A parent reports that her 5-year-old child, who has had all recommended immunizations, had a mild fever 1 week ago, and now has bright red cheeks and a lacy red rash on the trunk and arms. The nurse recognizes that this child might have:

Question

1. Chickenpox (varicella).
2. German measles (rubella).
3. Roseola (Exanthem subitum).
4. Fifth disease (Erythema infectiosum).

Answer 1

4
Rationale:
1. Chickenpox (varicella) is unlikely if the child had all recommended immunizations. The rash of varicella progresses from papules to vesicles to pustules.
2. German measles (rubella) is unlikely if the child had all recommended immunizations. The rash of rubella is a pink maculopapular rash that begins on the face and progresses downward to the trunk and extremities.
3. Roseola typically occurs in infants, and begins abruptly with a high fever, followed by a pale pink rash starting on the trunk and spreading to the face, neck, and extremities.
4. Fifth disease manifests first with a flulike illness, followed by a red "slapped cheek" sign. Then a lacy maculopapular erythematous rash spreads symmetrically from the trunk to the extremities, sparing the soles and palms.