new_n_lost
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Five days after returning to his military base in South Carolina after survival training in the nearby countryside, an 18-year-old recruit reports to the infirmary complaining of a headache.
Physical examination reveals a fever, but no other abnormalities are noted. A few days later he returns to the infirmary with a maculopapular rash involving the hands and feet. The rash then spreads centripetally to involve the trunk. Which of the following diseases should be suspected?
A. Chickenpox
B. German measles
C. Measles
D. Mumps
E. Rocky Mountain spotted fever
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| unique1
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E
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| po
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DoWhatYouGotToDo!
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E. Rocky Mountain spotted fever
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| new_n_lost
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| new_n_lost
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The correct answer is E.
Take rashes involving the palms and soles (otherwise unusual sites) very seriously: only a small number of infections can cause this pattern, including Rocky Mountain spotted fever, meningococcemia, and secondary syphilis. Rocky Mountain spotted fever is caused by the rickettsia R. rickettsii, and is found throughout the United States, particularly in south central and eastern portions (not the Rocky Mountains). 3-12 days after a tick bite, patients develop malaise, frontal headache, and fever. Several days later, the rash described in the question stem develops. Other manifestations can include hepatosplenomegaly, thrombocytopenia, and (potentially fatal) disseminated intravascular coagulation.
Chickenpox (choice A), or varicella, is characterized by maculopapules that evolve into vesicles over hours to days, then eventually form crusts. Typical lesions first appear on the trunk and face and rapidly spread to involve other areas.
The maculopapular rash of German measles (choice B), or rubella, usually begins on the face, then spreads down the body.
Although the maculopapular rash of measles (choice C), or rubeola, can include the palms and soles, it typically begins along the hairline in frontal and temporal regions, then spreads down the trunk to the limbs.
Mumps (choice D) is characterized by fever, malaise, parotitis, and orchitis, but not a rash.
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| lq2006
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Rocky Mountain spotted fever
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