HSP

Question 1

Urgent Findings that need intervention

Answer 1

1. AMS - significant change from baseline mental status (lack of perfusion to brain, not protecting airway)
2. Respiratory Distress/Depression - tachypnea, grunting, slow shallow breathing –> all suggests compromise of oxygenation and ventilation
3. Mottled Skin/Cyanosis - inadequate tissue perfusion or oxygenation –> NEED TO FIX

Question 2

Mechanism of petechiae and purpura

Answer 2

Trauma
Platelet deficiency/dysfunction
Coagulation abnormalities
Vascular fragility (vasculitis)
Combo

Question 3

Get the patient’s perspective

Answer 3

What do you think is going on?
What concerns you most?
What do you think happened?

Question 4

DDx for bruising and leg pain

Answer 4

Coag disorder
Henoch-schonlein purpura
idiopathic thrombocytopenic purpura
leukemia
viral infection

Question 5

Coagulation disorder

Answer 5

may present with petechiae or small bruising, hemarthrosis, minor trauma, family history

Question 6

Henoch-Schonlein Purpura presentation

Answer 6

often as otherwise healthy child with leg bruises and pain walking
50% of cases have URI preceding bruising

Question 7

ITP

Answer 7

asymptomatic petechiae –> URI preceding

Question 8

Leukemia

Answer 8

consititutional symptoms of fever, malaise, weight loss

- bone pain from infiltration of bone marrow with leukemic cells and bruising from thrombocytopenia

Question 9

Viral Infection

Answer 9

enterovirus can cause petechiae rash and sometimes pain with walking

Question 10

Examining lymph nodes

Answer 10

Size --> >2 cm = concern
Location
Tenderness
Texture
Mobility - hard and non-mobile = concern
Distribution --> diffuse = concern

Question 11

Hepatomegaly

Answer 11

although palpating liver can be normal –> if you feel it, you need to investigate it further

• can be from inflammation, infiltration, accumulation of storage material, congestion, or obstruction
• can percuss to hear difference or feel by palpation

Question 12

Causes of arthralgia or arthritis in kids

Answer 12

Trauma, septic arthritis, transient synovitis, reactive arthritis
Lyme disease, rheumatic fever, lupus, HSP

Question 13

DDx for rash and leg pain

Answer 13

1. HSP - rash unique for tendency for lower extremities and buttocks (periarticular vasculitis) –> no splenomegaly
2. ITP - no splenomegaly
3. Leukemia - bone pain, splenomegaly, lymphadenopathy

Question 14

Splenomegaly

Answer 14

Infection - EBV, CMV, Sepsis, endocarditis
Hemolysis - sickle cell
Malignancy - leukemia, lymphoma
Lupus, venous congestion, CHF

Question 15

Examining the spleen

Answer 15

lie supine or in lateral position –> palpate anteriorly and posteriorly

Question 16

Labs for HSP

Answer 16

1. CBC with smear - need platelet count for ITP vs HSP
2. BUN and Cr - determine extent of renal involvement
3. UA - hematuria/proteinuria

Question 17

HSP

Answer 17

self-limited IgA mediated small vasculitis that involves skin, GI, renal, joints
- most commonly diagnosed vasculitis in kids
HALLMARK = non-thrombocytopenic purpura
1/3 have renal involvement
- early steroids MAY prevent GI and renal involvement

Question 18

ITP diagnosis

Answer 18

binding of antiplatelet antibody to platelet surface –> removal and destruction of platelets in spleen and liver
*smear shows immature giant platelets cells

Question 19

HSP prognosis

Answer 19

symptoms usually last a month and self-resolve without treatment

• resample urine to monitor kidney function and BP
• re-evaluate if things get worse

Question 20

Intussusception

Answer 20

telescoping of proximal bowel into distal bowel –> bowel compression and ischemia
- most common cause of bowel obstruction in kids 6 months - 6 years
- paroxysmal abdominal pain, currant jelly stools, sausage felt in abdomen
Tx = air or barium enema, US

Question 21

Complications of HSP

Answer 21

1. GI Bleeding - 50% have this, from same inflammation that caused vasculitis, stool guaiac test to confirm –> short course of steroids
2. Kidney - 1/3 of kids have kidney problems –> hematuria and self-resolving

Question 22

Recurrence of HSP

Answer 22

30% - weeks to months after 1st episode

- same symptoms