MLA Domain 5 · Presentation
Bruising
18 conditions in Finalist present this way. Work down the list and ask what would separate each one from the next — that discriminator is the exam question.
classic presentation · 7
Neutropenic sepsis, bleeding from thrombocytopenia/DIC, or tumour lysis syndrome → emergencies
Active major bleeding → blood-product support (platelets, FFP, cryoprecipitate) while treating the cause
Marrow failure; transformation to AML; the congenital anomalies are the diagnostic key
Significant mucosal/GI bleeding; suspected intracranial bleed (severe headache/neuro signs) — rare but serious
Significant weight loss / vitamin K deficiency coagulopathy
Neutropenic sepsis or serious bleeding from severe pancytopenia → emergencies
Thrombocytopenia + schistocytes (microangiopathy — TTP/HUS/DIC) → emergency; in TTP do NOT give platelets
recognised feature · 8
Severe pancreatitis (Glasgow ≥3 / persistent organ failure) → HDU/ITU, high mortality
Any white pupillary reflex (leukocoria) → urgent ophthalmology; persistent unexplained bruising/pallor/bone pain; a chil
Intracranial or significant bleeding in haemophilia → urgent factor replacement
Rapid onset + weight loss + hypokalaemia + pigmentation → ectopic ACTH (often small-cell lung cancer) — investigate for
Vascular (type IV) EDS — spontaneous arterial or hollow-organ rupture
Any solid lump must complete triple assessment — do not attribute to trauma without excluding cancer
Septic bursitis (hot, red, fevered bursa) → aspirate + antibiotics
Angioedema with airway or breathing compromise / anaphylaxis → IM adrenaline
differential of the above · 3
New/worsening pain + weight loss → exclude pancreatic cancer (chronic pancreatitis raises the risk)
Refractory symptoms despite a gluten-free diet, or new alarm features → re-evaluate (adherence, refractory coeliac, lymp
Severe abdominal pain (intussusception), GI bleeding, hypertension or significant proteinuria (renal involvement)