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Dermatology - Chapters > Chapter 17- Purpura > Flashcards

Chapter 17- Purpura Flashcards

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Dermatology Board Prep flashcards
1
Q

petechiae - purpuric maclues

A

Thrombocytompenic Purpura (TTP)

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2
Q

What is the most common cause of Thrombocytopenic Purpura (TTP)?

A

drugs

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3
Q

What age group does Thrombocytompenic Purprura effect? What are specific questions you would ask them?

A

Children & Adults
but for children with acute thrombocytopenic purport there is usually a history of a viral infection with the preceding 1-3 weeks.

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4
Q

What are the 7 cause of thrombocytopenic purpura?

A
  1. Drugs
  2. Viral infections
  3. Aids
  4. Collagen vascular disease
  5. Hematologic malignancy
  6. ITP
  7. TTP
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5
Q

thrombotic thrombocytopenic purpura (TTP) is usually accompanied by what?

A

fever, hemolytic anemia, and neurologic symptoms

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6
Q

_______ is frequently found in patients with hematologic malignancies or chronic ITP (idiopathic/immune thrombocytopenic purpura)

A

Splenomegaly

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7
Q

due to mucosal bleeding possibly being present with thrombocytopenic purpura, what should also be examined?

A

conjuctivae and oral cavity

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8
Q

petechial lesions of the lower legs due to weakened capillaries, causing leakage (but not enough to cause elevation of the lesion); looks like cayenne pepper.

A

Schamberg’s disease

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9
Q

in a patent with dermatitis, _____ could cause petechiae.

A

venous stasis

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10
Q

what lab should be done in a patient with petechiae?

A

complete blood cell count and platelet count.

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11
Q

platelet count <50 000/mm^3 occurs when there is bleeding from _____.

A

thrombocytopenia

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12
Q

a platelet count of <20 000/mm^3 results in bleeding from _____

A

minor trauma

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13
Q

a platelet count <10 000/mm^3 predisposes the patient to _____

A

internal bleeding

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14
Q

what can you do to distinguish non inflammatory petechiae from vasculitis, although the clinical picture is usually so distinctive its not required.

A

skin biopsy

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15
Q

where else can drug - induced throbmbocytopenia produce bleeding?

A

gastrointestinal tract*** KNOW THIS!

- if suspected get urinalysis & stool guaiac

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16
Q

T/F Virus - induced acute thrombocytopenia resolves without therapy and without complications in 90% of children.

A

true

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17
Q

ITP in adults may resolve spontaneously, BUT more often becomes chronic with a waxing and waning course that requires ________ in many patients.

A

SPLENECTOMY!!!!!!!!

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18
Q

ITP is the presenting problem in some patients with underling “autoimmune” diseases such as _______.

A

Systemic Lupus Erythematosus (SLE)

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19
Q

Drug induced thrombocytopenia results from either a ____ or _____ mechanism.

A

toxic or an antibody - mediated mechanism

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20
Q

What are the drugs that cause platelet DESTRUCTION causing thrombocytopenia?

A
  1. quinidine
  2. quinine
  3. sulfonamides
  4. heparin
  5. digitoxin
  6. phenytoin
  7. Methyldopa
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21
Q

what causes thrombocytopenia through inhibition of bone marrow production.

A

cancer chemotherapy

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22
Q

what causes platelet DYSFUNCTION through inhibition of thrmboxane production in thrombocytopenia?

A

aspirin

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23
Q

_______ occurs in hematologic malignancies as a result of bone marrow replacement with malignant cells.

A

decrease platelet production

24
Q

T/F an autoimmune mechanism is operative in virus induced acute childhood thrombocytopenia, AIDS-associated thrombocytopenia, and chronic ITP.

A

true

** TTP cause is unknown

25
Q

T/F Petechiae occur as a result of the throbocytopenia from platelet consumption.

A

true

26
Q

Purpura; uncontrolled clotting results in diffuse thrombus formation. in the skin cause necrosis. uncommon life threatening diseases caused by underlying malignancy or trauma = _______

A

Dissementated Intravascular Coagulation (DIC)

27
Q

What would you expect to see upon physical examination of Dissemenated intravascular coagulation?

A

purpuric , stellate ecchymosis, which appears to be necrotic in the center.
**petechiae can also be present
most lesions are flat but palpable purpura can occur in patients with edema associated with skin infarction.

28
Q

is Disseminated intravascular coagulation seen in a bacterial or viral infection?

A

bacterial sepsis (meningococcemia)

29
Q

Disseminated intravascular coagulation (DIC) may aLso be associated with malignancy particularly _____ & ______.

A

prostatic carcinoma & acute promyelocytic leukemia

30
Q

T/F Disseminated intravascular coagulation can be precipitated by massive trauma.

A

true

31
Q

Occasionally, Disseminated intravascular coagulation may occur as an idiopathic or post infection phenomenon ________.

A

purpura fulminans. *patients with this usually have had an upper respiratory tract symptoms from viral or streptococcal infection

32
Q

What are the 5 causes of DIC:

A
  1. Bacterial sepsis
  2. Malignancy (prostatic carcinoma & acute promyelocytic leukemia)
  3. Amniotic fluid embolism
  4. Trauma
  5. Idiopathic (purpura fulminans)
33
Q

Localized intravascular coagulation occurs in patients with protein C deficiency who are given ________. The name of the disease is _____.

A

warfarin (an anti-coagulation drug)

Coumadin necrosis - NO SYSTEMIC SYMPTOMS

34
Q

Would a patient with DIC present with any symptoms?

A
  1. fever & shock
  2. infection = headache & stiff neck with meningococcal meningitis
  3. purpura fulminans = upper respiratory tract symptoms from viral or streptococcal infection)
  4. Coumadin necrosis are usually NOT infected systemically
35
Q

Where would you expect to find Coumadin necrosis?

A

one or a few localized areas , but the skin involvement i severe and results in a full thickness slough and is localized to FATTY AREAS SUCH AS THE BREASTS AND THIGHS

36
Q

Disseminated Intravascular Coagulation (DIC) is characterized by stellate purpura with dark gray central areas indicating _____ and _____.

A

thrombosis and infarction

37
Q

How do the vasculitic lesions differ from purpura in DIC?

A

purpura in DIC is usually flat but may occasionally be palpable.
***IF ELEVATED lesions in DIC can be distinguished from those of vasculitis by a SKIN BIOPSY.

38
Q

T/F In bacterial sepsis, vasculitis and DIC can coexist.

A

true

39
Q

palpable purpura , lesions elevated (palpable) due to inflammation and edema because of extravasation of blood from damaged blood vessels.

A

Vasculitis

40
Q

Cutaneous vasculitis affects only small vessels are results in purpuric papules. mediated by neutrophils and is termed _______.

A

Leukocytoclastic vasculitis

41
Q

an idiopathic syndrome of cutaneous vasculitis associated with arthritis and abdominal pain, accompanied by gastrointestinal and renal vasculitis.

A

Henoch-Schonlein purpura

42
Q

vasculitis confined to the skin in which an underlying cause cannot be found and has been called _______ or ______.

A

allergic cutaneous vasculitis or hypersenitivity vasculitis

*common but a diagnosis of exclusion

43
Q

what are the 3 infectious causes of cutaneous vasculitis?

A

bacterial, rickettsial, viral (hepatitis C virus)

44
Q

what are the two types of collagen vascular diseases causing cutaneous vasculitis?

A
  1. systemic lupus erythematosus

2. Rheumatoid arthritis

45
Q

what are the two idiopathic diseases causing cutaneous vasculitis?

A

Henoch-Schonlein purpura

Hypersensitivity

46
Q

what must be fused out and the history is the first step in doing so in diagnosing vasculitis?

A

systemic disease

47
Q

in a patient with fever and cutaneous vasculitis, ____ must be considered as the cause of vasculitis.

A

sepsis

48
Q

the rash in _____ starts on the wrists and ankles, abrupt onset of fever is accompanied by headache and myalgia, and is followed several days later by an erythematous rash.

A

Rocky Mountain spotted fever.

49
Q

T/F drug induced vasculitis is common.

A

FALSE! very uncommon

50
Q

Upon physical examination of a patient with vasculitis, what would expect to see?

A

purpuric papule (palpable purpura). Necrosis sometimes follows; it is heralded by the appearance of a dark gray color in the center of a lesion, followed by slough. In the absence of necrosis, lesions evolve by flattening and fading very quickly. As lesions fade, hemosiderin remains, leaving affected skin brown

51
Q

In _______, lesions are distinctive in that they are putular as well as purpuric, sparse, and distributed distally on the extremities.

A

Gonococcemia

52
Q

Patients with large vessel vasculitis, called _________, frequently experience ulcerations of the skin as a manifestation of obliterative necrosis of vessels that are larger than those involved in the vasculitis lesions.

A

Wegener’s Granulomatosis or polyarteritis nodosa

53
Q

Henoch-Schonlein purpura is usually self limiting, but _____ persists in nearly 30% of patients.

A

renal impairment

54
Q

Rheumatoid vasculitis is usually associated with a _____ tider of rheumatoid factor; a ______ in rheumatoid factor is usually accompanied by improvement in vasculitis.

A

high; reduction

55
Q

vasculitis is a ________ reaction.

A

type III immune complex reaction

Dermatology - Chapters (18 decks)

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