Pediatric Rheumatology Flashcards
Atlantoaxial instability is more common in Down syndrome patients and typically manifests with […] motor neuron symptoms.
Atlantoaxial instability is more common in Down syndrome patients and typically manifests with upper motor neuron symptoms.
e.g. spasticity, hyperreflexia, positive Babinski sign
Bowing of the legs is considered a normal variation in children up to […] years old.
Bowing of the legs is considered a normal variation in children up to 2 years old.
i.e. physiologic bowing of the legs; after 2 years old, bowing is pathologic (e.g. tibia vara, also known as Blount’s disease)
Langerhans cell histiocytosis in a child may manifest as a painful, lytic long bone lesion with overlying swelling and […]-calcemia.
Langerhans cell histiocytosis in a child may manifest as a painful, lytic long bone lesion with overlying swelling and hyper-calcemia.
classically associated with Birbeck granules on electron microscopy
Lyme arthritis presents as an inflammatory monoarticular or asymmetric oligoarticular arthritis, most commonly in the […].
Lyme arthritis presents as an inflammatory monoarticular or asymmetric oligoarticular arthritis, most commonly in the knee.
synovial fluid analysis typically reveals ~25,000 WBCs/mm3 with negative gram stain/culture; arthritis is the most common complication of late lyme disease
Osteoblastoma presents with bone pain, especially at night, that […] resolve with aspirin/NSAIDs.
Osteoblastoma presents with bone pain, especially at night, that DOES NOT resolve with aspirin/NSAIDs.
important distinguishing feature from osteoid osteoma
Osteogenesis imperfecta is caused by mutation in the genes coding for […].
Osteogenesis imperfecta is caused by mutation in the genes coding for type I collagen.
Osteogenesis imperfecta is characterized by multiple […] with minimal trauma.
Osteogenesis imperfecta is characterized by multiple fractures with minimal trauma.
may occur during the birth process; can mimic child abuse, but bruising is absent
Osteoid osteoma presents with bone pain, especially at night, that […] resolve with aspirin/NSAIDs.
Osteoid osteoma presents with bone pain, especially at night, that DOES resolve with aspirin/NSAIDs.
important distinguishing feature from osteoblastoma
Patients with Kawasaki disease may develop coronary artery […], which can rupture.
Patients with Kawasaki disease may develop coronary artery aneurysms, which can rupture.
echocardiography should be performed at the time of diagnosis and again 6 - 8 weeks later; dilated arteries are prone to thrombotic occlusion, which may cause myocardial ischemia and/or infarction
Radial head subluxation (nursemaid’s elbow) occurs when the radial head slips through part of the […].
Radial head subluxation (nursemaid’s elbow) occurs when the radial head slips through part of the annular ligament.
Serum sickness typically presents with fever, urticaria, arthralgia, and lymphadenopathy […] after antigen exposure. (timing)
Serum sickness typically presents with fever, urticaria, arthralgia, and lymphadenopathy 1 - 2 weeks after antigen exposure. (timing)
most commonly caused by beta-lactams and sulfa drugs; symptoms typically resolve with withdrawal of the offending agent
Slipped capital femoral epiphysis (SCFE) is characterized by […] rotation of the thigh upon hip flexion.
Slipped capital femoral epiphysis (SCFE) is characterized by external rotation of the thigh upon hip flexion.
also associated with limited abduction and internal rotation of the hip
Treatment for Kawasaki disease includes […] and […].
Treatment for Kawasaki disease includes aspirin and IVIG.
aspirin is given for its antithrombotic properties; this is an exception to the rule that children should never be given aspirin
What bone tumor is characterized by a bony mass with a radiolucent core on imaging?
Osteoid osteoma
What drug classes are most commonly associated with serum sickness?
beta-lactams and sulfa drugs
e.g. penicillin, amoxicillin, TMP-SMX
What eye pathology is associated with juvenile idiopathic arthritis (JIA)?
Uveitis
should be assessed for with slit-lamp examination
What is the likely diagnosis in a child that presents with bilateral lower extremity pain, especially at night, with a normal physical exam?
Growing pains
growing pains is characterized by no systemic symptoms with normal activity levels and physical exam
What is the likely diagnosis in a child that presents with hip pain several days after a viral URI with normal physical exam, laboratory studies, and X-ray?
Transient synovitis
most common cause of hip pain in children; X-ray is needed to assess for Legg-Calve-Perthes disease
What is the likely diagnosis in a child that presents with several months of back pain and recent urinary incontinence with a palpable “step-off” at the lumbosacral area on physical exam?
Spondylolisthesis
typically caused by forward slip of the L5 vertebrae over S1 in preadolescent children
What is the likely diagnosis in a child that presents with three months of symmetric arthritis of wrists, knees, and ankles that is worse in the morning?
polyarticular juvenile idiopathic arthritis
laboratory findings include leukocytosis, thrombocytosis, anemia, and elevated ESR
What is the likely diagnosis in a child that presents with two months of daily fever, pink macular rash, and knee/hip pain that is worse in the morning?
systemic-onset juvenile idiopathic arthritis (sJIA)
laboratory findings include leukocytosis, thrombocytosis, anemia, and elevated ESR; macular rash is characteristic of systemic JIA
What is the likely diagnosis in a child with a supracondylar humerus fracture that complains of increasing pain despite multiple analgesics?
Compartment syndrome
supracondylar humerus fracture classically occurs in a child after a fall on an outstretched hand; radiographs often reveal fat pads (lucency) anterior and posterior to the fracture
What is the likely diagnosis in a newborn with bilateral medial deviation of the forefoot that corrects with passive and active foot movement?
Metatarsus adductus
What is the likely diagnosis in a newborn with rigid medial and upward deviation of the forefoot and hindfoot?
Clubfoot (talipes equinovarus)
What is the likely diagnosis in a young Asian child that presents with one week of fever, conjunctivitis, lymphadenopathy, maculopapular rash, and hand/feet swelling?
Kawasaki disease
What is the likely diagnosis in a young boy that presents with two months of progressive hip pain with limited internal rotation/abduction of the affected hip?
Legg-Calve-Perthes disease
idiopathic osteonecrosis of the femoral head that typically presents in boys age 4 - 10 years old; initial X-rays may be negative
What is the likely diagnosis in an exclusively breastfed infant that presents with craniotabes, rachitic rosary, and genu varum?
Rickets (secondary to vitamin D deficiency)
What is the likely diagnosis in an infant that presents with head tilting toward one side with a neck mass that does not transilluminate on ultrasound?
Congenital muscular torticollis
versus cystic hygroma, which does transilluminate on ultrasound
What is the likely diagnosis in an infant that presents with leg-length discrepancy and asymmetric inguinal skin folds?
Developmental dysplasia of the hip
this diagnosis is further supported by a palpable “clunk” when performing the Barlow and Ortolani maneuvers
What is the likely diagnosis in an obese, adolescent boy that presents with progressive knee pain over the past month?
Slipped capital femoral epiphysis (SCFE)
knee pain is a common presenting symptom of SCFE (referred pain from the hip)
What is the next step in management for a child with suspected growing pains?
reassurance and supportive treatment
e.g. massage, OTC analgesics
What is the preferred imaging modality for diagnosis of developmental dysplasia of the hip in infants < 4 months old?
Hip ultrasound
What is the preferred imaging modality for diagnosis of developmental dysplasia of the hip in infants > 4 months old?
Hip X-ray
What is the recommended treatment for congenital clubfoot?
serial manipulation and casting
if conservative management fails, surgical treatment may be indicated (preferably performed between 3 - 6 months of age)
What is the recommended treatment for metatarsus adductus?
Reassurance
the majority of cases resolve spontaneously
What is the recommended treatment for slipped capital femoral epiphysis (SCFE)?
Immediate surgical pinning of the femoral head
lessens the risk of avascular necrosis of the femoral head and chondrolysis
What laboratory findings are associated with juvenile idiopathic arthritis (JIA)?
RBCs: […]
WBCs: […]
Platelets: […]
RBCs: decreased (anemia)
WBCs: increased (leukocytosis)
Platelets: increased (thrombocytosis)
reflective of systemic inflammation
What maneuvers are both diagnostic and therapeutic for radial head subluxation (nursemaid’s elbow)?
forearm hyperpronation or supination plus flexion
What muscle(s) are innervated by the superior gluteal nerve?
gluteus medius and minimus
responsible for hip abduction; nerve damage results in contalateral hip drop (“trendelenburg sign”)
What nerve injury results in loss of hip abduction (“trendelenberg sign”)?
Superior gluteal nerve injury
injury is ipsilateral to the extremity on which the patient stands (contralateral nerve injury)
What physical exam maneuvers are used to assess for developmental dysplasia of the hip?
Barlow and Ortolani maneuvers
[…] disease presents with focal pain and swelling at the tibial tuberosity, secondary to traction apophysitis of the tibial tubercle.
Osgood-Schlatter disease presents with focal pain and swelling at the tibial tuberosity, secondary to traction apophysitis of the tibial tubercle.
classically seen in young adolescent athletes after a recent growth spurt
[…] typically occurs in children after being lifted or pulled by the arm.
Radial head subluxation (nursemaid’s elbow) typically occurs in children after being lifted or pulled by the arm.
the child typically presents with the affected arm in a pronated position
Ewing sarcoma is a bone tumor associated with a characteristic “[…]” appearance on X-ray.
Ewing sarcoma is a bone tumor associated with a characteristic “onion-skin” appearance on X-ray.
typically arises in white males in the first or second decade of life
[…] is a bone tumor associated with a characteristic “onion-skin” appearance on X-ray.
Ewing sarcoma is a bone tumor associated with a characteristic “onion-skin” appearance on X-ray.
typically arises in white males in the first or second decade of life
Osteogenesis imperfecta may present with […] due to translucent connective tissue over choroidal veins.
Osteogenesis imperfecta may present with blue sclerae due to translucent connective tissue over choroidal veins
What MSK pathology is associated with metaphyseal cupping/fraying?
Rickets
