Exhibits

For each potential provider prescription, click to specify if the prescription is expected or unexpected for the adolescent. There must be at least 1 selection in every row. There does not need to be a selection in every column.

Rationale for Correct Choices:

• Scarlet fever: The child presents with fever, sore throat, strawberry-like tongue, and a characteristic erythematous rash. Petechiae on the palate and red, swollen pharynx are also suggestive of scarlet fever, which is caused by a group A Streptococcus infection.
• Initiate droplet precautions: Scarlet fever is caused by a bacterial infection (group A Streptococcus) that can spread through respiratory droplets, making droplet precautions necessary to prevent transmission to others.
• Administer amoxicillin: Amoxicillin is the antibiotic of choice for treating scarlet fever, as it targets the Streptococcus bacteria responsible for the infection. Proper antibiotic therapy is essential to prevent complications, such as rheumatic fever.
• Presence of abscess: Monitoring for the presence of abscesses, especially peritonsillar abscesses, is important in cases of untreated or severe streptococcal throat infections, which can lead to abscess formation.
• Level of consciousness: While this is not a direct sign of scarlet fever, monitoring the child's level of consciousness is important in case complications like sepsis or a severe infection arise, affecting the child’s overall condition.

Rationale for Incorrect Choices:

• Rheumatic fever: Rheumatic fever is a complication of untreated or inadequately treated group A Streptococcus throat infections, but the child’s presentation (such as the strawberry tongue and rash) is more consistent with scarlet fever. Rheumatic fever typically presents with migratory arthritis and carditis, which are not seen here.
• Kawasaki disease: Kawasaki disease presents with fever, conjunctival injection, and a red, cracked tongue, but it also includes a specific rash and the presence of erythema of the palms and soles, which are not described in this case.
• Measles: Measles typically presents with a high fever, cough, conjunctivitis, and a characteristic rash that starts on the face and spreads down the body. The child’s presentation, with a strawberry tongue and petechiae, does not fit for measles.
• Obtain a chest x-ray: While a chest x-ray can be useful in diagnosing pneumonia or other respiratory conditions, it is not necessary for diagnosing or managing scarlet fever. The primary concern here is the streptococcal infection in the throat.
• Prepare to administer vitamin A: Vitamin A is used in the treatment of measles to reduce complications, but it is not relevant in the management of scarlet fever. Amoxicillin is the mainstay treatment for scarlet fever.
• Administer aspirin: Aspirin is contraindicated in children with viral infections due to the risk of Reye's syndrome. It should not be administered in this case. Instead, amoxicillin is used to treat the bacterial infection.
• Proteinuria: Proteinuria is more commonly monitored in conditions like glomerulonephritis, which can follow streptococcal throat infections, but it is not a primary concern in this child, whose current diagnosis is more likely to be scarlet fever.
• Crackles in the lungs: Crackles in the lungs would indicate a respiratory infection, but the child’s lung examination is clear, and there is no evidence of pneumonia or other lung complications. Monitoring for crackles is not relevant in this case.
• Chorea: Chorea is a movement disorder seen in rheumatic fever, not in scarlet fever. While rheumatic fever can present with chorea, it is not relevant for this diagnosis, making this parameter irrelevant in this case.

A. Absence of Babinski reflex: The Babinski reflex (a fanning of the toes when the sole of the foot is stroked) is normal in infants and should be present until around 12 months of age. Its absence at 6 weeks would be atypical.
B. Absence of Moro reflex: The Moro reflex (a startle response) is typically present in newborns and may begin to disappear by 3-6 months of age. Its absence at 6 weeks would be concerning and could indicate neurological issues.
C. Closure of the posterior fontanel: The posterior fontanel typically closes by 6-8 weeks of age. This is a normal finding for a 6-week-old infant.
D. Closure of the anterior fontanel: The anterior fontanel typically closes between 12 and 18 months of age, not by 6 weeks. Therefore, closure of the anterior fontanel at 6 weeks would be unusual.