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peds > RHEUM > Flashcards

RHEUM Flashcards

1
Q

IDIOPATHIC JUVENILLE ARTHRITIS

A

<16

Intermittent fever + daily 
transient MP rash usually with fever 
serositis
hepato/splenimegaly 
labs: thrombocyttosi + leukocytosis , anemia , lymphadenopathy
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2
Q

list types of athriits

A

REACTIVE
PSORIATIC
JUVENILLED IDOPATHOC
SEPTIC
osteo - not relevant to kids

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3
Q

how can we classify arthritis

A

acute and chronic

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4
Q

cut off point for chronic arthitis

A

6 weeks

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5
Q

what/how many fetaures must be presnet for someone to have arthritis

A

2 of the features of arthitis OR INTRARTICULAR EDEMA

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6
Q

HOW long should morning stiffness be to be clincally relevant

A

> 10 minutes

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7
Q

what cardinal sign of inflammation isn’t really typical for juvenille RA

A

RUBOR - so if it is then suspect septic of acute rheumatic fever

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8
Q

what key featureS between RA in kids and septic

A

septic- won’t be able to weight bear AT ALL

RA- tolerable, they will still get on with their day

sep: dramtic onset within hours/das
ra:more chornic in nature

sep: LOOK ILL_ redness over skin
RA: look fine + skin not red

sep; usually 1 joint!

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9
Q

night time sympotms in RA

A

no no no think cancer and bening too like osteoriod osteoma

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10
Q

which cancers are we thinking bone pain

A

leukemia and bone cancer

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11
Q

what is quite relevant in the history of a kid with RA

A

usually will have a family history of Autoimmune conditions like chornes or diabtes

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12
Q

chronic osteomyelitis

imgaing for OM

A

draining sinus tact

mri is amazing for bone
x ray - too ealry to see

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13
Q

WHAT things should a person NOT HAVE ON PHYSICAL EXAM for Ra

A

Red joints
fever - unusual?
HSM?- double chek on vn usman
general lymphadenopathy

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14
Q

how can the eyes become affected in RA

most common location of OM

A

anterior uveitis - iridicycltiis with formation of syechia which means pupils don’t respond to light

long bones like femur and tibia

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15
Q

labs for ra

A

leukocytes should either be normal or high (if low suspect dx)

plt- normal or high - remember plt are a very sensitive pro inflammatory marker

neutrohilia
SHOULD NOT BE LYMPHOCYTOSIS dx leukemia

CRP + ESR (but remember crp is very acute so if this is a chronic or latent phase it can be normal )

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16
Q

dx for RA

A

immunodeficiency - because that can cause joint pain and fevers and also because of the treatment! it is contradictory, for RA we need to immunosuppression but we cant give that to a deficient person.

hemophilia - espcially if its a boy who is just starting to walk - do a clotting screen

17
Q

why do we think about ANA IN RA

A

because ANA + girls are risk for uveitis so we need to regularly asses every 3 months

ANA - (not such a risk )

18
Q

what imaging if you suspesct RA which is best

A

X RAY- need to rule out ewing sarcoma, and other bone cancers like sarcomas esp if its MONOARTCICULA

ultrasoinf of the joint- effusions and synovial hypertoophy

us is best because x ray changes will only be seen after 10 DAYS! osteopenia and reduced joint space !

19
Q

key buzzwords for RA

osteomyleitis tx

A

SYNOVIAL HYPERTROPHY
JOINT EFFUSION
INTRA ARTICULAR EDEMA

IV ab for several weeks(until labs are good ) then after swithc to oral fore several weeks

20
Q

TX RA

A

CS

-intrarticular if oligo
- iv - if poly

methotrexate -dmards- once a week (remember folic acid)

biolgical therapy
- anti IL-6
ANTI TNF

21
Q

DEF oligoarthtis

cause of osgood chatlet and signs

A

<4 joints or 4

osteochrondrtis of patella tendon
pain after exertion and some will have tibual tuberosity swelling

22
Q

why are we wary of cs

tx of oscgood shatle

A

because of stunted growth iTS VERY DIFFCULT FOR KIDS TO CATCH UP and the plethora of side effects

physi to strenghten quads, immobilizd

23
Q

what is the problem with physical exam of septic arthtis in regards to inflammaiton

A

some of the features will not be vsisable if tis a deep joint like the hip like redness and edema as joint is too

24
Q

tx for septic

complicatins of SEPTIC ARTHTIRIS

A

IV! 2 different ones - antistaph drugs
blood cultres

osteomyelitis
osteonecrosis (espcially hip and shoulder joints as head of femur the vessels cant supply blood due to the high pressure so need to make sure you drain joints to decrease the risk of necrosis

25
Q

most common cause of septic

transiet coxitis tx

A

STAPH

More frequently boys up to 4(8) yrs. of age, often following URTI. Well child, afebrile or sub-febrile
Limp but able to bear weight with limited internal rotation and extension

rest and nsaids THERE CAN BE EFFUSIONS! so drain

26
Q

leukemia vs juvanelle

A

leukemia can have low lymphocyes!

night pain = leukmia

high LDH

physical exam look unwell

leukemia HSM+ LYMPHADENOPATHY

lekmeia on physcial exam usally no evidence of arthritis

27
Q

joint aspirationc an rule out

FAMILIAL MEDITTERRANEAN FETAURES, epidemiology and what would you calsfifcy the illness under

A

infection and maliganancy!

AR,
fever, serositis(PAINFUL perionitis, painful chest) arthritis (lower limbs) rash (erysipelas like) , orchitis in between attacks its calm and self remitting
colchine to prevent amyloidosis

jews, turks armeians

its an autoinflammotry disorder (no immune vibes foind)

28
Q

Complications of RA

perthes disease , diagnosis , DX , tx

A

flexion contractures - will need physio and splinting

joint destruction- may need a prosthesis to repair the joint

anterior uveitis

boys, limp, referred pain to the knee , can result in deformaties! And the child may need to have a splint to keep immbolized

D: x ray - SCLEROIS

tx: <50% comservative, bed rest, no weight bearing
>50% splint, or osteotomy (cut and reshape bone)

DX - transiet synovitis as same symptoms but will resolce in 2 weeks, perthes disease is more chronic

29
Q

slipped capital epihysis , x ray fetaures

A

Dislocation of the epiphysis of the femoral head posteriorly and inferiorly
Overweight boys aged 10-14 yrs (more teens)
Associated with hypothyroidism and growth hormone deficiency Diagnosed radiographically; bilateral in 30%
Treatment – urgent referral to orthopedics – in the meantime non-weight bearing, immobilization to prevent avascular necrosis, surgery to fix the epiphysis in place with a SCREW
postive trendelenberg
x ray - widened epihysis, trethowans sign

30
Q

osteoid osteoma

A

night time pain, most commonly proximal femur and radiates to the knee!
tx, nsaids and surgery to remove
x ray- area of lucency surrounded by sclerosis

31
Q

key word for ex ray leukemia

main rf for oschgood schatler

A

lucent metaphyseal bands!!

young active boys who play sports

32
Q

osteochondritis descinas

A

pain from avascular necorsis of femoral medial condyle causinf bone and caritalge to seperate

common in girls

physio to streghtne the quads, and rest

33
Q

chonadromalcia patella

A

common in girls
softenign of patella cartialge
difficut to walk up the stairs and stand from sitting up

physio to streghent the quads

34
Q

gworing pains

A

doesnt affect mobilty
from 3-12
symmterical pain in lower limbs
NEVR HAPPENS IN THE IN THE MORING WHEN YOU WAKE UP
nomral physical exam

peds (26 decks)

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