Chapter 17- Purpura

Question 1

petechiae - purpuric maclues

Answer 1

Thrombocytompenic Purpura (TTP)

Question 2

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

Answer 2

drugs

Question 3

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

Answer 3

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

Question 4

What are the 7 cause of thrombocytopenic purpura?

Answer 4

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

Question 5

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

Answer 5

fever, hemolytic anemia, and neurologic symptoms

Question 6

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

Answer 6

Splenomegaly

Question 7

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

Answer 7

conjuctivae and oral cavity

Question 8

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.

Answer 8

Schamberg’s disease

Question 9

in a patent with dermatitis, _____ could cause petechiae.

Answer 9

venous stasis

Question 10

what lab should be done in a patient with petechiae?

Answer 10

complete blood cell count and platelet count.

Question 11

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

Answer 11

thrombocytopenia

Question 12

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

Answer 12

minor trauma

Question 13

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

Answer 13

internal bleeding

Question 14

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

Answer 14

skin biopsy

Question 15

where else can drug - induced throbmbocytopenia produce bleeding?

Answer 15

gastrointestinal tract*** KNOW THIS!

- if suspected get urinalysis & stool guaiac

Question 16

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

Answer 16

true

Question 17

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

Answer 17

SPLENECTOMY!!!!!!!!

Question 18

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

Answer 18

Systemic Lupus Erythematosus (SLE)

Question 19

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

Answer 19

toxic or an antibody - mediated mechanism

Question 20

What are the drugs that cause platelet DESTRUCTION causing thrombocytopenia?

Answer 20

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

Question 21

what causes thrombocytopenia through inhibition of bone marrow production.

Answer 21

cancer chemotherapy

Question 22

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

Answer 22

aspirin

Question 23

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

Answer 23

decrease platelet production

Question 24

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

Answer 24

true

** TTP cause is unknown

Question 25

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

Answer 25

true

Question 26

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

Answer 26

Dissementated Intravascular Coagulation (DIC)

Question 27

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

Answer 27

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.

Question 28

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

Answer 28

bacterial sepsis (meningococcemia)

Question 29

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

Answer 29

prostatic carcinoma & acute promyelocytic leukemia

Question 30

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

Answer 30

true

Question 31

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

Answer 31

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

Question 32

What are the 5 causes of DIC:

Answer 32

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

Question 33

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

Answer 33

warfarin (an anti-coagulation drug) | Coumadin necrosis - NO SYSTEMIC SYMPTOMS

Question 34

Would a patient with DIC present with any symptoms?

Answer 34

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

Question 35

Where would you expect to find Coumadin necrosis?

Answer 35

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

Question 36

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

Answer 36

thrombosis and infarction

Question 37

How do the vasculitic lesions differ from purpura in DIC?

Answer 37

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.

Question 38

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

Answer 38

true

Question 39

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

Answer 39

Vasculitis

Question 40

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

Answer 40

Leukocytoclastic vasculitis

Question 41

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

Answer 41

Henoch-Schonlein purpura

Question 42

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

Answer 42

allergic cutaneous vasculitis or hypersenitivity vasculitis | *common but a diagnosis of exclusion

Question 43

what are the 3 infectious causes of cutaneous vasculitis?

Answer 43

bacterial, rickettsial, viral (hepatitis C virus)

Question 44

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

Answer 44

1. systemic lupus erythematosus | 2. Rheumatoid arthritis

Question 45

what are the two idiopathic diseases causing cutaneous vasculitis?

Answer 45

Henoch-Schonlein purpura | Hypersensitivity

Question 46

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

Answer 46

systemic disease

Question 47

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

Answer 47

sepsis

Question 48

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.

Answer 48

Rocky Mountain spotted fever.

Question 49

T/F drug induced vasculitis is common.

Answer 49

FALSE! very uncommon

Question 50

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

Answer 50

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

Question 51

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

Answer 51

Gonococcemia

Question 52

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.

Answer 52

Wegener's Granulomatosis or polyarteritis nodosa

Question 53

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

Answer 53

renal impairment

Question 54

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

Answer 54

high; reduction

Question 55

vasculitis is a ________ reaction.

Answer 55

type III immune complex reaction