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10 Cards in this Set
- Front
- Back
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Mechanisms of Petechiae and Purpura:
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Trauma
Platelet deficiency or dysfunction (e.g. immune-mediated thrombocytopenia, bone marrow infiltration or suppression, malignancy) Coagulation abnormalities (e.g. hereditary or acquired clotting-factor deficiencies) Vascular fragility (e.g., immune-mediated vasculitis) Combinations of the above (e.g., infection causing coagulation abnormalities, vascular fragility, platelet consumption) |
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Bruises and child abuse
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- Bruises are the most common type of intentional injury.
- Accidental bruises tend to occur over bony prominences (e.g., shins, elbows, forehead) as a result of typical childhood bumps, scrapes and falls. Bruises in other locations, e.g., back, buttocks, face or ears, are concerning for non-accidental trauma. - Non-accidental bruises often take the shape of whatever was used to inflict them (e.g., handprint, finger marks, bite pattern, belt buckle). - Bruises in multiple stages of healing may suggest repeated injuries over time. - Bruises that are inconsistent with the history given to explain them or inconsistent with a child's developmental abilities (i.e., bruising in a child who is not mobile) should raise suspicion for non-accidental trauma. Bruises are the most common type of intentional injury. |
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Differential for Hepatomegaly:
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may occur as a result of inflammation (e.g., viral hepatitis), infiltration (e.g., leukemia/lymphoma), accumulation of storage products (e.g., glycogen-storage disease), congestion (e.g., congestive heart failure) or obstruction (e.g., biliary atresia).
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Arthralgia vs. Arthritis
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Arthralgia refers to pain in or around the joint -- without signs of synovitis. The term "arthritis" is used in the presence of true synovitis, defined as either joint swelling or joint pain with limitation of motion on exam.
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Differential for arthritis in school-age children:
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- Trauma
- Septic arthritis - Transient synovitis - Reactive arthritis (e.g., post-streptococcal arthritis) - Lyme disease - Rheumatic fever - Juvenile Idiopathic Arthritis - Systemic Lupus Erythematosus - Henoch-Schönlein Purpura |
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Splenomegaly in children differential:
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most often caused by infection (e.g., EBV, CMV, bacterial sepsis, endocarditis), hemolysis (e.g., sickle cell disease), malignancy (e.g., leukemia, lymphoma), storage diseases (e.g., Gaucher disease), systemic inflammatory diseases (e.g., SLE or juvenile idiopathic arthritis - JIA) or congestion (e.g., related to portal hypertension).
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Henoch-Schönlein Purpura (HSP) HSP (also known as anaphylactoid purpura):
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a self-limited, IgA-mediated, small vessel vasculitis that typically involves the skin, GI tract, joints and kidneys. It is the most common form of vasculitis (about 50%) in children. The hallmark of HSP is non-thrombocytopenic purpura. One-third of children with HSP have renal involvement, the most common manifestation of which is hematuria. Renal involvement is less common in children under two years of age, occurring in about 25% in that age group. About 5% of children with HSP progress to chronic renal failure, and fewer than 1% will have end stage renal disease.Arthritis, mainly of the knees and ankles, is seen in about 75% of children with HSP while colicky abdominal pain is present in 65% of patients. Two-thirds of patients report a recent upper respiratory tract infection.
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Idiopathic thrombocytopenic purpura (ITP)
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caused by the binding of an antiplatelet antibody to the platelet surface, leading to removal and destruction of platelets in the spleen and liver. It is the most common cause of isolated thrombocytopenia in otherwise healthy children.
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Intussusception:Clinical findings
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Classic triad of presenting findings (although occurs in a minority of
patients, so high level of clinical suspicion is required for diagnosis): Paroxysms of severe abdominal pain with inconsolable crying Passage of “currant jelly” stool containing blood and mucus Palpation of a “sausage-shaped” mass in the right abdomen |
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Intussuscpetion: Management
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Diagnosis and treatment of non-HSP related intussusception are
accomplished with air or contrast enema. Occasionally surgical reduction is needed in these cases. Diagnosis of HSP-related intussusception is by abdominal ultrasound, and treatment generally is surgical. |
