?
What is the likely rash pattern for an individual with herpes zoster?
What is the most common symptom seen in adults with primary infectious mononucleosis?
What is the most common symptom seen in adults with primary infectious mononucleosis?
What distinguishes the rash caused by Toxoplasma gondii from other infections?
What distinguishes the rash caused by Toxoplasma gondii from other infections?
What percentage of college freshmen are expected to have EBV-associated antibodies?
What percentage of college freshmen are expected to have EBV-associated antibodies?
What is a characteristic feature of the rash caused by Arcanobacterium haemolyticum?
What is a characteristic feature of the rash caused by Arcanobacterium haemolyticum?
Which type of skin lesions are characteristic of secondary syphilis?
Which type of skin lesions are characteristic of secondary syphilis?
What is the appearance of the mucous membrane ulcerations in secondary syphilis?
What is the appearance of the mucous membrane ulcerations in secondary syphilis?
What symptom can occur in patients after antibiotic treatment for syphilis?
What symptom can occur in patients after antibiotic treatment for syphilis?
Which lesion is a characteristic of late or tertiary syphilis?
Which lesion is a characteristic of late or tertiary syphilis?
What differentiates the rash seen in meningococcal infection from that in Rocky Mountain spotted fever?
What differentiates the rash seen in meningococcal infection from that in Rocky Mountain spotted fever?
Which of the following infections is associated with life-threatening outcomes in a young adult population?
Which of the following infections is associated with life-threatening outcomes in a young adult population?
What type of skin lesions are associated with bacterial endocarditis?
What type of skin lesions are associated with bacterial endocarditis?
What is the initial appearance of gumma lesions in tertiary syphilis?
What is the initial appearance of gumma lesions in tertiary syphilis?
What skin manifestation is commonly seen in disseminated gonococcal infection?
What skin manifestation is commonly seen in disseminated gonococcal infection?
Which symptom is common in patients with meningococcemia?
Which symptom is common in patients with meningococcemia?
What is a severe complication of meningococcemia associated with disseminated intravascular coagulation?
What is a severe complication of meningococcemia associated with disseminated intravascular coagulation?
Which rash presentation may mimic infections such as infectious mononucleosis?
Which rash presentation may mimic infections such as infectious mononucleosis?
How does the rash of acute retroviral syndrome typically present?
How does the rash of acute retroviral syndrome typically present?
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Study Notes
Fever and Rash: A Diagnostic Approach
- Fever with a rash is a common presentation, often the first indication of infection. It can also signal a serious non-infectious disorder.
Diagnostic Considerations
- A thorough approach is vital for timely diagnosis, treatment, and potential isolation.
- Epidemiologic clues are key, including patient age, season, travel history, geographic location, exposures (insects, animals, ill contacts), medications, immunizations, and immune status.
- Rash characteristics are also critical. This involves lesion characteristics, distribution and progression, timing in relation to fever, and any changes in morphology (e.g., papules to vesicles). Accompanying symptoms (pain, itching, numbness) are relevant.
Epidemiological Clues and Etiologies
- Pediatric Presentations:
- Measles (rubeola): Starts on head/neck, spreads centrifugally; fever, cough, runny nose, eye irritation, Koplik's spots.
- Chickenpox (varicella): Vesicular lesions on an erythematous base, appearing in crops; various stages (papules, vesicles, crusting).
- Rubella: Rash resembling measles, but patient often doesn't seem sick; prominent lymph nodes behind ears and neck.
- Fifth Disease (erythema infectiosum): "Slapped cheeks" appearance, followed by a diffuse maculopapular rash in a reticular pattern; caused by parvovirus B19.
- Roseola infantum (exanthem subitum): High fever (3-4 days), followed by seizures and a generalized maculopapular rash starting on the neck and trunk, spreading to face and extremities.
- Scarlet fever: Diffuse erythematous rash, sandpaper-like, blanching, followed by desquamation; often associated with strep throat.
- Acute rheumatic fever: Erythema marginatum (macular lesions with central clearing), subcutaneous nodules.
- Kawasaki syndrome: Fever >5 days, bilateral conjunctival injection, fissured lips, injected oropharynx/strawberry tongue, edema/erythema of hands/feet, rash, and cervical lymphadenopathy.
- Enteroviruses (coxsackievirus, echovirus): Various rashes, part of the differential diagnosis.
- Infectious mononucleosis (EBV): Fever, malaise, sweats, anorexia, sore throat, posterior cervical lymphadenopathy, splenomegaly; often maculopapular rash, especially after ampicillin—consider EBV.
- Arcanobacterium haemolyticum: Pharyngitis, fever, lymphadenopathy, maculopapular/scarlatiniform rash; less common, sensitive to erythromycin.
- Mycoplasma pneumoniae: Mild rash (maculopapular, vesicular), erythema multiforme, or Stevens-Johnson syndrome.
- Adult Presentations: Similar viral illnesses, including measles, can occur in adults. Also consider:
- Infectious Mononucleosis: Caused by various pathogens (EBV, CMV, HIV). Same symptoms as in children; maculopapular rash possible.
- HIV: Mononucleosis-like syndrome 2-6 weeks after infection; maculopapular, non-pruritic rash.
- Erythema Infectiosum (Fifth Disease): Increased constitutional symptoms (lymphadenopathy, arthritis, fever) in adults. Also considers other viral infections.
- Herpes Zoster (Shingles): Reactivation of latent varicella-zoster virus; vesicular lesions along a dermatome.
- Mycoplasma pneumoniae: Same as in children.
- COVID-19: Rash of differing morphologies can occur; more severe presentations may involve multisystem inflammatory syndrome.
- Seasonal and Geographic Factors:
- Seasonal patterns: Some infections (enteroviruses, Kawasaki syndrome, etc.) have clear seasonal patterns.
- Geographic clues: Travel/residence in specific regions may pinpoint etiologies (Rocky Mountain spotted fever, Lyme disease, etc.).
Exposure Histories and Other Factors
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Exposure history:
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Food/water/plants/animals: Various infections (toxoplasmosis, cat scratch disease, psittacosis, cryptococcosis, tularemia) can result.
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Occupational exposures: Specific jobs (farmers, florists, fish/meat handling) can introduce different types of infections (sporotrichosis, Erysipelothrix rhusiopathiae).
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Arthropod exposures: Infections like Lyme disease, ehrlichiosis/anaplasmosis, Rocky Mountain spotted fever, malaria, dengue, chikungunya, West Nile are associated with particular vector exposure.
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Medication History: Drugs can cause rashes. Severe drug reactions may include fever, and potentially a more concerning rash, such as Stevens-Johnson syndrome.
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Immunization history: Crucial for unvaccinated individuals, particularly for those vulnerable to childhood illnesses.
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Sexual history: Infections with STIs (syphilis, herpes simplex, lymphogranuloma venereum, etc.) can cause genital/rectal ulcers; rashes may appear.
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Immunocompetence: The causes and severity of fever/rash differ greatly if the patient is immunosuppressed.
Emergencies
- Meningococcal infection: Characterized by rapidly spreading petechial or purpuric rash, particularly on extremities.
- Bacterial endocarditis: Rare, involves specific skin lesions (petechiae, splinter hemorrhages, Janeway lesions, Osler's nodes, Roth spots).
- Rocky Mountain spotted fever (RMSF): Tick-borne; starts on wrists/ankles and extends centripetally, often progressing to petechiae.
- Necrotizing fasciitis: Rapidly spreading skin/tissue infection; significant local and systemic signs.
- Toxic shock syndrome: Generalized erythematous rash resembling sunburn or a rash from a significant burn.
- Miliary tuberculosis: Rare, involves skin (vesicular etc.) as part of a systemic infection.
Diagnostic Approach
- Thorough history and physical examination: Understanding the rash's appearance (morphology, distribution, progression, symptoms, treatment history) and origin are crucial.
- Detailed epidemiologic data: Using age, season, travel history, etc., to narrow down potential etiologies.
- Differential diagnosis: Using observed rash characteristics and supporting factors is crucial.
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