Aquifer Pediatrics: Case 21 - 6 yr old leg pain and rash Questions And Answers 100% Correct

Aquifer Pediatrics: Case 21 - 6 yr old leg pain and rash Questions And Answers 100% Correct 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 - B, C, D, E, F 2 | P a g e Katelyn Whitman© 2025, All Rights Reserved. Differential Diagnosis for Bruising and Leg Pain - 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 - 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). 3 | P a g e Katelyn Whitman© 2025, All Rights Reserved. Henoch-Schonlein purpurn (HSP) - 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) - Often presents with asymptomatic petechiae. A nonspecific URI precedes ITP more than 50% of the time. Leukemia - 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 - 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. 4 | P a g e Katelyn Whitman© 2025, All Rights Reserved. Prominent coughing and/or vomiting can also cause petechiae, generally above the nipple line. Bacterial Endocarditis - 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. Meningococcal septicemia - Children with meningococcal septiciemia may present with petechiae and purpura, which can be confused with bruising. While the early stages of meningococcemia may have only mild symptoms, by the time the hemorrhagic rash appears, patients are usually very ill appearing and require emergent care. Fever is usually present. Rocky Mountain Spotted Fever - The rash of RMSF is often petechial, and starts on the extremities before moving centrally. Fever is a hallmark of RMSF. Systemic lupus erythematosus (SLE) - The rash of SLE can be variable. More common in older children and in girls. 5 | P a g e Katelyn Whitman© 2025, All Rights Reserved. SLE often presents with constitutional symptoms such as fever and malaise. Based on your physical exam findings, including the possibility of a palpable spleen, which three diagnoses now are most likely? The best options are indicated below. Your selections are indicated by the shaded boxes. A. Coagulation disorder B. Henoch-Schönlein purpura (HSP) C. Idiopathic thrombocytopenic purpura (ITP) D. Leukemia E. Viral infection - B, C, D Findings in HSP, ITP, and Leukemia - HSP