A nonimmunized child appears at the clinic with a visible rash. Which of the following observations indicates the child may have rubeola (measles)?
A. Small blue-white spots are visible on the oral mucosa.
B. The rash begins on the trunk and spreads outward.
C. There is low-grade fever.
D. The lesions have a “teardrop on a rose petal” appearance.
Correct Answer: A. Small blue-white spots are visible on the oral mucosa.
Koplik’s spots are small blue-white spots visible on the oral mucosa and are characteristic of measles infection. Most cases show the characteristic Koplik spots of the disease, located in the buccal mucosa at the height of the second molar, and appear two to three days before the rash and disappear on the third day.
Option B: The body rash typically begins on the face and travels downward. The second phase, the eruptive, is characterized by the appearance of a maculopapular rash, initially fine that subsequently becomes confluent. The rash begins behind the auricle and along the hair implantation line, and extends downward to the face, trunk, and extremities.
Option C: High fever is often present. The primary or prodromal phase lasts four to six days and is characterized by the presence of high fever, malaise, coryza, conjunctivitis, palpebral edema, and dry cough.
Option D: “Teardrop on a rose petal” refers to the lesions found in varicella (chickenpox). The characteristic chickenpox vesicle, surrounded by an erythematous halo, is described as a dewdrop on a rose petal. Chickenpox is clinically characterized by the presence of active and healing lesions in all stages of development within affected locations. Lesions characteristically heal without scarring, although excoriation or secondary bacterial superinfection predisposes to scar formation.