Common childhood examthems - Post Test

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Question 1 of 10

1. Question
A 15-month-old child immunised for measles, mumps and rubella (MMR) two days ago presents with a fever temperature of 40Â°C and no rash. Two days earlier, a child at her nursery was diagnosed with measles. The mother is very concerned that her child now has measles. There are no other abnormal features other than a tachycardia and tachypnoea. Which one of the following is correct?
- The fever is likely to be secondary to the vaccination.
- The child could be defined as having a ‘probable’ case of measles if a fever of >38.5°C was present, macular papular rash and one out of the ‘three Cs’ cough, coryza or conjunctivitis
- The child should have had a first dose of MMR at 6 months of age and therefore measles is unlikely.
- Bacterial pneumonia is a complication of measles. Prophylactic antibiotics should be given to all under-2-year-olds with measles in the UK
- The MMR vaccine should be given to exposed immunocompetent unimmunised individuals within 96 hours of exposure to measles
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Question 2 of 10

2. Question
A 4-year-old, previously-well boy presents with a sandpaper rash, sore throat, fevers, a strawberry tongue and coryzal illness. Which one of the following is correct?
- Group A beta-haemolytic streptococci (GABHS) is a likely cause – this organism is commonly transmitted though food
- A throat swab culture is the gold standard investigation
- Antibiotic prophylaxis is indicated for children who are GABHS carriers
- This child should be excluded from school for at least 14 days
- Necrotising fasciitis is a common complication of streptococcal infections
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Question 3 of 10

3. Question
A 4-year-old unimmunised child is triaged in with a rash, fever and coryzal symptoms. Which one of the following is correct?
- In measles, a conjunctivitis and a vesicular rash is seen
- In rubella, a confluent erythematous rash to the cheeks, sparing of nasal bridge, and periorbital areas with circumoral pallor is seen
- In Gianotti-Crosti syndrome, a macular rash is seen
- In rubella, Pastias lines and a sandpaper paper rash are seen
- The rash of parvovirus B19 and rubella can be clinically confused
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Question 4 of 10

4. Question
A 3-year-old child with no past immunisations presents with a macular rash to the face and trunk, fevers and tender lymphadenopathy. Her mother is in her second trimester of pregnancy. The family have recently travelled to the UK and are asylum seekers. The general practitioner has concerns this may be rubella. Which one of the following is correct?
- The prognosis of rubella in adults and children is generally poor
- In the unimmunised mother, the risk of occurrence of congenital rubella syndrome (CRS) is uniform throughout the entire pregnancy
- Immunity from the MMR vaccine is life-long. Re-infection in immunised patients has not been demonstrated
- A child with a suspected case of rubella should be kept off school for at least 5 days after the appearance of the rash
- It is not necessary to notify a clinically suspicious case of rubella
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Question 5 of 10

5. Question
A 5-year-old, previously-well child presents with an erythematous oedematous macular rash extending over the cheeks, with sparing of the perioral areas and nasal bridge. He had fever, headaches and coryzal symptoms several days earlier. He is otherwise well and vital signs are stable. The triage notes have recorded a slapped cheek appearance. Which one of the following is correct?
- The child is likely to require admission
- This illness is associated with a transient aplastic crisis in those who are anaemic or have a predisposing condition such as sickle cell disease
- The child is highly infectious and should be excluded from school for 1 week
- This child requires a serological confirmation of the diagnosis
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Question 6 of 10

6. Question
A 15-month-old, previously-well child presents with a 4-hour history of general malaise, cough, diarrhoea, and a febrile fit with a sudden temperature of 40Â°C. The child appears well following the fit and recovers quickly. Some palatal papules are noted in the mouth. Which one of the following is correct?
- Infection with human herpesvirus 6 (HHV6) would be a rare cause for this presentation
- The child should have serological confirmation if HHV6/exanthem subitum were suspected
- In exanthem subitum the majority of children will present with a high fever, febrile fit and a macular truncal non-blanching rash
- As temperature is >40oC, a blood culture would be mandatory
- The child may warrant investigation for management of a septic illness if clinical course does not improve as expected
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Question 7 of 10

7. Question
A child is diagnosed with chicken pox, which one of the following statements is correct?
- A temperature of 39oC on day 7 of this illness would normally be expected.
- Secondary bacterial complications in patients with severe varicella are unlikely to occur in the immunocompetent child
- Oral acyclovir reduces the incidence of varicella zoster virus complications such as pneumonia, if it is given within 24 hours of onset of the skin rash
- Encephalitis, myelitis and polyradiculitis are recognised neurological complications of varicella, which can occur without a preceding rash
- Varicella zoster immunoglobulin (VZIG) is not required in infants whose mothers develop chicken pox 4 days after delivery
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Question 8 of 10

8. Question
Regarding disease transmission, which one of the following is correct?
- A child with measles should be excluded from school for 5 days after the onset of the rash
- Chicken pox remains infective until all the lesions have crusted
- Erythaema infectiosum/parvovirus B19 infection is solely transmitted by aerosol spread
- Rubella is mainly transmitted via the faecal-oral route
- Gianotti-Crosti syndrome is caused by viral infections alone
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Question 9 of 10

9. Question
Regarding immunisation and vaccination, which one of the following is correct?
- Post-MMR vaccination fever usually occurs within the first 4 days of vaccination.
- The MMR vaccine should be given to any exposed immunocompetent unimmunised individuals within 96 hours of exposure to measles
- WHO recommend at least 95% of children should receive a mumps containing vaccination at 12-18 months of age
- The vaccination schedule used from September 2006 includes a pneumococcal vaccine and a Hib/meningococcal B booster
- The primary course of vaccinations in childhood consists of dTaP/IPV/Hib given at 2 and 4 months
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Question 10 of 10

10. Question
Which one of the following is not a notifiable disease under the Public Health (Infectious Disease) Regulation 1988?
- Mumps
- Scarlet fever
- Pneumococcal meningitis
- Rubella
- Erythaema infectiosum
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