Oral manifestations of systemic disease — formative SAQs

SAQ 1 — The pale tired child with swollen bleeding gums (10 marks, 15 minutes)

A six-year-old boy presents with two weeks of fatigue, easy bruising and progressively swollen, painful, bleeding gums. On examination he is pale, the gums are diffusely boggy, enlarged and bleed on touching, and there are petechiae on the palate and bruising on the shins. His temperature is 38.6 degrees Celsius. ^[1]

a) What is the most likely diagnosis, and which two features in the mouth mark it as systemic rather than simple gingivitis? (2 marks) ^[1]

b) Name the single most urgent investigation and the immediate safety actions you would take for this child. (4 marks) ^[1]

c) Give two reasons why you would give empiric broad-spectrum antibiotics while awaiting results, and name the team you would transfer him to. (2 marks) ^[1]

d) Explain why the gingival infiltration will not respond to mouthwash or improved oral hygiene, and what will resolve it. (2 marks) ^[1]