Hy 2263 Patho phys. You gotta know the SECONDARIES of the primary dx...

[tommyk]

Hy 2263
A 10-year-old girl is brought to YOU with complaints of fatigue, abdominal pain and low grade fever . Four days ago her mother noticed a red rash on her daughter's feet, which has now spread to her thighs and and low grade fever. Five days ago her mother noticed it has now spread to her thighs and buttocks. The rash was initially small red dots, but has now become patches. Her daughter subsequently developed periumbilical, cramping, abdominal pain. (You probably know this already) Review of systems is positive only for a respiratory viral illness three weeks ago. Her temperature is 101F, pulse is 100/min, and respirations are 18/min. Abdominal examination is remarkable for tenderness to palpation near the umbilicus, but the abdomen is otherwise soft, with no rebound or guarding, and no organomegaly. Raised, palpable purpuric lesions are present on the buttocks and thighs. The ankles are tender and edematous bilaterally. Complete blood count reveals a leukocyte count of 10,000/mm3. Her hemoglobin 14 g/dL, and platelets are 355,000/mm3. Serum electrolytes are normal. Which of the following is her urinalysis most likely to reveal? [Also, What is the disease please? If it is an INFECTION, is it bacterial or viral?]
1-Elevated levels of copper
2-Glucosuria
3-Red blood cells
4-White blood cell casts
5-Yeast
6-Albumin
7-Lucky Charms cereal























































































a) #3 The constellation of "waist-down" purpura, arthritis, abdominal pain and nonthrombocytopenic purpura in a young female is classic for Henoch-Schönlein syndrome or HSP. The rash of HSP is characterized by petechiae which become purpura. A "viral illness" weeks before, is a common antecedent to HSP. Checking the patient's urine for hematuria is important in follow-up visits as the patient can develop end-stage renal failure in 1% of cases. The underlying pathophysiology is related to vasculitis of small blood vessels. Urinary copper is elevated in Wilson's disease or hepatolenticular degeneration. Glucosuria is seen in diabetic patients. White blood cell casts are clusters of leukocytes in the shape of the renal tubules, and are seen in pyelonephritis. Yeast is seen in patients on antibiotics or who are immunocompromised. Lucky Charms makes a good but sinful breakfast cereal...

[md90]

personally.. I like honey nut cheerios..