Petechiae, Purpura, Vasculitis
1.*You
are consulted by general surgery about a new rash on this 16-year old girl with
these lesions scattered over her legs. Over the phone your colleague described
the rash as “many small dark red macules that don’t go away when I press on
them.” What is the most appropriate morphologic term for this finding?

2.*You
see the patient, a 16-year old girl with these lesions scattered over her legs
and confirm she has petechiae and ecchymoses on her bilateral legs. They stop
at her waist. She has mild abdominal pain, fatigue myalgias, and arthralgias. Her
vital signs are T99.0 HR 94 RR 12 BP 106/82. WBC are 14.5, platelets are
165,000, and PT/INR is normal. What is the most likely cause of her purpura?

3.
A 28-year-old woman presents with scattered red macules on her legs, ankles, and feet (see photo) that are neither painful nor itchy. What is the next best step in diagnosis?

4.
A 7-year-old boy presents to the urgent care clinic with abdominal pain, joint aches, and a rash on his legs and feet (see photo). He does not have a history of frequent nosebleeds, easy bruising, or other episodes of abnormal bleeding. Based on the image and the patient’s history, what is the most likely diagnosis?

5.*This
is a 38 year-old man with a history of Crohn’s disease, recently treated with
azathioprine and prednisone. He was well until 3 days ago when he reported
worsening abdominal pain. No recent sick contacts or travel. He presented to
the ED with somnolence, fever, abdominal pain and a new rash. Vital signs were
T102.1 HR 117 RR 14 BP 86/54. What is the most likely cause of his purpuric
rash?

6.*This
69 year-old woman has noticed an increase in these marks (figure) on her forearms
in the past month or two. She feels otherwise well and her review of systems is
negative except for pain in her knees, which has chronic and due to
osteoarthritis. She takes hydrochlorothizaode for hypertension, naproxen twice
daily for osteoarthritis, a multivitamin, ginseng, garlic, and fish oil. What
is the next step in the management of this patient?

7.
I would recommend this module to a peer or student:
8.
The online modules increased your ability to visually recognize skin disease:
9.
Please use the space below to provide us with feedback about strengths of this module.
10.
Please use the space below to share any opportunities for improvement for this module.