Oral ulcers and mucosal disease — formative SAQs

SAQ 1 — The drooling febrile toddler with painful gums (10 marks, 15 minutes)

A two-year-old boy has three days of high fever, drooling and progressive refusal of all fluids. On examination his temperature is 39.2 degrees Celsius, the gingiva is diffusely swollen, red and bleeding, and there are shallow vesicles and ulcers across the gingiva, tongue and lips with tender cervical lymphadenopathy. He has passed no urine for eight hours and his capillary refill is three seconds. ^[1]

a) What is the diagnosis, and which two clinical features make dehydration the practical threat? (2 marks) ^[1]

b) Give the antiviral regimen you would use, including drug, dose, route, frequency, duration and the window of onset within which it should start, and cite the evidence. (3 marks) ^{[1] [2]}

c) Outline your immediate fluid and analgesia management, including the route you would choose if he cannot maintain oral hydration. (3 marks) ^[2]

d) Give two circumstances in which you would choose intravenous rather than oral aciclovir. (2 marks) ^[2]