D) Type IV

Explanation: Erythema multiforme is an acute, self-limited, type IV hypersensitivity reaction.

C) Patent ductus arteriosus

Explanation: Patent ductus arteriosus is a common cardiac defect associated with congenital rubella syndrome.

B) Matted and rough

Explanation: Crusts appear as matted and rough accumulations on the surface of a weeping lesion, consisting of blood, serum, pus, and epithelial debris.

A) Herpangina

Explanation: Coxsackievirus can cause Herpangina and Hand-Foot-and-Mouth Disease in children.

C) Red-purple

Explanation: Purpura is characterized by a red-purple color due to bleeding into the skin.

C) Flat or palpable

Explanation: Purpura can be either flat or palpable, indicating the presence of bleeding into the skin.

B) Scarlet Fever

Explanation: Scarlet Fever is known as the 'Second disease' and is characterized by a fever and maculopapular skin rash.

C) Medications and infections

Explanation: Stevens-Johnson syndrome is primarily precipitated by medications (e.g., NSAIDs, certain antibiotics, antiepileptics) or, less commonly, viral and bacterial infections (e.g., mycoplasma, herpes simplex virus).

C) Congenital rubella

Explanation: Congenital rubella is specifically mentioned as a virus that can cause fever with a purpuric rash, particularly in congenital infections.

B) Extent of mucosal involvement

Explanation: Erythema multiforme minor manifests with localized target lesions without mucosal involvement, while erythema multiforme major involves extensive mucosal compromise that is potentially life-threatening.

A) Fatigue, diarrhea, abdominal pain, arthritis

Explanation: Nonspecific symptoms such as fatigue, diarrhea, abdominal pain, and arthritis may precede the onset of Kawasaki disease.

C) Raised and hypertrophic

Explanation: Raised end-stage scars are described as hypertrophic, indicating an overgrowth of tissue.

C) Atrophic

Explanation: Scars that are thin, depressed, and atrophic are referred to as atrophic scars.

B) <2-3 mm

Explanation: Petechiae are small purpura that measure less than 2-3 mm in size.

B) Weeping lesion

Explanation: Crusts form on the surface of a weeping lesion, where there is an accumulation of blood, serum, pus, and epithelial debris.

B) It is a result of an underlying condition

Explanation: Secondary skin lesions like crusts are typically the result of an underlying condition, such as a weeping lesion, and involve the accumulation of various substances like blood, serum, pus, and epithelial debris.

C) Rubella

Explanation: Rubella, also known as German Measles, is referred to as the 'Third disease' and presents with a fever and maculopapular rash.

B) Matted, retained accumulations of blood, serum, pus, and epithelial debris on the surface of a weeping lesion

Explanation: Crusts are secondary skin lesions characterized by matted, retained accumulations of blood, serum, pus, and epithelial debris on the surface of a weeping lesion.

D) Fifth disease

Explanation: Erythema infectiosum is also known as the 'Fifth disease' and is characterized by a fever and maculopapular rash.

B) Staphylococcus aureus

Explanation: Staphylococcus aureus is the bacterium responsible for causing bullous impetigo in children.

C) When it affects more than 30% of the skin

Explanation: Stevens-Johnson syndrome is referred to as toxic epidermal necrolysis (TEN) when more than 30% of the skin is affected.

E) Hepatitis

Explanation: Hepatitis is not listed as a complication of German measles (rubella). The complications include otitis media, sinusitis, pharyngitis, croup, laryngitis, bronchitis, pneumonia, secondary bacterial infection, viral encephalitis, Guillain-Barré syndrome (GBS), arthritis, idiopathic thrombocytopenic purpura (ITP), autoimmune hemolytic anemia (AHA), and congenital rubella syndrome.

B) Leukocytopenia with relative lymphocytosis

Explanation: A common hematological finding in a complete blood count (CBC) for measles virus is leukocytopenia with relative lymphocytosis and increased plasma cells.

C) Intravenous immunoglobulins (IVIG) and aspirin

Explanation: Treatment with intravenous immunoglobulins (IVIG) and aspirin is essential and should be initiated as soon as possible after diagnosis.

D) Deep and ulcerative

Explanation: End-stage scars are described as thin, depressed, and atrophic; raised and hypertrophic; or flat and pliable. They are not characterized as deep and ulcerative.

C) Blood, serum, pus, and epithelial debris

Explanation: Crusts are composed of matted, retained accumulations of blood, serum, pus, and epithelial debris on the surface of a weeping lesion.

B) High fever (>39 C) lasting more than 5 days

Explanation: A high fever greater than 39°C that lasts more than 5 days and does not respond to usual treatment is a key characteristic of Kawasaki disease.

A) High fever

Explanation: Kawasaki disease is characterized by high fever, among other symptoms.

A) Eye ointment

Explanation: Care of the eyes in a patient with measles involves the use of eye ointment to prevent complications.

B) Trunk and limbs

Explanation: Erythema marginatum typically affects the trunk and limbs, while the face is spared.

B) Elevated ESR

Explanation: Kawasaki disease is supported by findings such as elevated ESR or evidence of cardiac involvement on echocardiography.

D) No, it is not recommended

Explanation: Passive immunization with immunoglobulin is not recommended for postexposure prophylaxis of rubella.

C) German measles rash is scattered and not confluent

Explanation: German measles rash is scattered and not confluent, whereas measles rash is confluent.

B) Erythema and swelling of the tongue (strawberry tongue)

Explanation: Oropharyngeal mucositis in Kawasaki disease includes erythema and swelling of the tongue, often referred to as 'strawberry tongue', along with cracked and red lips.

D) All of the above

Explanation: End-stage scars can exhibit various characteristics, including being thin, depressed, and atrophic; raised and hypertrophic; or flat and pliable.

C) Ecchymosis

Explanation: Ecchymosis refers to patches of bleeding into the skin that are greater than 1 cm in size.

C) Size greater than 1 cm

Explanation: Purpura can vary in size but are not specifically defined by being greater than 1 cm; that characteristic is specific to ecchymosis.

C) Measles

Explanation: Measles is referred to as the 'First disease' and is characterized by a fever with a maculopapular skin rash.

E) All of the above

Explanation: HHV-6, HHV-7, Enteroviruses, and HHV-4 can all cause a fever with a maculopapular rash.

E) Genetic mutations

Explanation: Erythema multiforme is associated with infections (e.g., Mycoplasma pneumoniae, herpes simplex virus, histoplasmosis) and medications (e.g., NSAIDs, sulfonamides, antiepileptics), but not genetic mutations.

B) Hemorrhagic fever viruses

Explanation: Hemorrhagic fever viruses are known to cause fever with a purpuric rash, unlike Norovirus, Human papillomavirus, Hepatitis A, and Varicella-Zoster virus.

B) Nasopharynx, blood, and CSF

Explanation: Viral culture for diagnosing congenital rubella syndrome can be performed using samples from the nasopharynx, blood, and cerebrospinal fluid (CSF).

B) An acute, necrotizing vasculitis of unknown etiology

Explanation: Kawasaki disease (KD) is described as an acute, necrotizing vasculitis of unknown etiology, primarily affecting children under the age of five.

A) Immunization of seronegative women before pregnancy

Explanation: Immunizing seronegative women before pregnancy is a key preventive measure to avoid congenital rubella syndrome.

B) A dermatologic manifestation of rheumatic fever

Explanation: Erythema marginatum is a dermatologic manifestation of rheumatic fever.

B) Pliable

Explanation: Flat end-stage scars are described as pliable, meaning they are flexible and not raised or depressed.

B) Adenovirus

Explanation: Adenovirus is listed as one of the viruses that can cause fever with a purpuric rash, distinguishing it from other common viruses like Influenza, Rhinovirus, Hepatitis B, and Epstein-Barr virus.

C) A lethal, generalized, demyelinating inflammation of the brain caused by persistent measles virus infection

Explanation: SSPE is defined as a lethal, generalized, demyelinating inflammation of the brain caused by persistent measles virus infection.

A) Isolation of the patient till rash disappears

Explanation: One of the primary treatments for measles is to isolate the patient until the rash disappears to prevent the spread of the virus.

A) They should be kept away from susceptible pregnant women

Explanation: Infants with congenital rubella syndrome should be kept away from susceptible pregnant women when sent home to prevent transmission of the virus.

B) 2-6 days

Explanation: The incubation period for Scarlet Fever typically ranges from 2 to 6 days.

B) Chorionic villi and amniotic fluid samples

Explanation: Chorionic villi and amniotic fluid samples are used for diagnosing congenital rubella syndrome in a fetus.

A) Sensorineural hearing loss, cataracts, and cardiac defects

Explanation: The classic triad of defects in congenital rubella syndrome includes sensorineural hearing loss, cataracts, and cardiac defects such as patent ductus arteriosus.

C) Streptococcus viridans

Explanation: Streptococcus viridans is commonly associated with infective endocarditis, which can present with a petechial-purpuric rash.

E) Mycobacterium tuberculosis

Explanation: Mycobacterium tuberculosis is not typically associated with sepsis and a petechial-purpuric rash, unlike Neisseria meningitidis, Haemophilus influenzae type b, Streptococcus pneumoniae, and Pseudomonas aeruginosa.

B) Males

Explanation: Males are slightly more affected by Kawasaki disease compared to females.

B) Varicella-Zoster Virus (VZV)

Explanation: Chickenpox is caused by the Varicella-Zoster Virus (VZV), also known as Human Herpesvirus 3 (HHV-3).

E) Sixth disease

Explanation: Roseola Infantum, also known as 'erythema sabitum', is referred to as the 'Sixth disease' and is characterized by a fever and maculopapular rash.

C) Asian descent

Explanation: Kawasaki disease is more common among children of Asian descent.

A) Bed rest and antipyretic with paracetamol

Explanation: Supportive treatment for measles includes bed rest, antipyretic with paracetamol, good hydration, and nutrition.

B) Analgesics or short course of low-dose prednisone

Explanation: Analgesics or a short course of low-dose prednisone can be used to treat arthritis associated with parvovirus B19 in erythema infectiosum.

B) Blueberry muffin rash

Explanation: Petechiae and purpura, often referred to as a 'blueberry muffin rash,' are characteristic skin manifestations of congenital rubella syndrome.

C) RT-PCR

Explanation: The identification of the virus RNA in measles can be done directly via RT-PCR (Reverse Transcription Polymerase Chain Reaction).

B) Within 1-2 days of the rash

Explanation: In doubtful cases, measles IgM antibodies can be estimated as they appear within 1-2 days of the rash.

B) Prenatal serological testing

Explanation: All pregnant women should have prenatal serological testing to determine their immune status to rubella.

D) 28 days

Explanation: Women are cautioned to avoid pregnancy for 28 days after receiving the rubella-containing vaccine.

D) Roseola infantum rash starts on the cheeks

Explanation: Roseola infantum rash starts on the cheeks, whereas measles rash starts on the face and spreads downwards.

B) Persons vaccinated before 12 months of age

Explanation: Modified Measles occurs in individuals with partial protection against measles, such as those vaccinated before 12 months of age or those who received immune serum globulin.

E) Full exposure to the measles virus

Explanation: Modified Measles is caused by partial protection against measles, not by full exposure to the virus.

B) After 24 hours

Explanation: A patient with scarlet fever is no longer infectious after 24 hours of antibiotic treatment and may return to daycare or school.

B) Mild non-specific illness with mild fever, malaise, headache, and myalgia

Explanation: The initial phase of Erythema infectiosum, also known as the viremia phase, is characterized by mild non-specific symptoms such as mild fever, malaise, headache, and myalgia for 4-5 days.

C) Bullous lesions

Explanation: Staphylococcal scalded skin syndrome is characterized by bullous lesions and widespread skin peeling.

C) HHV-4

Explanation: HHV-4, also known as Epstein-Barr Virus (EBV), is associated with Infectious Mononucleosis and can cause a fever with a maculopapular rash.

D) Herpes simplex virus

Explanation: Herpes simplex virus is not listed among the viruses that cause fever with a purpuric rash, unlike Enterovirus, HIV, Hemorrhagic fever viruses, and Congenital CMV.

B) Recent infection

Explanation: The detection of rubella-specific IgM antibody usually indicates a recent infection with the rubella virus.

B) Males between 8-11 years of age

Explanation: SSPE primarily affects males between 8-11 years of age.

C) Coronary artery aneurysms

Explanation: The most concerning manifestation of Kawasaki disease is coronary artery aneurysms, which can lead to myocardial infarction or arrhythmias.

B) It has a well-defined outer border and central clearing

Explanation: Erythema marginatum appears as a centrifugally expanding pink or light red rash with a well-defined outer border and central clearing.

B) Acute appendicitis

Explanation: Acute appendicitis is a gastrointestinal complication of measles, along with mouth ulcers, gastroenteritis, and mesenteric lymphadenitis.

B) Erythematous, sandpaper-like rash

Explanation: Patients with Scarlet Fever commonly present with an erythematous, sandpaper-like rash, among other symptoms.

C) Hepatosplenomegaly

Explanation: Hepatosplenomegaly is listed as an early feature of congenital rubella syndrome, along with jaundice, hemolytic anemia, thrombocytopenia, petechiae and purpura (blueberry muffin rash), and transient meningitis and/or encephalitis.

B) Diabetes

Explanation: Diabetes is one of the endocrine disorders associated with the late features of congenital rubella syndrome, along with thyroid dysfunction.

D) Microcephaly

Explanation: Microcephaly is a late feature of congenital rubella syndrome, while jaundice, hemolytic anemia, pneumonia, and thrombocytopenia are early features.

C) Coronary arteries

Explanation: Kawasaki disease tends to affect the coronary arteries, which are crucial for supplying blood to the heart muscle.

B) Blueberry muffin rash

Explanation: A blueberry muffin rash is a characteristic feature of congenital rubella syndrome, often presenting as purpura/petechiae.

B) Petechial or hemorrhagic rash

Explanation: Black measles is a severe form of measles characterized by a petechial or hemorrhagic rash, indicating bleeding under the skin.

B) Erythromycin for 10 days or azithromycin for 5 days

Explanation: For patients hypersensitive to penicillin, erythromycin can be given for 10 days or azithromycin for 5 days as alternative treatments for scarlet fever.

A) HSV-1 and HSV-2

Explanation: Herpes Simplex Virus infections in children are caused by HSV-1 and HSV-2.

B) Atypical measles

Explanation: Atypical measles is specifically mentioned as a condition that can cause fever with a purpuric rash, distinguishing it from other viruses like Influenza, Hepatitis C, Epstein-Barr, and Human papillomavirus.

B) RT-PCR

Explanation: RT-PCR (Reverse Transcription Polymerase Chain Reaction) is used to detect rubella RNA in samples such as throat swab, CSF, blood, and urine.

C) Viral encephalitis

Explanation: Viral encephalitis is a neurological complication of German measles (rubella). Other complications include otitis media, sinusitis, pharyngitis, croup, laryngitis, bronchitis, pneumonia, secondary bacterial infection, Guillain-Barré syndrome (GBS), arthritis, idiopathic thrombocytopenic purpura (ITP), autoimmune hemolytic anemia (AHA), and congenital rubella syndrome.

D) Arthritis

Explanation: Arthritis is a complication of German measles (rubella) that affects the joints. Other complications include otitis media, sinusitis, pharyngitis, croup, laryngitis, bronchitis, pneumonia, secondary bacterial infection, viral encephalitis, Guillain-Barré syndrome (GBS), idiopathic thrombocytopenic purpura (ITP), autoimmune hemolytic anemia (AHA), and congenital rubella syndrome.

B) Human herpes 6 or 7 viruses

Explanation: Roseola Infantum is caused by human herpes 6 or 7 viruses, which are enveloped double-stranded DNA viruses.

B) 1-2 weeks

Explanation: The incubation period for Roseola Infantum is typically 1-2 weeks, which is the time between exposure to the virus and the onset of symptoms.

B) Measles IgM antibodies

Explanation: In doubtful cases, measles IgM antibodies can be estimated. These antibodies appear within 1-2 days of the rash and persist for 1-2 months in unimmunized persons.

C) Neisseria meningitidis

Explanation: Neisseria meningitidis is one of the bacteria that can cause sepsis with a petechial-purpuric rash, along with other bacteria such as gonococcal, pneumococcal, and H. influenzae type b.

D) 1 year

Explanation: An infant with congenital rubella syndrome is infectious for 1 year after birth.

B) Necrotizing vasculitis

Explanation: Kawasaki disease is characterized as an acute necrotizing vasculitis, which affects the walls of medium-sized arteries throughout the body.

C) Japanese and Korean children

Explanation: Kawasaki disease is more common in Japanese and Korean children, indicating a higher prevalence in these populations.

B) Unilateral cervical lymphadenopathy

Explanation: Kawasaki disease typically presents with cervical lymphadenopathy, which is mostly unilateral, helping to differentiate it from other diseases with bilateral or generalized lymphadenopathy.

B) On the trunk

Explanation: The polymorphous rash associated with Kawasaki disease usually originates on the trunk, which is a key diagnostic feature.

B) They develop erythema and edema

Explanation: During the first week of Kawasaki disease, patients often experience erythema and edema of the hands and feet, including the palms and soles.

B) To confirm recent infection

Explanation: Measurement of rubella-specific IgG over several months can be confirmatory for recent infection, as it helps track the immune response over time.

A) IgM for rubella in serum

Explanation: IgM for rubella in serum is used to diagnose the measles virus. Other diagnostic methods include clinical diagnosis and complete blood count (CBC) showing leukocytopenia with relative lymphocytosis and increased plasma cells.

B) Through droplet infection

Explanation: Roseola Infantum is transmitted through droplet infection, which involves the spread of the virus via respiratory droplets.

C) Viral encephalitis

Explanation: Viral encephalitis is a neurological complication of measles, along with subacute sclerosing panencephalitis (SSPE) and Guillain-Barré syndrome (GBS).

C) PCR

Explanation: PCR (Polymerase Chain Reaction) is used to detect rubella RNA in the diagnosis of congenital rubella syndrome.

D) IgM

Explanation: IgM antibody serology is used in the diagnosis of congenital rubella syndrome.

C) From rash onset till 7 days

Explanation: Patients with German measles should be isolated from the onset of the rash until 7 days after to prevent the spread of the infection.

B) Bed rest and antipyretic with paracetamol

Explanation: Supportive treatment for scarlet fever includes bed rest and the use of antipyretics like paracetamol to manage fever.

E) Retinal detachment

Explanation: Retinal detachment is not listed as an ocular manifestation of congenital rubella syndrome. The syndrome includes salt and pepper retinopathy, microphthalmos, congenital glaucoma, and cataracts.

B) Transplacentally acquired antibody

Explanation: Infants with disease modified by transplacentally acquired antibody can experience Modified Measles, which is a milder form of the disease.

B) Hand hygiene (frequent hand washing)

Explanation: One of the primary prevention methods for Parvovirus B19 infection is maintaining good hand hygiene through frequent hand washing.

B) Desquamation of fingertips and toes

Explanation: After 2-3 weeks of Kawasaki disease, patients may experience desquamation (peeling) of the fingertips and toes, which is a notable symptom in the later stages of the disease.

C) On the extensor surfaces of the extremities

Explanation: The truncal rash of Erythema infectiosum typically appears first on the extensor surfaces of the extremities and then spreads to involve the trunk.

C) 4 days

Explanation: The 'slapped-cheek' rash of Erythema infectiosum typically lasts for 4 days.

A) Hydrops fetalis

Explanation: Erythema infectiosum can cause TORCH infections, leading to complications such as hydrops fetalis, fetal death, and miscarriage.

B) Infected person (case)

Explanation: The primary source of infection for German measles is an infected person, from whom the virus can spread to others.

D) ≥ 7 years after infection

Explanation: SSPE usually develops 7 or more years after a measles infection.

B) They should be isolated

Explanation: Infants suspected of having congenital rubella syndrome should be isolated while in the hospital to prevent the spread of the virus.

A) Enhances the barrier function and immunity of the ocular, respiratory, and gastrointestinal epithelium

Explanation: Vitamin A supplementation enhances the barrier function and immunity of the ocular, respiratory, and gastrointestinal epithelium, which is beneficial in the treatment of measles.

C) Intravenous immunoglobulin

Explanation: Intravenous immunoglobulin may be used for immunocompromised persons with severe anemia or chronic infection caused by erythema infectiosum.

C) Otitis media

Explanation: Otitis media is a respiratory complication of measles, along with sinusitis, pharyngitis, croup, laryngitis, bronchitis, and pneumonia.

B) Group A beta hemolytic streptococci

Explanation: Scarlet Fever is caused by Group A beta hemolytic streptococci, specifically strains that produce erythrogenic toxins A, B, or C.

C) No, not required

Explanation: No investigations are required to diagnose measles in typical cases, as the diagnosis can be made based on clinical presentation.

C) 1-2 months

Explanation: Measles IgM antibodies appear within 1-2 days of the rash and persist for 1-2 months in unimmunized persons.

A) Avoidance of exposure to infected children during the infectivity period

Explanation: Avoidance of exposure to infected children during the infectivity period is crucial, especially for females during pregnancy, to prevent German measles.

D) Staphylococcus epidermidis

Explanation: Staphylococcus epidermidis is not typically associated with causing fever with a petechial-purpuric rash, unlike Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria gonorrhoeae.

C) Urine, stools, and respiratory secretions

Explanation: Infants with congenital rubella syndrome tend to shed live virus in urine, stools, and respiratory secretions.

B) Children up to 5 years old

Explanation: Kawasaki disease primarily affects children up to 5 years old, making it a significant pediatric condition.

B) Avoidance of exposure to infected children

Explanation: A key preventive measure for scarlet fever is avoiding exposure to infected children to prevent the spread of the infection.

C) A lethal, generalized, demyelinating inflammation of the brain caused by persistent measles virus infection

Explanation: SSPE is defined as a lethal, generalized, demyelinating inflammation of the brain caused by persistent measles virus infection.

B) The condition must be reported to the local or state health department

Explanation: Suspected congenital rubella syndrome is a nationally notifiable condition and must be reported to the local or state health department.

C) No treatment is necessary in most cases

Explanation: Erythema infectiosum is often self-limited, meaning it resolves on its own without the need for treatment in most cases.

B) Infants and young children (6 months to 3 years)

Explanation: Roseola Infantum is most common in infants and young children aged 6 months to 3 years.

C) Viral myocarditis

Explanation: Viral myocarditis is a cardiovascular complication of measles, which can also lead to congestive heart failure.

E) Blurred vision

Explanation: Blurred vision is not a symptom of Scarlet Fever. Common symptoms include fever, pharyngitis, flushed cheeks with perioral pallor, and a white-coated or strawberry-red tongue.

C) MMR vaccine

Explanation: The MMR vaccine is recommended for susceptible, nonpregnant females exposed to rubella to provide active immunization against the disease.

C) Antibiotics

Explanation: Supportive treatment for German measles includes bed rest, antipyretic with paracetamol, and treatment of complications. Antibiotics are not used as German measles is caused by a virus.

B) Painless bilateral conjunctivitis without exudate

Explanation: Kawasaki disease is characterized by painless bilateral 'injected' conjunctivitis without exudate, distinguishing it from other conditions that may involve painful or exudative conjunctivitis.

C) Measles rash is confluent

Explanation: Measles rash is confluent, whereas erythema infectiosum rash is rose-colored and discrete.

B) Blanching confluent maculopapular rash

Explanation: The exanthem stage of measles is characterized by a blanching confluent maculopapular rash, which is a key feature of this stage.

C) ≥ 7 years

Explanation: SSPE usually develops 7 or more years after a measles infection.

C) Regression of skin rash by the same sequence

Explanation: During the convalescence stage of measles, the skin rash regresses by the same sequence in 3-5 days.

C) A palpable lesion >1 cm with a rounded surface

Explanation: Nodules are palpable lesions that are greater than 1 cm in diameter and have a rounded surface.

C) 12-24 hours

Explanation: Koplik spots last for 12-24 hours before they disappear, marking a distinctive feature in the Prodromal stage of measles.

D) Asthma

Explanation: Complications of erythema infectiosum include myocarditis, aseptic meningitis, encephalitis, and hepatitis, but not asthma.

E) Diabetes

Explanation: Diabetes is not listed as a cause of fever with rash, unlike Kawasaki disease, Erythema marginatum, Rheumatoid arthritis, and drug reactions.

B) Keratitis

Explanation: Keratitis is an ocular complication of measles, along with optic neuritis, corneal ulceration, and opacification.

B) Through droplet infection

Explanation: Scarlet Fever is primarily transmitted via droplet infection from an infected person or carrier.

C) Intellectual disability

Explanation: Intellectual disability is a late feature of congenital rubella syndrome, along with CNS defects like microcephaly and panencephalitis, skeletal abnormalities, endocrine disorders, and vascular disease.

B) Ecthyma gangrenosum

Explanation: Ecthyma gangrenosum is associated with Pseudomonas aeruginosa and presents with a petechial-purpuric rash.

E) High birth weight

Explanation: High birth weight is not an additional feature of congenital rubella syndrome. The syndrome is associated with low birth weight, purpura/petechiae, hepatosplenomegaly, osteitis, and other manifestations.

C) On the face

Explanation: The rash of both German measles and measles typically starts on the face and spreads downwards.

C) 10 days

Explanation: Penicillin should be administered for a complete 10 days to effectively eradicate streptococci in the treatment of scarlet fever.

B) Children between 8 and 11 years of age

Explanation: SSPE primarily affects boys between 8 and 11 years of age.

B) It fades, leaving a brown discoloration and desquamation

Explanation: After approximately 5 days of onset, the measles rash fades, leaving behind a brown discoloration and desquamation.

C) An alteration in skin color but cannot be felt (<1 cm)

Explanation: A macule is defined as an alteration in skin color that cannot be felt and is less than 1 cm in diameter.

B) A palpable solid lesion <1 cm

Explanation: Papules are palpable solid lesions that are less than 1 cm in diameter.

D) A vesicle containing purulent material

Explanation: Pustules are vesicles that contain purulent material.

B) Prodromal, Exanthematous, Recovery

Explanation: The clinical picture of measles consists of three stages: the Prodromal stage (3-4 days), the Exanthematous stage (5 days), and the Recovery stage (3-5 days).

C) 3-day measles

Explanation: German measles is also known as the 3-day measles, highlighting its relatively short duration compared to other similar illnesses.

B) Through droplet infection

Explanation: German measles is primarily transmitted through droplet infection, where the virus spreads via respiratory droplets from an infected person.

B) Fever for at least 5 days + ≥ 4 other specific symptoms

Explanation: The clinical diagnosis of Kawasaki disease requires a fever for at least 5 days along with either ≥ 4 other specific symptoms or < 4 specific symptoms with involvement of the coronary arteries.

B) Slapped-cheek rash

Explanation: The characteristic rash of Erythema infectiosum is known as the 'slapped-cheek' rash, which presents suddenly on the face, giving the child a slapped cheek appearance.

C) Exercise, warm baths, or emotional stress

Explanation: The rash in Erythema infectiosum may periodically reappear with exercise, warm baths, or emotional stress.

C) Trunk

Explanation: The rash in Roseola infantum typically starts on the trunk and then spreads rapidly to the arms and neck, with minimal involvement of the face.

B) It causes transient cessation of erythropoiesis

Explanation: Parvovirus B19 invades erythroid progenitor cells, causing a transient cessation of erythropoiesis, which can lead to temporary anemia.

C) 16%

Explanation: Infection with rubella between weeks 13 and 20 of gestation carries a 16% risk of congenital defects.

B) Rheumatic fever

Explanation: Rheumatic fever is a complication of untreated or subclinical infection with group A streptococcus (GAS), particularly tonsillopharyngitis.

B) Rash fades with desquamation

Explanation: During the convalescence stage of scarlet fever, the rash fades within 3-4 days and is followed by desquamation, including on the palms and soles.

B) Mild cases of measles

Explanation: Modified Measles typically presents as mild cases of measles in persons with partial protection against the disease.

B) 3-4 days

Explanation: The measles rash disseminates to the rest of the body towards the feet in 3-4 days, sparing the palms and soles.

C) Maternal immunity

Explanation: A negative IgM and positive IgG result in a serologic assay for Parvovirus B19 indicates maternal immunity.

D) No maternal immunity

Explanation: A negative IgM and negative IgG result in a serologic assay for Parvovirus B19 indicates no maternal immunity.

C) Tiny white or bluish-gray spots on an erythematous background opposite lower molar teeth

Explanation: Koplik spots are pathognomonic for measles and are tiny white or bluish-gray spots on an irregular erythematous background, typically found opposite the lower molar teeth.

C) Rubella virus

Explanation: The Rubella virus is the causative organism of German measles, responsible for the infection and its symptoms.

C) At the hairline behind the ears

Explanation: The maculopapular rash of German measles typically begins at the hairline behind the ears and then extends to the trunk and extremities, sparing the palms and soles.

C) Fifth disease

Explanation: Erythema infectiosum is also known as fifth disease, which is a common childhood illness caused by Parvovirus B19.

B) Reassurance

Explanation: For intrauterine rubella infection occurring after 16 weeks of pregnancy, the recommendation is to provide reassurance, as the risk of severe congenital defects is significantly lower.

C) It increases

Explanation: The risk of fetal infection with Congenital Rubella Syndrome increases again in the third trimester.

C) Termination of pregnancy

Explanation: Termination of pregnancy is not a part of the treatment for congenital rubella syndrome; it is a recommendation for intrauterine rubella infection before 16 weeks. Treatment for congenital rubella syndrome focuses on supportive care and surveillance.

C) Behind the ears and often above the hairline

Explanation: The measles rash typically begins behind the ears and often above the hairline before spreading to other parts of the body.

B) Increased WBCs with marked neutrophilia

Explanation: In scarlet fever, a complete blood count (CBC) typically shows increased white blood cells (WBCs) with marked neutrophilia, indicating a bacterial infection.

B) Generalized lymphadenopathy

Explanation: Generalized lymphadenopathy is a usual symptom during the exanthem stage of measles.

C) Leads to death within 1-3 years of diagnosis

Explanation: SSPE leads to death within 1-3 years of diagnosis.

B) Vesicles are raised, fluid-filled lesions <1 cm, bullae are >1 cm

Explanation: Vesicles are raised, fluid-filled lesions that are less than 1 cm in diameter, while bullae are larger than 1 cm.

B) Increased anti-measles IgG

Explanation: In patients with subacute sclerosing panencephalitis (SSPE), cerebrospinal fluid analysis shows increased levels of anti-measles IgG, indicating an immune response to the measles virus.

C) 5 days

Explanation: The Exanthematous stage of measles lasts for 5 days, following the Prodromal stage and preceding the Recovery stage.

C) 7 days before and 7 days after rash appearance

Explanation: The infectivity period for German measles is 7 days before and 7 days after the appearance of the rash, indicating the time frame during which the infected person can spread the virus to others.

B) Thrombocytopenia

Explanation: Thrombocytopenia is characterized by a decrease in platelets, which can lead to a petechial rash due to bleeding under the skin.

C) Regression of skin rash by the same sequence

Explanation: During the convalescence stage of German measles, the skin rash regresses by the same sequence in 2-3 days.

B) It decreases

Explanation: The risk of fetal infection with Congenital Rubella Syndrome decreases in the second trimester.

B) Droplet transmission

Explanation: The main route of infection for erythema infectiosum is droplet transmission, although it can also be transmitted through blood and transplacentally.

B) Dementia and personality changes

Explanation: Stage I of SSPE is characterized by dementia (loss of cognitive functions) and personality changes, including behavioral and intellectual deterioration.

C) Undergo serologic assays for IgG and IgM against Parvovirus B19

Explanation: A pregnant mother post-exposure to Parvovirus B19 should undergo serologic assays for IgG and IgM to determine her infection status and immunity.

A) Stage I

Explanation: Stage I of SSPE is characterized by dementia and personality changes.

B) Paroxysmal delta waves and periodic sharp and slow wave complexes

Explanation: Electroencephalography in SSPE shows paroxysmal delta waves (very slow, 1-3/sec) and periodic sharp and slow wave complexes.

C) They rise late and are used for diagnosing GAS sequelae

Explanation: ASOT (anti-streptolysin O titer) and anti-hyaluronidase levels rise 2-3 weeks after infection and are used for diagnosing sequelae of Group A Streptococcus (GAS) rather than the acute infection.

C) Electroencephalography (EEG)

Explanation: Electroencephalography (EEG) is used in the diagnosis of subacute sclerosing panencephalitis (SSPE) to detect characteristic patterns in brain activity.

B) High fever, coryza, cough, and conjunctivitis

Explanation: The Prodromal stage of measles is characterized by an acute onset of high fever (40-40.5°C), coryza, cough, and conjunctivitis lasting for 3-4 days.

A) Hepatitis

Explanation: Rare complications of erythema infectiosum include hepatitis, myocarditis, and aseptic meningitis/encephalitis.

B) Petechial rash

Explanation: Henoch-Schönlein purpura (HSP) commonly presents with a petechial rash, which is a small red or purple spot caused by bleeding into the skin.

C) Parvovirus B19

Explanation: Erythema infectiosum is caused by Parvovirus B19, which commonly affects children aged 5 to 15 years.

B) Only before the onset of the rash

Explanation: Erythema infectiosum is infectious only before the onset of the rash. Once the rash appears, the individual is no longer infectious.

B) Clinical diagnosis

Explanation: Roseola infantum is primarily diagnosed clinically, although detection of HHV-6 IgM is possible for confirmation.

C) Epilepsy, myoclonus, and autonomic dysfunction

Explanation: Stage II of SSPE is characterized by epilepsy, myoclonus, and autonomic dysfunction.

C) Acute infection

Explanation: A positive IgM and positive IgG result in a serologic assay for Parvovirus B19 indicates an acute infection.

B) Group A beta streptococcus

Explanation: A throat swab in a patient with scarlet fever typically reveals the presence of Group A beta streptococcus, which is the causative agent of the infection.

A) Transient aplastic crisis

Explanation: Erythema infectiosum can lead to transient aplastic crisis, especially in individuals with underlying conditions such as sickle cell anemia (SCA), thalassemia, and spherocytosis.

C) IgM antibodies

Explanation: In adults or atypical cases of erythema infectiosum, IgM antibodies are used to diagnose acute infection, indicating a recent exposure to the virus.

C) 2-3 weeks

Explanation: The incubation period for German measles is 2-3 weeks, during which the virus resides in the mucosa of the nasopharynx and throat before symptoms appear.

B) Passive immunization with immunoglobulins

Explanation: For chronically ill and immunocompromised individuals, passive immunization with immunoglobulins is recommended after direct exposure to prevent measles.

D) Dementia

Explanation: Dementia is a symptom of Stage I, not Stage II. Stage II is characterized by epilepsy, myoclonus, and autonomic dysfunction.

B) 50%

Explanation: If rubella infection occurs between weeks 9 and 12 of gestation, 50% of infants can have abnormalities.

D) 40%

Explanation: If rubella infection occurs in the first 8 weeks of gestation, there is a 40% likelihood of spontaneous abortion or stillbirth.

B) Within 24-48 hours

Explanation: In scarlet fever, the rash typically appears within 24-48 hours, starting around the neck and then spreading to the trunk and extremities.

C) Inflammatory response

Explanation: Elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels are indicative of an inflammatory response, which is common in bacterial infections like scarlet fever.

C) Rapid antigen (Strept) test

Explanation: The rapid antigen (Strept) test from a throat swab is used to quickly diagnose scarlet fever by detecting the presence of Group A Streptococcus.

C) A patch is an alteration in skin color but cannot be felt (>1 cm)

Explanation: A patch is similar to a macule but is larger than 1 cm in diameter.

C) Death within 1-3 years of diagnosis

Explanation: The prognosis for patients diagnosed with subacute sclerosing panencephalitis (SSPE) is poor, with death typically occurring within 1-3 years of diagnosis.

B) Through a clinical diagnosis

Explanation: Erythema infectiosum is typically diagnosed clinically in children, meaning that the diagnosis is based on the observation of symptoms and physical examination rather than laboratory tests.

A) Vasculitis

Explanation: Vasculitis is a systemic inflammatory disorder that can present with fever and a petechial rash due to inflammation of blood vessels.

B) Febrile convulsions

Explanation: Febrile convulsions may occur as a complication in high-risk children with Roseola infantum, particularly due to the high fever associated with the condition.

A) Avoidance of exposure to infected children

Explanation: Avoiding exposure to infected children during the infectivity period is a recommended action to prevent measles infection.

C) Decerebration, spasticity, and extrapyramidal symptoms

Explanation: Stage III of SSPE is marked by decerebration, spasticity, and extrapyramidal symptoms.

D) Stage IV

Explanation: Stage IV of SSPE is characterized by a vegetative state and autonomic failure, where the function of the cortex is impaired, but the function of the brainstem is preserved.

A) Sickle cell anemia

Explanation: Erythema infectiosum can lead to transient aplastic crisis in individuals with blood disorders such as sickle cell anemia, thalassemia, and spherocytosis.

E) IgG antibodies

Explanation: IgG antibodies remain positive for life following infection with erythema infectiosum, indicating past exposure and long-term immunity.

C) 2 weeks following infection

Explanation: IgG antibodies typically appear 2 weeks following infection with erythema infectiosum and remain positive for life, indicating long-term immunity.

C) Children

Explanation: Erythema infectiosum is typically diagnosed clinically in children, based on the observation of symptoms and physical examination.

E) All of the above

Explanation: Vasculitis, thrombocytopenia, Henoch-Schönlein purpura, acute hemorrhagic edema of infancy, and malaria can all present with fever and petechial rash.

C) Termination of pregnancy

Explanation: For intrauterine rubella infection occurring before 16 weeks of pregnancy, the recommendation is to counsel for termination of the pregnancy due to the high risk of severe congenital defects.

B) Supportive care and surveillance

Explanation: The management of congenital rubella syndrome involves supportive care based on individual disease manifestations and surveillance to monitor for late-term complications.

B) Antiviral drugs like ganciclovir or foscarnet

Explanation: In immunocompromised hosts, the use of antiviral drugs such as ganciclovir or foscarnet can be considered for treating Roseola infantum.

B) Active immunization with MMR vaccine

Explanation: The primary method of preventing measles infection is through active immunization with the MMR (measles, mumps, rubella) vaccine.

B) Active immunization with MMR vaccine

Explanation: For immunocompetent individuals, active immunization with the MMR vaccine is recommended after direct exposure to prevent measles.

B) Prodromal, Exanthem, Convalescence

Explanation: German measles (Rubella) progresses through three stages: Prodromal (1-5 days), Exanthem (1-2 days), and Convalescence (2-3 days).

B) IV immunoglobulin (IVIG)

Explanation: High single-dose IV immunoglobulin (IVIG) is used in the early treatment of Kawasaki Disease to reduce the risk of coronary artery aneurysms.

B) Until the fever has subsided, then continued at a lower dosage for its antiplatelet effect

Explanation: High-dose oral aspirin is used until the fever has subsided, then continued with a lower dosage for its antiplatelet effect until ESR has normalized (1-2 months).

D) All of the above

Explanation: Congenital rubella syndrome can lead to various eye conditions including cataracts, retinopathy, and glaucoma.

C) Tender and enlarged postauricular and occipital lymph nodes

Explanation: During the prodromal stage of German measles, tender and enlarged postauricular and occipital lymph nodes appear one day before the onset of the skin rash and persist for around one week, which is pathognomonic.

B) Fleeting rose-colored spots in the soft palate

Explanation: Forchheimer sign is characterized by fleeting rose-colored spots in the soft palate, occurring in 20% of patients with German measles.

B) Via airborne droplets

Explanation: Congenital Rubella Syndrome is primarily transmitted to an unimmunized seronegative mother mainly via airborne droplets.

B) Via transplacental transmission from an infected mother

Explanation: Congenital Rubella Syndrome is transmitted to the fetus transplacentally from an infected mother.

A) First trimester

Explanation: The risk of fetal infection with Congenital Rubella Syndrome is highest in the first trimester, decreases in the second trimester, and increases again in the third trimester.

D) Acute hemorrhagic edema of infancy

Explanation: Acute hemorrhagic edema of infancy typically presents with fever and a petechial rash in infants.

B) Sudden onset of high fever (> 40°C)

Explanation: Roseola infantum is characterized by a sudden onset of high fever, typically greater than 40°C, which lasts for 3-4 days before abruptly dropping with the appearance of a rash.

B) To monitor for late-term complications

Explanation: Surveillance is crucial in the management of congenital rubella syndrome to monitor for late-term complications that may arise as a result of the infection.

A) It is a notifiable disease

Explanation: Measles is classified as a notifiable disease, meaning that cases must be reported to public health authorities.

C) 85%

Explanation: Infection with rubella in the first 8 weeks of gestation carries an 85% risk of congenital defects, with 40% of cases resulting in spontaneous abortion or stillbirth.

D) No significant risk

Explanation: Infection with rubella after 20 weeks of gestation does not seem to cause congenital defects.

D) Increased ESR and CRP

Explanation: Kawasaki Disease is supported by laboratory findings such as increased ESR (Erythrocyte Sedimentation Rate) and CRP (C-Reactive Protein), along with leukocytosis and thrombocytosis.

A) An acute glomerular inflammation caused by nephritogenic strains of group A Streptococcus pyogenes

Explanation: PSGN (Post-streptococcal glomerulonephritis) is an acute glomerular inflammation that results from a preceding infection with nephritogenic strains of group A (beta-hemolytic) Streptococcus pyogenes.

B) 1-6 weeks

Explanation: PSGN most commonly develops in children approximately 1-6 weeks following a group A streptococcal tonsillopharyngitis or possibly skin infections such as impetigo.

C) Measles virus (Robula)

Explanation: Measles is caused by the measles virus, also known as Robula, which is a highly contagious viral pathogen.

C) Bilateral sensorineural hearing loss

Explanation: Congenital rubella syndrome is associated with bilateral sensorineural hearing loss, which is one of the key features of the syndrome.

B) Persistent high fever, sore throat, headache, follicular tonsillitis

Explanation: The prodromal stage of scarlet fever is characterized by an acute onset of persistent high fever, sore throat, headache, and follicular tonsillitis.

C) Cataracts

Explanation: The triad (3C) of congenital rubella syndrome includes cardiac defects, cataracts, and cochlear defects (bilateral sensorineural hearing loss).

C) The virus infects the upper respiratory tract and regional lymph nodes

Explanation: During the pathophysiology of measles, the virus infects the upper respiratory tract (URT) and regional lymph nodes (L.Ns.), leading to viremia and spreading the virus to the respiratory tract, skin, and other organs.

D) Diabetes

Explanation: Diabetes is not listed as a complication of scarlet fever. The complications of scarlet fever include otitis media, bronchitis, sinusitis, meningitis, osteomyelitis, and arthritis.

C) Measles virus (rubeola)

Explanation: The combination of symptoms including a rash that started on the head and progressed to the trunk and extremities, runny nose, fever, cough, and red, crusty eyes, along with the patient's recent immigration and lack of immunization records, strongly suggests measles.

C) 39-40°C

Explanation: Patients with measles often present with high fever, typically in the range of 39-40°C.

E) Otitis media

Explanation: Otitis media is not associated with rheumatic fever. Rheumatic fever causes symptoms such as pancarditis, migratory polyarthritis, subcutaneous nodules, erythema marginatum, and Sydenham chorea.

B) Measles rash is confluent, rubella rash is scattered

Explanation: Measles rash tends to be confluent, meaning the spots merge together, whereas rubella rash is typically scattered and does not merge.

B) Koplik spots

Explanation: Koplik spots are small, white lesions on the buccal mucosa that are pathognomonic for measles and help in its diagnosis.

E) Sore throat

Explanation: While runny nose, fever, cough, and red, crusty eyes are common symptoms of measles, a sore throat is not typically associated with this disease.

D) 5 days before and 5 days after the onset of rash

Explanation: A person with measles is most infectious 5 days before and 5 days after the onset of the rash.

C) To evaluate coronary artery aneurysms

Explanation: Echocardiography is performed to evaluate coronary artery aneurysms in patients with Kawasaki Disease, and it should be done at diagnosis, at 2 weeks, and at 6-8 weeks after onset.

D) Cardiac defect

Explanation: Cardiac defects are a feature of congenital rubella syndrome, not intrauterine rubella infection. Intrauterine rubella infection is associated with miscarriage, preterm birth, and fetal growth restriction.

B) Patent ductus arteriosus (PDA)

Explanation: The most common cardiac defect associated with congenital rubella syndrome is patent ductus arteriosus (PDA), along with pulmonary stenosis (PS).

B) Infected child

Explanation: The primary source of infection for measles is an infected child, who can spread the virus to others.

C) In cases of treatment-refractory disease

Explanation: IV glucocorticoids are used especially in cases of treatment-refractory Kawasaki Disease, as they lower the risk of coronary involvement.

C) 10-12 days

Explanation: The incubation period for measles is 10-12 days, during which the virus resides in the mucosa of the nasopharynx and throat.

C) It has a sandpaper feel

Explanation: The rash in scarlet fever is brightly erythematous, diffuse, and finely papular, giving a sandpaper feel to the skin.

B) Red with perioral pallor

Explanation: In scarlet fever, the cheeks typically appear red and flushed with characteristic perioral pallor.

C) Droplet and airborne route

Explanation: Measles is extremely contagious and is primarily transmitted through the droplet and airborne route.