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Section 1

Five You Can't Ignore ⭐️

5 Rashes in Children

Memorising “textbook” descriptions of conditions is essential in the MSRA. You’re often expected to make a spot diagnosis based on a very classic history, and it’s rare that a question is designed to trip you up. Here are 5 key rashes in children and how they will (pretty much always) present in exams. 👶

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Images are unlikely to appear in the actual MSRA exam, so it's a waste of time focusing on differentiating skin conditions from pictures. Instead, concentrate on how examiners like to describe them. 📸

Measles

  • Classic Exam Description: Erythematous maculopapular rash starting behind the ears and spreading downward, typically following a high fever, coryza and conjunctivitis. Koplik spots (small white spots) on the buccal mucosa are pathognomonic and confirm the diagnosis.
  • Causative Organism: Measles virus.
  • Management: Supportive care.
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It's important to commit to memory the likely causative organism 🦠 as this is often tested in medical exams.

Rubella 

  • Classic Exam Description: Erythematous maculopapular rash starting on the face and spreading rapidly to the trunk and limbs, often accompanied by mild fever and lymphadenopathy.
  • Causative Organism: Rubella virus.
  • Management: Supportive care.
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It's easy to mix up measles and rubella. In exams, the absence of Koplik spots in rubella will help you easily differentiate it from measles.

Scarlet Fever

  • Classic Exam Description: Sandpaper-like rash, strawberry tongue, and circumoral pallor (paleness around the mouth), often following strep throat.
  • Causative Organism: Streptococcus pyogenes (Group A Streptococcus).
  • Management: Phenoxymethylpenicillin (penicillin V) for 10 days.
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You should remember that measles, rubella, and scarlet fever are notifiable diseases, so all cases must be reported to public health.

Parvovirus B19 (Erythema Infectiosum)

  • Classic Exam Description: Bright red rash on the face appearing like “slapped cheeks” followed by a lacy red rash on the trunk and limbs.
  • Causative Organism: Parvovirus B19 virus. 
  • Management: Supportive care.

Roseola Infantum

  • Classic Exam Description: High fever for several days followed by a sudden appearance of a pink maculopapular rash as the fever settles.
  • Causative Organism: Human Herpesvirus 6 (HHV-6).
  • Management: Supportive care.
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A common exam case would ask you what advice you would give to a worried parent so it's key to memorise when simply offering reassurance and supportive care is needed.