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Rheumatology 2021 > Pediatric Patient with Joint Pain > Flashcards

Pediatric Patient with Joint Pain Flashcards

1
Q

What are the 6 types of juvenile idiopathic arthritis?

A

Oligoarticular, seronegative polyarticular, seropositive polyarticular, systemic onset, psoriatic, enthesitis related

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2
Q

What disease is associated with tibial tubercle overuse?

A

Osgood Schlatter Disease

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3
Q

What are the 2 reduction techniques to treat Nursemaid’s Elbow?

A

Hyperpronation, Supination with elbow flexion

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4
Q

What physical exam maneuver is used to aid in diagnosis of developmental dysplasia of the hip and involves a palpable “clunk” when the hip is reduced into the acetabulum during ABduction?

A

Ortolani maneuver

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5
Q

What 5 signs/symptoms will be found in Felty Syndrome?

A 
Splenomegaly
Anemia
Neutropenia
Thrombocytopenia
Arthritis (rheumatoid)
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6
Q

What four types of fractures are unique to kids?

A

Torus, Greenstick, Plastic Deformity, Physeal

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7
Q

What four complications are associated with SCFE?

A

Osteonecrosis of the femoral head
Chrondrolysis
Femoral Acetabular Impingement (FAI)
Early onset osteoarthritis

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8
Q

Risk factors for Osgood-Schlatter Disease

A

9-14 years old
Boys > girls
Rapid growth spurt
Sports that involve running, cutting, & jumping

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9
Q

What radiologic evidence could be suggestive of child abuse?

A

long bone fractures in non-walking children
fractures at multiple stages of healing
rib fractures
metaphyseal bucket handle fractures

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10
Q

What is the treatment for Developmental Dysplasia in the 0-6 month age group?

A

Pavlik Harness

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11
Q

What are common signs of Systemic Juvenile Idiopathic Arthritis vs other JIA subtypes?

A

Daily fevers! +/- rash with fever

Can also see elevated ESR/CRP and WBC

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12
Q

Which subtype of JIA is Felty Syndrome most commonly seen as an extra-articular symptom?

A

Seropositive (RF+) Polyarticular

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13
Q

Legg- Calve - Perthes presentation

A

painful or painless limp. Insidious onset is more likely. Initially, avascular events are silent, so the child is asx. May have some aching pain in the hip, or referred to the thigh or knee. May have activity related pain.

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14
Q

list risk factors for developmental dysplasia of the hip.

A

females, breech position in 3rd trimester, family hx, swaddling of the hips held in extension and adduction.

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15
Q

when should further work up be obtained for deep pain in calves that occurs at night in a 3-12 year old child, and is not associated with musculoskeletal findings.

A

labs and imaging shouldn’t be performed unless pain is located to a joint or continuous for >3 months without pain free periods, exacerbated by increased activity or PE is abnormal.

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16
Q

what is a pediatric pathologic fracture?

A

this is a fracture that occurred due to weakening by an underlying abnormality such as a bone tumor, Rickett’s or chronic renal insufficiency.

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17
Q

Unlike the other types of juvenile arthritis, which type of juvenile arthritis is commonly treated with DMARDs?

A

Seropositive Polyarticular (RF+)

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18
Q

Which type of juvenile arthritis may present with a salmon colored maculopapular rash?

A

Systemic Onset

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19
Q

What are causes of slipped capital femoral epiphysis?

A

Shearing of proximal femur at the growth plate due to:

  1. thick growth plate
  2. lack of sexual maturity
  3. mechanical stress
  4. ball/socket joint mechanics
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20
Q

When would you not use the Barlow test?

A

On an already dislocated hip.

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21
Q

What subtype of JIA is HLA-B27 positive?

A

Enthesitis

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22
Q

How is the presentation of oligoarticular JIA different than other JIA subtypes?

A

Asymmetric pattern with more than 4 joints involved; knee most commonly affected
Extra-articular sx including iritis
Commonly +ANA

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23
Q

11 year old obese female comes in with non-radiating, dull aching pain in hip and thigh with no recent trauma. +Frog-leg lateral radiograph. what is the most likely diagnosis?

A

SCFE

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24
Q

What is the treatment of Nursemaid’s Elbow?

A

Reduction - hyper pronation or supination

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25
Q

Which subtype of JIA is associated with iritis?

A

oligoarticular

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26
Q

Which subtype of JIA is associated with anterior uveitis?

A

psoriatic

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27
Q

Which subtype of JIA is associated with “joint inflammation and morning stiffness” and doesn’t affect more than 4 joints?

A

oligoarticular

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28
Q

Which polyarticular JIA affects large joints, seronegative or seropositive polyarticular JIA?

A

seronegative

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29
Q

What is the most common complication after tx of Nursemaid’s elbow?

A

Not hearing a click or pop with reduction = unsuccessful relocation (get x-ray)

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30
Q

What is the Galeazzi test used for?

A

Checking asymmetric knee height in development dysplasia of the hip. Positive if knees not parallel when resting feet on the exam table

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31
Q

What x-ray views are diagnostic for SCFE?

A

AP film and frog leg lateral

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32
Q

What are common physical exam findings for a patient for whom you suspect Osgood Schlatter Disease?

A 
Bony prominence
TTP at tibial tubercle (anterior)
Decreased quad flexibility
Pain with resisted quad extension
Pain with functional testing
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33
Q

What are some complications associated with Osgood Schlatter Disease?

A

painful ossicle when kneeling, tibial tubercle avulsion fracture, Genu recurvatum

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34
Q

What is the pathogenesis of Nursemaid’s elbow?

A

sudden pulling on the distal radius causing the annular ligament to slip over the head of the radius

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35
Q

A child presents with deep pain in the thighs, shins, and calf with normal labs and physical exam. He often wakes up in the mild of the night or from a nap due to the pain. What is the most likely diagnosis?

A

Growing pains

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36
Q

What are the treatment options for developmental dysplasia of the hip?

A

0-6 months: spontaneous reduction best accomplished with a pavlik harness
6-12 months (before walking): manual reduction under general anesthesia and spica cast
12+ months: surgery

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37
Q

Complications of pediatric fractures?

A

Growth arrest, neuromuscular compromise, permanent deformity, compartment syndrome, refracture.

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38
Q

Normal PE but child complains of pain that awakens them from sleep. What are you thinking?

A

Growing Pains

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39
Q

What types of active range of motion (2) are limited in the affected hip of a child with Legg-Calve-Perthes?

(eg. AB/adduction, int/external rotation, flex/extension?)

A

aBduction and internal rotation

40
Q

DIP joint synovitis, sacroiliitis, dactylitis, and nail pitting (hallmark) are associated with which subtype of JIA?

A

Psoriatic JIA

- these articular symptoms often present before the rash!

41
Q

Common complications of JIA?

A 
Macrophase activation syndrome (MAS)
Leg Length Discrepancy
Growth Impairment
Osteopenia
Osteoporosis
Gait abnormalities
Muscle Atrophy
Loss of vision
Glaucoma
Cataracts
42
Q

In general, how do we diagnose JIA, or when should we begin to suspect JIA?

A

6 weeks + of persistent joint swelling without another cause in childhood
No specific labs to confirm or exclude JIA

43
Q

Risk factors for SCFE?

A

obese or adolescent growth spurt

44
Q

Treatment for Osgood-schlatter disease?

A

RICE, which is rest, ice, elevation, NSAID, quad stretch, knee immobilization.

45
Q

XR findings for SCFE?

A

Posterior displacement of femoral epiphysis

46
Q

What causes unique formations of fractions in children?

A

Their Periosteum and physis

47
Q

What are some maneuvers or physical exam techniques to detect hip dysplasia in children?

A

Barlow Test and Ortolani Test

48
Q

besides number of joints affected, what is a big distinguishing feature between oligoarticular JIA and seronegative polyarticular JIA

A

in oligoarticular JIA extra-articular symptoms (iritis) are very prominent and common, in seronegative polyarticular JIA extra-articular symptoms are rare

49
Q

what is one thing you should NOT see in a patient’s history with suspected legg-calve-perthes

A

trauma!

50
Q

What is the treatment for Osgood Schlatter Disease?

A

Self limiting – sx will resolve once growth plate is ossified. Course is usually 6-8 months. Can use ice, alagesics, knee pads, PT, and activity modification for sx relief.

51
Q

What are the most common types of pathologic fracture in children?

A

proximal femur and humerus.

52
Q

When do you not use treatment for Legg Calve Perthes?

A

if the pt is under 5, has normal ROM, or less than half femoral head

53
Q

What is the MC patient population for Legg Calve Perthes?

A

4-10 yo
Males
Children who are small for their age

54
Q

Which sub-type of JIA includes the following epidemiology…

1) Teenage females with symmetric arthritis of the small joints of hands and feet
2) Resembles adult classic RF+ RA
3) More likely to have aggressive, erosive joitn disease
4) Rheumatoid nodules, Felty Syndrome, vasculitis, and lung disease can occur.
5) Iritis uncommon

A

Seropositive Polyarticular JIA (+RF)

55
Q

Clinical dx when chronic synovitis present in 1 joint for 6+ weeks and <16y/o

A

JIA Dx

56
Q

While working at a family practice clinic, you suspect a 13 yo male has JIA. What should be your next step?

A

Refer to a pediatric rheumatologist for early treatment

57
Q

What complications may occur with Systemic onset JIA?

A

Pericardial effusion (common but not hemodynamically significant=monitor)

Pericarditis and MAS (Macrophage activation syndrome)= LIFE threatening

58
Q

11 y/o girl presents overweight with non-radiating dull aching pain in the groin and a painful limb. Denes trauma. X-ray +frog leg lateral. What is the treatment?

A

Dx: SCFE
Treatment: crutches, admit, SURGERY

59
Q

Name the management goals for JIA and the treatment

A
  1. Reduce inflammation
  2. Restore function
  3. Reduce deformity
    - TX: NSAIDS, glucocorticoids, DMARDS
60
Q

Articular Sx of Psoriatic Arthritis?

A

Arthritis of one or more joints, sacroiliitis, distal IP joint synovitis, dactylitis, sausage digits, nail pitting, FHx of psoriasis

61
Q

What should you do if your attempt to reduce a radial head subluxation is unsuccessful?

A

Refer to Orthopedics

62
Q

what is the tx for 6-12 month old patients with developmental dysplasia of the hip

A

spica cast

63
Q

does a patient with a reduced nursemaid elbow need a sling?

A

no

64
Q

What pediatric diagnosis is Klein’s line, which can be seen on a frog leg lateral radiograph, associated with?

A

SCFE

65
Q

What type of radiograph would you use to diagnose developmental dysplasia in a 3 month old? 1 year old?

A

3 mo: US

1 year: radiograph

66
Q

Which condition pathology is due to vascular necrosis of the femoral head that leads to flattening and collapse of the affected bony structures?

A

Legg-Calve-Perthes (Avascular Necrosis of the Hip)

67
Q

Which condition occurs due to typically a number of the following:

  • breech birth position
  • ligament laxity
  • exaggerated positioning
  • soft surfaces
A

Developmental Hip dysplasia

68
Q

What is a greenstick fracture?

A

A fracture line that does not extend completely through the width of the bone. This fracture is high risk for repeat fractures.

69
Q

What are physical exam findings associated with a pediatric fracture?

A 
Parent carrying child
Child unwilling to use extremity
Aching or throbbing at rest
Pain increased with palpation
Swelling over injured area
Reduced or painful active/passive ROM +/- reduced strength
70
Q

What is another term for Nursemaid’s elbow?

A

Radial Head Subluxation

71
Q

What are some non-pharmacological treatments of growing pains?

A

Heat, massage, muscle stretching, physical therapy, and foot orthoses

72
Q

True or false: a spica cast is the treatment choice for a child 0-6 months with developmental dysplasia of the hip.

A

False; a Pavik Harness is used for children 9-6 months while a spica cast is used for children 6-12 months (prior to walking)

73
Q

What are possible complications of developmental dysplasia of the hips?

A

Avascular necrosis of the hip, residual dysplasia, early degenerative osteoarthritis

74
Q

What is an important thing to remember in the physical exam for a pediatric fracture?

A

Examine above and below the site of injury first and checking the neurovascular status!

75
Q

What type of diagnosis is developmental hip dysplasia?

A

Clinical diagnosis

76
Q

In general, which two specialties should be involved in the management of JIA?

A

Rheumatology, ophthalmology

77
Q

which pediatric fracture type carries with it a high risk of repeat fracture?

A

greenstick fracture

78
Q

What imaging needs to be done to diagnose Osgood-Schlatter?

A

None

79
Q

What additional symptoms are associated with JIA?

A

Daily spiking fever and a rash

80
Q

What are the lab findings for acutely ill Systemic Onset JIA?

A

Leukocytosis
very elevated ESR
Elevated Ferritin

81
Q

Two most common features of SCFE?

A

Pain and altered gait

82
Q

Complication of Osgood-Schlatter Disease

A

Painful Ossicle when walking
Tibial Tubercle avulsion fracture
Genu Recurvatum

83
Q

Pediatric age group commonly affected by Nurse Elbow

A

Age 1-3

84
Q

What is the Catterall Classification?

A

It is a standardized way to determine the extent of necrosis and prognosis in Legg-Calve-Perthes disease (AVN) using AP film (X-Ray imaging)

85
Q

What are the types of stress on a bone that can lead to fractures?

A

Tension
Compression
Bending
Torsion

86
Q

Four fracture patterns common in kids:

A

Torus
Greenstick (MC)
Plastic Deformity
Physeal/Growth Plate

87
Q

What maneuver reveals a clunk not click when gentle posterior pressure is applied to the hips in an adducted position and hip subluxes out of acetabulum?3

A

Barlow Maneuver

88
Q

You have a 12 yo patient with anterior knee pain that increases over time with activity and bony prominence below the patella. What is the likely dx?

A

Osgood-Schlatter

89
Q

Treatment for a pediatric fracture?

A

Immobilize with a splint, NSAIDs for pain, repeat image in 7-10 days to check for occult fracture

90
Q

What typically presents with a child who is limping and has limited abduction of the affected hip?

A

Legg- Calve- Perthes

91
Q

Which are we most worried about when it comes to SCLE and Legg Calves Perthes

A

AVN

92
Q

“Ice cream scoop falling off the cone”

A

SCLE

93
Q

Physical Exam findings for Developmental Dysplasia of the Hip

A

Displaced Hip proximally, displaced leg will be shorter, asymmetric skin folds, asymmetric knee height

94
Q

What diagnosis are you ruling out in order to diagnose nursemaids elbow?

A

FOOSH

95
Q

How is the extent of necrosis measured for Legg-Calve-Perthes (Avascular Necrosis)

A

its staged from I-IV

96
Q

What is the treatment for Developmental Dysplasia in children over 12 months?

A

Surgery

Rheumatology 2021 (3 decks)

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