Peds Rheum/Ortho Flashcards
4 criteria of Juvenile idiopathic arthritis (JIA)
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
Most common JIA
Oligo JIA
What should be monitored in children with JIA?
eyes; slit lamp exam q 6 months for increased risk of iritis and uveitis
Difference between oligo and polyarticular JIA
oligo 1-4 joints and poly 5+
RF always neg in oligo but can be pos or neg in poly
5 yo with asymmetric arthritis for 6 months plus plaques on extensor surfaces and nail pitting
psoriatic JIA
young child with limp and found to have swollen knee joint which is warm and tender. Positive ANA
Oligo JIA
Rheumatic condition in children with +HLA B-27
enthesitis JIA
How are JIAs treated?
1st line: NSAIDs
Methotrexate
Steroids (intra-articular or systemic)
DMARDs (rheumatic sx’s)
+ skin PE of psoriasis rash
Auspitz sign = bleeding when scale removed
Koebner phenomena = increased rxtn at site of trauma
Juvenile arthritis + salmon colored rash associated with fever spikes
systemic onset JIA
Diagnostic criteria of fevers for systemic onset JIA
- 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
JIA that doesn’t fit any category criteria called ______.
undifferentiated
Systemic Lupus Erythematosis (SLE) diagnostic criteria
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 is SLE ruled out?
(-) ANA
SLE treatment
Symptomatic: sunscreen, avoid cold, NSAIDs, anti-HTN, aspirin (for thrombosis)
Disease-specific: steroids, Belimumab, hydroxychloroquine
How is neonatal lupus acquired?
maternal antibodies (anti-Ro and anti-La) to neonate
Common manifestations of NLE
rash, cytopenias, hepatomegaly
Earliest sign of heart block in due to NLE? How is this treated?
fetal tachycardia
give steroids antenatal ASAP; pacemaker in infancy
Drugs that induce lupus
seizure meds (phenytoin, carbamazepine)
psych meds
isoniazid
minocycline
Dx of drug-induced lupus
+ anti-histone antibodies
+ ANCA
Diagnostic criteria of Kawasaki
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
Exception to using aspirin in children
Kawaskai Disease
Kawasaki disease tx
ADMIT
Cardiac Echo ASAP
IVIG and high dose aspirin
Major complication of Kawasaki disease
coronary artery aneurysm; need ECHO done
Newborn 2-4 wks old who favors head to one side and has restricted ROM of one sternocleidomastoid.
congenital muscular Torticollis
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
Possible Hip Dysplasia can be U/S at _____ age and XR at ______ age.
4-6 wks
2 months
Developmental Hip Dysplasia treatment
Pavlik harness if < 6 mon
Reduce/traction if > 6 mon
Surgery + 2 yo
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
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
SCFE treatment
surgical screws
Describe transient synovitis of hip cause and presentation
- caused by viral infection
- hip with mild effusion and no erythema or warmth
What should be r/o in transient synovitis of hip?
septic hip (red, hot)
TX of Transient synovitis of hip
NSAIDs
resolves in 48-72 hrs
DX and TX of septic arthritis
dx: high ESR, fever, sudden onset, ill-appearing
tx: emergency I&D and IV abx
How to treat Nursemaid’s Elbow?
reduction: supination-flexion technique to move radial head back in place
How is scoliosis treatment decided?
Risser index (maturation of pelvis; 0-5): 0-3 brace
Cobbs angle: < 20 observe, > 20 refer
bow legged is called ______ and knock-kneed is called ______. Which is more common?
genu varum (common at birth) genu valgum
When do genu varum and genu valgum tyypically resolve?
genu varum - 3 yo
genu valgum - 7 yo
- if not refer
In toeing treatment
brace foot/ankle
no W sitting
self-corrects
Toe walking normal if how old?
< 3 yo
Neuromuscular conditions with scoliosis
cerebral palsy, muscular dystrophy
Signs of what disorders may include a clubfoot?
spina bifida, DDH
Salter Harris Fractures
Type I: Straight across Type II: Above Type III: Lower Type IV: Two or Through Type V: cERush
compression fracture at distal radius
Buckle fx (Torus)
Toddler’s fracture
spiral fracture of tibia; common 9 months to 3 yrs old when learning to walk
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
Management of clavicle fracture
I: sling and pain control
Refer if II, III, open fracture, or tenting of skin
Boxer fracture
fracture of 5th metacarpal from punching wall
Buckle fracture treatment
splint
cast not recommended
