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Year 3 > Paeds Rheumatomolgy > Flashcards

Paeds Rheumatomolgy Flashcards

1
Q

DDx of limp/joint pain toddler 1-3 yrs

A 
Transient synovitis
Juvenile Arthritis 
Trauma
Growing pain
Child abuse
Developmental dysplasia of the hip
Malignancy
Neuromuscular disease
Referred pain
Haemophilia
Henoch schoenlein purpura
Autoimmune
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2
Q

DDx of limp/joint pain child 4-10 yrs

A 
Transient synovitis
Juvenile arthritis 
Trauma
Growing pain
Perthes’ disease
Rheumatic fever
Associated with IBD
Malignancy
Referred pain
Haemophilia
Henoch-Schoenlein purpura
Autoimmune
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3
Q

DDx of limp/joint pain adolescent 11-16 yr

A 
Slipped upper femoral epiphysis
Juvenile arthritis 
Trauma Mechanical(hypermobility)
Associated with IBD
Malignancy
overuse syndromes
Autoimmune
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4
Q

points to consider while Hx taking in joint pain in kids

A 
Age
Mode of onset (acute or insidious)
Any previous episodes of joint pain
Current or preceding illness or injury
Location, pattern, and duration of pain
Joint swelling, fever
Recent travel
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5
Q

benign symptoms of joint pain in kids

A

Worse with activity and better with rest
Worse at the end of the day
If night pain relieved with simple analgesia

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6
Q

benign signs of joint pain in kids

A

Worse with activity and better with rest
Worse at the end of the day
If night pain relieved with simple analgesia

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7
Q

red flag symptoms suggestive of serious conditions in kids joint pain

A

Fever
Malaise/lethargy
Morning joint stiffness or pain
Night pain refractory to simple analgesia and symptomatic during the daytime

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8
Q

red flag signs suggestive of serious conditions in kids joint pain

A

Joint swelling
Bony tenderness to palpation
Muscle weakness
Fall in height or weight growth curve

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9
Q

investigations of joint pain in kids: bloods

A

Raised WBC and Neutrophils
ESR Elevated 48 hours after the inflammation
Sensitivity high
CRP Elevated 6 hours after inflammation
Blood film: Normal film does not exclude malignancy-
bone marrow aspirate required
Blood cultures: 46-80% osteomyelitis
22-50% septic arthritis

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10
Q

investigations of joint pain in kids

A 
plain radiography
USS
MRI
bone scan
CT
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11
Q

USS in joint pain in kids

A

sensitive in detecting joint effusions

absence of effusion makes septic arthritis unlikely

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12
Q

MRI in joint pain in kids

A

very sensitive in detecting early osteomyelitis, Perthe’s, inflammatory disease and malignancy

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13
Q

bone scan in joint pain in kids

A

very sensitive in identifying early osteomyelitis

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14
Q

CT in joint pain in kids

A

useful to detect early bone changes and tumours, early fractures.
Significant exposure to ionizing radiation

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15
Q

septic arthritis/osteomyelitis in kids: features

A

fever
systemic upset
severe limitation of joint movements
beware of subtle presentation

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16
Q

septic arthritis/osteomyelitis in kids: investigations

A 
FBC
CRP
ESR
USS and guided aspiration
X-ray
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17
Q

septic arthritis/osteomyelitis in kids: managemen

A

urgent ortho input

may need joint washout and IV antibiotics

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18
Q

joint trauma in kids: features

A

history of trauma

signs of injury

19
Q

joint trauma in kids: investigations

A

x-ray/CT

20
Q

joint trauma in kids: management

A

in or outpatient depending on the cause and type

21
Q

irritable hip in kids: features

A

systemically well

22
Q

irritable hip in kids: investigations

A

FBC
CRP
ESR

23
Q

irritable hip in kids: managment

A

advise regular analgesia for 48 hrs

follow up in 7-10 days

24
Q

Henoch-Schoenlein purpura: features

A

purpuric rash
abdo pain
haematuria

25
Q

Henoch-Schoenlein purpura: investigations

A

urine dipstick and microscopy

BP

26
Q

Henoch-Schoenlein purpura: management

A

paeds referral and follow up

27
Q

haemarthrosis: features

A

if spontaneous or after minor injury consider haemophilia

28
Q

haemarthrosis: investigations

A

coagulation studies

29
Q

haemarthrosis: management

A

if clotting abnormal paeds referral

30
Q

rheumatic fever: features

A 
carditis
erythema marginatum
mograting polyarthritis
subcut nodules
chorea
31
Q

rheumatic fever: investigations

A 
ECG/ECHO
FBC
U+E
CRP
ESR
ASOT
DNase B
32
Q

rheumatic fever: management

A

refer to paeds

33
Q

serum sickness: features

A

hx of medication use

rash

34
Q

serum sickness: investigations

A 
FBC
U+E
CRP
ESR
ASOT
DNase B
35
Q

serum sickness: management

A

follow up in 7-10 days

36
Q

reactive arthritis: features

A

hx of recent viral illness

well child

37
Q

reactive arthritis: investigations

A

exclude septic arthritis

38
Q

reactive arthritis: management

A

follow up in 7-10 days

39
Q

JIA DDx medical

A 
Septic arthritis
Reactive arthritis
Rheumatic fever
Associated with IBD
Connective tissue disorder:
(Systemis Lupus,Juvenile Dermatomyositis, Connective tissue disorder)
Mechanical joint pain(hypermobility)
Growing pain
40
Q

JIA DDx malignancy

A

leukaemia
neuroblastoma
primary bone tumour

41
Q

JIA DDx surgical

A 
Perthe's disease
Slipped upper femoral epiphysis
Congenital hip dysplasia
Fracture
Trauma
Referred pain
42
Q

management of JIA

A 
Encourage normal activity
Drug treatment
Regular ophthalmology review for uveitis screening.
Physiotherapy, including hydrotherapy
Occupational therapy
Psychology
Family
School / peer group
43
Q

poor prognostic factors in JIA

A 
Active disease at 6 months 
Polyarticular onset and course
Extended oligoarticular
Female
Rh Factor +ve
ANA +ve
Persistent raised inflammatory markers
44
Q

complications of JIA

A 
Altered growth of limbs
Scoliosis
Short stature
Joint damage / destruction
Blindness(untreated uveitis)
Psychosocial effects of chronic disease
Loss of schooling

Year 3 (164 decks)

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