Peds 21 Flashcards
Alex is a well-appearing, afebrile, 6-year-old boy with recent URI who presents with acute onset of lower extremity petechiae, palpable purpura, and bilateral arthralgia. What’s your leading dx? What labs do you order to confirm?
IgA vasculitis (Henoch-Schonlein Purpura HSP)
CBC with differential, Urinalysis
What might you expect to see on labs if a child has IgA vasculitis?
Normal platelet count - non-thrombocytopenic
Blood in urine - hematuria
What might you expect to see on a CBC if a child has idiopathic thrombocytopenia purpura (ITP)?
low platelet count
What’s the treatment for IgA vasculitis?
- Supportive care for arthralgia and stomach pain (tylenol)
- observe for serious renal involvement (facial/extremity edema), intussusception (bilious vomit), bloody stool
On f/u, recheck repeat urine samples to monitor kidney inflammation and to follow blood pressure.
A previously healthy 4-year-old girl is brought to her clinician because her parents have noticed that she has been less active than usual for the past three weeks. Her father explains that it is difficult to get his daughter out of bed in the mornings and that she no longer plays outside with her older brother. Physical examination is notable for a temperature of 38.4 C, heart rate of 125 bpm, pallor, truncal bruising, and diffuse lymphadenopathy. The remainder of the exam, including a thorough neurologic assessment, is unremarkable. Which of the following is the most likely diagnosis?
A. Aseptic meningitis B. Kawasaki disease C. Non-accidental trauma D. Acute lymphoblastic leukemia E. Infections mononucleosis
D. Acute lymphoblastic leukemia
Acute lymphoblastic leukemia (ALL) is consistent with this child’s evidence of anemia (fatigue, tachycardia, pallor) and thrombocytopenia (unexplained bruising). Failure of two or more hematologic cell lines should always raise suspicion for malignant invasion of the marrow. Furthermore, the child’s chief complaint, fatigue, is the most common presenting symptom of acute leukemia. In addition, the incidence of ALL peaks at age 4 years.
A 5-year-old boy presents to the emergency department with two days of abdominal pain and one day of rash. He has not had any vomiting or diarrhea. Medical history is significant for an upper respiratory tract infection one week ago. He is otherwise healthy and takes no medications. Vital signs are normal. On examination he has petechiae and purpura on his buttocks and lower extremities. Palpation of the abdomen reveals mild tenderness. The remainder of the exam is normal. Laboratory studies are normal. A clinical diagnosis is made. Which of the following is most important to monitor at this patient’s follow-up visit in two days?
A. Urinalysis B. Platelet count C. Prothrombin time D. White blood cell count E. Hemoglobin
A. Urinalysis
This patient likely has IgA vasculitis.
A 5-year-old boy is brought to his pediatrician with two days of right ankle pain and rash over both lower extremities. He has not had any fever and is previously healthy. He recovered from an upper respiratory infection two weeks ago. Vital signs are normal. His right ankle is swollen and mildly tender. He has palpable purpura over both lower extremities. Which of the following statements is true about his likely diagnosis?
A. CBC would likely reveal thrombocytopenia
B. This disease is classified as a small vessel vasculitis
C. Urinalysis is not warranted for this patient’s workup
D. Treatment options include IVIG
E. This disease is equally common in girls and boys
B. This disease is classified as a small vessel vasculitis
IgA vasculitis is classified as a small vessel vasculitis. The exact mechanism of this disease is unknown; however, it is thought to be an IgA-mediated immune response affecting small vessels (skin, GI tract, joints, kidneys). Approximately 50% of cases follow viral URIs. Biopsy of affected organs shows leukocytoclastic vasculitis with IgA deposition.
A 6-year-old boy presents to the clinic with a chief complaint of acute onset of bruising. He is afebrile, and his mother reports that he recently had a URI. He was born full-term and has never been hospitalized. He was circumcised at birth with no problems with bleeding. No one in his family has any chronic medical problems. There have been no serious childhood illnesses or deaths. No one has a history of easy bruising or bleeding. On exam you find that he has a purpuric rash on his buttocks and legs. His urinalysis reveals 15 to 20 RBCs/hpf. Which of the following additional findings would be inconsistent with a diagnosis of IgA vasculitis?
A. Elevated serum IgA B. Blood in the stool C. Colicky abdominal pain D. Pain in his knees and ankles E. Low platelets
E. Low platelets
A mother brings her 8-year-old son to his primary care physician for pain in his knees and ankles that has been present for the past three days. She also notes that he has had a rash since yesterday, but otherwise feels well. The patient has no chronic illnesses, but he was brought in three weeks ago for an upper respiratory infection. Exam is significant for pain elicited on passive movement of the ankles and knees. Additionally, the patient is found to have an erythematous, slightly raised, non-blanching rash over his legs, buttocks, and posterior portion of his elbows. CBC shows WBC 8.9, Hgb 12.5, Hct 36.1, and Plt 327. Urinalysis is unremarkable. Which of the following is the best next step in management?
A. Observation B. Corticosteroids C. Intravenous immunoglobulin (IVIG) D. Intravenous hydration E. Ceftriaxone
A. Observation
The patient’s presentation is consistent with IgA vasculitis. Most cases of IgA vasculitis resolve within approximately one month and do not require treatment. However, symptomatic treatment for joint pain, e.g. acetaminophen, may be indicated.
