Derm Cases · Dermatology / Paediatrics / Infectious Disease / Emergency Medicine
OSCE — paediatric fever and rash: exanthem patterns and red flags
Eight-minute station on pattern recognition of classic paediatric exanthems, exclusion of meningococcaemia and Kawasaki disease, measles public-health actions, and safe disposition.
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Study tools
Target exams
NEET-PGINICETUSMLEPLABMRCP
Prompt
Eight-minute station on pattern recognition of classic paediatric exanthems, exclusion of meningococcaemia and Kawasaki disease, measles public-health actions, and safe disposition.
Brief (to candidate)
A 3-year-old with incomplete immunisation has fever, cough, coryza, conjunctivitis and a new cephalocaudal rash. Alternative stems include roseola timing, slapped cheek, HFMD, Kawasaki criteria, and purpura with shock. You have 8 minutes to pattern-match, exclude emergencies, and plan care.
Candidate instructions
- Identify the likely exanthem using timing and morphology.
- State measles public-health actions when relevant.
- Exclude meningococcus and Kawasaki.
- Give supportive care and return precautions.
- Counsel special risks (pregnancy/B19, aplastic crisis).
Examiner checklist
| Domain | Expected |
|---|---|
| Measles pattern | 3 Cs, Koplik, day 3–4 cephalocaudal rash; incomplete MMR raises suspicion; notifiable; isolate[1] |
| Other patterns | Roseola fever-then-rash; fifth slapped cheek + lace; HFMD oral+acral vesicles; scarlet sandpaper/Pastia/strawberry[3][4][5] |
| Emergencies | Non-blanching purpura + toxicity → immediate antibiotics; Kawasaki fever ≥5 d + mucocutaneous criteria → IVIG + aspirin[10][12] |
| Supportive care | Hydration, antipyretics (aspirin caution in viral illness), return precautions |
| Communication | Clear without blame on vaccines; explain when to re-attend |
Model key actions
- Pattern-match classic exanthems and name dangerous mimics first.
- Trigger measles public-health pathway when indicated.[1]
- Treat purpura and Kawasaki as time-critical.[10][12]
Common errors
- Discharging toxic purpura as viral.
- Missing incomplete Kawasaki.
- Calling measles a drug rash without isolation.
References6ShowHide
- [1]Hübschen JM, Gouandjika-Vasilache I, Dina J. Measles. Lancet, 2022.PMID 35093206
- [3]Leung AKC, Lam JM, Barankin B, et al. Erythema Infectiosum: A Narrative Review. Current Pediatric Reviews, 2024.PMID 37132144
- [4]Leung AK, Lam JM, Barankin B, et al. Roseola Infantum: An Updated Review. Current Pediatric Reviews, 2024.PMID 36411550
- [5]Leung AKC, Lam JM, Barankin B, et al. Hand, Foot, and Mouth Disease: A Narrative Review. Recent Advances in Inflammation & Allergy Drug Discovery, 2022.PMID 36284392
- [10]McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease. Circulation, 2017.PMID 28356445
- [12]Rambaud J. Purpura fulminans in children. La Revue du praticien, 2021.PMID 34553537