Measles

Casebank History
1

Where you are:
You are an FY2 in GP.

Who the patient is:
Mr George Smith, aged 18, came to you with rash.

What you must do:
Please talk to him, take history, discuss your plan of management and address the concerns.

Data Gathering

D: How can I help you? P: I have got rash al over my body.
D: Tell me more about it?
P: It started from the face and now it has appeared on my neck, chest and legs.
D: Since when ? P: Yesterday.
D: How did it start? P: It started on its own.
D: Does the rash come and go? P: No
D: Does anything make it better? P: No
D: Does anything make it worse? P: It’s getting worse.
D: Any Discharge? P: No
D: Any itchiness? P: Yes, it is itchy
D: Any bleeding? P: No
D: Any ulceration? P: No
D: Any other symptoms? P: I have fever from last 3 days and it was 38.5C.
D: Did you take anything for it? P: Paracetamol and it helped.
D: Anything else?
P: I have runny nose with the fever.
D: Anything else?
P: Like what?
D: Any redness or soreness in your eyes?
D: Any ulcers in the mouth?
D: Any loss of appetite?
D: Do you feel tired?

Ask about PMH, Lifestyle and Psychosocial history.
D: Do you have any kind of stress? P: No
D: Did you take MMR vaccine? P: No

Examination:

  • I would like to check your vitals and examine your lesion.
  • I would like to send for some initial investigations including Routine Blood Test.

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D: Do you have any idea what’s going on with you? (ICE)

Management

  • From my assessment, we are suspecting you may have a condition which we call measles.
  • It is a viral illness and can be very unpleasant due to its symptoms such as fever, runny nose and cough etc.
  • Anyone can get measles if they are not vaccinated or have not had it before. The infection usually takes 7 to 10 days to clear out.
  • The measles rash appears around after 2 to 4 days after the second day after the rash develops.

Treatment

  • Paracetamol/Ibuprofen
  • Drink plenty of water
  • Symptomatic

General Advice

  • Stay away from work for at least 4 days from when the measles rash first appeared.
  • Avoid contact with people who are vulnerable such as young children and pregnant women.
  • If you develop any chest pain, shortness of breath, coughing up blood, drowsiness, confusion or fits, please come back to us.