Aquifer Pediatrics: Case 21 - 6 yr old leg pain and rash fully solved 2023/2024

Aquifer Pediatrics: Case 21 - 6 yr old leg pain and rash Which of the following signs or symptoms would indicate a need for urgent stabilization? Select all that apply. The best options are indicated below. Your selections are indicated by the shaded boxes. A. Fever B. Altered mental status C. Mottled skin D. Respiratory distress E. Respiratory depression F. Cyanosis G. Pallor H. Obvious pain - correct answer B, C, D, E, F Differential Diagnosis for Bruising and Leg Pain - correct answer Coagulation Disorder Henoch-Schonlein purport (HSP) Idiopathic thrombocytopenia purport (ITP) Leukemia Viral infection Bacterial endocarditis Meningococcal septiciemia Rocky Mountain Spotted Fever (RMSF) Systemic lupus erythematosus (SLE) Coagulation disorder - correct answer A coagulation disorder may present with petechiae or superficial bruising, but more often presents with easy bruising in deep tissues or hemarthrosis. Bleeding disorders (hemophilias, von Willebrand's disease) are characterized by easy bruising in response to minor trauma. Spontaneous superficial bruising is less common. Hemophilias may present with painful bleeding into joints (hemarthrosis). Children with coagulation disorders often have a positive family history and/or personal history of bleeding (e.g., after trauma, immunizations, circumcision, dental work). Henoch-Schonlein purpurn (HSP) - correct answer HSP is a self-limited, IgA-mediated, small vessel vasculitis that typically involves the skin, GI tract, joints, and kidneys. Often presents in an otherwise well appearing child with bruising and leg pain (due to arthritis). In roughly 50% of cases, a URI precedes the diagnosis of HSP Idiopathic thrombocytopenia purport (ITP) - correct answer Often presents with asymptomatic petechiae. A nonspecific URI precedes ITP more than 50% of the time. Leukemia - correct answer Usually presents with constitutional symptoms such as fever, malaise and weight loss. Bone pain is also a common presentation of leukemia in children. The pain results from infiltration of the bone marrow by malignant cell. Petechiae can be caused by thrombocytopenia due to bone marrow replacement by malignant cells. Viral infection - correct answer Some viruses, such as enteroviruses, may present with a petechial rash. Children usually have a low-grade fever. Other constitutional complaints may be present or absent. Prominent coughing and/or vomiting can also cause petechiae, generally above the nipple line. Bacterial Endocarditis - correct answer Typical presenting complaints are fever, fatigue, and weight loss. A petechial rash is commonly seen. Bruising is not characteristic. Fever is usually present, but may be low-grade.