Peds Rheum/Ortho Flashcards by Samantha Camuso

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

How well did you know this?

Not at all

Perfectly

Most common JIA

Oligo JIA

How well did you know this?

Not at all

Perfectly

What should be monitored in children with JIA?

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

psoriatic JIA

How well did you know this?

Not at all

Perfectly

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

Oligo JIA

How well did you know this?

Not at all

Perfectly

Rheumatic condition in children with +HLA B-27

enthesitis JIA

How well did you know this?

Not at all

Perfectly

How are JIAs treated?

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

How well did you know this?

Not at all

Perfectly

+ skin PE of psoriasis rash

Auspitz sign = bleeding when scale removed

Koebner phenomena = increased rxtn at site of trauma

How well did you know this?

Not at all

Perfectly

Juvenile arthritis + salmon colored rash associated with fever spikes

systemic onset JIA

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

undifferentiated

How well did you know this?

Not at all

Perfectly

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 well did you know this?

Not at all

Perfectly

How is SLE ruled out?

(-) ANA

How well did you know this?

Not at all

Perfectly

SLE treatment

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

Disease-specific: steroids, Belimumab, hydroxychloroquine

How well did you know this?

Not at all

Perfectly

How is neonatal lupus acquired?

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

How well did you know this?

Not at all

Perfectly

Common manifestations of NLE

rash, cytopenias, hepatomegaly

How well did you know this?

Not at all

Perfectly

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

fetal tachycardia

give steroids antenatal ASAP; pacemaker in infancy

How well did you know this?

Not at all

Perfectly

Drugs that induce lupus

seizure meds (phenytoin, carbamazepine)
psych meds
isoniazid
minocycline

How well did you know this?

Not at all

Perfectly

Dx of drug-induced lupus

+ anti-histone antibodies

+ ANCA

How well did you know this?

Not at all

Perfectly

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