Heme/Lymph CIS

Question 1

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

Answer 1

Purpura

-Macular: non palpable/non-inflammatory and further divided into petechiae (<3mm) and ecchymosis (>5 mm)

Question 2

describe a characteristic of purpura in thrombocytopenic disorders

Answer 2

Non palpable

Question 3

what is the characteristic tetrad for Henoch Schonlein Purpura (HSP)?

Answer 3

• palpable purpura WITHOUT thrombocytopenia and coagulopathy
• plus 1 or more of the following: acute arthralgia and/or arthritis, acute abdominal pain, renal disease, IgA deposition on biopsy

Question 4

what are the considerations on exam for diagnosis of HSP?

Answer 4

• may follow a strep infection
• present with generalized arthralgias/myalgias
• rash
• palpable purpura (especially on LE and buttocks
• abdominal pain
• renal insufficiency

Question 5

management plan for HSP

Answer 5

• most resolve spontaneously so care is primarily supportive
• Assess renal status, overall fluid/electrolyte status, if super severe then corticosteroids
• IV HYDRATION
• Pain management (NSAIDS depending on renal status)
• Anti-emetics
• may need PPI to minimize acute gastritis/PUD from NSAID or steroid
• Acute abdominal series (plain film xray) or ultrasound is done to screen for intussusception

Question 6

what are platelet counts and coagulation studies like in HSP

Answer 6

normal

Question 7

what biopsy result is pathognomonic for HSP

Answer 7

• sample small blood vessels of superficial dermis
• light microscopy (hematoxylin and eosin stains)
• LEUKOCYTOCLASTIC VASCULITIS IN POSTCAPILLARY VENULES WITH IgA deposition

Question 8

what lab test is diagnostic for HSP

Answer 8

None but they can help rule out other DDx

Question 9

what in HSP is an indicator of long term kidney disease

Answer 9

Proteinuria

Question 10

what should be the initial screening test for a child if intussusception with HSP is considered

Answer 10

-ultrasonography rather than contrast enema

Question 11

in boys with HSP who present with scrotal symptoms, what can distinguish scrotal pain caused by HSP from testicular torsion

Answer 11

Doppler flow studies and/or radionuclide scans

Question 12

what age group is more likely to get intussusception

Answer 12

children

Question 13

OMM and HSP?

Answer 13

• acute setting: contraindicated
• upon recovery:
• viscerosomatic for kidney (T10-L1)
• for GI (upper: T5-9, lower: T10-L2)
• Whole body lymphatic treatment