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MS > Pediatric Rheum > Flashcards

Pediatric Rheum Flashcards

0
Q

milestones in peds to look for

A

weight and height retradtation
localized growth abnormalities
delayed secondary sex characteristics
going forward than regressing

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1
Q

chief compplaint in kids with arthritis

A

not pain- usually parents notice change ina ctivity

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2
Q

how to evalute a patient

A

limited ROM–>swelling/tenderness?–>symmetry?

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3
Q

benign juvenile hypermotility syndrome

A

some have painw with this and others dont

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4
Q

JI-JA overview

A

chronic arthritis persisting in >1 joint for >6 weeks at age <16 with exlcusion of other etio

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5
Q

pauci-oligo articular age 2-5 years

A

F»M
knee, ankle, wrist
ANA +
most severe

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6
Q

pauci-oligo articular 6-10 years

A

F=M

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7
Q

pauci-oligo articular age 11-18 years

A

M»F

lower limb, enthesitis, acute uveitis

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8
Q

enthetitis

A

inflammation where ligaments or tendons join to bones

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9
Q

polyarticular 2-5 years old

A

F>M

small and large joints with tenosynovitis

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10
Q

polyarticular 6-10 years

A

F>M

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11
Q

polyarticular 11-18 years

A

F»M
symmetric
RF+
erosive, like adult RA

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12
Q

systemic all ages groups

A

M=F

fever, rash,v araible arthritis, hematologic elevated ESR/CRP, auto ab -

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13
Q

lab values in JIA

A

high platelets
Iga deficient in 7-10%
anti CCP antibody is occasionally seen in kids

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14
Q

pathogenesis of synovitis

A

villous hyperplasia of synovium w/ hypervascularity and infiltration by lymphocytes and macrophages

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15
Q

main presentation JIA

A

younger boy or girls with less than 5 joints

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16
Q

main symptom

A

synovitis

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17
Q

other symptoms

A

synovitis, joint contracture, +/- erosions, deformity, and functional limitations

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18
Q

systemic onset JIA shows

A

rash +/i enlarged lymph nodes
rash very diagnostic for JIA
rash/fever last 2-5 hours and the arthritis resolves as it does

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19
Q

more severe rash in JIA

A

koebner phenomenom- linear skn lesiosn at site of trauma

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20
Q

epiphyseal overgrowth

A

inflammation at joint stimulates growth of its spiphyseal plate–>affected limb become slonger than the other side until its epiphyseal plate closes early–>ok limb over grows it
(smaller joint is the involved joint)

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21
Q

cspine may be associated with

A

micrognathia (lower jaw smaller than normal)

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22
Q

highest risk of uveitis

A

kids <7 with + ANA, oligoarticular

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23
Q

uveitis is usally

A

asymptomatic–>if undetected, blindness- keratopathy, cataracts

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24
Q

tx uveritis

A

ocular steroids

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25
Q

tx of JIA

A

NSAIDs 1st line- covers all signs and symptoms in 30%

refractory cases- 1 injection of sterioids–>stop dz

26
Q

systemic JIA

A

mTx, lefunomide, then biologics if they dont work

27
Q

percentage that goes into remission in adulthood with JIA

A

65% pauciarticualr

28
Q

percentage pauciarticular contineu to have active arthritis

A

50%

29
Q

population most likely to have active arthritis in adulthood

A

16 year old girls with + RF

30
Q

what do you need to exclude before dx pauci aritcualr 2-5 years

A

lyme arthritis

31
Q

m&m with systemic onset by age 15

A

14%, but 80% will achieve adult remission

32
Q

MC raynaud’s disease

A

ADD meds

33
Q

how do you tell primary and secondary raynaud’s

A

+ANA and nailfold path

34
Q

causes of secondary raynaud’s

A

CT disease
occlusive arteriole
vascular injury-frostbite, trauma
drugs and toxins

35
Q

drugs and toxins

A

b-blockers
vinyl chloride
ampetamine
ritalin/concerta

36
Q

chillblain’s is like

A

reverse raynauds==> venules instead of arterioles (pool blood in toes vs fingers)
*mostly benign

37
Q

how does chillblain’s come about

A

infectious skin condition presenting secondar to exposure to cold as PRURITIC and or painful erythematous to violaceous papules/plaques/nodules

38
Q

autoimmune diseases kids get

A 
raynauds
morphea
neonatal lupus
vasculitis
HSP
kawaski's
39
Q

other name for morphea

A

linear scleroderma

40
Q

tx for morphea

A

mild lesions do not require or respond to tx (may regress spontaneously)
–>lesions on face or joint line, treat aggressively (MTX)

41
Q

how do you get neonatal lupus

A

mother with active SLE can pass Ro and La abs to baby via placenta

42
Q

what does neonatal lupus present as

A

reversible skin rash, leukopenia, cytopenia

43
Q

big issue with neonatal lupus

A

irreversible heart bock

44
Q

management of neonatal lupus

A

cleck SLE mom for these antibodies

if yes, give dexamethasone

45
Q

2 most common forms of vasculitis in children

A

Henoch schonlein Purpura

kawaski disease

46
Q

when does HSP present

A

generally after age 3 (slight male predominance)

47
Q

what vessel does HSP infiltrate

A

capilarries and pre and post cap vessels

48
Q

what is HSP often preceded by

A

URI

49
Q

pathogenesis of HSP

A

IgA immune complexes

50
Q

skin findings of HSP

A

urticaria (hives) to purpura

51
Q

joint clinical presentation of HSP

A

transient asymmetric arthritis (almost NEVER involves the hips)

52
Q

clinical presentation of GI in HSP

A

colicky abdominal pain, bloody diarrhea, melena, intususception

53
Q

renal clinical presentation in HSP

A

micro/gross hematuria, proteinura, htn, nephrotic syndrome–>renal failure

54
Q

tx HSP

A

usually self-limiting and resoloves without sequelae

tx- supportive-hydration and time, meds only if severe disease or if theres suspcision of complx (renal dz)

55
Q

kawaski’s dz aka

A

mucocutaneous LN syndrome

56
Q

kawaski’s disease presentation

A

generalized systemic vasculitis, but has predilection for coronary arteries–>aneurysms in 20-25% of untreated patients with mortality of 2%

57
Q

tx kawaskis

A

Aspirin + iViG –>reduces aneurysms to 5%

58
Q

2 proposed mechanisms of kawaski’s

A 
polyclonal superantigen response
oligoclonal response (IgA)
59
Q

dx criteria of kawaski’s

A

fever + 4/5

bilateral conjunctival injection
polymorphous erythema rash
oropharyngeal involvement- STRAWBERRY TONGUE
cervical lymphadenopathy
extremity involvmeny
60
Q

extremity involvment of kawaski’s includes

A

edema of hands and feet
erythema of palms or soles
cutaneous desquamation
transverse nailg rooves

61
Q

incmplete/atypical KD

A

fever >5 days and <4 cardinal signs

62
Q

to confirm dx of KD or atypical KD

A

echo

MS (19 decks)

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