Pyrexia and Rash

Question 1

What is Disseminated Intravascular Coagulation?

Answer 1

Usually caused by infections (sepsis), inflammation, severe trauma, burns, cancer -
TF activates the coagulation cascade
Causes thrombosis (blocks small blood vessels) and haemorrhage (can cause rash from bleeding into skin)
Symptoms: chest pain, SOB, leg pain, problems speaking

Question 2

What is Acquired Aplastic Anaemia?

Answer 2

Rare
Bone marrow fails to produce red blood cells
Can cause petechial rash

Question 3

What is enterovirus?

Answer 3

Positive-sense single stranded RNA (eg echovirus Coxsackie)
Feco-oral transmission
Can cause fever, rash, blurred vision, pericarditits, HFMD

Question 4

What is Immune Thrombocytopenic Pupura(ITP)?

Answer 4

Clotting disorder
Often occurs following a viral illness
Can cause bruising

Question 5

Signs of pneumococcal/meningococcal septicaemia on examination

Answer 5

Signs of cardiovascular compromise ie HR, RR, capillary refill, BP, neurological status, cool mottled perfusion.
Rash found in any distribution may have petechiae, purpura and ecchymosis
Beware the child may have no signs of shock initially and look alert and playful

No sign of anaemia
No generalised lymphadenopathy, may have cervical lymphadenopathy if had concurrent URTI
No hepatosplenomegaly

Question 6

Signs of virus - influenza on examination

Answer 6

Signs of viral illness ie URTI, pyrexia with increased HR and RR
Achy joints
May have cervical lymphadenopathy but not generalised unless glandular fever
Petechiae but no purpura and no bruising

No sign of cardiovascular compromise, ie prolonged capillary refill, low BP
No hepatosplenomegaly
No sign of anaemia

Question 7

Signs of ITP on examination

Answer 7

Petechia, purpura and ecchymosis found anywhere

No sign of cardiovascular compromise.
No lympahadenopathy
No hepatosplenomegalyy

Question 8

Signs of HSP on examination

Answer 8

Rash mainly found on the extensor surfaces. Mainly palpable purpura, ecchymosis
Rash found mainly over lower limbs and buttocks it can extend to upper limbs
Swollen, painful joints
Swollen testes

No sign of cardiovascular compromise
No generalised lymphadenopathy may have cervical with concurrent URTI
No hepatosplenomegaly

Question 9

Signs of Leukaemia on examination

Answer 9

Pallor over mucous membranes
Generalised lymphadenopathy
Hepatosplenomegaly
Petechia ,purpura,ecchymosis over any part of body
Signs of cardiovascular compromise if very anaemic or have associated sepsis which can occur due to poorly functioning WBC

Question 10

What investigations are necessary for suspected HSP?

Answer 10

BP
Urinanalysis
FBC
Renal Function
PCR

Can have renal function and urinanalysis done for upto a year after to assess kidney involvement

Question 11

Expected symptoms in meningitits

Answer 11

Headache
Neck stiffness
Photophobia

(bulging fontanelle)

Question 12

Expected symptoms in sepsis

Answer 12

Unwell
Increased temp
Palpitations
Light headed 
cold peripheries
Increased resp rate/ difficulty breathing

Question 13

Typical symptoms in URTI

Answer 13

Sore throat
Cough
Swollen Glands

Question 14

Typical symptoms of cellulitis

Answer 14

Erythemtous, swollen hot painful rash

Question 15

Typical symptoms of UTI

Answer 15

Increased frequency, nocturia, increased incontinence, urgency, vomiting

Question 16

Typical symptoms of gastroenteritis

Answer 16

vomiting, diarrhoea, abdo pain

Question 17

Concerning features with a fever?

Answer 17

<50% feeding
Difficulty breathing, cries/moans
History of pale, mottled, cyanosed and hot
Dull expression, apathy, disinterested, dehydrated, drowsy
Significant reduction in number of wet nappies
Blood in stool, seizures, tachycardia(not explained by fever or pain)

Question 18

What is Intussuception?

Answer 18

Terminal ileum telescopes into caecum/ascending colon
Occurs in 2-3% of HSP patients
Usually idiopathic (Meckel’s Diverticulum)
Sausage shaped lump may be palpated
Blood - red currant jelly stools

Question 19

3 reasons for anaemia

Answer 19

Body is destroying RBC
RBC being lost
Body producing RBC too slowly

Question 20

Conditions where the body is destroying red blood cells

Answer 20

G6PD
sicklecell
thalasemia
drug/viral induced haemolytic anaemia
Physiological anaemia of the newborn

Question 21

RBC being lost

Answer 21

Haemorrhagic disease of the newborn
IBD
cowsmilk protein enteropathy
clotting disorders
menstruation

Question 22

Body producing RBC too slowly

Answer 22

Blackfan diamond syndrome
Transient aplastic anaemia
iron deficiency anaemia
chemotherapy
leukaemia

Question 23

What does the absence of blast cellls and haemolysis tell you about the cause of anaemia?

Answer 23

Not leukaemia or haemolytic anaemia

Question 24

What do normal reticulocytes inform you about anaemia?

Answer 24

No red cell aplasia

Question 25

What is Fanconi’s anaemia?

Answer 25

Rare inherited bone marrow condition
Absent or abnormal thumbs or freckly hands
Low set ears (deafness)
Strabismus

Question 26

3 facts on sickle cell anaemia

Answer 26

Autosomal recessive
1/2000 ( Can be as high as 40% in tropical Africa)
High mortality in first 5 years due to pneumococcus hemophilia or salmonella

Question 27

Most common childhood cancers? (10)

Answer 27

AML, ALL
Osteosarcoma, Ewing's sarcoma
Hepatoblastoma
Hodgkin's, Non-Hodgkins
Retinoblastoma
Rhabdomyosarcoma
Wilm' tumour (kidney)

Question 28

Which childhood cancers can present with head tilt?

Answer 28

Rhabdosarcoma
Optic glioma
Retinoblastoma
Medulloblastoma

Question 29

What is neurofibromatosis type 1?

Answer 29

Autsomal dominant condition
Pale, coffee-coloured patches (café au lait spots)
Soft, non-cancerous tumours on or under the skin (neurofibromas)
Clusters of freckles in unusual places – such as the armpits, groin and under the breast
Problems with the bones, eyes and nervous system

Associated with learning difficulties and less commonly, malignant peripheral nerve sheath tumours