Which finding is noted on assessing a child with scabies?

Appeared in: DSSSB - 28 August 2019 (Shift-1)

Explanation

The hallmark and pathognomonic (specifically characteristic) sign of a scabies infestation is the burrow created by the female mite.
This burrow appears on the skin as a short, wavy, or S-shaped gray or dark threadlike line.
The mite tunnels into the stratum corneum (the outermost layer of the skin) to lay its eggs, creating this visible track.
While intense itching and red papules are also symptoms, the burrow is the most definitive clinical finding for diagnosis.

Option A: Purple-coloured lines are not a characteristic finding of scabies. This presentation might suggest other dermatological conditions, such as lichen planus, which is characterized by purplish, polygonal papules.
Option B: While pink-red macules and papules are a common feature of scabies, they are a non-specific inflammatory and hypersensitivity reaction to the mite, its saliva, and feces. They are not the most defining or diagnostic sign.
Option C: Similar to pink-red macules, discrete red macules are a non-specific sign of inflammation. They are part of the clinical picture of scabies but are not the unique, pathognomonic sign used for definitive clinical diagnosis.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical assessment and identification of scabies as background academic context rather than a clinical decision trigger.
Accurate identification of scabies burrows is a key nursing skill for prompt diagnosis, which is critical to prevent outbreaks in families, schools, and healthcare facilities.
Nursing care involves educating the patient and family on the correct application of prescribed scabicides (e.g., 5% permethrin cream), emphasizing treatment of the entire body from the neck down.
Patient teaching must include environmental control measures, such as washing all clothing, towels, and bedding used in the last 72 hours in hot water and drying on a hot cycle.

How to Approach the Question

First, identify the key subject of the question, which is 'scabies' in a 'child'.
The question asks for a 'finding', implying you need to know the clinical signs of this condition.
Recall the pathognomonic (most characteristic and diagnostic) sign of scabies. Differentiate this from other common but non-specific signs.
Analyze the options: 'Gray threadlike lines' describes the mite's burrow. The other options describe general inflammatory reactions (macules) or an incorrect color (purple).
Select the option that describes the most unique and definitive sign of scabies, which is the burrow.

Concept Tested & Keywords

Concept Tested: Clinical assessment and identification of scabies.
Stem keywords: scabies, child, assessing, finding
Lead-in keywords: Which finding
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Negative lead-in flag: false

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E6 Medicine Harrison 22e Part 2 p. 1633-1635

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1982-1984

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 4 p. 78-80

Practise the full DSSSB - 28 August 2019 (Shift-1)

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