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

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Most common JIA

Oligo JIA

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What should be monitored in children with JIA?

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

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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

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

psoriatic JIA

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

Oligo JIA

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Rheumatic condition in children with +HLA B-27

enthesitis JIA

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How are JIAs treated?

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

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+ skin PE of psoriasis rash

Auspitz sign = bleeding when scale removed

Koebner phenomena = increased rxtn at site of trauma

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Juvenile arthritis + salmon colored rash associated with fever spikes

systemic onset JIA

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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

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

undifferentiated

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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")

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How is SLE ruled out?

(-) ANA

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SLE treatment

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

Disease-specific: steroids, Belimumab, hydroxychloroquine

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How is neonatal lupus acquired?

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

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Common manifestations of NLE

rash, cytopenias, hepatomegaly

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

fetal tachycardia

give steroids antenatal ASAP; pacemaker in infancy

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Drugs that induce lupus

seizure meds (phenytoin, carbamazepine)
psych meds
isoniazid
minocycline

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Dx of drug-induced lupus

+ anti-histone antibodies

+ ANCA

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Diagnostic criteria of Kawasaki

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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

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Kawaskai Disease

Kawasaki disease tx

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ADMIT
Cardiac Echo ASAP
IVIG and high dose aspirin

Major complication of Kawasaki disease

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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

Peds Rheum/Ortho Flashcards

(50 cards)