Paediatrics

Question 1

IGA VASCULITIS
What are the features of IgA vasculitis?
How would you diagnose?

Answer 1

IgA vasculitis aka Henoch Schonlein Purpura (HSP) has the following tetrad:

1. Palpable purpura (without thrombocytopenia or coagulopathy) - gravity-dependent –> lower extremities
2. Joints - arthralgia/ arthritis
3. Abdominal pain
4. Kidney disease

Primarily occurs in childhood: age 3-15.

Diagnosis:
Urinalysis, FBC, EUC, Coags
- Urinalysis and EUC –> may show kidney dysfunction
- Normal platelets, normal coags
Diagnosis confirmed by biopsy -
- Usually skin (or kidney if severe kidney dysfunction)
Consider abdominal imaging if significant abdo symptoms/signs

Question 2

What are you DDX for a child with a purpuric rash?

Answer 2

• Trauma –> non-accidental (child abuse), accidental, iatrogenic (e.g. procedure, tourniquet)
• Infection –> N. meningitidis (also: S pneumonia, GAS, S aureus, enterovirus, adenovirus, influenza)
• Haematological –> thrombocytopenia:
• – Immune thrombocytopenia (ITP)
• – Haemolytic uremic syndrome (HUS)
• – Malignancy - acute leukemia
• – Aplastic anaemia/ myelodysplasia
• – DIC
• – Drug-induced thrombocytopenia
• Vasculitis –> IgA vasculitis

Question 3

How would you further investigate an abnormal neurodevelopmental exam?

Answer 3

Urine metabolic study
TSH
Brain imaging
Genetic study
Formal neurodevelopmental assessment

Question 4

What are the causes of failure to thrive?

Answer 4

1 PARENTAL

• Social: low SES, poor education
• Emotional: MH, post-partum depression
• D&A

2 CHILD
Decreased supply
- FEEDING: poor breast milk supply, cleft lip, oral motor dysfunction
- ABSORPTION: GIT disease
Increased demand
- INCREASED BMR: hyperthyroidism
- CHRONIC DISEASE