Medical Emergencies · patient case question
For Patient E, each statement about this illness is true EXCEPT one. Which is the EXCEPTION?
Patient case: Five patients, five medical problems
Patient: Five separate patients in one session
Chief Complaint: A: mid-appointment shakiness. B: routine care. C: reviewing a medication list. D: an occupational health question. E: a child brought in by a parent.
Background: A: type 1 diabetes, took her insulin but skipped breakfast. B: 40-pack-year smoker with a chronic productive cough. C: on long-term corticosteroid therapy. D: a dental assistant with a new serology report. E: 6-year-old with sore throat, fever and a rash.
Findings: A: shaky, sweating, confused but conscious and able to swallow; capillary glucose 54 mg/dL. B: barrel chest, prolonged expiration. E: a sandpaper-textured rash, and a tongue with a white coating through which swollen red papillae project.
Show answer and explanation
Correct answer: D. The causative organism is Staphylococcus aureus
- A. This IS true. Transmission is by direct contact and respiratory droplet, which is why it moves rapidly through schools and households.
- B. This IS true and is exactly what is described. The sequence runs from a WHITE coating through which swollen hyperplastic fungiform papillae project — the white strawberry tongue — which sloughs after a few days to leave a deep red surface with prominent papillae, the red or raspberry strawberry tongue.
- C. This IS true. The incubation period is short, roughly one to three days, which contributes to the speed of spread.
- D. CORRECT as the exception. SCARLET FEVER is caused by GROUP A BETA-HAEMOLYTIC STREPTOCOCCUS (Streptococcus pyogenes), specifically strains producing an erythrogenic (pyrogenic) exotoxin, which is what produces the rash. Staphylococcus aureus causes a different toxin-mediated illness, staphylococcal scalded skin syndrome, in which the skin blisters and peels rather than developing a sandpaper rash.
Note: Scarlet fever matters in dentistry mainly for what follows untreated group A streptococcal infection: ACUTE RHEUMATIC FEVER, which damages heart valves and creates a lifelong cardiac concern, and post-streptococcal glomerulonephritis. Treatment is penicillin. Keep the other causes of a strawberry tongue in the differential — KAWASAKI DISEASE and toxic shock syndrome — since both are serious and neither responds to antibiotics.
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