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PAEDS SC1 > Rheum > Flashcards

Rheum Flashcards

1
Q

Paucitarticular JIA

A

MC!!!!!

```
4 or less joints
ANA +
RF -
Young females
Uveitis- slit lamp
No other systemic
~~~

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2
Q

Poly arthritis JIA

A

5+ joints
+ RF= RARE= SEVERE
+ ANA = MILDER- younger

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3
Q

Systemic onset stills disease

A

Recurrent high fever
HSM
salmon macular rash

  • ANA
  • RF
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4
Q

Tx JIA

A

NSAIDS= #1

STEROIDS

IMMUNOSUPPRESSIVE

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5
Q

Definition JIA

A

Autoimmune arthritis with morning stiffness

Gradual LOM

for at least 6 weeks

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6
Q

Bow legs genu varum associated with

A

Rickets
OI
Blount disease

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7
Q

Age genu varus

A

1-3 years

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8
Q

XR genu varum

A

Beaking of medial tibial epiphysis

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9
Q

Blount disease

A

SEVERE GENU VARUM
(Tibia vara)

UNILATERAL

BLACKS

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10
Q

Knock knees genu valgum associated with

A

JIA

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11
Q

Age genu valgum

A

2-7 years old

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12
Q

Tx genu valgum

A

Resolves spon

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13
Q

Pes planus associated with

A

Hyper mobility

Congenital tarsal fusion

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14
Q

When is flat feet normal and why?

A

Toddlers

Since fat pad covering the medial longitudinal arch

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15
Q

AGE of pets planus

A

1-2 years old

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16
Q

Tx of pets planus

A

arch support and footwear

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17
Q

AGE of in toeing

A

1-2 years old

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18
Q

in toeing associated with

A
  • metatarsus varus
  • medial tibial torsion
  • persistent anteversion femoral neck
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19
Q

Metatarsus varus

A

Adduction highly mobile forefoot

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20
Q

age of metatarsus varus

A

infants;

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21
Q

tx metatarsus varus

A

since heel held in normal position…

  • passively correctable
  • no treatment unless > 5 yo and symptomatic
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22
Q

medial tibial torsion

A

tibia laterally rotated LESS than normal wrt femur

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23
Q

AGE medial tibial torsion

A

TODDLERS

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24
Q

Medial tibial torsion associated with

A

bowing of the tibia

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25
Q

Tx of medial tibial torsion

A

self corrected within 5 years

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26
Q

Persistent anteversion femoral neck

A

at hip when femoral neck twisted forward MORE than normal

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27
Q

AGE of persistent ante version of femoral neck

A

childhood

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28
Q

persistent anteversion femoral neck a/w

A

hypermobile joints

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29
Q

tx persistent anteversion femoral neck

A

self corrects by 8 years old

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30
Q

W sitting

A

persistent ante version of femoral neck

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31
Q

OUT-toeing age

A

6-12 months

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32
Q

OUT-toeing a/w

A
  • ED
  • Marfans
  • hypermobile joints
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33
Q

AGE toe walking

A

1-3 years

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34
Q

toe walking a/w

A
  • spastic diplegia
  • muscular dystrophy
  • JIA
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35
Q

EXCLUDE toe walking

A
  • mild CP
  • tight achilles
  • arthritis of foot and ankle
  • OLDER— DUCHENNES
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36
Q

VARIATION of NORMAL POSTURE PC: 6-12 months

A

out toeing

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37
Q

VARIATION of nORMAL POSTURE PC: 1-2 yo

A

pes planus

in-toeing

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38
Q

VARIATION of NORMAL POSTURE PC: 1-3 yo

A

bow legs genu varum

toe walking

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39
Q

VARIATION OF NORMAL POSTURE PC: 2-7 yo

A

knock knees

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40
Q

TALIPES EQUINOVARUS=

A

club foot

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41
Q

types of talipes equinovarus

A

positional talipes

talipes equinovarus

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42
Q

talipes equinovarus a/w

A

BOYS (2:1)
olgiohydramnios, spina bifida
DDH

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43
Q

tx talipes equinovarus

A

PONSETTI METHOD– plaster casting and brace

…… if unsuccessful= sx

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44
Q

ROCKER BOTTOM FEET=

A

VERTICAL TALUS

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45
Q

Talipes calcaneovalgus

A

dorsiflexes and everted

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46
Q

Talipes equinovarus

A
  • think calf
  • short foot
  • heel plantarflexed
  • supination
  • inversion
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47
Q

Talipes calcaneovalgus associated with

A

DDH

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48
Q

what two abnormal postures are a/w DDH

A

talipes calcaneovalgus

talipes equinovarus

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49
Q

FLAT FEET= PATHO– OLDER KIDS…. A/W

A

TJT

  • tendon achilles contraction
  • JIA
  • tarsal coalition
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50
Q

Tarsal coalition

A

symptomatic once ossifies– PRE-ADOLESCENT

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51
Q

PES CAVUS A/W

A
  • friederich’s ataxia

- peroneal muscular atrophy (type 1 hereditary motor sensory neuropathy)

52
Q

which leg more common for DDH

A

LEFT

53
Q

Risk factors for DDH

A

7

  • breech
  • oligohydramnios
  • females 4:1
  • first born
  • race [chinese protected]
  • fam hx
  • a/w: NTD/NM/foot deformities: talipes calcaneovalgus, and talipes equinovarus
54
Q

PC DDH > 8 weeks

A

Limited AB
Limp
Length leg discrepancy
Asymmetric leg folds

55
Q

Tx DDH

A 
newborn- pavlik- 6 weeks
6weeks-pavlik- 8 weeks
4 months- spica cast
18 months- triple acetabular osteotomy
teen- Ganz procedure= periacetabular osteotomy
56
Q

Ganz procedure

A

periacetabular osteotomy

57
Q

Scoliosis mild

A

painfree

58
Q

Scoliosis severe

A

cardioresp compromise

59
Q

Causes of scoliosis

A
  1. Idiopathic

-

60
Q

Tx– surgery for scoliosis when…

A

neuromuscular disorder

respiratory disease

61
Q

MCC TORTICOLLIS

A

SCM TUMOR= congenital muscular torticollis

62
Q

PC congenital muscular torticollis

A

first few weeks of life, resolves spontaneously by 2-6 months

63
Q

LATER CHILDHOOD CAUSES TORTICOLLIS

A
  • muscular spasm
  • ENT infection spread
  • C- spine arthritis/ deformity
  • Spinal tumor= osteoid osteoma
  • Posterior fossa tumor
64
Q

Nocturnal idiopathic pain=

A

GROWING PAINS

65
Q

PC GROWING PAINS

A
  • at night
  • 3-12yo
  • LL pain, symmetric [may be other]

NO- pain with walking/ activity
NO- limp

WELL OTHERWISE :)

66
Q

MSK pain (generalised or local) WORSE after exercise

A

hypermobility

67
Q

AGE hypermobility

A

older kids/ adolescents

68
Q

Hyper mobility foot deformities

A
  • pes planus
  • anteversion femoral neck
  • out-toeing
69
Q

Hyper mobility associated pathology

A

Downs
ED
Marfans

70
Q

Idiopathic pain syndrome=

A

CRPS:

congenital reigonal pain syndrome

71
Q

Age of CRPS

A

adolescent females

72
Q

Local CRPS

A 
foot and ankle
hyperesthesia
allodynia
cool to touch
distract--> normal
73
Q

Diffuse CRPS

A

SEVERE PAIN

night disturbance–day time fatigue

74
Q

MCC ACUTE LIMB PAIN

A

TRAUMA!

75
Q

Causes of OM

A
  1. S.aureus
  2. Strep pneumo (multi)
  3. Haemophilus (multi)
  4. Salmonella– SICKLE CELL
  5. TB
76
Q

INSIDIOUS PC OM INFANT

A

decrease limb movement or swelling (harder to appreciate)

77
Q

Dx OM:

A
  • blood cultures
  • increase ESR/CRP
  • imaging:
    XR: normal at first, soft tissue swelling
    US: periosteal elevation
    MRI: subperiosteal pus and debris
    RAI/Bone scan
78
Q

Tx OM:

A
  • IV antibiotics
  • aspiration
  • Sx decompression of subperiosteal space
  • Sx drainage
79
Q

Malignancies presenting with acute limb pain

A
  1. ALL
  2. Neuroblastoma
  3. Bone tumors
    - osteosarcoma
    - ewing’s sarcoma
    - osteoid osteoma
80
Q

PC ALL

A
  • night pain

- arthritis

81
Q

PC Neuroblastoma

A

INFANT

  • bone mets
  • septic arthritis
82
Q

PC Osteoid osteoma

A

NIGHT pain– resolves with NSAID’s

  • joint swelling
  • joint tenderness
  • joint effusions
  • scoliosis – SPINE INVOLVED
83
Q

Dx osteoid osteooma

A

XR: radiolucent core, sclerotic rim

84
Q

Ddx acute limb pain

A
  1. TRAUMA
  2. OM
  3. Malignancy
85
Q

Ddx knee pain

A
  1. osgood schlatter
  2. chondromalacia patellae
  3. Subluxation and dislocation patella
  4. osteochondritis dissecans
  5. injuries
86
Q

PC: male adolescent active, with knee pain after exercise

A

Osgood schlatter

87
Q

Defn osgood

A

osteochondritis of the patella tendon as inserts into the tibia

88
Q

Knee pain adolescent male

A

osgood

89
Q

knee pain adolescent female

A

osteonchondromalacia patellae

90
Q

PC osgood

A

knee pain AFTER exercise
+ hamstring tightness
+ local tenderness
_ SWELLING over tibial tuberosity

91
Q

Tx osgood

A
  • decrease activity
  • physio- quads
  • hamstring stretching
  • orthotics
  • knee immobiliser
92
Q

Defn chondromalacia patellae

A

softening of the cartilage of patella

93
Q

PC: female adolescent, pain with sitting–>standing, and going up the stairs

A

Chondromalacia patellae PC

94
Q

chondromalacia patellae a/w

A
  • hypermobility

- flat feet

95
Q

PC: subluxation patella

A

instability, giving way

96
Q

PC: dislocation patella

A

SUDDEN SEVERE PAIN,

LATERAL DISLOCATION

97
Q

Tx: patella

A

quads exercises

sx– realign pull of quads on patellar tendon

98
Q

Osteochondritis dissecans defn

A

= segmental AVN subchondral bone

—–> thus get separation of bone and cartilage from medial epicondyle

99
Q

PC: active adolescent with persistent knee pain

A

osteochondritis dissecans PC

[can also get loose bodies: thus locking and giving way]

100
Q

younger kids: bone or ligaments stronger?

A

ligaments stronger– thus fracture more often

101
Q

RED FLAG SIGNS BACK PAIN

A
  • weight loss/malaise
  • night pain
  • fever
  • scoliosis
  • neuro symptoms
  • YOUNGER
102
Q

Ddx back pain

A
  1. mechanical
  2. tumors
  3. vertebral OM or discitis
  4. spinal cord/ nerve entrapment
  5. scheuermann disease
  6. spondylosis/ spondylosthisesis
103
Q

Scheuermann disease

A

= osteochondrosis of vertebral body
PC: fixed thoracic KYPHOSIS– +/- pain

often asymptomatic

104
Q

Spondylosis/ spondylosthesis

A

stress fracture of pars interarticularis of vertebra

increased risk

  • gymnastics
  • cricket bowlers
105
Q

Transient synovitis

A 
ACUTE pain, non wt bearing
no/mild fever
normal child
comfy at rest; mov't--> limited IR, and pain
WCC= normal
ESR= normal/ ^
US: fluid in joint
XR= normal
mgmt:
- rest
- analgesia

lasts perthes

106
Q

MCC acute hip pain kids 2-12 years old

A

transient synovitis; post viral or a/w viral

107
Q

Septic arthritis

A 
ACUTE pain, non weight bearing
fever
sick looking child
pain at rest; mov't--> SEVERE pain; d: FABER
WCC= ^^^/normal
ESR= ^^^^
US: fluid in joint
XR: normal----> WIDE joint space

mgmt:

  • joint aspirate with US
  • prolonged antibiotics
  • rest
  • analgesia
  • wash out
  • immobliize
108
Q

AGE OM

A
109
Q

CAUSES OF OM:

A
  1. S.aureus (1 joint)

2. H influ (1+ joints)

110
Q

5-10 year old with hip/knee pain and limp

A

PERTHES DISEASE

111
Q

Tx perthes

A
  1. bed rest and analgesia
  2. maintain AB
    - plasters
    - calipers
    - femoral or pelvic osteotomy
112
Q

Direction of displacement SUFE

A

posteroinferior

113
Q

PC SUFE

A

10-15yo
OBESE
HYPOgonadism
HYPOthyroidism

+ LIMP OR HIP PAIN–> KNEE

  • acute post minor trauma
  • chronic
114
Q

RESTRICTIONS IN SUFE

A

AB

IR

115
Q

Tx SUFE

A

pin fixation in situ

116
Q

CAUSES OF REACTIVE ARTHRITIS….post extra-articular infection

A
  1. enteric bacteria: salmonella/ camp/ shigella/ yersinia
  2. viral
  3. STI’s
  4. mycoplasma
  5. borrelia burdorferi

+ rheumatic fever
+ post-strep RA

117
Q

Tx reactive arthritis

A

NONE,

NSAID’s

118
Q

PC HSP:

A 
palpable purpura butt and legs
arthritis: knees and ankles
abdo pain
haematuria
proteinuria

MCC VASCULITIS KIDS

119
Q

HOW OFTEN DO SLE AND DERMATOMYOSITIS OCCUR IN KIDS?

A

RARE!!!!!!!!!!!!

120
Q

death in juvenile dermatomyositis

A

resp F

asp pneumonia

121
Q

still birth
large head
very short limbs
small chest

A

Than-ato-phoric dysplasia

XR: DX
Antenatal US

122
Q

ABSENCE of all or part of clavicles
DELAYED closure fontanelles/ ossification of skull

can bring shoulders in front of chest to touch

A

Cleido-cranial dys-os-to-sis

123
Q

Arthro-gry-posis

A

STIFFNESS and CONTRACTORS of joints

124
Q

Arthro-gry-posis a/w

A
  • oligohydramnios
  • widespread congenital anomalies
  • chromosomal disorders

skin= thin, decrease sc, muscle atrophy around joints

125
Q

Tx arthrogryposis

A
  1. physio

2. correct deformities: splints/plaster/ sx

PAEDS SC1 (13 decks)

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