Peds Rheum/Ortho Flashcards

1
Q

4 criteria of Juvenile idiopathic arthritis (JIA)

A

1) onset 6mon - 16yo
2) arthritis 1+ joints (edema, warmth, inflam, tender, limited ROM) x 6 wks
3) sx’s present 6 months
4) Can’t be explained by vasculitis, neoplasm, infection, CT disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Most common JIA

A

Oligo JIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What should be monitored in children with JIA?

A

eyes; slit lamp exam q 6 months for increased risk of iritis and uveitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Difference between oligo and polyarticular JIA

A

oligo 1-4 joints and poly 5+

RF always neg in oligo but can be pos or neg in poly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

5 yo with asymmetric arthritis for 6 months plus plaques on extensor surfaces and nail pitting

A

psoriatic JIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

young child with limp and found to have swollen knee joint which is warm and tender. Positive ANA

A

Oligo JIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Rheumatic condition in children with +HLA B-27

A

enthesitis JIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How are JIAs treated?

A

1st line: NSAIDs
Methotrexate
Steroids (intra-articular or systemic)
DMARDs (rheumatic sx’s)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

+ skin PE of psoriasis rash

A

Auspitz sign = bleeding when scale removed

Koebner phenomena = increased rxtn at site of trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Juvenile arthritis + salmon colored rash associated with fever spikes

A

systemic onset JIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Diagnostic criteria of fevers for systemic onset JIA

A
  • fever spikes once per day for at least 2 weeks
  • fevers accompanied by salmon colored rash which fades as fever goes away
  • no signs of infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

JIA that doesn’t fit any category criteria called ______.

A

undifferentiated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Systemic Lupus Erythematosis (SLE) diagnostic criteria

A

4/11 criteria; mneumonic “SOAP Brain MD”

Serositis
Oral Ulcers (painless)
Arthritis/Arthralgia
Photosensitivity

Blood (Hematologic) Disorder
Renal Abnormality
ANA
Immunologic Disorder (Serologies)
Neurologic Disorders
Malar Rash ("butterfly")
Discoid Rash ("coin")
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is SLE ruled out?

A

(-) ANA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

SLE treatment

A

Symptomatic: sunscreen, avoid cold, NSAIDs, anti-HTN, aspirin (for thrombosis)

Disease-specific: steroids, Belimumab, hydroxychloroquine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is neonatal lupus acquired?

A

maternal antibodies (anti-Ro and anti-La) to neonate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Common manifestations of NLE

A

rash, cytopenias, hepatomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Earliest sign of heart block in due to NLE? How is this treated?

A

fetal tachycardia

give steroids antenatal ASAP; pacemaker in infancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Drugs that induce lupus

A

seizure meds (phenytoin, carbamazepine)
psych meds
isoniazid
minocycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Dx of drug-induced lupus

A

+ anti-histone antibodies

+ ANCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Diagnostic criteria of Kawasaki

A

1) high fever (+101) x +5 days
2) 4 of following: bilat non-exudative conjunctivitis, mucous membrane involvement (beefy red throat, strawberry tongue, cracked lips), non-vesicular rash, extremity change, cervical lymphadenopathy

22
Q

Exception to using aspirin in children

A

Kawaskai Disease

23
Q

Kawasaki disease tx

A

ADMIT
Cardiac Echo ASAP
IVIG and high dose aspirin

24
Q

Major complication of Kawasaki disease

A

coronary artery aneurysm; need ECHO done

25
Newborn 2-4 wks old who favors head to one side and has restricted ROM of one sternocleidomastoid.
congenital muscular Torticollis
26
Tests to dx Developmental Hip Dysplasia
+ Barlow = hips add and push down + Ortolani = hips up and out Galeazzi sign = knees uneven; lower knee with DHD
27
Possible Hip Dysplasia can be U/S at _____ age and XR at ______ age.
4-6 wks | 2 months
28
Developmental Hip Dysplasia treatment
Pavlik harness if < 6 mon Reduce/traction if > 6 mon Surgery + 2 yo
29
Athletic 6 yo boy with insidious onset painless limp. XR shows sclerotic femoral head and widened metaphysis. Likely dx? Tx?
Legg-Calve Perthes Disease tx: self-resolves; traction; progress to arthritis 50-60 yo
30
XR shows "ice cream falling off cone." What is dx? What is typical patient epidemiology?
dx: SCFE (slipped capital femoral epiphysis) typically heavyset 12 yo boy with knee/groin pain
31
SCFE treatment
surgical screws
32
Describe transient synovitis of hip cause and presentation
- caused by viral infection | - hip with mild effusion and no erythema or warmth
33
What should be r/o in transient synovitis of hip?
septic hip (red, hot)
34
TX of Transient synovitis of hip
NSAIDs | resolves in 48-72 hrs
35
DX and TX of septic arthritis
dx: high ESR, fever, sudden onset, ill-appearing tx: emergency I&D and IV abx
36
How to treat Nursemaid's Elbow?
reduction: supination-flexion technique to move radial head back in place
37
How is scoliosis treatment decided?
Risser index (maturation of pelvis; 0-5): 0-3 brace Cobbs angle: < 20 observe, > 20 refer
38
bow legged is called ______ and knock-kneed is called ______. Which is more common?
``` genu varum (common at birth) genu valgum ```
39
When do genu varum and genu valgum tyypically resolve?
genu varum - 3 yo genu valgum - 7 yo * if not refer
40
In toeing treatment
brace foot/ankle no W sitting self-corrects
41
Toe walking normal if how old?
< 3 yo
42
Neuromuscular conditions with scoliosis
cerebral palsy, muscular dystrophy
43
Signs of what disorders may include a clubfoot?
spina bifida, DDH
44
Salter Harris Fractures
``` Type I: Straight across Type II: Above Type III: Lower Type IV: Two or Through Type V: cERush ```
45
compression fracture at distal radius
Buckle fx (Torus)
46
Toddler's fracture
spiral fracture of tibia; common 9 months to 3 yrs old when learning to walk
47
Jone's fracture vs Dancer's fracture
Jones: stress fx at base of 5th metatarsal Dancer: avulsion fx where ligament pulls off part of 5th metatarsal base
48
Management of clavicle fracture
I: sling and pain control | Refer if II, III, open fracture, or tenting of skin
49
Boxer fracture
fracture of 5th metacarpal from punching wall
50
Buckle fracture treatment
splint | cast not recommended