B6-006 CBCL Juvenille Idiopathic Arthritis

Question 1

-common elbow injury in children <5 caused by a sudden pull on the arm.
-causes the immature annular ligament to slip over the head of radius

Answer 1

radial head subluxation (nursemaid’s elbow)

Question 2

child holding their injured arm in slightly flexed and pronated position

Answer 2

radial head subluxation (nursemaid’s elbow)

Question 3

overuse injury caused by repetitive strain and chronic avulsion of the proximal tibial tubercle

Answer 3

Osgood-Schlatter disease

Question 4

-commonly occurs in adolescents following growth spurt or running/jumping athletes
-presents with progressive anterior knee pain

Answer 4

Osgood-Schlatter disease

Question 5

-overuse injury that commonly presents in young, female athletes as anterior knee pain
-exacerbated by prolonged sitting or kneeling

Answer 5

patellofemoral syndrome

Question 6

abnormal acetabulum development in newborns

Answer 6

developmental dysplasia of the hip

Question 7

risk factor for developmental dysplasia of the hip

Answer 7

breech presentation

Question 8

manipulation of newborn hip reveals “clunk”

Answer 8

developmental dysplasia of the hip

Question 9

a diagnosis of developmental dysplasia of the hip can be confirmed via what imaging modality?

Answer 9

US

Question 10

idiopathic avascular necrosis of the femoral head

Answer 10

Legg-Calve-Perthes

Question 11

commonly presents between 5-7 years with insidious onset of hip pain that may cause the child to limp

Answer 11

Legg-Calve-Perthes

Question 12

Legg-Calve-Perthes is more common in [males/females] and the intial Xray is often [normal/abnorma]

Answer 12

males
normal

Question 13

classically presents in an obese young adolescent with hip/knee pain and altered gait

Answer 13

slipped capital femoral epiphysis

Question 14

increased axial force on the femoral head causes epiphysis to displace relative to femoral neck

Answer 14

slipped capital femoral epiphysis

**ice cream falling off cone

Question 15

slipped capital femoral epiphysis is diagnosed via what imaging modality?

Answer 15

Xray

Question 16

systemic arthritis seen in <16 years of age

Answer 16

systemic juvenile idiopathic arthritis

Question 17

daily spiking fevers, salmon-pink macular rash, arthritis

Answer 17

systemic juvenile idiopathic arthritis

Question 18

systemic juvenile idiopathic arthritis is associated with what pathology of the eye?

Answer 18

uveitis

Question 19

expected labs for systemic juvenile idiopathic arthritis

Answer 19

leukocytosis
thrombocytosis
anemia
elevated ESR
elevated CRP

Question 20

disruption of blood flow to the femoral head

Answer 20

Legg-Calves-Perthes

Question 21

congenital malformation of the acetabulum

Answer 21

developmental hip dysplasia

Question 22

displacement of the epiphysis relative to the femoral head

Answer 22

slipped capital femoral epiphysis

Question 23

dysregulation of the adaptive immune system

Answer 23

JIA

Question 24

bone fragmentation at the tibial tuberosity

Answer 24

Osgood Schlatter

Question 25

chrondrocalcinosis is associated with

Answer 25

pseudogout

Question 26

next step in management of slipped capital femoral epiphysis

Answer 26

surgical evaluation

Question 27

splint can be used in some case of

Answer 27

development hip dysplasia

Question 28

[...] is an important management strategy for patellofemoral pain

Answer 28

quadriceps strengthening

Question 29

next best step for JIA that is unresponsive to naproxen and only involves a single joint

Answer 29

intra articular steroid injection

Question 30

best treatment of oligoarticular JIA with systemic symptoms

Answer 30

methotrexate

Question 31

what medication can cause osteoporosis and be associated with fragility fractures?

Answer 31

prednisone

Question 32

common side effect of methotrexate

Answer 32

oral ulcers

Question 33

common side effect of anakinra

Answer 33

injection site reactions

Question 34

individuals with JIA are at high risk for [...] and require consistent monitoring as it can present asymptomatically

Answer 34

uveitis

Question 35

immature annular ligament slipping over radial head

Answer 35

radial head subluxation

Question 36

treatment for radial head subluxation

Answer 36

manual reduction

Question 37

MOA: inhibition of dyhydrofolate reductase

Answer 37

methotrexate

Question 38

besides age, what can be helpful in distinguishing JIA from adult onset RA?

Answer 38

pattern of joint involvement

Question 39

most children with systemic JIA will require persistent use of [...] to achieve remission

Answer 39

immunomodulatory therapy

Question 40

risk of uveitis is [higher or lower] in soJIA than other types of JIA

Answer 40

lower

Question 41

what percentage of patients with soJIA develop MAS?

Answer 41

10%

Question 42

immune dysregulation associated with infections or oncologic process

Answer 42

HLH **the term MAS is reserved for patients with underlying rheumatologic disease

Question 43

[...] should prompt consideration that a patient with soJIA is progressing to MAS

Answer 43

hepatic dysfunction

Question 44

fever, rash, arthritis, and evidence of multiorgan dysfunction

Answer 44

MAS

Question 45

approximately 20% of MAS in soJIA occurs at time of

Answer 45

initial diagnosis

Question 46

first-line treatment for MAS

Answer 46

pulse dosing IV steroids

Question 47

MIS-C is associated with thrombo[...]

Answer 47

thrombocytopenia

Question 48

KD is associated with thrombo[..]

Answer 48

thrombocytosis

Question 49

used in refractory Kawasaki disease

Answer 49

inflixumab

Question 50

second-line treatment for MAS or MIS-C

Answer 50

anakinra

Question 51

what type of arthritis is associated with IL-1?

Answer 51

soJIA

Question 52

what type of arthritis is associated with TNFa?

Answer 52

oligoarticular and polyarticular JIA

Question 53

what type of arthritis is associated with IL-17?

Answer 53

psoriatic and ankylosing spondylitis

Question 54

1-4 joints impacted

Answer 54

oligoarticular

Question 55

JIA typically presents with [...] involvement, while RA typically presents with [...] involvement

Answer 55

JIA: oligoarticular RA: polyarticular

Question 56

[...] can be seen in MAS due to the significant consumptive process and bone marrow involvement

Answer 56

thrombocytopenia

Question 57

Legg-Calve-perthes typically affects children in the age range of [...]

Answer 57

5-7

Question 58

methotrexate can be used to treat [....]JIA

Answer 58

polyarticular JIA

Question 59

anakinra can be used to treat [...] JIA

Answer 59

soJIA

Question 60

tenderness of the patella tendon

Answer 60

Osgood-Schlatter

Question 61

discomfort with patellar grind

Answer 61

patellofemoral syndrome

Question 62

hyperglycemia can be associated with what medication?

Answer 62

prednisone