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Dermatology > Petechiae, Purpura, and Vasculitis > Flashcards

Petechiae, Purpura, and Vasculitis Flashcards

1
Q

What is purpura?

A

red/purple lesions dur to extravasation of blood into skin/mucosa

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2
Q

What is diascopy?

A

use of glass slide to apply pressure to lesion to determine erythema:
- secondary to vasodilation (blanchable w/ pressure)
- erythrocyte extravasation (retains red color)

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3
Q

What may non-blanchable erythema indicate?

A

underlying issue

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4
Q

What are some causes of purpura?

A
  • hyper/hypo-coaguable states
  • vascular dysfunction
  • extravascular issues
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5
Q

What are the 2 types of purpura and how are they differentiated?

A
  • petechiae = small lesions < 3mm = pin-point dots
  • ecchymoses = large lesions > 5mm
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6
Q

What are the 4 different morphologies of purpura?

A

palpable, macular/flat, retiform, non-retiform

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7
Q

What does palpable purpura indicate?

A

vascular inflammation (vasculitis)

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8
Q

What does macular purpura indicate?

A

non-inflammatory

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9
Q

What is retiform purpura and what does it indicate?

A

angulated w/ sharp edges

arterial occlusion in disseminated intravascular coagulation (DIC) or arterial inflammation (medium vessel vasculitis)

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10
Q

What is non-retiform purpura and what does it indicate?

A

indistinct non-angulated edges = blood leakage due to trauma, weakened connective tissue, hypo-coagulable state

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11
Q

Etiology of Scurvy

A

Vitamin C deficiency

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12
Q

Pathophysiology of Scurvy

A

Vitamin C reqauired for normal collagen structure = no Vit. C = skin and vessel fragility

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13
Q

Clinical presentation of Scurvy

A
  • perifollicular purpura
  • large ecchymoses on lower legs
  • intramuscular and periosteal hemorrhage
  • keratotic plugging of hair follicles
  • hemorrhagic gingivitis (in those w/ poor oral hygiene)
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14
Q

Diagnosis of Scurvy

A

History = indicative in dietary history

PE

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15
Q

What is Solar Purpura?

A

senile purpura = common in geriatric population

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16
Q

Pathophysiology of Solar Purpura

A

weakened collagen and connective tissue

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17
Q

Etiology of Solar Purpura

A

Chronic UV damage = degrades collagen and elastin

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18
Q

What is purpura fulminans?

A

petechiae and large retiform ecchymotic patches on upper and lower extremities

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19
Q

What can presence of petechial or purpuric lesions in a patient with meningitis indicate?

A

sepsis and DIC (disseminated intravascular coagulation)

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20
Q

Etiology of DIC (disseminated intravascular coagulation)

A

unregulated intravascular clotting due to depletion of clotting factors

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21
Q

What lab workup would a patient with DIC show in terms of PT/PTT

A

elevated clotting time bc platelet count is low (takes more time to clot)

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22
Q

Treatment for DIC?

A

treat underlying condition

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23
Q

What is the most common tick-borne infection in the USA?

A

Rocky Mountain Spotted Fever

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24
Q

Etiology for Rocky Mountain Spotted Fever

A

Rickettsia rickettsii

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25
Clinical presentation for Rocky Mountain Spotted Fever
petechial rash after several day since onset of fever starts as faint macules on wrists/ankes → becomes petechial on trunk, extremities, palms/soles
26
Diagnosis of Rocky Mountain Spotted Fever
Hx of hiking/traveling where these ticks are present; fever onset days before petechial rash PE
27
What are important history items to include when clinically evaluating purpura
- FMHx of bleeding/thrombotic disorders - use of drugs/meds affecting platelet function/coagulation - medical conditions that may result in altered coagulation
28
Lab order to evaluate purpura
CBC with differential PT/PTT = assess platelet function/coagulation states
29
What can cause petechiae?
- impaired platelet function - DIC, infection - ↑ intravascular venous pressure - thrombocytopenia - inflammatory skin diseases
30
What can cause ecchymoses?
- external trauma - DIC, infection - coagulation defects - skin weakness/fragility - "pinch purpura" of systemic amyloidosis
31
What causes palpable purpura?
inflammation of cutaneous vessels
32
What causes vessel inflammation?
vessel wall damage + extravasation of erythrocytes
33
What is vasculitis?
inflammation of small cutaneous vessels can occur as a primary process or secondary to an underlying disease
34
What is palpable purpura the hallmark lesion for?
leukocytoclastic vasculitis (small vessel vasculitis)
35
What is the clinical morphology of vasculitis?
correlates w/ size of affected vessel
36
What do small vessel vasculitis indicate?
palpable purpura urticarial lesions = rare case
37
What do small-medium vessels vasculitis indicate?
subcutaneous nodules, retiform (reticulated) purpura ulceration/necrosis may be present
38
What do large vessel vasculitis indicate?
claudication (lower leg cramps); ulceration; necrosis
39
What is systemic vasculitis?
involving vessels in other organs
40
What are lab test used to evaluate suspected vasculitis and how do they do that?
- Urinalysis = detects renal involvement - ANA = (+) antinuclear Ab test detecting connective tissue disorder - ANCA = indicates ANCA-associated or drug-incuded vasculitis - Complement = low serum complement levels = urticarial vasculitis - ESR = systemic vasculitides and sedimentation rates
41
What is Henoch-Schonlein Purpura (HSP)?
most common form of systemic vasculitis in kids AKA: IgA vasculitis
42
What is HSP (Henoch-Schonlein Purpura) characterized by?
- palpable purpura (vasculitis) - arthritis - abd pain - potential kidney disease
43
Epidemiology of HSP (Henoch- Schonlein Purpura)
- childhood disease (3-15 yo) - peak at winter
44
Diagnosis of HSP (Henoch-Schonlein Purpura).
Clinical presentation (Hx and PE) +/- skin biopsy
45
Skin biopsy result with HSP (Henoch-Schonlein Purpura)
- IgA immune complexes deposit in vessel walls - leukocytoclastic vasculitis in postcapillary venules
46
DDx for HSP (Henoch-Schonlein Purpura)?
strep infection r/o w/ ASO or throat culture
47
Prognosis of HSP (Henoch-Schonlein Purpura)
- kids typically completely recover - can worsen into progressive renal disease (more common in adults)
48
How can you determine systemic involvement with HSP (Henoch-Schonlein Purpura)?
- renal = UA, BUN/Cr (creatine) - GI = stool guaiac - HSP may be secondary to an underlying malignancy
49
Treatment for HSP (Henoch-Schonlein Purpura)
supportive; prednisone
50
What historical information is always associated with leukocytoclastic vasculitis (LCV)?
IV medication/drug use
51
Clinical presentation of Leukocytoclastic Vasculitis?
- palpable purpura!!! - palpable hemorrhagic papules coalescing (form together) into plaques - bilateral presentation on lower extremities
52
Diagnosis of Leukocytoclastic Vasculitis?
Clincial = Hx and PE skin biopsy
53
Treatment of leukocytoclastic vasculitis.
stop IV drug use; determine systemic involvement and treat that
54
What is polyarteritis nodosa?
- affects medium arteries - systemic disorder of necrotizing vasculitis
55
What is polyarteritis nodosa (PAN) characterized by?
painful subQ nodules (can ulcerate) may present w/ livedo reticularis
56
Etiology of polyarteritis nodosa?
unknown; may affect any organ: skin, peripheral nerves, kidneys, joints, GI
57
What viruses can be associated with polyarteritis nodosa?
HepB, HepC, HIV, Parvo-B19
58
Clinical presentation of polyarteritis nodosa?
- parasthesias - ↓ sensation and reflexes - fever
59
Diagnosis of polyarteritis nodosa?
Clincial = Hx and PE Skin biopsy = skin nodules w/ medium-size artery inflammation renal involvement
60
What is mononeuritis multiplex?
peripheral neuropathy of 2 or more nerves in PNS **nerve next to affected artery can be damaged during inflammatory process ** tingling, numbness, pain and paralysis
61
What is the 2 different types of polyarteritis nodosa diseases?
cutaneous and systemic
62
What are the characteristics of cutaneous polyarteritis nodosa?
- skin involvement +/- polyneuropathy - arthralgias, myalgias - fever - common w/ kids (s/p strep infection) - chronic but benign course
63
What are the characteristics of systemic polyarteritis nodosa?
- neuro involvement = mononeuritis multiplex, stroke - renal = HTN - may affect: joint, heart, GI, liver - orchitis in HepB patients
64
Prognosis of polyarteritis nodosa?
chronic (mos-yrs) -- exacerbation/remissions
65
Treatment of polyarteritis nodosa?
- wound care of ulcers - systemic corticosteroids (not systemic PAN) - systemic PAN = refer to consults; adjunctive therapy - treat underlying conditions (ie: HepB)
66
What may petechia/purpura indicate in a septic patient?
DIC (disseminated intravascular coagulation) disease

Dermatology (5 decks)

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