Joints and Skin Flashcards
ABCDE criteria
- for adults
- for children and adolescents
- asymmetry, border irregularity, color variegation, diameter > 6 mm, recent evolution
- amelanotic (like warts or pyogenic granuloma), bleeding papule or nodule (may ulcerate), color uniformity and sometimes smooth border, de novo/any diameter
EFG - elevated, firm, growing progressively for > 1 month consider __
melanoma - especially in children and adolescents
red to purple papule that usually is pedunculated and often has a collarette of scale at its base
pyogenic granuloma but also consider melanoma, especially in adolescents and children
Pyogenic arthritis (septic hip) in children: which organisms do you need to cover?
Staphylococcus, streptococcus, Kingella (which is often associated with a preceding viral illness).
Kocher criteria for septic hip?
- Temp >38.5
- WBC >12
- ESR >40
- Unable to ambulate
- CRP >25
Teen with diffuse low back pain that does not radiate, right hamstring muscles, tenderness over paraspinal muscles. Next best step in management?
Core stabilization therapy
Pain with extension of lumbar spine, local radiation?
Hint: most common cause of anatomic back pain in children
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)
Diagnosis of GBS - testing considerations?
LP - cytoalbuminergic dissociation with elevated protein
MRI +/- contrast may show nerve root enhancement
EMG can confirm demyelinating OR axonal injury
GBS treatment
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.
Entrapment of ectodermal tissue along lines of embryonic fusion
When should they be imaged?
Dermoid cyst - MRI or CT, if located over midline craniospinal axis (nasal bridge, occiput, midline back) - looking for possible intracranial extension or spinal dysraphism.
Management/monitoring of a non-ossifying fibroma
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.
Locations of unicameral (simple) bone cysts vs. aneurysmal bone cysts (blood filled located cysts)
Management?
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.
Gout management: when starting pegloticase, _ therapies should be discontinued
Urate lowering therapies such as febuxostat or allopurinol. Reason: peg antibodies can manifest with increasing urate, which these may otherwise hide
Erythema nodosum causes? (Most common)
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.