Peeling of the palms and the soles is not characteristic feature of?

Appeared in: SJH Nursing Officer - 2019

Explanation

The rash of chickenpox (varicella) is described as centripetal, meaning it starts on the trunk and spreads outwards, often sparing the extremities.
While some lesions can appear on the palms and soles, it is not a predominant feature.
Significant peeling (desquamation) of the palms and soles is not a characteristic sign of chickenpox infection.

Option B: Scarlet fever is incorrect because it is known to cause desquamation. After the characteristic 'sandpaper' rash fades, significant peeling of the skin, particularly on the hands and feet, occurs.
Option C: Kawasaki disease is incorrect as periungual desquamation (peeling around the nails of fingers and toes) that extends to the palms and soles is a classic sign in the subacute phase of the illness.
Option D: Tinea infection is incorrect because fungal infections of the feet (tinea pedis) and hands (tinea manuum) commonly present with chronic scaling, flaking, and peeling.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Differential diagnosis of skin conditions based on rash characteristics and desquamation as background academic context rather than a clinical decision trigger.
Observing the distribution and characteristics of a rash, including subsequent peeling, is a critical nursing assessment skill for accurate differential diagnosis.
In a pediatric patient presenting with fever and peeling skin on the hands and feet, it is crucial to consider Kawasaki disease due to the risk of serious cardiac complications like coronary artery aneurysms.
What if? If the patient was a child with a high fever for 5 days, red eyes, a 'strawberry tongue,' and now peeling fingertips, the diagnosis would strongly point towards Kawasaki disease, requiring urgent cardiology consultation.

How to Approach the Question

First, identify the negative framing of the question by spotting the word 'NOT'. This means you are looking for the exception among the options.
The core of the question is about 'peeling of the palms and the soles' (palmar-plantar desquamation).
Systematically review each option and recall or determine if it is associated with this specific symptom.
Evaluate Option A (Chickenpox): The rash is centripetal and usually spares palms/soles. Peeling is not a key feature.
Evaluate Option B (Scarlet fever): Known for post-rash desquamation on hands and feet.
Evaluate Option C (Kawasaki disease): A classic sign is periungual peeling of fingers and toes.

Concept Tested & Keywords

Concept Tested: Differential diagnosis of skin conditions based on rash characteristics and desquamation.
Stem keywords: Peeling, palms, soles
Lead-in keywords: not characteristic feature
Negative lead-in flag: The question asks to identify the condition where peeling of palms and soles is NOT a characteristic feature.

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E6 Medicine Harrison 22e Part 1 p. 187-189

Practise the full SJH Nursing Officer - 2019

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