Pyrexia and Rash Flashcards
What is Disseminated Intravascular Coagulation?
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
What is Acquired Aplastic Anaemia?
Rare
Bone marrow fails to produce red blood cells
Can cause petechial rash
What is enterovirus?
Positive-sense single stranded RNA (eg echovirus Coxsackie)
Feco-oral transmission
Can cause fever, rash, blurred vision, pericarditits, HFMD
What is Immune Thrombocytopenic Pupura(ITP)?
Clotting disorder
Often occurs following a viral illness
Can cause bruising
Signs of pneumococcal/meningococcal septicaemia on examination
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
Signs of virus - influenza on examination
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
Signs of ITP on examination
Petechia, purpura and ecchymosis found anywhere
No sign of cardiovascular compromise.
No lympahadenopathy
No hepatosplenomegalyy
Signs of HSP on examination
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
Signs of Leukaemia on examination
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
What investigations are necessary for suspected HSP?
BP Urinanalysis FBC Renal Function PCR
Can have renal function and urinanalysis done for upto a year after to assess kidney involvement
Expected symptoms in meningitits
Headache
Neck stiffness
Photophobia
(bulging fontanelle)
Expected symptoms in sepsis
Unwell Increased temp Palpitations Light headed cold peripheries Increased resp rate/ difficulty breathing
Typical symptoms in URTI
Sore throat
Cough
Swollen Glands
Typical symptoms of cellulitis
Erythemtous, swollen hot painful rash
Typical symptoms of UTI
Increased frequency, nocturia, increased incontinence, urgency, vomiting
Typical symptoms of gastroenteritis
vomiting, diarrhoea, abdo pain
Concerning features with a fever?
<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)
What is Intussuception?
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
3 reasons for anaemia
Body is destroying RBC
RBC being lost
Body producing RBC too slowly
Conditions where the body is destroying red blood cells
G6PD sicklecell thalasemia drug/viral induced haemolytic anaemia Physiological anaemia of the newborn
RBC being lost
Haemorrhagic disease of the newborn IBD cowsmilk protein enteropathy clotting disorders menstruation
Body producing RBC too slowly
Blackfan diamond syndrome Transient aplastic anaemia iron deficiency anaemia chemotherapy leukaemia
What does the absence of blast cellls and haemolysis tell you about the cause of anaemia?
Not leukaemia or haemolytic anaemia
What do normal reticulocytes inform you about anaemia?
No red cell aplasia
What is Fanconi’s anaemia?
Rare inherited bone marrow condition
Absent or abnormal thumbs or freckly hands
Low set ears (deafness)
Strabismus
3 facts on sickle cell anaemia
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
Most common childhood cancers? (10)
AML, ALL Osteosarcoma, Ewing's sarcoma Hepatoblastoma Hodgkin's, Non-Hodgkins Retinoblastoma Rhabdomyosarcoma Wilm' tumour (kidney)
Which childhood cancers can present with head tilt?
Rhabdosarcoma
Optic glioma
Retinoblastoma
Medulloblastoma
What is neurofibromatosis type 1?
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
