Table of Contents

Alice Chaney iHuman Case Study

Alice Chaney is a 2-year-old female presenting to the clinic with her mother with chief complaint of a rash that started this morning and has spread significantly. She reports a recent history of fever (103°F) that began 3 days ago but resolved 24 hours prior to the rash appearance, along with associated upper respiratory symptoms including cough and runny nose.

In this comprehensive guide, we’ll walk you through how to approach her case, from initial pediatric assessment through systematic physical examination to the final diagnosis of Exanthema Subitum (Roseola). You’ll learn the key clinical reasoning steps for pediatric viral exanthems, what the iHuman grading rubric expects, and a complete step-by-step solution to help you confidently navigate this complex pediatric case simulation involving viral illnesses and childhood rash evaluation.

Alice Chaney iHuman Case Overview (Doorway Information)

Patient Overview: Alice Chaney is a 2-year-old female presenting with chief complaint of rash that started this morning and has spread rapidly across her body. She was brought to the clinic by her mother following a recent febrile illness that resolved just before the rash appearance.

Key Background Information:

Age/Gender: 2-year-old female
Height/Weight: 2’10” (86cm) / 28.0lb (12.7kg)
Chief Complaint: Rash since this morning that has spread significantly
Duration: Recent onset following resolution of 3-day febrile illness
Fever History: High fever (103°F) that started 3 days ago and resolved 24 hours ago
Presenting Situation: Pediatric clinic presentation with concerned mother
Associated Symptoms: Cough, runny nose, and recent high fever that has resolved
Significant History: No known allergies, no current medications, recent febrile illness
Current Status: Afebrile child with new-onset rash distribution
Risk Factors: Age group 6 months to 2 years, recent viral prodrome
Rash Characteristics: Started on abdomen, spread to extremities, non-pruritic

The patient appears alert and interactive during assessment, with notable dermatologic findings including maculopapular pink rash on trunk and extremities following recent febrile illness. Her presentation is consistent with viral exanthem, specifically Exanthema Subitum (Roseola), making this an excellent case for learning systematic pediatric assessment and viral illness recognition skills.

Alice Chaney (2 y/o female) – Pediatric Viral Exanthem Assessment

CC: Rash since this morning that has spread significantly
MSAP: Exanthema Subitum (Roseola) – viral exanthem following resolution of high fever in a previously well 2-year-old
Associated symptoms: Recent resolution of high fever, persistent cough and runny nose, maculopapular rash distribution
History: Recent 3-day febrile illness with fever up to 103°F, upper respiratory symptoms, no known sick contacts
High-risk factors: Age group 6 months to 2 years, typical viral exanthem pattern, post-febrile rash appearance

History Questions:

How can I help your daughter today?
Can you tell me more about this rash and when it started?
When did you first notice the rash, and where did it begin?
Tell me about any fever she’s had recently
When did her fever start, and how high did it get?
Has the fever completely resolved now?
Can you describe what happened two to four days before the rash started?
Does she have any other symptoms or concerns we should discuss?
On what part of her body did the rash start, and where has it spread?
Is the rash painful or itchy for her?
What treatments have you tried for her symptoms?
Does she have any known allergies?
Is she taking any over-the-counter or prescription medications?
Has she been coughing, and is she bringing up any sputum?
How has her appetite been during this illness?
How many wet and dirty diapers is she having per day?
Has she been exposed to anyone who is sick?
How is she acting compared to her normal behavior?
Any changes in her sleep patterns?
Tell me about her eating and drinking during this illness?

Physical Exam:

Vitals: Temperature, pulse, blood pressure (if cooperative), respirations, oxygen saturation, pain assessment (age-appropriate scale)
General appearance: Level of alertness, interaction with caregiver, apparent distress, activity level, hydration status
Dermatologic Assessment:
- Systematic evaluation of rash distribution and characteristics
- Assessment of lesion morphology (macular, papular, maculopapular)
- Evaluation of rash color, blanching, and pattern
- Documentation of areas affected and progression
HEENT examination:
- Head and fontanelle assessment (if applicable)
- Eye examination for conjunctival changes
- Ear examination for signs of infection
- Throat and oral cavity evaluation
- Lymph node palpation
Cardiovascular Assessment:
- Heart rate and rhythm evaluation
- Assessment for murmurs or extra sounds
- Peripheral perfusion and capillary refill
Respiratory Assessment:
- Respiratory effort and pattern
- Lung sounds and adventitious sounds
- Assessment for respiratory distress
Abdominal Assessment:
- Inspection, palpation for organomegaly
- Assessment for tenderness or masses
Neurological Assessment:
- Age-appropriate cognitive assessment
- Motor function and reflexes
- Assessment for signs of meningeal irritation

Assessment Note: A.C. is a 2-year-old female presenting with characteristic viral exanthem following resolution of high fever. Physical examination notable for maculopapular pink rash on trunk and extremities with clear progression pattern following febrile illness. Her presentation is consistent with Exanthema Subitum (Roseola) in the typical age group with classic symptom progression.

Diagnostic Testing: Generally clinical diagnosis based on characteristic presentation; rarely requires laboratory testing

Diagnosis: Exanthema Subitum (Roseola)

Plan:

Supportive care and symptom monitoring
Parent education about viral exanthem and expected course
Follow-up instructions and return precautions
Fever management strategies for future episodes
Isolation precautions during acute phase

Alice Chaney SOAP Note

Patient: Alice Chaney

Subjective Data

CC: 2-year-old female presents with “rash since this morning that has spread a lot”

HPI: 2-year-old previously healthy female presents to pediatric clinic with mother for evaluation of new-onset rash. Mother reports that patient developed high fever 3 days ago that reached 103°F. During the febrile period, patient also experienced cough and runny nose but remained relatively well-appearing despite high temperature. Fever resolved completely 24 hours ago, and this morning mother noticed a pink rash that started on patient’s abdomen and has rapidly spread to arms and legs. Patient does not appear to be bothered by the rash, and it is not pruritic. Mother denies any known sick contacts and reports no recent travel or new exposures.

Patient has continued to eat and drink normally, has normal urine output and bowel movements. No vomiting or diarrhea. Cough and runny nose persist but have improved since fever resolution. Mother is concerned about the rash appearance and spreading pattern.

Medications: None currently; acetaminophen given during febrile period

Allergies: No known drug, food, or environmental allergies reported

PMH: Previously healthy 2-year-old with normal growth and development, up-to-date vaccinations

Family History: No significant family history of skin conditions or immunodeficiency

Social History: Lives with both parents, attends daycare, no recent travel, no known sick contacts

Review of Systems: Notable for recent high fever, persistent cough and runny nose, new-onset non-pruritic rash. Denies irritability, decreased feeding, vomiting, diarrhea, or lethargy.

Objective Data

General: Alert, active, well-appearing 2-year-old female, appropriate interaction with mother, no acute distress

Vital Signs: Temperature 98.6°F, Heart Rate 110 bpm, Respiratory Rate 24/min, Blood Pressure (if obtained), Oxygen Saturation 99% on room air

Physical Examination:

Appearance: Well-nourished, well-developed 2-year-old, appropriate for stated age
HEENT: Normocephalic, atraumatic, eyes clear without discharge, ears clear, throat mildly erythematous, no lymphadenopathy
Cardiovascular: Regular rate and rhythm, no murmurs, rubs, or gallops, good peripheral perfusion
Respiratory: Clear lung sounds bilaterally, no respiratory distress, mild residual cough noted
Abdomen: Soft, non-tender, no organomegaly or masses
Skin: Maculopapular pink rash noted on trunk, abdomen, and extremities. Lesions are discrete, 2-4mm in diameter, blanch with pressure. Rash most prominent on trunk with extension to arms and legs. No vesicles, pustules, or desquamation noted.
Neurological: Alert and responsive, age-appropriate behavior, no focal deficits

Growth Parameters: Height 2’10” (86cm), Weight 28.0lb (12.7kg) – appropriate for age

Assessment

Primary Diagnosis: Exanthema Subitum (Roseola) (B08.20)

Secondary Concerns:

Viral upper respiratory infection, resolving
Post-viral rash (resolved fever followed by characteristic rash)

Differential Diagnoses

Exanthema Subitum (Roseola): Classic presentation of high fever in well-appearing child for 3-5 days followed by characteristic rash upon fever resolution. Roseola typically affects children between 6 months and 2 years, presents with sudden high fever (103-105°F) lasting 3-5 days, followed by distinctive maculopapular pink rash that starts on trunk and spreads to extremities.

Human Parvovirus 19 (Fifth Disease): Parvovirus B19 can cause fever and rash, but typically presents with characteristic “slapped cheek” appearance on face and spreads to chest, back, buttocks, and extremities. Less likely given rash distribution and pattern.

Rubella (German Measles): Can cause fever and rash, but rash typically starts on face and spreads downward. Patient’s vaccination status makes this unlikely.

Measles: Would present with higher fever, conjunctivitis, coryza, cough (4 C’s), and Koplik spots. Rash pattern differs from current presentation.

Drug Reaction: No recent medication exposure reported, making this unlikely.

Most Likely Diagnosis: Exanthema Subitum evidenced by classic pattern of high fever in well-appearing child followed by sudden onset of pale rose-pink maculopapular rash starting on trunk after fever resolution, occurring in typical age group of 6 months to 2 years.

Plan

Health Promotion: ✓ Routine Pediatric Care – Continue regular well-child visits and maintain vaccination schedule ✓ Growth and Development Monitoring – Ongoing assessment of developmental milestones and growth parameters ✓ Infectious Disease Prevention – Education about hand hygiene and infection control measures ✓ Parental Education – Comprehensive education about viral exanthems and normal childhood illnesses

Screening: ✓ Symptom Monitoring – Close observation for fever recurrence or complications ✓ Rash Assessment – Monitor rash progression and resolution pattern ✓ Hydration and Nutrition – Ensure adequate fluid intake and nutrition during recovery

Interventions: ✓ Supportive Care – Symptomatic treatment for persistent cough and congestion ✓ Fever Management – Parent education about appropriate fever management strategies ✓ Comfort Measures – Cool baths or lightweight clothing for comfort during rash phase ✓ Isolation Precautions – Guidelines for daycare return and prevention of transmission

Complete Step-by-Step Guide to Writing the Alice Chaney iHuman Case Study

Completing the Alice Chaney iHuman case requires a systematic approach focused on pediatric viral exanthem assessment and childhood rash evaluation. This comprehensive guide will walk you through each section of the simulation, providing specific strategies and key points to ensure you achieve the required 70% score.

Step 1: Pre-Case Preparation and Initial Approach

Before diving into the case, take a moment to review the doorway information and formulate your initial clinical approach.

Key Information to Note:

2-year-old female with new-onset rash
Recent high fever that resolved before rash appearance
Consider viral exanthems, particularly Roseola
Age group typical for Exanthema Subitum

Initial Clinical Mindset: Approach this case with viral exanthems as your primary consideration. The age (2 years old), recent high fever pattern, and post-febrile rash appearance immediately suggest Roseola (Exanthema Subitum), which commonly affects children between 6 months and 2 years with distinctive fever-then-rash pattern.

Step 2: Conducting the History of Present Illness (HPI)

The HPI is crucial for establishing the foundation of your pediatric diagnosis. Use systematic questioning while keeping childhood viral illness considerations in mind:

Onset: Ask about when rash started and relationship to recent illness

Key points to elicit: Timeline of fever resolution and rash appearance

Location: Determine rash distribution and spread pattern

Target response: Started on abdomen, spread to extremities

Duration: How long symptoms have persisted

Important detail: Recent fever lasting 3 days, rash new-onset

Character: Detailed description of rash and associated symptoms

Critical descriptors: Maculopapular, pink, non-pruritic, spreading pattern

Aggravating factors: What makes symptoms worse

Essential findings: Activity level, environmental factors

Relieving factors: What provides relief

Key response: Fever relief with acetaminophen, rash not bothersome

Timing: Pattern and relationship to fever

Important pattern: Rash appeared after complete fever resolution

Severity: Impact on child’s behavior and function

Typical response: Well-appearing child despite rash, minimal functional impact

Associated Symptoms:

Ask specifically about: Recent fever pattern, upper respiratory symptoms, appetite, activity level
Key findings: High fever (103°F), cough, runny nose, normal behavior

Step 3: Review of Systems (ROS)

Conduct a thorough but focused ROS, paying special attention to pediatric viral illness systems:

Constitutional:

Recent fever patterns, energy levels, appetite changes
Sleep patterns and activity level
Weight loss or failure to thrive

Dermatologic:

Rash characteristics, distribution, and progression
Pruritus, pain, or discomfort from rash
Previous skin conditions or allergic reactions

Respiratory:

Cough, congestion, difficulty breathing
Upper respiratory symptoms
Any concerning respiratory signs

Gastrointestinal:

Appetite, feeding patterns, vomiting, diarrhea
Fluid intake and urine output
Abdominal pain or discomfort

Neurological:

Behavior changes, irritability, lethargy
Any seizure activity during fever
Developmental appropriate responses

Step 4: Past Medical History, Social History, and Family History

Past Medical History:

Previous febrile illnesses or rash episodes
Vaccination history and schedule
Any chronic medical conditions
Previous hospitalizations or significant illnesses

Social History:

Daycare or school attendance
Recent travel or new exposures
Living situation and family contacts
Known sick contacts or outbreaks

Family History:

Family history of skin conditions
Immunodeficiency disorders
Similar recent illnesses in family members
Genetic or hereditary conditions

Step 5: Physical Examination Strategy

Perform a comprehensive pediatric physical examination:

General Assessment:

Expected findings: Well-appearing, interactive child with characteristic rash
Critical component: Age-appropriate behavior and activity level

Vital Signs:

Look for: Normal temperature (post-febrile), stable vital signs for age

Dermatologic Examination:

Comprehensive rash assessment: distribution, morphology, characteristics
Look for: Pale rose-pink maculopapular rash starting on trunk and spreading to neck, extremities, lasting 24-48 hours

Systematic Physical Exam:

HEENT examination for complications
Cardiovascular and respiratory assessment
Abdominal examination for organomegaly
Neurological assessment for age

Risk Assessment:

Comprehensive assessment for serious complications
Hydration and nutrition status evaluation

Step 6: Developing Differential Diagnoses

Propose at least 3-4 appropriate differentials with rationales:

Primary Consideration: Exanthema Subitum (Roseola)

Supporting evidence: Classic post-febrile rash pattern, appropriate age group

Secondary Considerations:

Human Parvovirus 19 (Fifth Disease): Viral rash but different distribution pattern
Rubella: Viral exanthem but different progression and vaccination status
Drug reaction: Consider medication-related causes

Step 7: Diagnostic Test Interpretation

Interpret clinical findings to support your diagnosis:

Expected Key Findings:

Clinical diagnosis based on characteristic presentation
No laboratory testing typically required
Classic fever-rash sequence pattern

Step 8: Final Diagnosis and Most Significant Active Problem (MSAP)

Primary Diagnosis: Exanthema Subitum (Roseola)

Justification:

Classic clinical course with 3-5 day high-spiking fever followed by sudden fever resolution and appearance of widely disseminated pink papular rash
Appropriate age group (6 months to 2 years)
Characteristic rash distribution and timing
Well-appearing child with typical viral prodrome

MSAP Selection: Choose “Exanthema Subitum (Roseola)” as your Most Significant Active Problem, as this represents the primary condition requiring parent education and supportive management.

Step 9: Comprehensive Management Plan

Develop a multi-faceted treatment approach:

Immediate Management:

Supportive care and symptom monitoring
Parent education about expected course
Comfort measures for rash and residual symptoms

Short-term Management:

Symptomatic treatment for ongoing respiratory symptoms
Hydration and nutrition support
Activity recommendations and daycare return guidelines

Long-term Management:

Follow-up care for complete recovery
Prevention strategies for future viral illnesses
Routine pediatric care continuation

Patient Education:

Roseola education including typical 5-7 day total illness duration, rash resolution in 24-48 hours, and when to seek further care
Fever management strategies for future episodes
Infection control and prevention measures

Follow-up Plan:

Return visit if symptoms worsen or new concerns
Routine well-child care continuation
Daycare return after rash resolution

Step 10: Documentation and Submission Tips

Writing Your Summary:

Create a concise 350-word summary explaining your clinical reasoning for pediatric viral exanthems
Include how you arrived at the problem list with consideration of childhood rash evaluation
Cite specific assessment findings and age-related factors
Use professional pediatric terminology appropriate for viral illness management

Key Documentation Elements:

Assessment Statement: Brief patient summary with key dermatologic and viral illness findings
Clinical Reasoning: Explain diagnostic thought process for viral exanthems
Age Considerations: Link symptoms to typical childhood illness patterns
Management Rationale: Justify treatment choices and parent education needs

Final Submission Checklist:

✓ Complete pediatric history with systematic viral illness questioning
✓ Comprehensive physical examination including detailed rash assessment
✓ Appropriate differential diagnoses with pediatric considerations
✓ Correct final diagnosis and MSAP
✓ Evidence-based management plan including parent education
✓ Professional documentation with proper pediatric terminology

Alice Chaney iHuman Case Summary

Grading Criteria

The Alice Chaney iHuman case will evaluate you across several critical domains to ensure comprehensive pediatric viral exanthem assessment skills. Here’s what you need to focus on to maximize your score:

(1) History Taking (Major Points): You must ask targeted questions about rash characteristics and recent illness history to get full credit. Essential questions include: rash onset and distribution pattern, recent fever timeline and resolution, associated symptoms assessment, previous illness or exposure history. Don’t miss asking about: appetite and hydration status, daycare attendance, vaccination history. The rubric specifically rewards students who ask about fever-rash temporal relationships and characteristic viral illness patterns.

(2) Physical Examination (High Weight): Focus your exam on systematic dermatologic assessment and pediatric evaluation. Must-do components: detailed rash examination, vital signs assessment, age-appropriate physical exam, growth parameter documentation. Pro tip: The rubric awards points for thorough rash characterization and systematic pediatric assessment – key components that relate directly to viral exanthem diagnosis.

(3) Differential Diagnosis (Critical for Scoring): You need to propose at least 3 appropriate differentials with brief rationales. Expected differentials include: Exanthema Subitum (Roseola), Human Parvovirus 19, Rubella, and drug reactions. Scoring secret: The rubric rewards students who can distinguish between viral exanthems based on age, rash distribution, and temporal patterns.

(4) Final Diagnosis & MSAP: You must correctly identify Exanthema Subitum (Roseola) as your Most Significant Active Problem (MSAP). Justification is key – cite the post-febrile rash pattern, appropriate age group, and characteristic distribution as supporting evidence.

(5) Management Plan (Heavily Weighted): The rubric expects comprehensive supportive care including: appropriate parent education, symptom management strategies, follow-up planning, and infection control measures. High-scoring responses mention: supportive care measures, parent education about viral course, daycare return guidelines, and routine pediatric follow-up.

(6) Patient Communication: Demonstrate appropriate communication for pediatric patients and families. Bonus points for: explaining the diagnosis in parent-friendly terms, discussing expected illness course, addressing parental concerns, and providing clear follow-up instructions.

Example of a High-Scoring Clinical Summary

Here’s how a top-performing student might document this case:

Patient Summary – Alice Chaney

Situation: 2-year-old female presenting with characteristic viral exanthem following resolution of high fever and upper respiratory symptoms.

Background: Significant findings include appropriate age group for Roseola, classic fever pattern with 103°F temperature lasting 3 days, complete fever resolution 24 hours prior to rash onset. Past medical history unremarkable with up-to-date vaccinations and normal growth and development.

Assessment: Physical examination notable for well-appearing child with maculopapular pink rash on trunk and extremities, consistent with post-febrile viral exanthem. Clear temporal relationship between fever resolution and rash appearance supports classic Roseola presentation.

Primary Diagnosis: Exanthema Subitum (Roseola)

Recommendation:

Supportive care with symptomatic treatment for residual respiratory symptoms
Parent education about expected illness course and rash resolution timeline
Comfort measures including cool baths and lightweight clothing
Daycare return after rash resolution and feeling well
Follow-up care for any concerning symptoms or complications
Routine pediatric care continuation with vaccination schedule maintenance

Patient and Family Education Provided: Explained Roseola diagnosis and typical illness course, discussed expected rash resolution within 24-48 hours, emphasized supportive care measures and when to seek further medical attention, provided information about preventing transmission and daycare return guidelines.

Conclusion

By following this comprehensive approach to the Alice Chaney case, you’ll demonstrate the pediatric viral exanthem assessment skills that iHuman evaluates. Remember, success in pediatric viral illness cases requires understanding childhood disease patterns: gather detailed history about fever-rash temporal relationships, perform systematic dermatologic examination with characteristic rash documentation, consider age-appropriate viral exanthems in differential diagnosis, and develop family-centered management plans addressing both medical care and parent education. The key is treating each iHuman simulation as you would a real pediatric encounter – be thorough, consider the complexity of childhood viral illnesses, and always prioritize family education and supportive care. With this guide, you’re well-prepared to excel in this important pediatric viral exanthem case simulation.

Frequently Asked Questions

Q1: What is the correct diagnosis for Alice Chaney’s pediatric presentation?

Alice Chaney’s primary diagnosis is Exanthema Subitum (Roseola). The key distinguishing features include the classic pattern of high fever (103°F) lasting 3 days followed by sudden fever resolution and appearance of maculopapular pink rash starting on the trunk and spreading to extremities. Students often struggle between different viral exanthems, but remember that Roseola typically affects children between 6 months and 2 years, with the characteristic “fever-then-rash” pattern where the rash appears as the fever breaks.

Q2: What are the critical physical examination components I need to perform to score well?

Essential physical exam elements include comprehensive dermatologic assessment with detailed rash characterization, age-appropriate vital signs, systematic pediatric examination, and growth parameter documentation. Many students miss points by inadequately describing rash morphology and distribution patterns, which are crucial for viral exanthem diagnosis. Don’t forget to assess the child’s general appearance and behavior, hydration status, and any complications from the recent febrile illness.

Q3: How do I pass the Alice Chaney case and meet the 70% requirement?

You must score a cumulative 70% on the iHuman assessments to successfully complete the required lab component. To achieve this score, focus on thorough pediatric history-taking using systematic viral illness questioning, complete all recommended physical exam components with attention to rash assessment, propose appropriate differential diagnoses (including Roseola, Fifth Disease, and other viral exanthems), and develop a comprehensive family-centered management plan that includes parent education, supportive care, and follow-up planning. The key is being systematic and remembering that pediatric cases require family-centered care approaches.

Q4: What management interventions should I include in my treatment plan?

The comprehensive management plan should focus on supportive care since Roseola typically resolves within 5-7 days with the rash lasting 24-48 hours. Include parent education about the expected illness course, symptomatic treatment for residual respiratory symptoms, comfort measures for the rash, guidelines for daycare return after rash resolution, and follow-up instructions for any concerning symptoms. Students often forget to address infection control measures and when to seek further medical attention, which are crucial components for managing viral illnesses in children and can impact your overall score.