MLA Domain 5 · Presentation

Purpuric/ petechial rash

6 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 · 2

Bacterial meningitis

Non-blanching rash, septic shock, reduced GCS, focal signs/seizures → do not delay antibiotics; signs of raised ICP

Henoch-Schönlein purpura (IgA vasculitis)

Severe abdominal pain (intussusception), GI bleeding, hypertension or significant proteinuria (renal involvement)

recognised feature · 1

Meningitis

Non-blanching rash, septic shock, reduced GCS, focal signs/seizures, raised-ICP signs → do not delay antibiotics

differential of the above · 3

Encephalitis

Reduced GCS, status epilepticus, raised ICP; delay in aciclovir worsens outcome

Migraine

Aura + COCP (stroke risk → COCP is UKMEC 4); thunderclap or new focal/systemic features → exclude secondary causes (see

Subarachnoid haemorrhage

Reduced GCS, focal deficit, rebleeding (highest risk first 12h), hydrocephalus, vasospasm (delayed ischaemia)