Petechiae, Purpura, and Vasculitis - Schwarzenberger

Question 1

What is purpura?

Answer 1

Essentially “blood under the skin”

• non-blanchable, pink to purple macules/patches or papules caused by extravasated RBC’s in skin or mucous membranes

Question 2

3 Main causes of purpura?

Answer 2

• coagulation/clotting abnormalities
• leaky or abnormal blood vessels
• other causes, including trauma

Question 3

2 types of purpura? Which is associated with inflammation? Inflammatory purpura is a sign for what?

Answer 3

• non-palpable/macular (NON inflammatory)
• palable (inflammatory) = signs of vasculitis

Question 4

2 types of non-palpable purpura?

Answer 4

petechiae, ecchymosis

Question 5

What type of non-palpable purpura is this?

Answer 5

Petechiae

Question 6

Petechiae features?

Size?

Location?

Painful or painless?

Answer 6

• small <3 mm red or purple dots
• usually on dependent areas of body
• generally painless

Question 7

Who is most likely to have petechiae (2 types of pts)?

Answer 7

pt with hemophilia or with cancer receiving chemotherapy

Question 8

Petechiae is generally considered to be an abnormality in what?

Answer 8

platelets

Question 9

Non-platelet related petechiae is usually due to what?

Answer 9

things that increase capillary fragility or allow them to leak

Question 10

What was the dx of this type of petechiae?

Answer 10

Scurvy, due to vit C defiency

• petechiae associated with hair follicles, hair is curled

Question 11

Non-scientific name for ecchymosis?

Answer 11

Bruise

Question 12

Ecchymosis features?

Size?

Location on body?

Painful or painless?

Answer 12

• Larger areas of purpura (>5mm)
• can be anywhere on body
• may/may not be painful, tender

Question 13

Ecchymosis are usually due to what?

Answer 13

Coagulation defect (hyper or hypocoaguable)

Question 14

Purpura is multifactorial.

Answer 14

Just know it.

Question 15

Palpable purpura is a hallmark for ?

Answer 15

Leukocytoclastic vasculitis (this will be on the test. i guarantee it)

Question 16

What is this type of purpura Dr. S talked about? What immunoglobulin is it associated with?

Answer 16

HSP (Henoch-Schonlein purpura),

Associated with IgA (shown in clumps on IF)

Question 17

Unlike bland petechiae/ecchymosis, palpable purpura is assocaited with what?

Answer 17

Inflammation in blood vessels (aka vasculitis)

Question 18

Remember, where are blood vessels found?

Answer 18

Dermis/ Subq. not in epidermis

Question 19

Vasculitis classified based on?

Answer 19

Size of vessel involved (small, mixed small/medium, medium, large vessel vasculitis)

Question 20

Vasculitis is more predominantly seen in where geographically on body?

Answer 20

Dependent areas

• Lower extremities (in ambulatory patients)
• Ass cheeks in bed-ridden patients

Question 21

List features of small vessel vasculitis

Answer 21

palpable purpura

blisters, less commonly hives (like urticarial vasculitis)

Question 22

List features of medium vessel vasculitis

Answer 22

• Nodules, purpura, livedo reticularis/racemosa
• Ulcers, skin necrosis

Question 23

List features of large vessel vasculitis

Answer 23

Less likely to affect skin

Question 24

List diseases with small vessel vasculitis?

Answer 24

HSP, infections, Drug reactions, autoimmune diseases, malignancy associated vasculitis, Idiopathic

Question 25

Name some mixed (small/medium) vasculitis?

Answer 25

ANCA associated vasculitis (Churg-strauss, Microscopic polyangiitis, Wegner’s granulomatosis)

Cryoglobulinemic vasculitis

Question 26

Disease associated with medium vessel vasculitis?

Answer 26

Polyarteritis nodosa

Question 27

Diseases of large vessel vasculitis?

Answer 27

Giant cell arteritis, takayasu arteritis, Behcet’s

Question 28

Based on your understanding of how small, medium, and large vessel vasculitis present. Which type is this? Bonus points. Name that dx?

Answer 28

Churg-Strauss (small/medium vessel vasculitis)

• not much palpable purpura, more nodules

Question 29

What do you call this pattern seen on skin? Associated with what disease/size of vessel involvement?

Answer 29

This is livedo reticularis, seen in polyarteritis nodosa (medium vessel vasculitis)

Question 30

Name this. A distinctive form of ecchymosis with a “net-like” pattern

Prognosis?

Answer 30

Retiform purpura

Worst kind of purpura to have.

Question 31

Retiform purpura results from what?

Answer 31

Vascular ischemia, usually due to an underlying thrombotic disorder

Question 32

This type of retiform purpura is known as? aka?

Answer 32

Purpura fulminans (DIC)

Question 33

Street drug associated with DIC?

Answer 33

Shitty cocaine. Key word: shitty

Question 34

Retiform pupura + fever. Most worrisome diagnosis?

Answer 34

Meningococcemia (wear gloves/mask)