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HP CHO -9 October 2022
Medical Surgical Nursing
Medium

Which among the following manifests with fever and catarrhal symptoms of the upper respiratory tract followed by typical rashes?

Appeared in: HP CHO -9 October 2022

Explanation

  • Measles (Rubeola) classically presents with a prodromal phase lasting several days.
  • This prodrome includes high fever and significant catarrhal symptoms of the upper respiratory tract, known as the '3 Cs': cough, coryza (runny nose), and conjunctivitis.
  • A pathognomonic sign, Koplik's spots (bluish-white spots inside the cheek), appears during the prodrome.
  • This is followed by a characteristic maculopapular rash that begins on the face and hairline and spreads downwards over the body.

Why Other Options Were Wrong

  • Option A: Poliomyelitis is a viral infection affecting the nervous system. While it can start with fever and sore throat, a rash is not a characteristic feature. Its primary concern is the potential for paralysis.
  • Option C: Rubella (German measles) also causes fever and a rash, but the symptoms are typically milder than measles. The catarrhal symptoms are less pronounced, and a key feature is tender lymphadenopathy, especially of the postauricular and suboccipital nodes.
  • Option D: Tetanus is a bacterial infection caused by Clostridium tetani. It does not cause fever, catarrhal symptoms, or a rash. Its hallmark symptoms are muscle stiffness and painful spasms, such as trismus (lockjaw).

Related Visual

Visual explanation — Related Visual
Clinical Relevance
  • Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Identification of communicable diseases based on clinical presentation as background academic context rather than a clinical decision trigger.
  • Measles is extremely contagious and requires immediate implementation of airborne precautions in a healthcare setting to prevent nosocomial spread. The patient should be in a negative-pressure isolation room.
  • Nurses play a crucial role in supportive care, including administering antipyretics for fever, ensuring hydration, and providing eye care for conjunctivitis and photophobia.
  • Public health notification is mandatory for suspected measles cases to initiate contact tracing and prevent community outbreaks. Vaccination status of contacts should be assessed.
How to Approach the Question
  • First, break down the question's description into key clinical features: 1) Fever, 2) Catarrhal (upper respiratory) symptoms, and 3) a subsequent rash.
  • The sequence is important: respiratory symptoms and fever appear before the rash.
  • Evaluate each option against this clinical picture.
  • Poliomyelitis and Tetanus can be quickly eliminated as they do not typically present with a rash as a primary feature.
  • Differentiate between Measles and Rubella. Recall that Measles has a more severe prodrome with high fever and the classic '3 Cs' (cough, coryza, conjunctivitis), plus Koplik's spots. Rubella is generally milder with prominent lymph node swelling.
  • The description in the question perfectly matches the classic presentation of Measles.
Concept Tested & Keywords
  • Concept Tested: Identification of communicable diseases based on clinical presentation.
  • Stem keywords: fever, catarrhal symptoms, upper respiratory tract, rashes
  • Lead-in keywords: Which among the following
  • Clinical cues: Sequence of symptoms: fever and respiratory issues followed by a rash.

Question ID

QySs9KQyr8kVQwhaoDBrex

Reference Book

E6 Comprehensive Textbook of Community Health Nursing for BSc Nursing Students Part 2 — Subpart A (pp 1-275 of 550) p. 30-32

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 2036-2038

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