Joints and Skin

Question 1

ABCDE criteria

1. for adults
2. for children and adolescents

Answer 1

1. asymmetry, border irregularity, color variegation, diameter > 6 mm, recent evolution
2. amelanotic (like warts or pyogenic granuloma), bleeding papule or nodule (may ulcerate), color uniformity and sometimes smooth border, de novo/any diameter

Question 2

EFG - elevated, firm, growing progressively for > 1 month consider __

Answer 2

melanoma - especially in children and adolescents

Question 3

red to purple papule that usually is pedunculated and often has a collarette of scale at its base

Answer 3

pyogenic granuloma but also consider melanoma, especially in adolescents and children

Question 4

Pyogenic arthritis (septic hip) in children: which organisms do you need to cover?

Answer 4

Staphylococcus, streptococcus, Kingella (which is often associated with a preceding viral illness).

Question 5

Kocher criteria for septic hip?

Answer 5

1. Temp >38.5
2. WBC >12
3. ESR >40
4. Unable to ambulate
5. CRP >25

Question 6

Teen with diffuse low back pain that does not radiate, right hamstring muscles, tenderness over paraspinal muscles. Next best step in management?

Answer 6

Core stabilization therapy

Question 7

Pain with extension of lumbar spine, local radiation?

Hint: most common cause of anatomic back pain in children

Answer 7

Spondylolysis is a crack in the pars interarticularis, the posterior aspect of the vertebral ring. Bilateral spondylolysis can result in vertebral body shifting forward (spondylolisthesis)

Question 8

Diagnosis of GBS - testing considerations?

Answer 8

LP - cytoalbuminergic dissociation with elevated protein

MRI +/- contrast may show nerve root enhancement

EMG can confirm demyelinating OR axonal injury

Question 9

GBS treatment

Answer 9

Treatment for pediatric GBS is typically intravenous immunoglobulin. Supportive care required for GBS includes close monitoring for progression of weakness, especially of the respiratory muscles, and monitoring for evidence of dysautonomia including cardiac arrhythmias, hypertension, bladder dysfunction, and ileus.

Question 10

Entrapment of ectodermal tissue along lines of embryonic fusion

When should they be imaged?

Answer 10

Dermoid cyst - MRI or CT, if located over midline craniospinal axis (nasal bridge, occiput, midline back) - looking for possible intracranial extension or spinal dysraphism.

Question 11

Management/monitoring of a non-ossifying fibroma

Answer 11

NOF: if >50% of bone diameter, monitor with radiographs for pathologic fracture

When evaluating radiolucent lesions, sclerosis or thickening of the bone surrounding a defect is indicative of a stable, benign lesion. Lesions that expand beyond the cortex and do not have distinct margins are more concerning for malignancy, and would merit evaluation by oncology or orthopaedic surgery.

Question 12

Locations of unicameral (simple) bone cysts vs. aneurysmal bone cysts (blood filled located cysts)

Management?

Answer 12

Simple (usually proximal humerus or femur): If likely to result in a surgical fracture, such as the femoral neck, refer to ortho for steroid injections vs. operative mgmt.

ABC: always refer to ortho for operative mgmt. These are usually located in eccentric locations and tend to have a more located appearance.

Question 13

Gout management: when starting pegloticase, _ therapies should be discontinued

Answer 13

Urate lowering therapies such as febuxostat or allopurinol. Reason: peg antibodies can manifest with increasing urate, which these may otherwise hide

Question 14

Erythema nodosum causes? (Most common)

Answer 14

EN can be idiopathic, but the most common associations are streptococcal infection, hormones (including oral contraceptives, hormone replacement therapy, or pregnancy), inflammatory bowel disease, sarcoidosis, lymphoma, and medication reactions.