Non blanching rashes Flashcards
What terms are used to describe non-blanching rashes?
Petechiae: <5mm
Purpura: 5-10mm
Ecchymoses: >1cm
List 6 common causes of non-blanching rashes
Meningococcal sepsis Henoch-Schönlein purpura Idiopathic thrombocytopaenic purpura Haemolytic uraemic syndrome Forceful coughing/ vomiting Non-accidental injury
What causes Meningococcal meningitis? Which group is it most commonly seen in?
Neisseria meningitides
Gram -ve diplococcus
Commensal of nasopharynx.
<5s
List 3 symptoms of meningococcal sepsis
Fever
Neck stiffness
Confusion +/- seizures
List 5 findings on examination that meningococcal sepsis can present with
Kernig’s sign (pain + resistance on passive knee extension with hips fully flexed)
Brudzinski’s sign (knees + hips flex on bending the head forward)
Non-blanching rash
Photophobia
Hypovolaemic shock: low BP, high HR, cap refill time >2s, skin may look mottled
List 4 investigations for meningococcal sepsis
Bloods: FBC, CRP, U+E, clotting: inflammatory markers may be raised.
Blood cultures
Pharyngeal swab: to screen for Neisseria meningitides in the pharynx.
Lumbar puncture: definitive dx
What is the immediate management of meningococcal sepsis?
Transfer to hospital
IM Benzyl penicillin if in primary care
What is the empirical treatment for meningococcal sepsis?
in <3 months: IV cefotaxime + amoxicillin
in >3 months: IV ceftriaxone + IV dexamethasone
List 3 complications of meningococcal sepsis
Seizures
Raised ICP + hydrocephalus
Disseminated intravascular coagulation leading to multi-organ failure
Describe the aetiology of Henoch-Schönlein purpura
IgA mediated vasculitis of unknown aetiology.
Often occurs post-infection with most common trigger being group A strep.
Give 2 risk factors for Henoch-Schönlein purpura
Age: <10s -peak of cases 4-6 years old.
Season: autumn/winter months.
List 5 symptoms of Henoch-Schönlein purpura
A prodromal mild URT illness or GI infection Generalised abdo pain Bloody diarrhoea N+V Joint pain
Give 2 clinical findings in Henoch-Schönlein purpura
Low-grade fever
Symmetrical rash on back of the legs, buttocks + arms
List 4 complications of Henoch-Schönlein purpura
Recurrence (1/3)
Nephrotic or nephritic syndrome
Renal failure
Intussusception
List 4 complications of Henoch-Schönlein purpura
Recurrence (1/3)
Nephrotic or nephritic syndrome
Renal failure
Intussusception
Describe the rash in HSP
Macular rash begins as erythematous
then becomes purpuric + raised
What does Immune thrombocytopenic purpura involve?
development of a purpuric rash in those with low circulating platelets (<100 x 10⁹/L) in the absence of any clear cause.
Describe the risk factors for Immune thrombocytopenic purpura
ITP usually follows a viral illness in children
No known specific risk factors in adults.
Give 2 symptoms of Immune thrombocytopenic purpura
Prodromal viral illness in children
Epistaxis
(Many asymptomatic)
Give the signs of Immune thrombocytopenic purpura
Petechiae +/- bruising
Give 5 differentials for Immune thrombocytopenic purpura
Meningococcal sepsis Aplastic anaemia Leukaemia Non-accidental injury Disseminated intravascular coagulation
What 3 investigations would you order for Immune thrombocytopenic purpura ?
Bloods (FBC) + blood film: will show thrombocytopenia.
Bloodborne virus screen (HIV, hepatitis C): to exclude secondary cause of ITP.
Bone marrow biopsy: if dx uncertain.
Describe the approach to management of Immune thrombocytopenic purpura
In children, ITP is usually self-limiting.
Tx based on Sx, rather than absolute platelet count.
Active tx is rarely needed for platelet counts of >50×10⁹/L.
Refer to haematology.
Describe the management of Immune thrombocytopenic purpura
Stopping any meds which may affect platelets e.g. NSAIDS
Oral prednisolone = 1st-line
Possibly IV immunoglobulins (IVIG) or monoclonal antibodies e.g. rituximab.
Splenectomy considered once all medical tx options exhausted
