CLIPP 21- HSP

Question 1

DDX bruising/leg pain (9)

Answer 1

• coagulation disorder (easy bruising after minor trauma, hemarthrosis)
• HSP (palpable purpura, preceded by URI)
• ITP (asymptomatic petechiae, preceded by URI)
• Leukemia (constitutional symptoms)
• viral infection (enterovirus, low grade fever, coughing/vomiting)
• bacterial endocarditis (fever, fatigue, weight loss, +/- bruising)
• meningococcal septicemia
• Rocky Mountain Spotted Fever (rash starts on extremities, FEVER)
• SLE (constitutional symptoms)

Question 2

Henoch-Schonlein Purpura features (course, cause, epidemiology, systems, presentation)

Answer 2

• self limited, lasts approximately 1 month
• IgA mediated small vessel vasculitis following URI
• most common vasculitis in children, boys>girls
• typically involves skin, GI tract (abdominal pain/intestinal bleeding), joints (arthralgias), and kidneys (hematuria)
• non-thrombocytopenic purpura with symmetric distribution in gravity-dependent areas

Question 3

ITP features (3)

Answer 3

• superficial petechiae and bruising
• no hepatosplenomegaly
• thrombocytopenia with normal WBC and Hgb

Question 4

Intussusception features (3)

Answer 4

• paroxysmal severe abdominal pain with inconsolable crying
• “currant jelly” stool
• “sausage-shaped” mass in right abdomen
• vomiting, lethargy, toxic appearance

Question 5

petechiae/purpura mechanisms (5)

Answer 5

• trauma
• platelet deficiency/dysfunction
• coagulation abnormalities
• vascular fragility
• combinations of the above

Question 6

Features of skin lesions (5)

Answer 6

-type, arrangement, location, pattern of distribution, progression over time

Question 7

Causes of hepatomegaly (5)

Answer 7

• inflammation (viral hepatitis)
• infiltration (leukemia/lymphoma)
• accumulation of storage products (glycogen storage disease)
• congestion (CHF)
• obstruction (biliary atresia)

Question 8

Complications of HSP (4)

Answer 8

-chronic renal failure, GI bleeding, intussusception, recurrence

Question 9

Treatment of HSP

Answer 9

-early corticosteroids(?), observation for complications

Question 10

Complications of ITP

Answer 10

intracranial hemorrhage

Question 11

Treatment of ITP (4)

Answer 11

-observation, corticosteroids, IVIG, anti-D immunoglobulin

Question 12

Emergent findings (3)

Answer 12

-AMS, Respiratory distress, mottled skin/cyanosis

Question 13

Urgent findings (3)

Answer 13

fever, pallor, pain

Question 14

Causes of Splenomegaly (6)

Answer 14

• Infection (EBV, CMV, sepsis, endocarditis)
• Hemolysis (SCD)
• Malignancy (leukemia/lymphoma)
• Storage diseases (Gaucher disease)
• systemic inflammatory disease (SLE, JIA)
• Congestion (portal hypertension)

Question 15

Lab evaluation of HSP (3)

Answer 15

• platelet count (normal)
• UA (hematuria/proteinuria)
• BUN/Creatinine

Question 16

ALL features (2)

Answer 16

• bone pain

- splenomegaly and lymphadenopathy