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Peds Exam 2 > Lecture 6 - Rheum/MSK > Flashcards

Lecture 6 - Rheum/MSK Flashcards

1
Q

What are the 5 pediatric rheumatology disorders?

A 
juvenile arthritis 
SLE (lupus) 
Juvenile Dermatomyositis
Scleroderma 
Vasculitis 
-Henoch-Schonlein Purpura 
-Kawasaki Disease
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2
Q

JIA

A

Juvenile Idiopathic Arthritis (JIA)
fromerly known as juvenile rheumatoid arthritis

MC childhood arthritis 
1:1000 children (pretty common) 
two peaks: 
1-3 years old 
8-12 years old
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3
Q

When do you see JIA?

A

two peaks
1-3 years old
8-12 years old

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4
Q

How do you dx JIA?

A

must be chronic (>6 weeks)
age of onset <16 years
evidence of joint inflammation - redness, swelling, limited ROM, pain

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5
Q

What signs show chronicity of JIA?

A

synovial thickening
bony proliferation
contracture
limb length discrepancy - d/t affect on growth plates

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6
Q

Oligoarticular JIA vs polyarticular JIA

A

oligoarticular <5 joints

polyarticular >5 joints

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7
Q

Classification of JIA

A

oligoarticular <5 joints

polyarticular >5 joints

systemic JIA

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8
Q

Systemic JIA

A

aka Still’s Disease

think of it as a systemic inflammation that PRECEDES the onset of arthritis

typical fever curve
daily and diurnal temperature spike over 39C
returns quickly to below baseline
child feels well between temperature spikes

Characteristic Rash
-dematographia
-papulomacular rash
migratory and quickly fades

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9
Q

What labs will you expect to see with JIA?

A

evidence of systemic inflammation

  • CBC (WBC, RBC, platelets)
  • erythrocyte sedimentation rate
  • C reaction protein
  • serum protein

Antinuclear antibodies
negative rheumatoid factors

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10
Q

How can you tell the difference between JIA and rheumatoid arthritis?

A

JIA has negative rheumatoid factors

RA has positive rheumatoid factors

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11
Q

When do you expect to see ANA?

A

ANA - antinuclear antibodies

highest in <7 years and female pts

MC in oligoarticular JIA

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12
Q

For pts with suspected JIA, what do you need to test for r/o other diseases?

A 
joint fluid analysis 
CBC
serologic testing for Lyme 
radiography 
-osteopenia
-osteomyelitis
-malignancy
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13
Q

What is the treatment in JIA?

A

NSAIDs first line treatment

disease modifying agents

  • hydroxychloroquine
  • methotrexate
  • biologic agents
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14
Q

What is the number one treatable cause of blindness in children?

A

uveitis

a complication of JIA

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15
Q

Uveitis

A

number one treatable cause of blindness in children
a complication of JIA

inflammation of the iris, ciliary body and choroid

tends to be asymptomatic in
get screening in pts with chronic arthritis

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16
Q

What is the prognosis of JIA?

A

remission 70-85% within 2-5 years

oligoarticular >90%

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17
Q

JDM

A

juvenile dermatomyositits

0.1:100,000 (rare)
peak of onset 4-10 years

F>M

Heliotrope Rash (face)
Gottron’s Papules (hand)
Periungual erythema

hip and shoulder gridles
abdominal and neck muscle weakness

gour sign - muscular dystrophy in their thigh and hips

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18
Q

What is the clinical manifestation of JDM?

A

Heliotrope Rash (face)
Gottron’s Papules (hands)
Periungual erythema

hip and shoulder gridles
abdominal and neck muscle weakness

gour sign - muscular dystrophy in their thigh and hips

inflammatory myositis

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19
Q

What is the treatment of JDM?

A

immunosuppressive therpay

  • prednisone
  • steroid-sparing agents

stretching to maintain ROM

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20
Q

What is the prognosis of JDM?

A

70% well and functional

10% die

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21
Q

Henoch Schonlein Purpura

A 
most common systemic vasculitis of childhood 
MC in 3-15 years 
M > F 
13:100,000 
peaks in winter 
100% get palpable purpura seen on the legs and buttocks (dependent areas) 
edema
Arthralgias/arthritis (80%)
-usually in the lower extremity joints 
-acute and very painful 
GI involvement (50%) 
Renal involvement (35%)
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22
Q

What age group is more likely to get Henoch Schonlein Purpura?

A

3-15 years

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23
Q

What is the most common systemic vascultitis in children?

A

Henoch Schonlein Purpura

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24
Q

HSP lab testing

A

elevated inflammatory markers (ESR, CRP, WBC)
MUST NOT HAVE THROMBOCYTOPENIA or else you should be thinking leukemia
normocytic, normochronic anmeia (anemia of chronic illnes)

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25
Q

Pathology of HSP

A

leukocytoclastic vasculitis with IgA deposition

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26
Q

EULAR consensus criteria for HSP

A

classical palpable non-thrombotyopenic purpruic rash and any one of the following:

  • arthritis or arthralgia
  • abdominal pain and/or GI blood loss
  • any biopsy with predominant IgA deposition
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27
Q

What is the treatment for HSP?

A

supportive care
NSAIDS for arthritis
corticosteroids
-for severe GI disease and active renal disease

28
Q

What is the prognosis of HSP?

A

66% resolve within one month

at least 50% have recurrence -usually with 6 weeks but can be up to 2 years

29
Q

Kawasaki Disease

A

2nd most common vascultitis of childhood

MC in East Asia

<5 years old MC - uncommon before 6 months

february to may MC

fever lasting 5 days 
red eyes -bilateral conjunctivitis 
body rash 
swollen red tongue 
lymphadenopathy
30
Q

What age group is MC to get Kawasaki Disease?

A

6 months - 5 years

31
Q

Clinical Manifestations of Kawasaki disease

A 
fever lasting 5 days 
red eyes - bilateral conjunctivitis 
body rash 
swollen red tongue 
lymphadenopathy
32
Q

FEBRILE

A

dx criteria of Kawasaki disease

F- fever
E -enanthem
B- bulbar conjunctiviits 
R - rash 
I - internal organ involvement
L - lymphadenopathy 
E - extremity changes

if a pt presents with 4 or more –suggestion of Kawasaki even if they haven’t had fever for the 5 days

33
Q

What is the treatment for Kawasaki disease?

A

goal: prevent CAD

IVIG within 7 days of fever to better prevent CV complications

aspirin to help reduce pain and fever and decrease risk of blood clots (only time kids every get ASA)

34
Q

Growing pains

A

occur in 10-20% of all children

peak age of onset 3-7

worse after activity and late in the day

check CBC to r/o leukemia

tx: stretching and reassurance

35
Q

What are Red Flags for potential malignancy?

A 
non-articular bone pain 
back pain 
bone tenderness 
severe constitutional sxs
night sweats
ecchymosis/bruising
36
Q

DDH

A

developmental dysplasia of the hip

newborns have ligamentous laxity that can lead to spontaneous dislocation of the hip
1-2:1000
L > R (33% bilateral)

37
Q

What are the risk factors of DDH?

A

female
breech presentation
family hx

38
Q

What are the clinical manifestations of DDH?

A

asymmetrical creases on the back of thighs and buttocks

Galeazzi Sign - when both feet are on the table and one knee is lower than the other

39
Q

Galeazzi Sign

A

when both feet are on the table and one knee is lower than the other

seen with DDH

40
Q

Barlow vs Ortolani Tests

A

Barlow - dislocation

Ortolani - reduction

41
Q

What is the treatment for DDH?

A

based on age at dx

goal is stable reduction that results in normal development of hip

Pavlik harness - up to 6 months –hips should be reduced 2 weeks after the start of harness

42
Q

Avascular Necrosis of Femoral Head

A

aka legg calve perthes disease

caused by interruption of blood flow to the capital femoral epiphysis
typically presents in pts 2-12 years old
M > F

atraumatic, painless limp
may have some milk or intermittent hip/groin pain, anterior thigh or knee pain

common complication of sickle cell disease

43
Q

What age group is most likely to get Avascular Necrosis of Femoral Head?

A

3-12 years old

44
Q

Flattening of femoral head

A

seen in late disease of avascular necorsis of femoral head

45
Q

What is the treatment of avascular necrosis of femoral head?

A

should be followed by orthopedics

pain control and restoration of hip range of motion

braces, surgery for containment of the femoral head in the acetabulum (usually for kids >6)

46
Q

Slipped capital femoral epiphysis

A

orthopedic EMERGENCY
common adolescent hip disorder
M > F
average age 10-16 years

risk factors

  • obesity
  • trisomy 21
  • endocrine disorders
47
Q

Risk factors of slipped capital femoral epiphysis

A
  • obesity
  • trisomy 21
  • endocrine disorders
48
Q

How do pts with slipped capital femoral epiphysis present?

A

hip or knee pain
limp
decreased ROM
may hold leg in external rotation position

49
Q

What is the treatment for slipped capital femoral epiphysis?

A

go non-weight bearing with URGENT referral to orthopedics

surgery - internal fixation with cannulated screw

goal: to prevent further slippage, enhance physeal closure, minimize complications

50
Q

Osgood-Schlatter disease

A

common among athletes

common cause of knee pain at insertion of patellar tendon on the tibial tubercle
microfracture or partial avulsion in the ossification center on developing tibial tubercle
usually occurs after growth spurt
M > F
11 years for girls
13-14 for boys

51
Q

What is the clinical manifestation of osgood-schlatter disease?

A

pain during and after activity
may have tenderness and local swelling over tibial tubercle
can develop bony enlargement of the tibial tubercle

52
Q

What is the treatment for osgood-schlatter disease?

A 
rest and activity modification
NSAIDS, ice 
lower extremity flexibility and strengthening exercises 
course typically benign 
may last 1-2 years
53
Q

In Toeing vs Out Toeing?

A

In toeing more common in girls
worse around 4-6 years of age

internal femoral torsion >2 years

internal tibial torsion <2 years

out toeing
external tibial torsion

most of these go away on their own
tx is reassurance

54
Q

Genu Varum vs Genu Valgum

A

Varum - bowleg

Valgum - knock knees

knock knees MC in 3-4 year olds and typically resolves by 5-8 years of age

surgery only if they’re not able to walk normally

55
Q

Torticollis

A

shortening of sternocleidomastoid muscle
may result in plagiocephally

usually first identified in infant because of head tilt

Treatment is aimed at increasing ROM

56
Q

Polydactyly

A

2nd most common hand anomaly behind syndactaly (fusion of the fingers)

AA more common and typically involve little finger

Caucasians typically involve thumb

57
Q

What are the 3 different types of polydactyly?

A

Type 1 - soft tissue only –tx: ligation or electrocautery

Type 2 - duplicate finger, including bones/joints -surgery

Type 3 - duplication of finger AND metacarpal –tx: surgery

58
Q

Scoliosis

A

lateral curvature of the spine

most often idiopathic
80% >11 years of age

59
Q

What are non idiopathic causes of scoliosis?

A

cerebral palsy
muscular dystrophy
MSK disorders

60
Q

When does the AAP recommend scoliosis screening?

A

Females at age 10 and 12

Males once at age 13-14

61
Q

Cobb angle

A

on Xray
derived from positions of most tilted vertebrae above and below apex of curve

scoliosis

62
Q

What are the major risk factors of scoliosis?

A

F > M
potential for future growth (SMR - if they’re presenting early in SMR its more concerning of progression in curve)
Magnitude of curve at time of dx

63
Q

What is the treatment for scoliosis?

A

bracing for 20-40 degrees

spinal fusion for >40 degrees

64
Q

Nursemaid’s Elbow

A

axial traction on a pronated forearm with elbow in extension

annular ligament slips over head of radius and becomes trapped in radiohumeral joint

by the age of 5 this annular ligament has strengthened enough to not move over the radius

65
Q

When is Nursemaid’s Elbow most common?

A

1-4 years

66
Q

How to pts with Nursemaid’s elbow present?

A

not using arm
child holds arm close to body with elbow fully extended or slight flexed and forearm pronated
pain with active supination
little distress unless attempting to use the arm

67
Q

What is the treatment for Nursemaid’s elbow?

A

place thumb on prominence of radial head
apply gentle longitudinal traction
supinate forearm fully
flex elbow

Peds Exam 2 (11 decks)

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