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Infant or child with easy bruising

Clinical Discipline(s)/Organ System(s)
Haematology, Paediatrics
Progress Test Topic(s)
Blood and lymph
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 2
Applied 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
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
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
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)
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
Conditions to be considered relating to this scenario
immune thrombocytopenia (ITP), Henoch-Schonlein purpura
Less common but 'important not to miss'
meningococcaemia, non-accidental injury, leukaemia and other malignancies, haemophilia
other inherited coagulation and platelet abnormalities
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