Paediatrics

Question 1

Clinical features of dehyration in children

Percentage loss of body weight is the best measure of dehydration.

Answer 1

Question 2

List 5 causes of fever with petechiae

PURPURA - Larger non blanching spots (>2mm)

Petchie are pin point non blanching spots

Answer 2

1. viral infections - enterovirus /Influenza
2. Neisseria meningitidis
3. other causes of bacteriamia -Streptococal pneumonia/Haemophilus influenza
4. HSP
5. ITP
6. Leukaemia
7. illness characterised by omiting or cough causing petechie in head and neck

Question 3

What are the characterstics of HSP

Answer 3

HSP typically presents with the triad of

1. purpuric rash on the extensor surfaces of limbs (mainly lower) and buttocks,
2. joint pain/swelling and
3. abdominal pain

The commonest age group is 2 - 8 y

Question 4

how do you assess in HSP

Answer 4

Purpura: If atypical distribution or the child is unwell, consider meningococcaemia, thrombocytopenia, or other rare vasculitides.

Joint Pain: Swelling and arthralgia of large joints are often the patient’s main complaint. In most situations this pain resolves spontaneously within 24-48 hours.

Abdominal pain: Uncomplicated abdominal pain often resolves spontaneously within 72 hours. However serious abdominal complications may occur including intussusception, bloody stools, haematemesis, spontaneous bowel perforation, and pancreatitis.

Renal disease: Haematuria is present in 90% of cases, but only 5% are persistent or recurrent.

Less common renal manifestations include proteinuria, nephrotic syndrome, isolated hypertension, renal insufficiency and renal failure ( <1%). Renal involvement may only present during the convalescent period.

Subcutaneous oedema (scrotum, hands, feet, sacrum): This can be very painful.

Rare complications - pulmonary and CNS invo

Question 5

What are the investigations for HSP

Answer 5

1. Urine microscopy - redcells
2. FBC
3. Blood culture
4. EUC