21- bruising

Question 1

causes of petechiae/purpura

Answer 1

Trauma

Platelet deficiency or dysfunction (e.g. immune-mediated thrombocytopenia, bone marrow infiltration or suppression, malignancy)

Coagulation abnormalities (e.g. hereditary or acquired clotting-factor deficiencies)

Vascular fragility (e.g., immune-mediated vasculitis)

Combinations of the above (e.g., infection causing coagulation abnormalities, vascular fragility, platelet consumption)

Question 2

Henoch-Schönlein purpura (HSP)

Answer 2

HSP is a self-limited, IgA-mediated, small vessel vasculitis that typically involves the skin, GI tract, joints, and kidneys.

Often presents in an otherwise well appearing child with bruising and leg pain (due to arthritis). Petechiae primarily on legs

In roughly 50% of cases, a URI precedes the diagnosis of HSP.

Question 3

diffuse adenopathy occurs when…

Answer 3

generalized infection, malignancy, storage diseases, and chronic inflammatory disease.

Question 4

hepatomegaly causes

Answer 4

inflammation (e.g., viral hepatitis),
infiltration (e.g., leukemia/lymphoma), accumulation of storage products (e.g., glycogen-storage disease),
congestion (e.g., congestive heart failure) or obstruction (e.g., biliary atresia).

Question 5

causes of arthritis in child

Answer 5

Trauma
Septic arthritis
Transient synovitis
Reactive arthritis (e.g., post-streptococcal arthritis)
Lyme disease
Rheumatic fever
Juvenile idiopathic arthritis
Systemic lupus erythematosus
Henoch-Schönlein Purpura

Question 6

arthritis vs arthralgia

Answer 6

Arthralgia refers to pain in or around the joint without signs of synovitis

arthritis is used in the presence of true synovitis, defined as either joint swelling or joint pain with limitation of motion on exam.

Question 7

labs to test for HSP

Answer 7

UA
BUN, Cr- for renal function

CBC with differential- platelet count (if low–> ITP)

Question 8

causes of splenomegaly

Answer 8

infection (EBV, CMV, bacteria, endocard)

hemolysis- sickle cell

malignancy- leukemia/lymphoma

storage- gaucher dz

lupus, juvenile idiopathic arthritis

portal HTN

Question 9

years you can get intusscecption

Answer 9

6 mo-6 yrs

most under 2

Question 10

HSP recurrence

Answer 10

The recurrence rate for HSP is about 30%. Symptoms may return weeks to many months after the first episode.
Like the initial episode, a recurrence may start with abdominal pain, rather than rash, so it is important to keep HSP in mind if a patient has significant abdominal pain in the future.
If a recurrence does occur, it is important to recheck the urine to evaluate for renal involvement.

Question 11

HSP treatment

Answer 11

supportive- NSAIDS for joint pain

resolves within 4-6 weeks

Question 12

HSP epidemiology

Answer 12

boys > girls

2-17 yrs, mostly 4-6

Question 13

evaluation of a skin lesion

Answer 13

Type (shape, color, consistency, size)

Arrangement (confluent, scattered, symm)

Location

Pattern of distribution (sun-ex, flexural)

Progression over time