Petechiae, purpura and vasculitic rashes — branching viva

Opening question

Examiner: Take me through this child. What is your immediate frame? ^[8]

Candidate: This is a sick child with a rapidly progressive non-blanching rash and signs of septic shock — meningococcal septicaemia or purpura fulminans until proven otherwise. My first split is sick versus well, and this child is unwell: the fever, irritability, cool peripheries, prolonged capillary refill and the spreading dark purpuric rash all place her in the emergency pathway. My immediate frame is the first-hour sepsis bundle: oxygen, access, blood cultures, a broad-spectrum parenteral antibiotic such as ceftriaxone, and a fluid bolus, with escalation to intensive care. ^{[8] [9]}

Examiner: How do you confirm the rash is non-blanching? ^[8]

Candidate: With the glass test. I press a clear glass or transparent tumbler firmly over a lesion; petechiae and purpura remain visible through the glass because the blood is extravascular, whereas an erythematous inflammatory rash would fade. A non-blanching rash means blood outside the vessel lumen, which points me to a platelet, vessel-wall or coagulation problem. ^[8]