The bruised child

Question 1

regarding history of the bruised child

-what is an important first question

Answer 1

spontaneous or following injury

Question 2

regarding history of the bruised child
-duration and what this suggests

Answer 2

days/weeks- acute aquired

months/years-congenital or chronic acquired

Question 3

regarding history of the bruised child
-types of mucosal bleeding

Answer 3

oral

epistaxis

GI

menorrhagia

Question 4

regarding history of the bruised child
-what does menorrhagia suggest (2)

Answer 4

thrombocytopenai

VWD

Question 5

regarding history of the bruised child
-types of internal bleeding (excluding mucosal bleeds)

Answer 5

haemarthorsis

intracranial

Question 6

regarding history of the bruised child
-what does an intracranial bleed suggest

Answer 6

clotting deficiencies

Question 7

regarding history of the bruised child
-what does a fmaily history of brusing suggest 2

Answer 7

VWD

clotting deficenceis

Question 8

regarding history of the bruised child
what does a recent history fo infection suggest 3

Answer 8

acute leukaemia

bone marrow failure

ITP

Question 9

regarding history of the bruised child
-symptoms of bone marrow failure 4

Answer 9

anaemia

lethargy/pallor

leucopenia

infection

Question 10

regarding history of the bruised child
symtom in HSP

Answer 10

abdo pain

Question 11

wehn examing a brusied child what should be assessed 11

Answer 11

 Signs of systemic infection
 Raised intracranial pressure
 Signs of trauma
 Site, number and severity of bruises/ petechiae
 Evidence of mucosal bleeding from
lips/gums/haematemesis/melaena/epistaxis
 Signs of anaemia
 Hepatosplenomegaly
 Lymphadenopathy
 Swollen painful joints
 Congenital abnormalities i.e. limb defects, cardiac probs
 General examination of the child in cases of NAI (including ophthalmic exam)

Question 12

in a bruised child what should be investgiated for in all cases 2

Answer 12

FBC

coag

Question 13

investigations in a bruised child for:
sepsis 2

Answer 13

bld cult

infeciton screen

Question 14

investigations in a bruised child for:
major haemorrhage

Answer 14

urgent cross match

volume expandes

correct DIC/ITP

identify source and stop bleeding (?surgery)

Question 15

investigations in a bruised child for:
DIC

Answer 15

manage sepsis (sepssi 6)

correct coagulopahty

Question 16

investigations in a bruised child for:
hereditary coag disorders 2

Answer 16

clotting factor assasys

platelet aggregation studies

Question 17

investigations in a bruised child for:
HSP 3

Answer 17

BP

urinalysis

abdo USS

Question 18

investigations in a bruised child for:
NAI 4

Answer 18

skeletal survey

CT (if <1yo)

retinoscopy

photos