Mehl. Peds MSK arthritides/joint (sacroilitis, scolio, psoriasis, JIA) 04-04 (1) Flashcards
2CK Peds forms love JIA (Juvenile idiopathic arthritis). It will sound like regular RA but just in a kid.
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JIA. USMLE will structure these Qs where they want you to pick between JRA and septic arthritis (SA) as answer choices.
This can be confusing since SA can occur in patients with JRA. They might say a kid has a low-grade fever and a warm, red, painful knee (sounds like SA), but then they say he’s had similar episodes in the past (i.e., they want JRA over SA). This is because SA is usually a one-off event; for JRA, however, the vignette will say “intermittent” or “episodic.” Low-grade fever can occur in autoimmune flares (not limited to JRA; HY for sarcoidosis as well).
JIA. ….maculopapular rash only in ~50% of JRA Qs???
“Salmon-pink”
“Salmon-pink” maculopapular rash only in ~50% of JRA Qs. Often described as a buzzy finding, but I’d say about half of JRA vignettes don’t even mention rash.
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2CK forms are obsessed with ……… in JRA. ???
anemia of chronic disease.
JIA. HY point is that MCV can absolutely be low. Resources push normal MCV for AoCD. This is absolute nonsense. Plenty of 2CK NBME Qs give MCV as 70s in AoCD.
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JIA. Can be associated with ???????
Serous pericarditis.
JIA. If the Q asks what arthrocentesis will show in JRA, the answer is ??
Leukocytes
Both should be ordered for JIA (and RA in adults).????????????
For antibodies, anti-cyclic citrullinated peptide (anti-CCP) is more specific than rheumatoid factor.
JIA. Tx plan?
Tx for JRA has arms of management: 1) symptoms; 2) disease progression.
JIA. Tx - symptoms?
For symptoms, give NSAIDs first, followed by steroids. These do not slow disease progression. NSAIDs and steroids are for symptoms only.
JIA. Tx - disease progression?
For disease progression, we use disease-modifying anti-rheumatic drugs (DMARDs), which slow disease progression.
Methotrexate is given first, followed by adding an anti-TNF-a agent (i.e., infliximab, adalimumab, or etanercept).
Scoliosis. Sideways curvature of spine, creating an S- or C-shaped curve. Usually idiopathic; affects 3% of population; girls 4:1.
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Scoliosis. Most common type is ?
idiopathic adolescent thoracic scoliosis.
Scoliosis. Can be associated with ? 3
Marfan syndrome, Friedreich ataxia, NF1
Scoliosis. what used to Dx?
Adams forward bend test used to diagnose.
Scoliosis. Tx?
USMLE wants you to know most children do not need treatment, but that curvatures will remain throughout life.
Scoliosis. when Tx with bracing?
Answer = bracing if curvature is >25 degrees and child is still growing.
Scoliosis. I’ve never seen surgery as answer for scoliosis on NBME; literature says recommended only when curvature >40 degrees
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Psoriasis. Can occur in children and teens.
15% of patients with psoriasis will get arthritis before any skin findings.
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Psoriasis. Plaques are described as ?
silvery and scaly and over extensor regions (elbows); plaques can also show up on the face (i.e., forehead and lip).
Plaques are described as silvery and scaly and over extensor regions (elbows); plaques can also show up on the face (i.e., forehead and lip). Dx?
Psoriasis
Psoriasis. What sign when plaque is removed?
Auspitz sign is bleeding of the scales if removed.
Psoriasis. HY point for USMLE is that psoriasis is part of the ????
HLA-B27 constellation (PAIRà Psoriasis, Ankylosing spondylitis, IBD, Reactive arthritis).
For example, if 17M has silvery plaque on elbow and forehead + bloody stool ->???
the latter is most likely IBD due to HLA-B27 association. Plaque = psoriasis
Psoriasis. Don’t confuse psoriasis + IBD combo with dermatitis herpetiformis + Celiac disease combo!!!!!!!!!!
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Psoriasis. Tx?
Treatment for plaque psoriasis is topicals first: USMLE wants calcipotriene (vitamin D derivative), triamcinolone or hydrocortisone (both corticosteroids), and coal tar.
Choose in that order if you are forced. Chronic application of topical steroids causes dermal collagen thinning, so they are not preferred prior to topical vitamin D.
Psoriasis. when oral meds for Tx?
Oral meds are given if patient fails topicals, OR if patient has systemic psoriasis (i.e., arthritis). Oral methotrexate is HY on new NBME material as the first-line oral agent used.
An old NBME has oral acitretin (a vitamin A derivative) as an answer, where methotrexate is not listed.
Sacroiliitis.
Sacroiliitis is broad term that refers to arthritis of lower back; ankylosing spondylitis (AS) is most severe form.
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Vignette will almost always be male 20s-40s who has lower back pain worse in the morning that improves throughout the day. Dx?
However, there is Q on 2CK Peds form where AS is diagnosis in an 8-year-old, so you need to know it’s possible in peds.
Sacroiliitis/ankylosing spondylitis (AS)
nebuvo tiksliai nurodyta kuris pries to pirmo case kur adult
Lower back pain in patient with IBD, psoriasis, or reactive arthritis points toward ??
sacroiliitis (HLA-B27 PAIR).
Sacroiliitis. Hemato?
High ESR and anemia of chronic disease high-yield.
Sacroiliitis. Dx?
x-rays of the lumbosacral spine and sacroiliac joints.
USMLE wants “slit-lamp examination” to look for anterior uveitis in ankylosing spondylitis. Any autoimmune disease can theoretically increase risk of this eye finding, but for whatever reason USMLE likes it for AS.
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Sacroiliitis. Treat same as JRA.
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