Pyrexia + Rash Flashcards
What are the differentials for pyrexia and a rash?
- Disseminated intravascular coagulation, acquired aplastic anaemia
- Bacterial infection i.e. meningococcal/pneumococcal septicaemia
- Viral infection i.e. enterovirus and influenza
- Vasculitis e.g. HSP
- Accidental or non-accidental injury
- Immune thrombocytopenic purpura (ITP)
- SLE
- Deficiency in Vit C, K, B
- Leukaemia
- Inherited condition of no platelets i.e. Wiskott-Aldrich syndrome and bleeding disorders i.e. vW disease
- SEs of meds, immunisation related
- Felt tip
What questions would you want to ask about pyrexia and rash?
- Have they ever had marks like this before?
- Have they had the usual amount of energy or looked pale lately?
- Do they bruise easily or have heavy nosebleeds?
- Any meds/allergies
- Who lives at home, are you related, are you fit and well?
- Any antenatal problems? Birth weight?
- Ask about diet
- Vaccination hx
What are the signs/symptoms of meningococcal/pneumococcal septicaemia?
- Signs of CV compromise i.e. HR, RR, CRT, BP, neurological status, cool mottled perfusion
- No generalised lymphadenopathy, may have cervical lymphadenopathy if had concurrent URTI which often causes the nasal portal for infection
- 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
What are the signs and diagnosis of a virus I.e. influenza?
- No sign of CV compromise I.e. prolonged CRT, decreased BP
- Signs of viral illness I.e. URTI, pyrexia with raised HR + RR
- Achy joints
- Petechiae but no purpura and no bruising
- No hepatosplenomegaly
- May have cervical lymphadenopathy but no generalised unless glandular fever
- No sign of anaemia
What are the signs and diagnosis of ITP?
- No sign of CV compromise, lymphadenopathy of hepatosplenomegaly
- Petechiae, purpura and ecchymosis found over any bit of body
What are the signs and diagnosis of HSP?
- No generalised lymphadenopathy, May have cervical with concurrent UTI
- Rash found mainly over lower limbs and buttocks, can extend to upper limbs
- Rash mainly found on the extensor surfaces, mainly palpable purpura, ecchymosis
- Swollen, painful joints
- Swollen testes
- Abdominal pain
- Can cause IgA nephritis - haematuria and proteinuria that can develop to nephrotic syndrome
What are the signs and diagnosis of leukaemia?
- Pallor over mucous membranes
- Generalised lymphadenopathy
- Hepatosplenomegaly
- Petechiae, purpura, ecchymosis over any part of body
- Signs of CV compromise if very anaemia or have associated sepsis which can occur due to poorly functioning WBC
What are the signs and diagnosis of NAI?
- Unusual pattern of marks
- CV compromise depends on severity of internal injury
What investigations do you want to do for fever + rash?
- FBC, platelets
- CRP, blood cultures
- U+Es, urinalysis, PCR
What investigations do you do for HSP in children?
- Often renal involvement e.g. increased PCR, blood, protein
- Children will have their BP and urine checked for renal involvement for up to a year after rash resolves
- Rash doesn’t scar
What are the differentials for painful testicles?
- HSP - scrotal oedema
- Intussusception
- Testicular torsion
What is intussusception?
When one part of the bowel invaginate into the lumen of the adjacent bowel, usually around the ileo-caeca, region. Usually affects infants 6-18 months old. Boys are affected 2x as often as girls.
What are the features of intussusception?
- Paroxysmal abdominal colicky pain
- Child draws their knees up and turns pale during pain
- Vomiting
- Bloodstained stool - ‘red currant jelly’ (late sign)
- Sausage shaped mass in RUQ
What are the investigations for intussusception?
USS shows ‘target sign’ (looks like a bullseye)
What is the management for intussusception?
- Most kids treated via reduction by air insufflation (simply by blowing air into the bowel)
- If above fails or peritonitis occurs - surgery
