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Peds clerkship > Rheum > Flashcards

Rheum Flashcards

1
Q

def. arthritis

A

evidence of joint effusion or >2 of tenderness, pain on movement, limited ROM or increased warmth

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2
Q

def. arthritis

A

evidence of joint effusion or >2 of tenderness, pain on movement, limited ROM or increased warmth

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3
Q

key to joint assessment

A

must RO infection

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4
Q

important Hx for joint pain

A

OPQRST

  • morning stiff
  • weight bearing
  • systemic Sx
  • rashes
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5
Q

red flags for joint pain

A
  • fever
  • pinpoint pain
  • pain out of proportion
  • night pain
  • weight loss
  • erethyma
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6
Q

invest. for joint pain

A
  • CBC and diff
  • smear
  • CRP/ESR
  • autoimmune workup
  • synovial fluid
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7
Q

7 major cats. causing joint pain and important examples p235

A
  1. malig
  2. trauma/overuse
    - osgood shlatter
  3. infection
    - septic arth.
    - osteomyelitis
    - transeint synovitis
  4. heme
    - SCD, hemophillia
  5. inflamm
    - juvenile arth
    - SLE
    - HSP
  6. non-inflamm
    - growing pain
    - fibro
  7. ortho/mech
    - slipp capital
    - Legg calve perthes
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8
Q

def. septic arth

A

direct entry of organism into joint - mostly S aureua and strep

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9
Q

present of septic arth

A

acute monoarth

  • swelling, warm, red
  • fever chills
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10
Q

invest of septic arth

A
  • high WBCS
  • high CRP and ESR
  • aspirate and culture joint
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11
Q

mgmt of septic arth

A
  • IV abx

- drain joint

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12
Q

def. osteomylitis

A

heme spread of pathos into bone

  • most often long bones
  • same bugs as joints
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13
Q

invest of osteomyl

A
  • high WBCS
  • high CRP and ESR
  • bone scan
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14
Q

mgmt of oseto

A
  • IV abx, followed by oral
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15
Q

def. transient synovitis

A

benign, self limited, sterile inflammation leading to joint effusion

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16
Q

etiology of transient

A
  • unknwn, but often after viral
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17
Q

clinical presentation

A
  • sudden onset of painful hip
  • most common in boys 3-8
  • generally well with low grade fever
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18
Q

mgmt of transient synovitis

A

bed rest and anti-inflammatories

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19
Q

def. slipped capital femoral

A
  • ant. displacement of femoral head to neck

- urgent ortho consult

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20
Q

present of slipped capital femoral

A
  • limb in external rotation and flexion
  • overweight males 10-14
  • may have endo issues
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21
Q

invest of slipped capital femoral

A
  • xray

- TSH

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22
Q

def. Legg-calves perthes

A
  • self limited, avasc. necrosis of cap femoral epiphysis
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23
Q

present of Legg-calves perthes

A

painful limp and decreased ROM

- boy 4-10

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24
Q

invest of Legg-calves perthes

A

xray or MRI

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25
Q

mgmt of Legg-calves perthes

A

supportive or abduction splints

- surgical osteotomy

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26
Q

def. osgood schlatter

A

overuse of patellar tendon causes bone microavulsion

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27
Q

present of osgood schlatter

A

pain and swelling over tibial tuberosity

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28
Q

mgmt of osgood schlatter

A

rest and alter activities

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29
Q

def. growing pain

A

intermittent, non-articular pain in childhood with normal exam findings

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30
Q

present of growing pains

A

pain at night
often calf
3-10
relveived by heat/massage/mild anal

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31
Q

def. (diagnostic) for JIA

A
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32
Q

5 JIA subtypes

A
  1. systemic
    - fever
    - rash
    - HSM
  2. oliogarth
    - 5 joints
    - usually symmetric
    - RF -
  3. psortiatic
    - knees, small joints of hand and feet
    - scaly scalp lesions
    - nail changes - pitting, hyperkeratosis
    - dactylitis
  4. entesitis related
    - tendon, ligament or joint capsule at point of insertion
    - esp . older boys with asymmetric involvment
    - HLAB27
33
Q

classification of SLE

A

MDSOAPBRAIN

- p 239

34
Q

present of HSP

A
  • non-thrombopenic purpura
  • abdo pain
  • arthritis and artralgia
35
Q

present of HSP

A
  • non-thrombopenic purpura
  • abdo pain
  • arthritis and artralgia
36
Q

key to joint assessment

A

must RO infection

37
Q

important Hx for joint pain

A

OPQRST

  • morning stiff
  • weight bearing
  • systemic Sx
  • rashes
38
Q

red flags for joint pain

A
  • fever
  • pinpoint pain
  • pain out of proportion
  • night pain
  • weight loss
  • erethyma
39
Q

invest. for joint pain

A
  • CBC and diff
  • smear
  • CRP/ESR
  • autoimmune workup
  • synovial fluid
40
Q

7 major cats. causing joint pain and important examples p235

A
  1. malig
  2. trauma/overuse
    - osgood shlatter
  3. infection
    - septic arth.
    - osteomyelitis
    - transeint synovitis
  4. heme
    - SCD, hemophillia
  5. inflamm
    - juvenile arth
    - SLE
    - HSP
  6. non-inflamm
    - growing pain
    - fibro
  7. ortho/mech
    - slipp capital
    - Legg calve perthes
41
Q

def. septic arth

A

direct entry of organism into joint - mostly S aureua and strep

42
Q

present of septic arth

A

acute monoarth

  • swelling, warm, red
  • fever chills
43
Q

invest of septic arth

A
  • high WBCS
  • high CRP and ESR
  • aspirate and culture joint
44
Q

mgmt of septic arth

A
  • IV abx

- drain joint

45
Q

def. osteomylitis

A

heme spread of pathos into bone

  • most often long bones
  • same bugs as joints
46
Q

invest of osteomyl

A
  • high WBCS
  • high CRP and ESR
  • bone scan
47
Q

mgmt of oseto

A
  • IV abx, followed by oral
48
Q

def. transient synovitis

A

benign, self limited, sterile inflammation leading to joint effusion

49
Q

etiology of transient

A
  • unknwn, but often after viral
50
Q

clinical presentation

A
  • sudden onset of painful hip
  • most common in boys 3-8
  • generally well with low grade fever
51
Q

mgmt of transient synovitis

A

bed rest and anti-inflammatories

52
Q

def. slipped capital femoral

A
  • ant. displacement of femoral head to neck

- urgent ortho consult

53
Q

present of slipped capital femoral

A
  • limb in external rotation and flexion
  • overweight males 10-14
  • may have endo issues
54
Q

invest of slipped capital femoral

A
  • xray

- TSH

55
Q

def. Legg-calves perthes

A
  • self limited, avasc. necrosis of cap femoral epiphysis
56
Q

present of Legg-calves perthes

A

painful limp and decreased ROM

- boy 4-10

57
Q

invest of Legg-calves perthes

A

xray or MRI

58
Q

mgmt of Legg-calves perthes

A

supportive or abduction splints

- surgical osteotomy

59
Q

def. osgood schlatter

A

overuse of patellar tendon causes bone microavulsion

60
Q

present of osgood schlatter

A

pain and swelling over tibial tuberosity

61
Q

mgmt of osgood schlatter

A

rest and alter activities

62
Q

def. growing pain

A

intermittent, non-articular pain in childhood with normal exam findings

63
Q

present of growing pains

A

pain at night
often calf
3-10
relveived by heat/massage/mild anal

64
Q

def. (diagnostic) for JIA

A
65
Q

5 JIA subtypes

A
  1. systemic
    - fever
    - rash
    - HSM
  2. oliogarth
    - 5 joints
    - usually symmetric
    - RF -
  3. psortiatic
    - knees, small joints of hand and feet
    - scaly scalp lesions
    - nail changes - pitting, hyperkeratosis
    - dactylitis
  4. entesitis related
    - tendon, ligament or joint capsule at point of insertion
    - esp . older boys with asymmetric involvment
    - HLAB27
66
Q

classification of SLE

A

MDSOAPBRAIN

- p 239

67
Q

def. HSP

A

most common in childhood

  • IgA immune depostition
  • small vessels of skin, GI, kidneys, joints and CNS
68
Q

present of HSP

A
  • non-thrombopenic purpura
  • abdo pain
  • arthritis and artralgia
69
Q

invest of HSP

A

clinical Dx

- can do CBC lytes to help RO

70
Q

mgmt of HSP

A
  • supportive
  • anti-inflamm
  • steroids
71
Q

def. kawasakis

A

acute, self limited medium vasculitis

- 3 mos to 5 years

72
Q

presentations of. kawasakis

A
  • may have infect. trigger
  • ## high spiking remittant fever
73
Q

Dx for complete def. kawasakis

A

Fever for 5 days and 4 of:

  1. bilat. conjunctivitis
  2. mucositis - strawberry tongue
  3. polymorphous rash
  4. changes in hands and feet - red or edema
  5. cervical adenopathy
74
Q

Dx of incomplete

A

fever + 3 or less

75
Q

lab findings for kawasakis

A
  • high WBC
  • anemia
  • high ESR/CRP
  • high platelets
  • high tranaminas
  • low albumin
76
Q

invest. for def. kawasakis

A
  • echo for heart probs
  • ## need to look out for aneurysms
77
Q

mgmt of kawasakis

A

IVIG and ASA (high dose)
if coronry issues - anti-coag
if IVIG fails, try once more
- if fails, pred

78
Q

outpatietn mgmt of. kawasakis

A
  • f/u ECHO in 6 wks

- delay live viruses for 1 year

Peds clerkship (22 decks)

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