A nurse is assessing a patient with suspected measles. What is a classic sign of measles that can be identified during a physical exam?

Appeared in: NORCET 7 Prelims -2024

Explanation

Koplik spots are the pathognomonic sign of measles, meaning they are uniquely characteristic of this disease.
These spots are described as small, bluish-white dots on a red base, appearing on the buccal mucosa (inside the cheeks) opposite the molars.
They appear 1-2 days before the main measles rash, making them a crucial early diagnostic indicator.
The spots are transient and typically fade as the more widespread maculopapular rash begins.

Option B: A maculopapular rash is a key feature of measles, but it is not a unique or pathognomonic sign. Many other viral exanthems (e.g., rubella, roseola) also present with a similar rash.
Option C: Strawberry tongue is not associated with measles. It is a classic sign of other conditions, primarily Scarlet fever and Kawasaki disease.
Option D: Red, swollen tonsils are a non-specific finding indicating pharyngeal inflammation. While a sore throat can be part of the measles prodrome, this sign is much more indicative of tonsillitis or streptococcal pharyngitis.

Clinical Relevance

Nursing practice connection: Use the key finding related to Recognition of pathognomonic signs of measles to guide bedside assessment, documentation, and the next nursing action.
Early identification of Koplik spots allows for prompt implementation of airborne precautions, which is critical for preventing the spread of the highly contagious measles virus in a healthcare setting.
Recognizing the pathognomonic sign of measles prevents misdiagnosis and ensures the patient receives appropriate supportive care, including Vitamin A supplementation, and monitoring for common complications like pneumonia and otitis media.
What if the patient presented with a rash but no Koplik spots were observed? The nurse should consider other differential diagnoses like rubella or roseola, and laboratory confirmation (e.g., measles IgM serology) would become essential for a definitive diagnosis.

How to Approach the Question

First, analyze the question to identify the core concept: it asks for a 'classic sign' of measles. The word 'classic' often implies a pathognomonic or highly specific finding.
Review each option and evaluate its association with measles.
Recall or look up the defining characteristics of measles. The prodromal phase includes fever, cough, coryza, conjunctivitis, and the key sign: Koplik spots.
Consider the specificity of each option. A maculopapular rash is common in many viral illnesses. Strawberry tongue is classic for other diseases. Red, swollen tonsils are very non-specific.
Identify Koplik spots as the most specific and unique sign for measles among the choices provided.
This process of elimination, based on the specificity of clinical signs, leads to the correct answer.

Concept Tested & Keywords

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E6 Medicine Harrison 22e Part 1 p. 1682-1684

E6 Parks TextBook of Preventive & Social Medicine part 1 — Subpart A (pp 26-201 of 604) p. 150-152

Practise the full NORCET 7 Prelims -2024

Attempt every question from this paper in a timed mock, then review the full solution for each one.