MedU Clipp 21

Question 1

(5) Signs and Symptoms that Indicate Urgent Stabilization?

Answer 1

• Altered Mental Status
  
  • Cerebral Perfusion, Airway, Circulation
• Mottled Skin
• Respiratory Distress
  
  • Tachypnea, Grunting, Increased work of Breathing
• Respiratory Depression
  
  • Slow, Shallow, Oxygenation and Ventilation
• Cyanosis

Question 2

What causes Petechiae and Purpura?

Answer 2

• Trauma
• Platelet Deficiency or Dysfunction
  
  • Immune-mediated Thrombocytopenia
  • Bone marrow Infiltration / suppression
  • Malignancy
• Coagulation abnormalities (hereditary, clotting-factor)
• Vascular fragility (immune-mediated vasculitis)
• Combos
  
  • Coag Abnormalities, Vascular fragility, platelet consumption

Question 3

(10) DDx for Bruising and Leg Pain?

Answer 3

• Coagulation Disorder
• Henoch-Schonlein purpura (HSP)
• Idiopathic Thrombocytopenic Purpura (ITP)
• Leukemia
• Viral Infection
• Bacterial Endocarditis
• Drug Reaction
• Meningococcal Septiciemia
• Rocky Mountain Spotted Fever
• Systemic Lupus Erythematosus (SLE)

Question 4

Causes of Hepatomegaly?

Answer 4

• Inflammation (Viral Hepatitis)
• Infiltration (Leukemia / Lumphoma)
• Accumulation of Storage Products (Glycogen Storage)
• Congestion (CHF)
• Obstruction (Biliary Atresia)

Question 5

Causes of Arthritis in Children?

Answer 5

• Trauma
• Septic Arthritis
• Transient Synovitis
• Reactive Arthritis
• Lyme Disease
• Rheumatic Fever
• Juvenile Idiopathic Arthritis
• Systemic Lupus Erythematososu
• Henoch-Schonlein Purpura

Question 6

(3) DDx for Rash and Leg Pain?

Answer 6

• Henoch-Schonlein Purpura
  
  • primarily the lower extremities
  • periarticular vasculitis (arthritis or arthralgia)
• Idiopathic Thrombocytopenic Purpura
  
  • NOT a/w splenomegaly
• Leukemia
  
  • Pain secondary to bone marrow expansion
  • Splenomegaly
  • Lymphadenopahty

Question 7

Infections that Cause Splenomegaly?

Answer 7

• Epstein-Barr virus
• Cytomegalovirus
• Bacterial Sepsis
• Endocarditis

Question 8

Hemolysis that causes Splenomegaly?

Answer 8

Sickle Cell Disease

Question 9

Malignancy that causes Splenomegaly?

Answer 9

• Leukemia
• Lymphoma

Question 10

Storage Diseases that cause Splenomegaly?

Answer 10

• Gaucher Disease

Question 11

Systemic Inflammatory Diseases that cause Splenomegaly?

Answer 11

• Systemic Lupus Erythematosus
• Juvenile Idiopathic Arthritis

Question 12

Congestion that causes Splenomegaly?

Answer 12

• A complication of Portal Hypertension

Question 13

Laboratory Evaluation of Henloch-Scholen Purpura (HSP)?

Answer 13

• Platelet Count
• Urinalysis
• BUN and Creatine

Question 14

What is Henoch-Schonlein Purpura (HSP)?

Answer 14

• a.k.a. Anaphylactoid purpura
• Self-limited
• IgA-mediated
• Small-vessel Vasculitis
• Typically involves the Skin, GI tract, Joints, Kidney’s

Question 15

Signs and Symptoms of HSP?

Answer 15

• Hallmark of HSP is non-Thrombocytopenic purpua
• Renal involvement (33%)
• Hematuria
• Arthritis (knees and ankles)
• Colicky Abdominal Pain (65%)
• Upper Respiratory Tract Infection (66%)

Question 16

What is Idiopathic Thombocytopenic Purpura (ITP)?

Answer 16

• ITP is caused by the binding of an anti-platelet antibody to the platelet surface
• -> Leading to the Removal and Destruction of Platelets in the Spleen and Liver
• -> Isolated Thrombocytopenia in Healthy Children

Question 17

What is Intussusception?

Answer 17

• A Proximal Segment of Bowel invaginates or Telescopes into the Distal segment adjacent
• Mesentery becomes entrapped
• Vascular compression
• Ischemia
• ‘Currant-jelly’ stool

Question 18

What is the Classic Presentation of Intussusception?

Answer 18

• Paroxysms of Severe Abdominal Pain w/ Inconsolable crying
• Passage of “Currant Jelly’ Stool w/ Blood and Mucus
• Palpation of a “Sausage-shaped” mass in the Right Abdomen

Question 19

Treatment of Intussusception?

Answer 19

• Air Enema
• Barium Enema
• Reduction by Hydrostatic pressure
• HSP-intussusception is usually ileo-ileal and will not be reduced by Air or Barium Enema

Question 20

Complications of HSP?

Answer 20

• Intestinal Bleeding - Stool Guaiac test
• Kidney Involvement - Hematuria

Question 21

How do you tell the difference between HSP and ITP?

Answer 21

• Thrombocytopenia is not a characteristic of HSP
• Low Platelets is commonly seen in ITP
• Often the delineating finding