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CSI > peds rheum > Flashcards

peds rheum Flashcards

1
Q

JIA

A

prolonged fever, salmon patch rash, arthritis, visceral involvement

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2
Q

scarlet fever

A

strawberry tongue, bilateral cervical LAD, fever, rash

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3
Q

rheumatic fever

A

Rash, subcutaneous nodules, fever, polyarthralgia, chorea

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4
Q

viral syndrome (enterovirus)

A

Fever 3-5 days, non-descript non-painful rash, can walk

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5
Q

kawasaki

A

fever > 5days, nonpurulent conjunctivitis, erythematous rash, swelling and erythema of extremities, unilateral LAD

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6
Q

osteomyelitis/septic joint

A

Low grade fever, painful walking

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7
Q

RMSF

A

Fever

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8
Q

Steven johnson

A

Severe pruritic rash, fever

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9
Q

measles

A

conjunctivitis, fever, rash, non-immunized

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10
Q

kawasaki

A

Mucocutaneous lymph node syndrome

Acute Febrile Vasculitic syndrome of early childhood

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11
Q

kawasaki symps list

A

Supporting Sx: Non-remitting High grade Fever > 5 days PLUS 4/5 of the following:
red macpap rash
unilat cerv adeno>1.5 cm
strawberry tongue, red fissurd lips, injected pharynx
non-pur. conjunc, bilat, painless
redness/swell of hands/feet
desquamations of tips, transfers grooves across nails -beau lines)

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12
Q

kawasaki labs

A

No specific diagnostic test; Elevated ESR/CRP, Anemia, Elevated WBC, Thrombocytosis, Hypoalbuminemia, Elevated AST/ALT
Case: Echocardiogram with coronary artery aneurysms

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13
Q

kawasaki complications

A 
coronary artery aneurysm
CNS manifest (mening.)
liver dysfunc
arthritis
hydrops of gall bladder
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14
Q

kawasaki pathoma

A 
Kawasaki Motorcycle
Hold on with Palms and Soles:
Edema
Erythema
Desquamation
Heart Racing: CAA
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15
Q

kawasaki tx

A

Usually self-limiting ~12 days
BUT leads to significant morbidity and mortality
IV IG (dec. CAA)
Aspirin
(Anti-inflammatory, anti-pyretic, anti-platelet)
Possible Reye syndrome- recommend influenza vaccine
Echocardiogram- evaluate for CAA

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16
Q

kawasaki buzz words

A 
High-grade Fever for multiple days
Strawberry Tongue
Conjunctivitis
Thrombocytosis and peeling of fingers
Erythematous Maculopapular Rash
Coronary Artery Aneurysms
Treated with Aspirin in Childhood
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17
Q

“gelling phenomenon”

A

joint pain is worse in the morning and after periods of sitting and watching television

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18
Q

ESR vs CRP

A

ESR: concentration of fibrinogen and other inflammatory modulators that have half-lives of days to weeks.
CRP: made exclusively in the liver and can rise and fall within hours of an acute inflammatory stimulus

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19
Q

JIA (Juvenile Idiopathic Arthritis)

A
20
Q

JIA types

A

polyarthritis
oligoarthritis
systemic: characteristic arthritis that develops with fever and rash; and exclusion of other juvenile arthritis

21
Q

JIA comps

A

Chronic iridocyclitis in pauciarticular JRA (other ocular disease includes iritis, and uveitis)

Joint deformities in polyarticular JRA
(can have positive or negative rheumatoid factor)

22
Q

common tests for GAS (rheumatic fever)

A

throat cx

anti–streptolysin O (ASO) and anti–deoxyribonuclease B (anti–DNAase B)

23
Q

ASO titers

A

peak 3 to 6 weeks after GAS infection.
They are elevated in 80% of patients with typical rheumatic fever (and GABHS pharyngitis)
less than 50% of kicks w/ rec. GABHS skin inf.
less than 70% of patients with chorea

24
Q

Anti–DNAase B titers

A

more reliable, in both pharyn. and skin GABHSpts

peak 6 to 8 weeks after GABHS infection. The elevated titers may persist for several months after infection

25
Q

elevation of ??? in 95% rheumatic fever pts

A

anti–DNAase B, antistreptokinase, or antihyaluronidase

26
Q

Jones Criteria for rheumatic fever

A

2 major criteria or 1 major + 2 minor + evidence of recent GAS infection (+ throat cx/RADT, rising ASO titers)
MAJOR: carditis, polyarthritis, chorea, erythema marginatum
MINOR: fever, arthralgia, elevated APPs, prol. PR interval

27
Q

JIA tx

A

Hospitalization
Cardiology consult
PCN or Erythromycin (if patient is allergic to PCN)
arthritis and carditis tx: ASA 90 to 120mg/kg/day until symptoms resolve
chorea tx: Haloperidol, phenobarbital, or valproic acid

28
Q

JIA ppx

A

Start prophylactic antibiotics immediately after the therapeutic antibiotic course is completed.
Continue until child is an adult and is recurrence free for 10 years (longer if they have residual heart disease)
Options for lower risk of recurrent ARF:
PCN V K, Sulfadiazine, Macrolides

Higher risk of recurrent ARF:
Benzathine PCN G intramuscularly, every 4 weeks

29
Q

RF summary

A 
Age range: 5-15yo
Seasonality: Winter
Preceding URI
Strep Pharyngitis
Jones criteria
30
Q

RF: carditis

A 
Prolonged PR interval
Varying degrees of heart block
Cardiomegaly may be noted on CXR
Inflammation of valves and endocardium
valvular regurgitation/stenosis
Mitral valve most common
(rheuMATic: Valves affected Mitral>Aortic>Tricuspid)
31
Q

RF: skin/ST

A

(typically only in carditis patients)
Subcutaneous nodules over bony prominences
present up to a month
Erythema marginatum
annular erythema, usually present on the trunk and proximal portions of the extremities, sparing the face

32
Q

RF: CNS

A

Sydenham Chorea
abrupt, purposeless, nonrhythmic, involuntary movements that cease during sleep
muscular weakness
emotional disturbances; ranges from outbursts of inappropriate behavior to transient psychosis
Occur 3-8 months after GAS infection

33
Q

RF labs

A 
elev. ESR, CRP
CXR: mild effusion
EKG: prol. PR interval
Echo: mitral valve regurg
\+ASO
34
Q

erythema nodosum

A

type of panniculitis, inflammation of subcutaneous fat in the skin, usually first evident as an outcropping of erythematous nodules that are highly sensitive to touch
Most located symmetrically on the ventral aspect of the lower extremities
tests: CBC, ESR, ASO titers, Excisional biopsy (when clinical diagnosis is in doubt)

35
Q

Henoch Schonlein Purpura

A

Small-vessel vasculitis associated with abrupt onset of a rash, palpable purpura most common; GI manifestation, arthritis and arthralgia, and late renal manifestations, commonly after exposure to triggering antigen (eg infectious agent)
tests: CBC, ESR, abdominal US, urinalysis, ASO titers, Excisional biopsy (when clinical diagnosis is in doubt)

36
Q

Immune thrombocytopenic purpura

A

Thrombocytopenia associated with petechia or purpura; bleeding (e.g., gingival, gastrointestinal, mucocutaneous); symptoms of end-organ ischemia (in patients with thrombotic disease)
tests: CBC with peripheral smear, coagulation studies, platelet-associated antibody (immunoglobulin G), electrolytes, BUN, creatinine, LDH, urinalysis

37
Q

leukemia

A

Nonspecific symptoms of fever, easy bleeding, skin findings (e.g., petechiae, purpura), bone pain, fatigue, hepatosplenomegaly, lymphadenopathy
tests: CBC, ESR, coagulation profile, bone marrow biopsy

38
Q

meningococcemia

A

Malaise, fever, rash (e.g., maculopapular rash, petechiae, ecchymosis), and hypotension with possible associated symptoms of meningitis or tenosynovitis
tests: CBC, PT/aPTT, fibrinogen, fibrin degradation productions, blood culture, CSF analysis and culture

39
Q

polyarteritis nodosa

A

Multisystem involvement from segmental inflammatory, necrotizing vasculitis of the small- and medium-sized muscular arteries leading to general symptoms of fever, weakness, weight loss, malaise, myalgia, rash (e.g., livedo reticularis, purpura), headache, and abdominal pain
tests: Biopsy of involved organ, urinalysis, CBC, ESR, CRP, angiography

40
Q

RMSF

A

Headache; fever associated with a centripetal rash (involving palms and soles, spreading to arms, legs, and trunk) that is often petechial; report of recent tick bite or outdoor activity in endemic area
tests: Immunofluorescence staining of tissue specimen or serologic analysis for Rickettsia rickettsii, CBC, electrolytes

41
Q

HSP (Henoch Schonlein Purpura/IgA vasculitis)

A

most common vasculitis in children(about 50% of cases).

S/S
Hallmark: non-thrombocytopenic palpable purpura.
LE and buttocks
Colicky abdominal pain (50%)
Occult blood (50%)
Arthritis(50-67% kiddos)
Mainly in knees and ankles
]renal involvement (hematuria) (1/3rd kiddos)
screen monthly with UA for 6 months, nephritis is a late finding
recent URI (2/3 cases)
elevated ASO (50%)

42
Q

HSP dx

A

triad of purpura, abdominal pain, and arthritis
Non-blanching palpable purpura of LE and butt
absence of thrombocytopenia
Skin biopsy(rare): characteristic IgA deposits in vessel walls
Renal biopsy (only indicated if nephritis develops): membranoproliferative glomerulonephritis similar to IgA nephropathy

43
Q

HSP comps

A

considered benign

hosp. if abd pain, GI bleed, intussusception, renal involve
- 5% kids–>renal failure
- 2-3% intussusception (60% ileoileal)
- 33% recurrence rate

44
Q

HSP tx

A

min: supportive
mild: acetomin/NSAIDs
mod: corticosteroids
sev: cortsters + adj. immunsuppr (cyclophosphamide, IVIG) or plasmapheresis

45
Q

HSP labs

A

Abdominal CT:marked bowel wall thickening from the vasculitis
Abdominal US: identify constipation, intussusception, or other GI involvement
ASO titers – Previous strep inf
BMP (electrolytes, BUN, Cr) – monitor for renal insufficiency
Blood culture – Evaluate for bacteremia or sepsis as possible cause
CBC – identify WBC, HCT, Hgb, platelets
Anemia could indicate GI bleed
Identify thrombocytopenia
CRP, ESR – indicate inflammatory reaction
IgA levels – typically elevated in HSP, but nonspecific
PT/PTT – Elevated levels make bleeding diathesis more probable
UA – Assess for renal involvement
Serology – Evaluate for cause of infection

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