# A 6-year-old child is brought to the pediatric clinic with a 2-day history of fever, sore throat, and a rash. Which assessment finding would be most characteristic of scarlet fever? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542278 > language: ko > subject: Child Health ## 문제 A 6-year-old child is brought to the pediatric clinic with a 2-day history of fever, sore throat, and a rash. Which assessment finding would be most characteristic of scarlet fever? ## 보기 1. Koplik's spots on the buccal mucosa 2. Vesicular rash that crusts over 3. Petechial rash on the trunk and extremities 4. Sandpaper-like rash with circumoral pallor **✔ 정답** **정답: 4** ## 해설 Sandpaper-like rash with circumoral pallor is the most characteristic finding of scarlet fever, caused by group A streptococcus. Other options are typical of measles (Koplik's spots), chickenpox (vesicular rash), or meningococcemia (petechial rash). ## 심화 해설 Understanding Scarlet Fever Scarlet fever is an acute infectious syndrome caused by group A Streptococcus pyogenes, a gram-positive bacterium that produces pyrogenic exotoxins [1,4]. These exotoxins act as superantigens, causing an amplified hypersensitivity reaction that leads to the characteristic clinical manifestations [4]. The classic presentation includes fever, sore throat, and a distinctive rash, typically following streptococcal pharyngitis or tonsillitis [1,3]. Analyzing the Characteristic Rash The rash of scarlet fever is a direct result of the circulating streptococcal pyrogenic exotoxins affecting the skin. The correct answer is the fine, red, sandpaper-like rash that blanches with pressure. Why This is the Correct Answer The rash is described as a blanching, erythematous, maculopapular eruption with a texture often compared to sandpaper [1,4]. This "sandpaper-like" quality is a hallmark finding. The blanching nature of the rash is a key physical examination feature; when you press on the reddened skin, it turns white or pale before the color returns. This occurs because the erythema is due to dilation of capillaries, and pressure temporarily empties them of blood. The rash typically begins on the trunk and spreads, often sparing the face but with circumoral pallor [2]. Concurrent oral manifestations, such as "strawberry tongue," are also common [1,4]. Why the Other Options are Incorrect * Option 2: Vesicular rash that crusts over within 24 hours. This description is classic for varicella (chickenpox) infection, caused by the varicella-zoster virus, not a bacterial toxin-mediated rash. The lesions progress from macules to papules to vesicles that then crust over, which is a different pathophysiology from scarlet fever. * Option 3: Maculopapular rash that starts on the face and spreads downward. This progression is highly characteristic of rubeola (measles). While scarlet fever rash is maculopapular, it does not typically start on the face; it more commonly appears first on the trunk and has the distinct sandpaper texture, which is a critical differentiator [2]. * Option 4: Petechial rash that does not blanch with pressure. A non-blanching petechial rash indicates extravasation of blood into the skin, a sign of vasculitis or thrombocytopenia. This is a hallmark of serious conditions like meningococcemia, not the toxin-mediated capillary dilation seen in scarlet fever. The fact that the scarlet fever rash blanches is a crucial clinical clue that helps rule out these more emergent conditions [1]. Clinical Application for the NCLEX-RN For a pediatric patient with fever and sore throat, a nurse must be able to differentiate rashes based on their morphology and progression. When assessing a suspected scarlet fever case, the priority assessment finding is the unique texture and blanching quality of the rash. Palpating the rash is essential to detect the fine, sandpaper-like feel, and performing a blanch test helps confirm the diagnosis and rule out petechial causes. Recognizing this allows for early identification, prompt antibiotic treatment to prevent complications, and implementation of droplet precautions until 24 hours of effective antibiotic therapy has been completed [1,3].References (research sources) - [1]Scarlet FeverResearch articleSabir S, Nguyen AD. (2026) - [2]Localized Leg Erythema as the Primary Symptom of Scarlet Fever: An Atypical Presentation.Research articleIto Y. (2025) · DOI: 10.7759/cureus.79983 - [4]Recrudescence of Scarlet Fever and Its Implications for Dental Professionals.Research articleMatsubara VH, Christoforou J, Samaranayake L. (2023) · DOI: 10.1016/j.identj.2023.03.009 ## 임상 시나리오 Clinical Assessment A 6-year-old presents with 2-day history of fever, sore throat, and a diffuse erythematous rash. On examination, the skin feels like coarse sandpaper with a finely papular texture. Note the striking circumoral pallor—pale skin around the mouth contrasting with flushed cheeks. The tongue may appear white-coated initially (white strawberry tongue) and later become red and swollen (red strawberry tongue). Pharynx is erythematous with possible exudate and petechiae on the soft palate. Anterior cervical lymphadenopathy is often present. Diagnostic Workup Perform a rapid antigen detection test (RADT) for Group A Streptococcus from a throat swab. If negative in a child, confirm with a throat culture. The Centor or McIsaac criteria can help guide testing decisions. In scarlet fever, the clinical presentation of pharyngitis with a sandpaper rash and circumoral pallor is highly suggestive, but microbiological confirmation is standard. Consider a complete blood count if systemic illness is severe. Management & Treatment Initiate antibiotic therapy: Penicillin V (oral) or amoxicillin for 10 days is first-line. For penicillin-allergic patients, use cephalexin or clindamycin. A single dose of intramuscular benzathine penicillin G is an alternative if adherence is a concern. Supportive care includes antipyretics (acetaminophen or ibuprofen) and adequate hydration. Emphasize that the child is no longer contagious after 24 hours of antibiotics. Educate parents to complete the full course to prevent complications like acute rheumatic fever or post-streptococcal glomerulonephritis. Return to school is permitted after 24 hours on antibiotics and clinical improvement. Complications & Follow-Up Monitor for suppurative complications (peritonsillar abscess, otitis media) and non-suppurative sequelae (acute rheumatic fever, post-streptococcal glomerulonephritis). Desquamation of the skin, especially on the palms and soles, may occur 1-2 weeks after the rash fades. No routine follow-up throat culture is needed unless symptoms recur. Advise parents to return if the child develops joint pain, dark urine, or decreased urine output, which could indicate immune-mediated complications. ## 핵심 개념 - **Scarlet fever** — Scarlet fever. A disease caused by infection with Group A beta-hemolytic streptococci (Group A Streptococcus pyogenes), characterized by a distinctive rash and systemic symptoms due to erythrogenic toxin. - **Circumoral pallor** — Circumoral pallor. A phenomenon where the area around the mouth appears relatively pale when there is a rash-like redness on the face. One of the diagnostic signs of scarlet fever. - **Sandpaper-like rash** — Rash like sandpaper. A fine, rough red rash that feels like sandpaper when touched. The most characteristic skin finding of scarlet fever. - **Strawberry tongue** — Strawberry tongue. A condition where the papillae of the tongue become red and swollen, and the white coating peels off, making it look like the surface of a strawberry. It can appear in scarlet fever and Kawasaki disease. - **Group A Streptococcus** — Group A Streptococcus. A gram-positive coccus that causes various infections such as pharyngitis, scarlet fever, cellulitis, and toxic shock syndrome. It is also the cause of non-suppurative late complications like rheumatic fever and glomerulonephritis. ## 같은 주제 문제 - [A 6-year-old child is brought to the pediatric clinic with a 2-day history of fever, sore …](https://mymerci.kr/pages/nclex_q.php?qn_id=542277) - [A 7-year-old child is brought to the pediatric clinic with a 2-day history of fever and so…](https://mymerci.kr/pages/nclex_q.php?qn_id=542279) - [A 6-year-old child is admitted to the pediatric unit with a diagnosis of scarlet fever. Wh…](https://mymerci.kr/pages/nclex_q.php?qn_id=542280) - [A 4-year-old child is admitted to the pediatric unit with a diagnosis of scarlet fever. Wh…](https://mymerci.kr/pages/nclex_q.php?qn_id=542281) - [A 6-year-old child is diagnosed with scarlet fever. Which nursing intervention should be t…](https://mymerci.kr/pages/nclex_q.php?qn_id=542282) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._