Petechiae, Purpura, And Vasculitis

Front 1

What is the term for red-purple lesions that result from extravasation of blood into skin or mucous membranes?

Can it be palpable or non-palpable?

Define petechiae, ecchymoses

Which type of purpura is usually non-inflammatory? Which type is a sign of vascular inflammation? (PALPABLE OR MACULAR)

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Front 2

What is the term for use of a glass slide to apply pressure to the lesion in order to distinguish erythema SECONDARY TO VASODILATION (blanchable with pressure) from ERYTHROCYTE EXTRAVASATION (retains its red color)?

What are the two coagulable states purpura may result from? What are the two vascular states?

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Front 3

Identify which is petechia and which is eccymosis.

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Front 4

Ecchymoses or petechiae?

Back 4

Ecchymoses

Front 5

Identify ecchymoses and identify petechiae

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What does he have?

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What is this?

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B. Nutritional deficiency

Front 10

Scurvey results from insufficient intake of what? What could be two causes of this? An increased what could cause scurvy? Loss during what procedure could cause scurvy?

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What are some characteristic exam findings of scurvy? (what type or purpura, large ecchymoses where, what two types of hemorrhage, what type of hair follicle plugging, what type of gingivitis)

What should you remember to ask about in all patients with purpura?

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IV antibiotics = may be started before lumbar puncture

Front 15

What two things does Andrew likely have?

Presence of petechial or purpuric lesions in patient with meningitis should raise concern for what two things?

What is a gram - diplococcus that causes meningococcal disease?

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What does DIC results from? What is the primary treatment?

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What is another life threatening condition to consider in a patient with a petechial rash (think micro)?

When does the rash occur? Describe location and progression of rash.

What is the classic triad (that many patients do not have)?

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What "tests" are necessary for diagnosis of purpura?

What are some important history items (FH, drugs, medical conditions)?

What is used to help assess platelet function and evaluate coagulation states?

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What are the two biggest differences in terms of causes between petechiae and ecchymoses (when dealing with non-palpable purpura)?

Back 19

Petechiae = platelets

Ecchymoses = Coagulation defects

Front 20

What does palpable purpura result from?

What does vessel inflammation cause?

What may be a primary process or a secondary process to another underlying disease?

What is the hallmark lesion of leukocytoclastic vasculitis (small vessel vasculitis)?

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How is vasculitis classified?

Clinical morphology of each:

Small vessel:

Small to medium vessel:

Large vessel:

Can diseases involve more than one size of vessel?

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Front 22

What are two main causes of small vessel vasculitis (leukocytoclastic vasculitis)?

What are some other causes?

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1. ANCA associated vasculitides (Churg strauss, microscopic polyangiitis, Wegeners)

2. Takayasu arteritis

3. Essential cyroglobulinemic vasculitis

4. Giant cell arteritis

5. Polyarteritis nodosa

Identify where they belong (small + medium, medium, large) in terms of vessel size affected

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What tests can you do to evaluate patient with suspected vasculitis?

1. Platelets

2. Systemic vasculitides with sedimentation rate >50

3. Wegeners, microscopic PA, drug-induced vasculitis, Churg-Strauss

4. Mixed cryoglobulinemia with low complement, urticarial vasculitis and lupus

5. Detection of renal involvement

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Front 29

What is the most common form of systemic vasculitis in children? What is it characterized by?

What season is peak incidence? Preceded by what type of infection?

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How is the diagnosis of HSP made?

What will biopsy show and where? (what size vessels)

What will the immune complexes in the wall contain? (IgG, IgA, etc.)

How do you rule out streptococcal infection?

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What may HSP be a manifestation of in adults? Do most children completely recover? What its the treatment?

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Front 41

Polyarteritis nodosa (PAN) is a potentially systemic disorder of necrotizing vasculitis of __________ arteries.

What is it characterized by? Patients may also present with what?

What viruses has it been associated with?

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What is the disease?

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PAN

Hyperpigmented nodules along medium-sized vessels

Front 43

What are some key diagnostic features of systemic PAN? (think heat, biopsy, organ involvement, decreased sensation)

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For patients with chronic PAN, what do you apply to skin ulcerations?

Patients without cutaneous PAN may be treated by what alone?

Patients with organ involvement (systemic), who do you call and what do you give them?

Should you treat any underlying infections such as HBV?

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