Self assessment questions

摘要

A 10-month-old boy was referred by his general practitioner with a 5-day history of pyrexia and irritability. He was medically fit and fully immunised. On arrival to the admissions unit he was alert, but difficult to console. He was pyrexic with a temperature of 38.5 °C, his heart rate was 150beats/min, and he had normal blood pressure. Although he was pale on inspection, his capillary refill time was less than 2 s centrally. There was no evidence of a rash. His mother said that he had been less mobile over the past 3 days and she was concerned that he may be finding it painful to bear weight. Further examination revealed an injected oropharynx, peri-oral pallor and several small mobile cervical lymph nodes.