MODULE 22 EMQs
Match each paediatric presentation to the appropriate condition.
Thombotic thrombocytopaenic purpura
Leucoclastic vasculitis
Henoch-Schonlein Purpura
Epstein Barr virus infection
CMV infection
Idiopathic thombocyopaenic purpura
Rubella
Erythema Nodosum
Measles
Erythema Multiforme
Bullous pemphigoid
Thombotic thrombocytopaenic purpura
Leucoclastic vasculitis
Henoch-Schonlein Purpura
Epstein Barr virus infection
CMV infection
Idiopathic thombocyopaenic purpura
Rubella
Erythema Nodosum
Measles
Erythema Multiforme
Bullous pemphigoid
EMQ 1.
A 4 year old boy presents with abdominal pain, diffuse non blanching rash across both lower limbs and painful knees and ankles.
Pathology:
Hb 103 mg/dL
Platelets 560 x109/L
Urea 10.9 mmol/L
Creatinine 138 umol/L
Answer: Heinloch Schonlein Purpura
Comment: the typical history and high platelet count suggest a diagnosis of HSP.
EMQ 2.
A 5 year old girl presents with a diffuse purpuric rash and a fever. Her parents report that she has been intermittently confused. Her pathology shows
Hb 98 mg/dL
Platelets 88 x 109/L
Urea 12.3 mmol/L
Creatinine 145 umol/L
Red cell fragments are noted on her blood film.
Answer: Thrombotic Thrombocytopaenic Purpura
Comment: the film evidence of haemolysis, combined with neurologic symptoms and renal failure suggests TTP.
EMQ 3.
A 7 year old girl presents to the emergency department with a diffuse petechial rash and fever. Her parents complain of frequent nosebleeds.
Her pathology shows:
Hb 126 mg/dL
WCC 8.1 x 109/L
Platelets 268 x 109/L
Urea 4.5 mmol/L
Creatinine 36 umol/L
Answer: Idiopathic thrombocytopaenic purpura
Comment: the isolated thrombocytopaenia suggests a diagnosis of ITP.
EMQ 4.
A 3 year old boy presents to the emergency department with a cough, runny nose, red eyes and a red itchy rash. His parents report that the rash began 3 days after his cough and spread down from his face across his body. The rash is fine, and diffusely maculopapular.
Answer: Measles
Comment: this is a classic history for measles.
EMQ 5.
A 15 year old girl presents with an itchy red rash to both arms and legs. Several of the lesions appear to have an erythematous halo with central sparing, and in others the skin has started to blister and slough off.
A 4 year old boy presents with abdominal pain, diffuse non blanching rash across both lower limbs and painful knees and ankles.
Pathology:
Hb 103 mg/dL
Platelets 560 x109/L
Urea 10.9 mmol/L
Creatinine 138 umol/L
Answer: Heinloch Schonlein Purpura
Comment: the typical history and high platelet count suggest a diagnosis of HSP.
EMQ 2.
A 5 year old girl presents with a diffuse purpuric rash and a fever. Her parents report that she has been intermittently confused. Her pathology shows
Hb 98 mg/dL
Platelets 88 x 109/L
Urea 12.3 mmol/L
Creatinine 145 umol/L
Red cell fragments are noted on her blood film.
Answer: Thrombotic Thrombocytopaenic Purpura
Comment: the film evidence of haemolysis, combined with neurologic symptoms and renal failure suggests TTP.
EMQ 3.
A 7 year old girl presents to the emergency department with a diffuse petechial rash and fever. Her parents complain of frequent nosebleeds.
Her pathology shows:
Hb 126 mg/dL
WCC 8.1 x 109/L
Platelets 268 x 109/L
Urea 4.5 mmol/L
Creatinine 36 umol/L
Answer: Idiopathic thrombocytopaenic purpura
Comment: the isolated thrombocytopaenia suggests a diagnosis of ITP.
EMQ 4.
A 3 year old boy presents to the emergency department with a cough, runny nose, red eyes and a red itchy rash. His parents report that the rash began 3 days after his cough and spread down from his face across his body. The rash is fine, and diffusely maculopapular.
Answer: Measles
Comment: this is a classic history for measles.
EMQ 5.
A 15 year old girl presents with an itchy red rash to both arms and legs. Several of the lesions appear to have an erythematous halo with central sparing, and in others the skin has started to blister and slough off.