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Paediatrics > Paeds Rheum > Flashcards

Paeds Rheum Flashcards

1
Q

What are the three key causes of limping child that you mustn’t miss?

A
  1. infection / infl (esp osteomyelitis/septic arthritis)
  2. trauma (esp NAI)
  3. tumour
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2
Q

Osteomyelitis is most commonly caused by which bacterium?

A

Staph aureus

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3
Q

Osteomyelitis is infection of metaphysis of long bones. It usually happens by haematogeneous spread, or direct from soft tissue.

What bacterium commonly causes osteomyelitis in children with sickle cell anaemia?

A

salmonella in sick cell

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4
Q

What bacterium can cause osteomyelitis in immunocompromised children?

A

TB

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5
Q

X ray in osteomyelitis is initially normal. What would MRI show?

A

subperioesteal pus

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6
Q

What is the treatment for osteomyelitis?

A

Immediate IV Abx
then oral Abx for wks after

may need surgical drainage

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7
Q

What blood tests would you do if suspect osteomyelitis?

A

Blood cultures

WCC, CRP/ESR

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8
Q

What bacterium usually causes septic arthritis in older children?

A

Staph aureus

also consider Neisseria gonorrhoea in sexually active

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9
Q

In babies, what bacteria cause septic arthritis?

A

Kingella kingi
Group B strep
(group B strep also causes osteomyelitis in neonates)

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10
Q

What is the treatment for septic arthritis?

A

Immediate IV Abx

may need washout / surgical drainage

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11
Q

What is the medical name for “irritable hip” in 2-10 yr olds?

A

Transient synovitis

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12
Q

What is commonest cause of acute hip in 2-10 yr olds?

A

Transient synovitis

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13
Q

What is the treatment for transient synovitis?

A

self-limiting! Rest and analgesia! resolves in <1wk

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14
Q

What percentage of children with transient synovitis go on to develop Perthe’s disease?

A

3%

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15
Q

In transient synovitis, does the child usually have pain at rest?

A

no

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16
Q

Which criteria distinguish Septic arthritis from transient synovitis?

A

Kocher’s criteria

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17
Q

Kocher’s criteria indicating septic arthritis are…..(x4)

A

fever >38.5
non-weight bearing
raised ESR
raised WCC

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18
Q

3 key risk factors for developmental dysplasia of the hip?

A

female
breech birth
positive FHx

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19
Q

What are the clinical examinations for DDH?

A

Barlow

Ortolani

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20
Q

what investigation confirms diagnosis of DDH

A

ultrasound

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21
Q

what is treatment for DDH?

A 
Pavlik harness (flexed abducted)
older - surgery
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22
Q

idiopathic avascular necrosis of the femoral head. whats this?

A

Perthes disease

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23
Q

What would Bart Simpson get?

A

Perthe’s disease (short schoolboys age 5-10, low socioeconomic)

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24
Q

In Perthe’s disease they get hip pain which develops over a few weeks, limp, and reduced range of movement in which directions?

A

all ROMs!

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25
Q

What is the treatment for Perthe’s disease?

A

physio, rest in cast/braces
< 6yrs - observation
>6 yrs - surgery for deformities

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26
Q

What does SCFE stand for?

A

“slipped capital femoral epiphysis” - epiphysis of femoral head SLIPS off the back!

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27
Q

Which age group does SCFE affect?

A

adolescents

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28
Q

What kind of pain does SCFE cause?

A

hip pain referred to knee.

limp

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29
Q

SCFE affects adolescents with what body types?

A

obese

or just had a growth spurt

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30
Q

what is osgood-sclater disease?

A

osteochondritis of the patellar tendon where inserts at the knee

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31
Q

Sporty adolescent male Charlie Knox has knee pain after exercise, localized tenderness on knee cap, and swelling over tibial tuberosity. What treatment do you recommend?

A

decrease activity :(

physio (quads strengthening and hamstring stretching)

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32
Q

softening of articular cartilage of patella = ?

A

chrondromalacia patellae

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33
Q

Adolescent female with knee pain standing up and walking upstairs ?

A

chrondromalacia patellae (Ailsa Bell)

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34
Q

what is the treatment for chondromalacia patellae?

A

phsyio (Paul) - quads strengthening

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35
Q

what is the most common form of arthritis in childhood?

A

reactive arthritis

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36
Q

which joints does reactive arthritis often affect in kids?

A

ankles and knees

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37
Q

in reactive arthritis, how long do they usuallly take until complete recovery?

A

UNDER 6 wks

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38
Q

name three common bacteria than lead to reactive arthritis is KIDS?
what about in teenagers?

A

kids: salmonella, shigella, campylobacter
teens: chlamydia, gonorrhoea

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39
Q

what causes reactive arthritis in low-income countries?

A

rheumatic fever (strep)

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40
Q

what is the treatment for reactive arthritis?

A

NSAIDs! complete recovery <6wks!

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41
Q

what would CSR/ERP and Xray of joint show in reactive arthritis?

A

CSR/ERP normal/raised

X ray normal!!

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42
Q

malignancy in children can cause leg pain. name two NON-BONE cancers that can cause leg pain

A

acute lymphoblastic leukaemia

neuroblastoma

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43
Q

what BENIGN bone tumour can cause leg pain?

A 
osteiod osteoma 
(affects adolescent boys, pain at NIGHT, improves w NSAIDs)
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44
Q

what is the treatment for osteoid osteoma? (benign bone tumour)

A

surgical removal. (good prognosis)

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45
Q

name two malingant bone tumours which can cause leg pain in children

A

Osteosarcoma

Ewing sarcoma

46
Q

adolescent male with persistent localized bone pain and mass. otherwise well. what are you thinking?

A

osteosarcoma or Ewing sarcoma

47
Q

adolescent male with persistent localized bone pain and mass. you suspect osteosarcoma or ewing. what investigations?

A 
X ray
MRI
bone scan
(CT chest for lung mets)
(bone marrow sampling)
48
Q

what does X ray/MRI/bone scan show in osteosarcoma/ewing?

A

destruction + new bone formation

ewing - soft tissue mass

49
Q

what is treatment for osteosarcoma/ewing?

what extra for ewing?

A

combination chemo
.. then surgery

ewing - radio for local

50
Q

a 6 yr old with episodes of generalized pain in legs. wakes from sleep. symmetrical. never at start of day. no limp. Physical examination normal. What do you suspect?

A

growing pains!

51
Q

What are the 5 rules for growing pains!

A
  1. 3-12 yrs
  2. symmetrical
  3. never at start of day / after walking
  4. no limp
  5. physical examination normal
52
Q

what other problem is hypermobility associated with?

A

flat feet!

like me! I’m lucky I didn’t get chrondromalacia patellae!

53
Q

symmetrical hyperextension of thumbs, fingers, elbows, knees. they can put their palms flat on floor with knees straight! Can cause MSK pain, often worse after exertion. What is this?

A

hypermobility

54
Q

Hypermobility can be a normal finding especially in young girls. It can also be a feature of which 3 diseases?

A
  1. Down’s
  2. Marfan’s
  3. Ehlers Danlos
55
Q

what is allodynia??

A

pain from a stimulus that doesnt usually cause pain

56
Q

severe pain, hyperaesthesia and allodynia. worse with psychological stress. otherwise well and physical Ex normal. What is this?

A

“complex regional pain syndromes”

treat with physio & MDT

57
Q

RIGHT KATE. Give me the 6 key causes of back pain in children. You can do it.

A
  1. Mechanical
  2. Tumour (benign)/Malignancy
  3. Discitis / osteomyelitis
  4. Compression of spinal cord/nerve root
  5. Spondylo-lysis!
  6. Schuermann disease
58
Q

What is Schuermann disease?

A

osteochondrosis of vertebral body (hunchback + back pain)

dodgy ossification near the cartilage

59
Q

What are the 2 key complications of Perthe’s disease?

A

osteoarthritis

premature fusion of growth plates

60
Q

BackPainRedFlag - focal neuro defecit. What could this be?

A
  1. Compression of spinal cord/nerve root
61
Q

BackPainRedFlag - high fever. What could this be?

A
  1. Discitis / osteomyelitis
62
Q

BackPainRedFlag - night waking / persistent pain. What could this be?

A
  1. Malignancy
63
Q

Name some back pain red flags. Don’t have to get them all just try hun

A 
young age 
high fever
night waking / persistent pain
scoliosis which is painful 
focal neuro
weight loss / systemic malaise
64
Q

BackPainRedFlag - weight loss / systemic malaise. What could this be?

A
  1. Malignancy
65
Q

BackPainRedFlag - scoliosis which is painful. What could this be? (x2)

A
  1. Maligancy

3. Discitis / osteomyelitis

66
Q

Fixed thoracic kyphosis (hunchback) + back pain. Suspect?

A

Shuermann disease

67
Q

Heavy schoolbag on one shoulder. Back pain. Likely cause?

A

Mechanical back pain

68
Q

Which bone tumour is often found in spine?

A

osteoid osteoma (benign)

69
Q

What is the treatment for discitis / osteomyelitis in spine?

A

IV Abx immediately!

70
Q

How are you gonna do in these exams Kate?

A

FINE! :)

71
Q

Define Juvenile Idiopathic Arthritis

A

umbrella term for …
persistent joint inflammation in under 16s,
lasting for 6wks,
with no identified cause.

72
Q

Please name the 5 types of Juvenile Idiopathic Arthritis.

A
  1. Oligoarticular
  2. Polyarticular
  3. Psoriatic
  4. Enthesitis-related
  5. Systemic
73
Q

How many joints does oligoarticular JIA affect?

A

<4

74
Q

How many joints does polyarticular JIA affect?

A

> 4

75
Q

Asymmetric. Mostly knee or ankle. Associated with chronic anterior uveitis. What kind of JIA is this?

A

Oligoarticular

76
Q

Why do you arrange a 3 monthly eye screening for any child with JIA?

A

To check for UVEITIS

77
Q

Which joints does polyarticular JIA tend to affect, and in what distribution?

A

symmetrical large and small joints, often fingers! can also be asymmetrical tho

78
Q

This type of JIA can be Rheumatoid Factor positive or Rheumatoid Factor negative. Often with nodules and low-grade fever. Affects joints symmetrically.

A

Polyarticular (>4 joints)

79
Q

What is prognosis of polyarticular JIA ?

A

Bad. Destroys joints. Causes overgrowth of bone on affected side. Can cause scoliosis.

80
Q

Which type of JIA is also known as Still’s Disease?

A

Systemic JIA

81
Q

Name some features of Systemic JIA.

A 
arthralgia / myalgia
salmon pink macular rash 
hepatosplenomegaly
lymphadenopathy
quotidian spiking temps
82
Q

Which type of JIA has the highest mortality?

A

Systemic JIA (Still’s Disease)

83
Q

Which type of JIA causes salmon pink macular rash?

A

Systemic JIA

84
Q

Diagnosis of psoriatic JIA if:
- arthritis + actual psoriasis

or athritis plus (x3)…. ?

A
  1. Dactylitis
  2. Nail pitting
  3. First degree relly with PSORIASIS
85
Q

Which JIA is like ANKYLOSING SPONDYLITIS, in that it inflames lumbar spine and sacroiliac joints?

A

enthesitis-related JIA (HLA-B27)

86
Q

What is an enthesis?

A

the connective tissue between tendon/ligament and bone

87
Q

Which joints does enthesitis-related JIA affect?

HLA-B27

A

lumbar spine
sacroiliac
also Achilles!

88
Q

Name 4 risk factors for JIA.

A

female sex
age <6yrs
HLA polymorphism
FHx autoimmunity

89
Q

JIA is a clinical diagnosis. But what bloods might be helpful?

A 
FBC (normocytic anaemia)
ESR/CRP
ANA
HLA-B27
RF
90
Q

What percent of oligoarticular JIA are ANA positive?

A

70%

91
Q

Most JIAs affect females more often than males. Except WHICH?

A

Enthesisitis-related JIA - males

92
Q

If ANA is positive, this is associated with increased risk of what?

A

UVEITIS

93
Q

HLA-B27 is positive in what 90% of which JIA?

A

enthesitis-related JIA

94
Q

What imaging might you consider in JIA?

A

X-ray
ultrasound
MRI

95
Q

Give me some non-pharma management of JIA.

A

MDT - OT and physio
try to do lots of sports, dance :)
support for family

96
Q

Give me 5 types of medications which can be used in JIA.

A 
NSAIDs / analgesics
Corticiosteroids
Methotrexate
DMARDs
Biologics
97
Q

Give me 2 examples of DMARDs that may be used for JIA

A

sulfasalazine , leflunomide

98
Q

This Biologic is used to treat patients with POLYARTICULAR JIA for whom methotrexate has failed. It is the only TNF blocker licensed for JIA.

A

Etanercept

99
Q

Etanercept is a Biologic, the only TNF blocker licensed for treating JIA. When can it be used?

A

polyarticular, when methotrexate has failed

100
Q

Give me two examples of Biologics used in JIA

A

etanercept (TNF blocker)

tocilizumab (IL-6 blocker)

101
Q

Tocilizumab is a Biologic, an IL-6 blocker used for treating which kind of JIA?

A

Systemic JIA

when steroids + methotrexate have failed

102
Q

Corticosteroids are used to treat JIA. In what forms are steroids used?

A

Intra-articular injections
Systemic steroids for quick symptom relief/systemic disease
Topical steroids for uveitis

103
Q

Methotrexate is first line treatment for JIA (if multiple joints are affected or steroid injections not enough in a particular joint). How is it given? What should you monitor?

A

weekly methotrexate injections.

blood monitoring for liver & bone marrow

104
Q

Name 6 complications of JIA

A
  • chronic anterior uveitis.
  • joint deformities
  • growth failure
  • anaemia of chronic disease
  • delayed puberty
  • osteoporosis
105
Q

Why would osteoporosis be a complication of JIA?

A

corticosteroids + reduced weight bearing

106
Q

Uveitis can lead to….

A

cataracts, glaucoma, possibly blindness

107
Q

Which has polyarticular JIA has a worse prognosis, RF+ve or RF-ve ?

A

RF positive has worse prognosis

108
Q

Who should be involved in the care of a child with JIA?

A 
paediatricians
rheumatology MDT
opthalmologist
arthritis nurse
physio
OT
109
Q

What are the two types of oligoarticular JIA?

A

persistent

extended

110
Q

Which type of JIA is tocilizumab used for?

A

systemic JIA

111
Q

Why might a child with JIA have growth failure?

A

cortciosteroids + chronic disease

Paediatrics (14 decks)

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