Non blanching rashes Flashcards

1
Q

What terms are used to describe non-blanching rashes?

A

Petechiae: <5mm
Purpura: 5-10mm
Ecchymoses: >1cm

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2
Q

List 6 common causes of non-blanching rashes

A
Meningococcal sepsis
Henoch-Schönlein purpura
Idiopathic thrombocytopaenic purpura
Haemolytic uraemic syndrome
Forceful coughing/ vomiting
Non-accidental injury
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3
Q

What causes Meningococcal meningitis? Which group is it most commonly seen in?

A

Neisseria meningitides
Gram -ve diplococcus
Commensal of nasopharynx.
<5s

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4
Q

List 3 symptoms of meningococcal sepsis

A

Fever
Neck stiffness
Confusion +/- seizures

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5
Q

List 5 findings on examination that meningococcal sepsis can present with

A

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

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6
Q

List 4 investigations for meningococcal sepsis

A

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

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7
Q

What is the immediate management of meningococcal sepsis?

A

Transfer to hospital

IM Benzyl penicillin if in primary care

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8
Q

What is the empirical treatment for meningococcal sepsis?

A

in <3 months: IV cefotaxime + amoxicillin

in >3 months: IV ceftriaxone + IV dexamethasone

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9
Q

List 3 complications of meningococcal sepsis

A

Seizures
Raised ICP + hydrocephalus
Disseminated intravascular coagulation leading to multi-organ failure

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10
Q

Describe the aetiology of Henoch-Schönlein purpura

A

IgA mediated vasculitis of unknown aetiology.

Often occurs post-infection with most common trigger being group A strep.

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11
Q

Give 2 risk factors for Henoch-Schönlein purpura

A

Age: <10s -peak of cases 4-6 years old.
Season: autumn/winter months.

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12
Q

List 5 symptoms of Henoch-Schönlein purpura

A
A prodromal mild URT illness or GI infection
Generalised abdo pain
Bloody diarrhoea
N+V
Joint pain
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13
Q

Give 2 clinical findings in Henoch-Schönlein purpura

A

Low-grade fever

Symmetrical rash on back of the legs, buttocks + arms

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14
Q

List 4 complications of Henoch-Schönlein purpura

A

Recurrence (1/3)
Nephrotic or nephritic syndrome
Renal failure
Intussusception

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15
Q

List 4 complications of Henoch-Schönlein purpura

A

Recurrence (1/3)
Nephrotic or nephritic syndrome
Renal failure
Intussusception

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16
Q

Describe the rash in HSP

A

Macular rash begins as erythematous

then becomes purpuric + raised

17
Q

What does Immune thrombocytopenic purpura involve?

A

development of a purpuric rash in those with low circulating platelets (<100 x 10⁹/L) in the absence of any clear cause.

18
Q

Describe the risk factors for Immune thrombocytopenic purpura

A

ITP usually follows a viral illness in children

No known specific risk factors in adults.

19
Q

Give 2 symptoms of Immune thrombocytopenic purpura

A

Prodromal viral illness in children
Epistaxis
(Many asymptomatic)

20
Q

Give the signs of Immune thrombocytopenic purpura

A

Petechiae +/- bruising

21
Q

Give 5 differentials for Immune thrombocytopenic purpura

A
Meningococcal sepsis
Aplastic anaemia
Leukaemia
Non-accidental injury
Disseminated intravascular coagulation
22
Q

What 3 investigations would you order for Immune thrombocytopenic purpura ?

A

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.

23
Q

Describe the approach to management of Immune thrombocytopenic purpura

A

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.

24
Q

Describe the management of Immune thrombocytopenic purpura

A

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

25
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
26
What triad defines Haemolytic uraemic syndrome?
Microangiopathic haemolytic uraemia Acute kidney injury Thrombocytopaenia
27
Describe the aetiology of Haemolytic uraemic syndrome
Post infection with Escherichia coli O157. | Commonly found in faeces of sheep, cows + goats (petting zoos + improper hand hygiene)
28
List 3 risk factors for Haemolytic uraemic syndrome
Age: young children esp. 6 months - 5 years. + elderly Immunocompromised adults Season: peak in summer.
29
List 4 symptoms of Haemolytic uraemic syndrome
Diarrhoea, typically turns bloody ~day 3 Abdo pain Fever Vomiting
30
List 3 signs of Haemolytic uraemic syndrome
Abdo tenderness HTN secondary to AKI Small petechiae on skin can occur due to low platelets
31
Give 3 differentials for Haemolytic uraemic syndrome
Acute gastroenteritis Intussusception Disseminated intravascular coagulation
32
Give 3 investigations for Haemolytic uraemic syndrome
Bloods: FBC, U+E, CRP, clotting: may show thrombocytopenia, raised WCC, anaemia + AKI Urinalysis: screen for haematuria + proteinuria. Stool cultures: screen for E.Coli O157.
33
Describe management for Haemolytic uraemic syndrome
Supportive; maintenance of fluid balance + correction of electrolyte abnormalities. Severe cases may lead to development of renal failure requiring dialysis. Notifiable disease to PHE
34
What should you ask about in the history when suspecting HUS?
Recent exposure to farm animals + if child attends school or playgroup.