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PCM IV DF > Heme and Lymph > Flashcards

Heme and Lymph Flashcards

1
Q

non blanchable, hemorrhagic skin lesions that result from leakage of RBCs into skin

A

purpura

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2
Q

macular purpura

A

non palpable/ non-inflammatory
petechiae if under 3 mm
ecchymosis if over 5 mm

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3
Q

purpura + thrombocytopenia and abnormal coagulation studies

A 
septicemia
HUS
Leukemia
ITP
coagulpathies (hemophilia)

SHLIC

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4
Q

are purpura palpable in thrombocytopenic purpuric disorders

A

no

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5
Q

purpura + normal platelet count and coagulation studies

A

henosch-schoenlein purpura (HSP or IgA vasculitis)

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6
Q

common in children with HSP but not in adults

A

intussesception

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7
Q

tetrad for HSP is

A

palpable purpura without thrombocytopenia and coagulopathy

\+ 1 or more of the following
-acute arthralgia and or arthritis
acute abdominal pain
renal disease 
IgA depostion on biopsy
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8
Q

immune mediated vasculitis that may be triggered by a variety of antigens including various infections and immunizations

A

IgA vasculitis (IgA nephropathy)

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9
Q

considerations for diagnosis of HSP:

may follow ____ infection and present with generalized what

A

strep

arthralgias/myalgias, rash, palpable purpura (especially on LE and buttocks) abdominal pain, and renal insufficiency

PAM RARI

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10
Q

acute hemorrhagic edema of infancy

called what else
what age
extent of disease
presents with 
biopsy
A

leukocytoclastic vasculitis
children btwn ages of 4 months to two years
self limited disease, resolves in 1-3 weeks
fever, purpura, ecchymosis, inflammatory edema of limbs (FEPI)
biopsy demonstrates leukocytoclastic vasculitis with occasional IgA deposition

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11
Q

hypersensitivity vasculitis

from what
symptoms
histopath

A

inflammation of the small vessels that occurs after exposure to:
drugs, infection, or without known tigger

fever, urticaria, LAD, arthralgias (no GN)

histopathology: leukocytoclastic vasculitis primarily of postcap venules, but IgA deposition is absent

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12
Q

other small vessel vasculitieds: primary vasculitieds

A

granulomatosis with polyangiitis (wegner)
microscopic polyangiitis
eosinophilic granulomatosis with polyangiitis (churg strauss syndrome)

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13
Q

secondary vascular inflammation

A

SLE
RA
infectious disease (hepatitis)

uncommon in children

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14
Q

pt doing insanity workout with arthralgias, abdominal pain, renal insufficiency, cpk elevation

A

rhabdomyolysis

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15
Q

until pt develops the classical purpura of HSP could have DDx of

A

arthritis and arthralgia

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16
Q

rheumatic fever vs HSP

A

evidence of recent gropu A beta hemolytic strep infection

+ clincial course of Jones criteria: rash diff, erythema marginatum, nodules and carditis

17
Q

possible history of recent strep + clinical course of HSP tetrad then

A

HSP

18
Q

septic and toxic synovitis aka transient synovitis

A

joint symptoms similar to those seen in pts with HSP

only one or two joints, unlike polyarthritis seen in HSP

-affected joints are warm and erythematous in septic arthritis, unlike hsp

19
Q

reactive arthritis trigger

A

variety of GU or GI pathogens like b-hemolytic strep

20
Q

differentiating acute abdominal emergency from HSP before purpura develops

A

rash of HSP usually precedes GI manifestations and seldom lags b more than few days

21
Q

managment of HSP

A

vast majorit of pts recover spontaneously thus care is primarily supportive

22
Q

what do you need to assess in HSP

A

renal status, overall fluid/electrolyte status

in severe cases, corticosteroids have been used (only when absolutley need them)

23
Q

what is impiric to give in HSP

A

IV hydration (saline/D5/LR)

24
Q

other drugs for HSP

A

pain managment (possible NSAIDs)
anti-emetics for N/V
PPI for acute gastritis/PUD from NSAID or steroids
acute abdominal series (xray) or US to screen for intussusception

25
Q

lab tests to consider with HSP

A

IgA levels, higher level associated with renal involvement

routine blood test: CBC, CMP, urinalysis
-confirmation of normal platelet cont and coag studies (PTT) necessary

hypocomplementemia

skin biopsy

kidney biopsy

26
Q

hypocomplementemia in HSP

A

(typically normal in HSP)

  • more likely in children with recent strep
  • levels normalize within 3 months
27
Q

skin biopsy in HSP

A

sample small BV of superficial dermis

H&E stain demonstrate leukocytoclastic vasculitis in postcappilalary venules with IgA deposition***

28
Q

kidney biopsy in HSP

A

IgA depostion in the mesangium on immunofluorescence microscopy identical to that in IgA nephropathy

29
Q

light microscopy changes on kidney biopsy in HSP

A

range from isolated mesangial proliferation to severe cresentic GN

30
Q

ANA, anti ds DNA, anca, RF in HSP are what

A

negative

31
Q

why importnat to monitor urine analysis in HSP

A

always will be blood in UA, but if there is protein, need to worry about if kidney disease will become chronic

proteinuria in hsp is indicator of long term kidney disease

32
Q

imaging to consider in HSP

A

plain abdominal radiography
-can see intussusception and dilated loops of bowel

abdominal US
can detect intussusception

doppler flow studies and/or radionuclide scans
-in boys with scrotal symptoms, can distinguish scrotal pain caused by HSP vs testicular torsion

33
Q

abdominal US, for a child if intussusception is considered then what first

A

US rather than contrast enema

contrast enema neither detect nor help reduce ileoileal intussusception

34
Q

what kind of intussusception in HSP (more than 1/2 of cases)

A

ileoileal intussusception

35
Q

adult clinical findings in HSP

A

palpable purpura, arthritis, GI symptoms. 1/3 of pts have renal impairment

36
Q

OMT in HSP

A

only after recovery

37
Q

check what for OMT after recvoery

A

T10-L1 for kidney
upper and lower GI (T5-9 and T10-L2)
whole body lymphatic treatment

38
Q

right lymphatic duct drains

what drains rest of body

A

right head and neck, right UE, all lung lobes except upper left

thoracic duct

39
Q

sequence

A

thoracic inlet–> thoracic area–> abdominal area–>UE or LE–> UE or LE–> head and neck–> thoracic inlet

TTALHT

PCM IV DF (7 decks)

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