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Laughing Pedi > MSK / Rheum > Flashcards

MSK / Rheum Flashcards

0
Q

5Ps of compartment syndrome

A

Pain, Paresthesia, Pallor, Paralysis, Pulseless

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1
Q

varus vs valgus

A

varus: distal inward
valgus: distal outward

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2
Q

blue sclera

Dx, Time of presentation, prognosis/issues, genetics?

A

OI type 1
Fractures in preschoolers
Autosomal Dominant
hearing loss by adult (conductive and sensorineural)

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3
Q

type A vs B OI type 1

A

A: good teeth
B: bad teeth

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4
Q

most severe type of OI, genetics

A

type 2: born w/ multiple fractures

inherited as new mutation or germinal mosaicism

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5
Q

achondroplasia:
- genetics
- cause of sudden death

A

AD, or spontaneous mutation in >80%

cervicomedullary junction compression

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6
Q

congenital torticollis can be associated w/ what?
Tx?
When till surgery?

A

hip dysplasia.

PT/stretching, but surgery if still present at 1y

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7
Q

head tilt with fusion of cervical vertebrae (congenital synostosis of cervical vertebrae)
Dx, other issues?

A

Klippel-Feil syndrome
issues: short neck, low occipital hairline, scoliosis, myelo, renal issues, sprengel deformity, deafness (assoc GU, cardiopulm, CNS issues)
(Clipper file: clippers giving bad haircut and spine disaster)

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8
Q

normal kyphosis

A

20-40, No intervention if < 60.

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9
Q

Bad posture, kyphosis, back pain in teen
Dx
Tx

A

Scheuermann dz

NSAID, pt, obs

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10
Q

What is sprengel deformity?

A

looks like torticollis, but its due to failure of scapula to descend and affected side is broader and shorter
Congenital elevation of the scapula

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11
Q

Barlow vs Ortolani

Which side usu worse?

A

Barlow: adduction w/ downward pressure
Ortolani: attempt to relocate
Left worse

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12
Q

migratory arthritis w/ rash?

A

think rheumatic fever, strep

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13
Q

one femoral head smaller than other in 4-8 yr old boy?

A

Legg Calve Perthes: avascular necrosis of femoral head

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14
Q

when do XR findings of osteomyelintis appear?

A

10-14 days after infx

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15
Q

chronic knee pain that locks and swells in adolescent?

Dx and tx?

A

osteochondritis dissecans

adolescent boys: immobilization, eventual removal of fragments if not improved

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16
Q

pain just below knee in adolescent athlete?

A

Osgood Schlatter

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17
Q

When to observe for scoliosis?

A

if curve < 25degrees

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18
Q

When to brace for scoliosis

A

if more than 2 yrs growth expected, and curve is 25-40

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19
Q

When surgery is needed for scoliosis

A

curve >40-45

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20
Q

Dx w/ swelling of bone shafts only in cortical bone, with progressive cortical thickening. DDX?

A

Caffey Dz.

DDX: NAT, but there is no periosteal involvement

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21
Q

internally rotated foot with contracted achilles
Dx?
Tx?
how often both feet?

A

club foot, tx: stretch, cast serially (Ponsetti 4-5 wks), surgical release in late 1st year.
50% bilateral

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22
Q

genu varus ok until when, then think what?

A

bow legged okay until age 2 and if bilateral.

If not, think rickets, Blounts disease

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23
Q

Blount’s disease

What is it, what are the types

A

pathology of proximal tibial physis/epiphysis
Infantile: African Americans, no tx needed
Adolescent: obese African American: need tx

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24
Q

absent radius (thumb issues): name 3

A
  1. TAR: thrombocytopenia, absent radius
  2. Fanconi ANEMIA: fan blade cuts it off
  3. VATER: R: absent radius
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25
Q

two syndromes to think of w/ high arches?

A
  1. Friedreich (Fried arch)

2. Hurlers

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26
Q

Flat feet, pes planus tx:

A

usu no intervention

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27
Q

Tx for salter 1 frx

A

2-3 weeks cast

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28
Q

Type 2 SH fracture?

Tx

A

metaphysis splits w/ some physis (the dogbone part: meta)

closed reduction 3-6 wk cast

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29
Q

Type 3 SH?

Tx

A

through growth plate and epiphysis, may need open reduct. WORSE than 2 b/c goes into joint space…

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30
Q

the deal with fat pads on XR?

A

anterior fat pad: all right

posterior fat pad: poor…fracture?

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31
Q

snuff box pain?

A

scaphoid bone fracture even if negative XR

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32
Q

hip extended and externally rotated in obese teen male.
How to dx?
Tx?

A

SCFE
Frog leg/AP XR
Tx: immobilize, no wt bearing, may need pins/bone grafts

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33
Q

CAuses of arthritis in children?

A

GLOVE: GC/genetic, Lyme, Osteomyelitis, Viral (toxic synovitis), Evasive infx (septic arthritis)

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34
Q

ANA and RF and ESR levels in ankylosing spondylitis

A

Normal ana, RF, mild incr ESR

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35
Q

back pain relief by exercise and pain in knees?

A

Think anklyosing spondylitis

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36
Q

Drugs used to treat pain in Ankylosing spondylitis

A

NSAID
sulfasalazine
methotrexate

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37
Q

aphthous stomatitis, genital ulcerations, uveitis, GI ulcers, arthritis. high ESR/CRP, normal ANA/RH
Dx and Tx

A

Behcet syndrome

tx: systemic steroids

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38
Q

heliotrope rash on face, tight shiny skin on knuckles/elbows (Gottron papules), periungual lesions

A

dermatomyositis

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39
Q

organ issues in dermatomyositis

A

esoph, lung

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40
Q

tx for dermatomyositis

A

steroids, MTX, IVIG, antimalarials. NO sunlight

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41
Q

Lowe syndrome vs ehler’s danlos?

A

Lowe also with blindness, hypotonia, ID (low vision, low tone, low IQ) Lowe also called oculocerebrorenal syndrome

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42
Q

median age of HSP

A

5 yo Boy

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43
Q

potential complication acutely of HSP

A

ileoileal intussusception

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44
Q

plts in HSP?

A

NORMAL

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45
Q

salmon colored evanescent rash

A

JRA

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46
Q

Timing criteria for JRA

A

< 16 yr, at least 6 wks in at least 1 joint

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47
Q

Labs abnl in JRA?

A

high ANA, RF usually neg but can distinguish subtypes

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48
Q

When is JRA likely to have RF+

A

older pts w/ polyarthritis JRA usually with more serious issues and nodules, like adult version

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49
Q

Polyarthritic JRA:

+/- systemic disease?

A

unlikely

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50
Q

Oligo JRA / Pauci

  • def
  • main complication
  • the deal w/ boys?
A

less than 5 joints, usu ANA pos young female.
Typical to have chronic uveitis
Boys may be HLAB27 pos w/ good prognosis

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51
Q

high fever, leukocytosis, small pale red macules w/ central clearing and coalescing, HSM, LAD, pleuritis/pericarditis.
Dx?

A

Systemic JRA / Stills

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52
Q

ANA and RF in systemic JRA?

A

both normally negative

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53
Q

WHat is tolmetin sodium?

A

an NSAID

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54
Q

Tx for JRA if cardiac involvement?

A

steroids

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55
Q

leading cause of acquired heart disease in kids < 5 y

A

Kawasaki

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56
Q

when to do echo in kawasaki?

A

dx, 2-3 wks, 6-8 wks

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57
Q

tx of kawasaki?

A

IVIG 2g/kg x1-2 doses
hi dose ASA 80mg/kg/day x 1-2d
low dose ASA 5mg/kg/day x 2 mos

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58
Q

if fever, rash, and conjunctivitis, which is measles?

A

exudative conjunctiviits, and rash starting and the top and going down

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59
Q

where is the rash in Scarlet fever?

A

flexural areas of extremities

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60
Q

erythema chronicum migrans ECM

A

bullseye rash in Lyme

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61
Q

Bell’s palsy in lyme, what time frame?

A

Months…

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62
Q

Lyme dx steps

A

Ab titer, then western blot confirm

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63
Q

False pos for lyme?

A

SLE, dermatomyositis, rickettsial dz

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64
Q

concern if child treated for Lyme gets chills, fever, hypotension, sepsis-like?

A

Jarisch-Herxheimer: lysis of organism, release of endotoxin

65
Q

Major criteria for Marfan?

A
  1. 4 Skeletal: tall, high arched palate, hyperextensible joints, pectus
  2. dilation/dissx asc Ao. Also get mitral regurg/prolapse
  3. lumbosacral dural ectasia
  4. ectopia lentis (anterior)
66
Q

bugs to worry about for post-infx arthritis and tx?

A

Salmonella, Yersinia, campylobacter, or viral. No tx. supportive care.

67
Q

post vaccine arthralgia, likely issue?

A

post MMR live vaccine, with post-infx arthritis from rubella component

68
Q

Seronegative spondyloarthropathy means what

A

ANA and RF normal

69
Q

can’t see, pee, climb tree?

A

Reiter: urethritis, iritis, arthritis

70
Q

bugs before Reiter?

A

Yersinia, shigella, salmonella, Chlamydial

71
Q

dysuria, conjunctival injection, swollen foreskin, negative UA

A

Reiter. reactive arthritis

72
Q

murmur best at apex + arthritis?

A

MR murmur, most common in RF.

73
Q

most common two murmurs of rheumatic fever?

A

MR first (apex), AR next (new murmur and mild CHF).

74
Q

Jones criteria for Rheumatic?

A

Recent GAS infx + 2 major or 1 major + 2 minor!

75
Q

What are the major criteria: JONES / RF?

A 
Joints: polyarthritis
Heart: carditis, CHF, new murmurs, cardiomegaly
Nodules: subctaneous on extensors
Erythema marginatum
Sydenham chorea
76
Q

Minor JONES / RF?

A

FEAR: fever, elevated inflamm markers, Arthralgia not arthritis which is major), pRolonged pR interval
or HELP: hot, elevated labs, arthaLgia, Prolonged PR

77
Q

erythema marginatum

A

RF

78
Q

erythema migrans

A

lyme

79
Q

Treatment of acute rheumatic fever?

A

GAS tx, sx, prophylaxis: PCN, ASA for arthritis/fever, steroids for carditis, haldol for chorea, digoxin for heart failure

80
Q

LAb tests they want for ARF?

A

Strep: ASO titers and positive streptozyme. Need definitive documentation of recent strep infx.

81
Q

noncaseating granulomas, bilateral peribronchial infiltrates?

A

Sarcoid

82
Q

sarcoid vs TB?

A

think EKG rhythm issue in Sarcoid

83
Q

easy fatigue in sports, renal and eye disease, hypercalcemia and calciuria?

A

SArcoid (granulomas secrete vit D)…

84
Q

linear hyperpigmented patch that becomes fibrotic

Dx and tx? Prognosis?

A

localized, linear scleroderma. self-limited. Tx w/ topical lubricant or photochemotx. May need steroids, antimalarials, immunosuppressives if progressive (MTX, penicillamine). Does not progress to systemic

85
Q

ANA in scleroderma

A

positive in systemic form

86
Q

serum sickness

  • type of rxn
  • tx?
A

type III hypersensitivity, fever, urticaria, arthralgia, LAD

tx antihistamine/steroids

87
Q

Shirmer test?

A

measures tear production from eye for Sjogren syndrome

88
Q

painless parotid swelling?

A

Sjogren

89
Q

SLE pathophys

A

Ag-Ab complexes in lots of tissues

90
Q

urine finding in SLE

A

cellular casts

91
Q

sensitive test for SLE

specific test for SLE

A

ANA sens, anti-smith specific

92
Q

Drug induced Lupus? Categories and three most common

A

D-SLE: drugs for heart, sulfonamides, lithium, epilepsy drugs
three most common: procainamide, hydralazine, quinidine

93
Q

signs of active renal dz in SLE?

A

incr anti-DNA titers, decr levels of complement C3, C4, CH50

94
Q

neonate w/ lupus
clue?
dx?

A

heart block / bradycardia, hydrops…
anti-ro SS-A Abs,
anti-la SS-B Abs

95
Q

best indicator of good response to Lupus tx?

A

normalization of C3 and C4

96
Q

common tx for lupus if NSAIDs don’t work, and its main s/e?

A

hydroxychloroquine, ototox, ocular: blurring, permanent retinal damage

97
Q

sinus, lung, kidney involvement in white child

lab?

A

Wegener Granulomatosis

c-ANCA

98
Q

Tx of Wegener?

A

cyclophosphamide, steroid

99
Q

cANCA in kids?

A

Wegener

100
Q

advice for people with benign hypermobility

A

stretch before sports

101
Q

normal WBC in synovial fluid

A

<200

102
Q

arthritis from trauma, how many WBC?

A

200-2000

103
Q

arthritis from SLE? WBC in synovial fluid?

A

5000

104
Q

RF, WBC in synovial fluid

A

5000

105
Q

JRA, WBC in synovial fluid

A

15-20,000

106
Q

Reiter, WBC in synovial fluid

A

20,000

107
Q

septic arthritis, WBC in synovial fluid

A

> 50,000

108
Q

Define heat stroke

A
  1. temp > 105
  2. hot dry skin (no sweating)
  3. CNS depression
109
Q

What can lead to end organ damage how?

What is tx?

A

release of endotoxins and cytokines

ice packs neck, groin, axilla. Cool to 101-102, not lower

110
Q

what is a hyphema?

What is tx?

A

blood between cornea and iris after eye trauma

OPHTHO referral, admit w/ bed rest and head at 30degrees to decr intraocular pressure. Shield (not patch) eye.

111
Q

what is a blow out fracture

what are the sx of blow out fracture

A

orbital wall or floor fracture

blunt eye trauma w/ double vision when looking to one side and dysconjugate gaze to one side. normal pupils.

112
Q

eye w/ severe pain, tearing, but NO diplopia / dysconjugate gaze

A

corneal abrasion

113
Q

blood in anterior eye chamber w/ possible visual impairment, NO diplopia

A

hyphema

114
Q

pain and severe photophobia but no diplopia

A

traumatic iritis

115
Q

visual deficit in peripheral field, curtain like.

no dysconjugate gaze

A

detached retina

116
Q

pain, tearing and diffuse uptake of fluorescein stain in eye?

A

refer to ophtho for concer about ulceration of corneal epithelium or GN infection of eye, esp in contact lenses

117
Q

most typical ankle injury

A

inversion injury w/ lateral ligaments: anterior talofibular ligament

118
Q

% of sports injuries involving the lower extrem

A

75%

119
Q

acute knee injury with “pop”, and knee effusion, and positive drawer sign.
Definitive dx?

A

ACL tear, definitive diagnosis is MRI

120
Q

pain over dorsum of hand near base of thumb?

A

snuff box: scaphoid fracture :(

121
Q

Tx of mid shaft clavicular fracture?

A

sling, no reduction

122
Q

pain in the distal / superior clavicle area and negative XR

A

acromioclavicular separation

123
Q

type of clavicular fracture that can be complicated, and requires what?

A

medial: CT scan

124
Q

pulseless, pain, paresthesia, pallor?

A

compartment syndrome

125
Q

confusion without amnesia or LOC?

Dx and tx?

A

grade 1 concussion

examine q5 min after removal from game. Need 20 min rest, then can return if no amnesia or HA

126
Q

confusion w/ amnesia but NO LOC

A

Grade 2, remove from game, examine frequently. F/u 24 hrs.

1 week off sx free

127
Q

LOC head injury

A

Grade 3: ER, sx free 2 weeks

128
Q

What is the risk re: growth in females taking anabolic steroid use?

A

early closure of epiphyseal plates: short

129
Q

do you get arrhythmias and seizures w/ steroid use (anabolic)

A

no

130
Q

common lab findings in anabolic steroid use?

A

LFTs high, low HDL, high LDL, oligospermia/azospermia

131
Q

How do you test for anabolic steroid use? What is the timing for detection?

A

PO steroids remain in urine days-wks

IM steroids remain in system for 6 mos or more

132
Q

is hyperactivity a sign of steroid withdrawal?

Depression?

A

Not hyperactivity

Depression yes

133
Q

IS GH detected in drug screening?

A

N

134
Q

hydration for teen athlete?

A

8oz (240mL) before exercise, then every 20 min unless very intense/high endurance sports for > 1 hr, then solution w/ 6-8% glucose

135
Q

what does weight loss in wrestler imply?

A

lower muscle endurance (loss of water weight)

136
Q

Rule about amount of weight loss?

A

3 lbs / week or 1.5% body weight per week.

137
Q

in athletes with modest cardiomegaly (f) or cardiac hypertrophy (m) what are restrictions/

A

none, normal findings in healthy athletes

138
Q

rigid spine, elbow contracture early, cardiomyopathy, autosomal dom or x-linked disease

A

Emory Dreifus

139
Q

JRA NOT assoc w/ uveitis

A

systemic JRA

140
Q

uveitis most common with which JIA?

Correlates with?

A

oligoarthritis > polyarthritis. NOT systemic.

Correlates with ANA

141
Q

Treatment specific for polyarticular RF+ JIA?

A

cyclic citrullinated peptide

142
Q

JIA, splenomegaly, neutropenia is what?

A

Felty syndrome

143
Q

HLA B27 assoc arthritis (now called enthesitis-related arthritis (ERA))

A
  1. Juvenile ankylosing spondylitis
  2. IBD related
  3. Reactive arthritis (Reiter’s)
144
Q

dactylitis - what is it, what should you think of?

A

sausage digit: psoriatic arthritis

145
Q

Discoid lupus rash path?

A

hyperkeratosis, follicular plugs, atrophic annular lesions

Dermal Band Test

146
Q

4 lupus skin/rash criteria (of the 11)

A

malar rash
discoid lesion
photosynthesis
oral/nasal mucosal lesions

147
Q

lab abnormalities that are part of the SLE criteria (3)

A

cytopenias (anemia, leukopenia, TCP)
Positive ANA
Positive immuno: anti DS DNA, anti smith, antiphospholipid Abs

148
Q

3 ITIS / SLE dx criteria?

A

nonerosive arthrisis
nephritis
pleuritis/pericarditis

149
Q

The stand alone SLE dx criteria?

A

Encephalopathy

150
Q

nuclear pattern of ANA assoc with what? The rest?

A

nuclear: scleroderma

The rest nonspecific (speckled, rim, homogeneous)

151
Q

Anti Ro and La have what three assoc?

A
  1. photosens
  2. neonatal SLE
  3. Sjogren’s
152
Q

lupus anticoagulant does what to coags?

A

prolongs aPTT

153
Q

Summary of SLE diagnostic criteria

A

11:
4 skin - photosens, malar, discoid, mucosal
3 itis - arthritis, nephritis, pericarditis/pleuritis
3 labs- penias, ANA, immuno
1 other - enceph

154
Q

Gottron papules?

A

Juvenile dermatomyositis

155
Q

what is curative for periodic fever, aphthous stomatitis, pharyngitis and adenopathy syndrome?

A

T&A

156
Q

sinusitis, pulm hemorrhage, glomerulonephritis, recurrent otitis, UTI?
Lab?
Complication

A

Consider Wegeners: Granulomatosis Polyangitis
+c ANCA
subglottic stenosis

157
Q

treatment of familial Mediterranean fever?
How many days of fever
Concern if not treated

A

colchicine
3 d
amyloidosis

158
Q

CAuse of intoeing in those walking less than 1 yr vs those >2y

A

tibial torsion in early walking

femoral anteversion in those over 2y

159
Q

Blood test predictive of uveitis in JRA?

A

ANA +

Laughing Pedi (24 decks)

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