| Show Learning Points most relevant to Phase 1: |
Infant or child with easy bruising
| Clinical Discipline(s)/Organ System(s) Haematology, Paediatrics | Progress Test Topic(s) Blood and lymph |
Description
A 3 year old NZ European boy is taken to the GP by his mother because he has a number of bruises on his legs. Recently when he slipped off a step, he developed a large bruise over his buttock. He is otherwise well but had an upper respiratory tract infection 2 weeks earlier.
Progress Test-Type Questions: Question 1 | Question 2Applied Science for Medicine
- Biology of platelet production and function
- Physiology and pathology of coagulation
- Acquired and inherited abnormalities of platelets
- Genetics of inherited coagulation abnormalities: haemophilia, von Willebrand disease
- Immune-mediated disease: immune thrombocytopenia (ITP), Henoch-Schonlein vasculitis
- Biology of platelet production and function
- Physiology and pathology of coagulation
- Acquired and inherited abnormalities of platelets
- Genetics of inherited coagulation abnormalities: haemophilia, von Willebrand disease
- Immune-mediated disease: immune thrombocytopenia (ITP), Henoch-Schonlein vasculitis
Clinical and Communication Skills
- Elicit a history
- Recognition of petechiae and purpura and differential diagnosis; identify common causes of easy bruising
- Identify 'red flags' on examination for malignancy (lympadenopathy, hepatosplenomegaly, bone tenderness)
- Identify features (red flags) in history and examination that suggest possible non-accidental injury (very young child, unexplained bruises, unusual sites, delay in seeking medical attention)
- Interpretation of full blood count and coagulation profile
- Resuscitation and management of meningococcaemia
- Appropriate engagement and consultation with patient and family/whānau
- Management of haemophilia, von Willebrand disease, ITP
- Diagnosis and prognosis of childhood vasculitis syndromes
- Elicit a history
- Recognition of petechiae and purpura and differential diagnosis; identify common causes of easy bruising
- Identify 'red flags' on examination for malignancy (lympadenopathy, hepatosplenomegaly, bone tenderness)
- Identify features (red flags) in history and examination that suggest possible non-accidental injury (very young child, unexplained bruises, unusual sites, delay in seeking medical attention)
- Interpretation of full blood count and coagulation profile
- Resuscitation and management of meningococcaemia
- Appropriate engagement and consultation with patient and family/whānau
- Management of haemophilia, von Willebrand disease, ITP
- Diagnosis and prognosis of childhood vasculitis syndromes
Personal and Professional Skills
- Communicate empathetically with caregivers even when entertaining the possibility of non-accidental injury
- Communicate empathetically with the child
- Screening safety questions for family violence
- Having difficult conversation with parents (life threatening conditions: leukaemia and other malignancy)
- Communicate with the patient and family/whānau in a way that ensures they have sufficient knowledge and understanding to be able to make informed decisions and give informed consent
- Communicate empathetically with caregivers even when entertaining the possibility of non-accidental injury
- Communicate empathetically with the child
- Screening safety questions for family violence
- Having difficult conversation with parents (life threatening conditions: leukaemia and other malignancy)
- Communicate with the patient and family/whānau in a way that ensures they have sufficient knowledge and understanding to be able to make informed decisions and give informed consent
Hauora Māori
- Awareness of differing risk profiles for Māori (and other disadvantaged populations) compared with non-Māori in New Zealand (e.g. housecrowding and meningitis)
- Inequities in rates of infectious disease and non-accidental injury for Māori compared with non-Māori, and application of this to clinical decision making and management
- Awareness and ability to recognise own stereotypes and biases in relation to Māori patients and whānau
- Awareness of disproportionate impact of socioeconomic deprivation on Māori, particularly Maori children
- Understanding of the role of kaupapa Māori health policies, services and research in reducing inequalities (e.g. meningitis vaccine policy/programme, domestic violence and parenting programmes for whānau)
- Awareness of differing risk profiles for Māori (and other disadvantaged populations) compared with non-Māori in New Zealand (e.g. housecrowding and meningitis)
- Inequities in rates of infectious disease and non-accidental injury for Māori compared with non-Māori, and application of this to clinical decision making and management
- Awareness and ability to recognise own stereotypes and biases in relation to Māori patients and whānau
- Awareness of disproportionate impact of socioeconomic deprivation on Māori, particularly Maori children
- Understanding of the role of kaupapa Māori health policies, services and research in reducing inequalities (e.g. meningitis vaccine policy/programme, domestic violence and parenting programmes for whānau)
Population Health
- New Zealand meningococcal disease epidemiology typing, preventative strategies (including vaccinations)
- Non-accidental injury, family violence and child protection services
- Societal determined factors associated with non-accidental injury and family violence (e.g. deprivation)
- Assessment and sensitivities/checklist and referral
- Epidemiology of inherited coagulation abnormalities
- New Zealand meningococcal disease epidemiology typing, preventative strategies (including vaccinations)
- Non-accidental injury, family violence and child protection services
- Societal determined factors associated with non-accidental injury and family violence (e.g. deprivation)
- Assessment and sensitivities/checklist and referral
- Epidemiology of inherited coagulation abnormalities
Conditions to be considered relating to this scenario
Common
immune thrombocytopenia (ITP), Henoch-Schonlein purpura
immune thrombocytopenia (ITP), Henoch-Schonlein purpura
Less common but 'important not to miss'
meningococcaemia, non-accidental injury, leukaemia and other malignancies, haemophilia
meningococcaemia, non-accidental injury, leukaemia and other malignancies, haemophilia
Uncommon
other inherited coagulation and platelet abnormalities
other inherited coagulation and platelet abnormalities
