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Peds > Rheum > Flashcards

Rheum Flashcards

1
Q

What condition mainly affects the SI joints causing eventual fusion of the spine?

A

Ankylosing spondylitis

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2
Q

What antigen is positive over 90% of the time with ankylosing spondylitis?

A

HLA-B27

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3
Q

True or False: Ankylosing spondylitis more often affects males?

A

True (3:1)

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4
Q

What two main things besides ortho problems is ankylosing spondylitis associated with?

A
  1. Eye problems (iritis. uveitis)

2. IBD

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5
Q

Bamboo spine on plain film, night pain, morning stiffness relieved by exercise, pain of large joints (knee), leg/back pain (increased when bending over), low grade fever, weight loss?

A

Ankylosing spondylitis

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6
Q

How can you differentiate between pain due to ankylosing spondylitis versus low back pain?

A

AS: Improves with activity and worse with rest
Mechanical: Worse with activity and improves with rest

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7
Q

What happens to ANA, RF, and ESR in ankylosing spondylitis?

A

ANA/RF: Normal

ESR: Normal or mildly elevated

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8
Q

Kid younger than 10, heliotrope rash on face (similar to lupus), tight/shiny/scaly skin on extensor surfaces of extremities or over interphalangeal joints, periungual lesions?

A

Dermatomyositis

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9
Q

What is Gottron’s sign?

A

Tight, shiny, or scaly skin on extensor surfaces of the extremities or over the itnerphalangeal joints (seen in dermatomyositis)

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10
Q

What symptoms does the rash associated with dermatomyositis cause?

A
  1. Pruritus

2. Hair loss (if on scalp)

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11
Q

How might the periungual lesions seem in dermatomyositis be described?

A

Nail fold telangectasias

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12
Q

Describe the heliotrope rash seen in dermatomyositis?

A

Violaceous “butterfly” discoloration of the malar region and/or eyelids

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13
Q

What are the findings that constitute the “myositis” part of dermatomyositis?

A

Proximal muscle weakness: Difficulty getting dressed or climbing steps, clumsy, voice change, difficulty swallowing

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14
Q

What is the most appropriate initial step to evaluate a patient with clinical dermatomyositis?

A

Cretine kinase level (often elevated)

*You would do this before EMG or MRI

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15
Q

What is the most common systemic vasculitis in kids?

A

HSP

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16
Q

What systems does HSP involve?

A

Skin, GI, joints, kidneys

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17
Q

What causes HSP?

A

Etiology unknown, but often with antecedent bacterial or viral infection

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18
Q

Who is more often affected with HSP, boys or girls?

A

Boys

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19
Q

Which symptom is present in all cases of HSP, but may not be the first sign?

A

Palpable purpura (usually on lower extremities and buttocks)

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20
Q

What are the main symptoms of HSP?

A
  1. Palpable purpura
  2. Colicky abdominal pain
  3. Heme positive stools
  4. Renal disease
  5. Asthritis/arthralgia
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21
Q

What is often the cause of abdominal pain in HSP?

A

Intussuception

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22
Q

How does renal disease in HSP present?

A
  1. Hematuria
  2. Proteinuria
  3. Azotemia
  4. HTN
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23
Q

What lab tests diagnose HSP?

A

None

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24
Q

What labs are suggestive of HSP in the right clinical scenario?

A
  1. Elevated BUN and creatinine
  2. Heme positive stool
  3. UA with hematuria
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25
Q

What happens to platelet count and coags in HSP?

A
  1. No thrombocytopenia (normal platelet count)

2. Normal PT/PTT

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26
Q

What is HSP often misdiagnosed as?

A

Abuse (Rash appears like bruises)

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27
Q

What is the treatment for HSP?

A

No specific treatment- Care is supportive only and most cases resolve without issue

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28
Q

What can the rash seen with HSP be confused with?

A

Erythema marginatum (rheumatic fever)

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29
Q

Besides skin findings, what other feature is common between HSP and erythema marginatum?

A

Joint pains (but, the joint pain seen in rheumatic fever is more severe and a more prominent feature)

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30
Q

What is the rash often seen in JIA?

A

Salmon-colored evanescent rash

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31
Q

True or false: JIA is not typically associated with abdominal pain and the rash isn’t purpuric

A

True

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32
Q

What is another name for IgA vasculitis?

A

HSP (this is an autoimmune vasculitis associated with IgA deposition)

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33
Q

What test needs to be done in all patients with HSP?

A

UA: To evaluate for hematuria and proteinuria

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34
Q

What do the findings on renal biopsy show for HSP?

A

Exact same as IgA nephropathy

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35
Q

What is the natural course for hematuria and proteinuria in HSP?

A

Transient and resolve in a few months without permanent kidney damage

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36
Q

Which patients have an increased risk of long-term renal disease in HSP?

A

Presenting with:

  1. Nephrotic-range proteinuria
  2. Elevated creatinine
  3. HTN
  4. Females
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37
Q

What did JIA used to be called?

A

Juvenile rheumatoid arthritis

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38
Q

What is the most common rheumatologic disease of childhood?

A

JIA

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39
Q

How is JIA diagnosed?

A

Basically a diagnosis of exclusion

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40
Q

How does JIA typically present?

A
  1. Morning stiffness
  2. Gradual loss of motion
  3. Rash
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41
Q

What age and time requirements must be met for JIA diagnosis?

A
  1. Under 16 years of age

2. Symptoms present for at least 6 weeks in at least one joint

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42
Q

What joints are more commonly involved in JIA?

A

Large joints (versus small joints)

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43
Q

What lab is often positive in JIA?

A

ANA

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44
Q

Who is more affected by JIA, boys or girls?

A

Girls…except:

  • Systemic onset: Equal
  • Enthesitis-related JIA: Boys
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45
Q

True or False: RF is a helpful lab to diagnose JIA?

A

False- RF is seldom positive and there are also a lot of false positives

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46
Q

Name 3 specific subtypes of JIA

A
  1. Polyarthritis
  2. Oligoarthritis/Pauciarthritis
  3. Systemic onset JIA
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47
Q

What are the requiresments for polyarthritis?

A

5 or more joints affected in first 6 months of disease

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48
Q

Which gender does polyarthritis JIA occur more commonly in?

A

Females

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49
Q

True or False: Systemic disease is common in polyarticular JIA

A

False

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50
Q

What are the requirements for oligoarthritis/pauciarthritis?

A

4 or fewer joints affected during first 6 months of disease

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51
Q

Which age group with oligoarthritis (JIA) is ANA-positive?

A

Young females (2-4 years of age)

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52
Q

What is the main morbidity of oligoarthritis?

A

Chronic uveitis

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53
Q

True or False: RF is usually negative in oligoarthritis?

A

True (but when it is positive the disease is often worse)

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54
Q

What are boys with oligoarthritis usually positive for?

A

HLA-B27 (their prognosis is good)

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55
Q

What is Still’s disease?

A

Systemic Onset JIA

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56
Q

Which gender does systemic JIA affect more frequently?

A

Males and females equally

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57
Q

True or False: Extraarticular involvement is common in systemic JIA

A

True

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58
Q

Most JIA deaths involve which type?

A

Systemic

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59
Q

What is an important consideration in evaluation of fever of unknown origin from a rheum perpective?

A

Systemic onset JIA

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60
Q

What is the timeframe for systemic JIA?

A

The systemic manifestations may precede joint manifestations by several months

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61
Q

Name 6 presenting symptoms of systemic onset JIA

A
  1. High fever with shaking chills
  2. Leukocytosis (as high as 30-50,000)
  3. Rash
  4. Hepatosplenomegaly
  5. Lymphadenopathy
  6. Pleuritis/pericarditis/serositis
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62
Q

What are the time requirements for fever/chills with systemic onset JIA?

A

At least 2 weeks duration that is daily for at least 3 days

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63
Q

Describe the rash seen in systemic onset JIA?

A

Small, salmon-colored macules with central clearings which coalesce and are vanescent “come and go”.

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64
Q

True or False: Uveitis is rare in systemic JIA

A

True

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65
Q

What are ANA and RF in systemic onset JIA?

A

Usually negative (ANA is only positive about 10% of the time)

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66
Q

True or False: Most of the systemic manifestations of systemic JIA are self-limited

A

True

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67
Q

Name 3 more minor forms of JIA

A
  1. Psoriatic
  2. Enthesitis-related
  3. Undifferentiated
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68
Q

What type of JIA is seen with family history of psoriasis and may have nail pitting and dactylitis?

A

Psoriatic arthritis

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69
Q

Which gender is psoriatic arthritis more common in?

A

Girls (despite association with HLA B-27)

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70
Q

What type of JIA involves sacro-iliac tenderness and HLA B-27?

A

Enthesitis-related arthritis

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71
Q

What is the only arthritis more common in boys?

A

Enthesitis-related arthritis

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72
Q

True or False: You can see anterior uveitis in enthesitis-related arthriris?

A

True

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73
Q

What is it called when you have an arthritis that doesn’t fit criteria of another chronic arthritis?

A

Undifferentiated arthrtitis

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74
Q

What condition can JIA be difficult to distinguish from?

A

Leukoemia (especially when they have MSK findings in addition to the hematologic ones)

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75
Q

How are the MSK symptoms of JIA and leukemia different?

A

JIA: Morning stiffness, spiking fevers, rashes
Leukemia: MSK pain awakens child at night, bone pain that doesn’t involve a joint

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76
Q

How are the timing of symptoms different in JIA and leukemia?

A

JIA: Periodic, waxing and waning
Leukemia: Persistent and worsening

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77
Q

How are the hematologic abnormalities different in JIA and leukemia?

A

JIA: More mild
Leukemia: More severe

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78
Q

Name 5 findings that are typical of both JIA and leukemia and won’t help you differentiate between the two

A
  1. Lymphadenopathy
  2. Leukocytosis
  3. Anemia
  4. Fatgiue
  5. Hepatosplenomegaly
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79
Q

Name the 3 mainstays of treatment for JIA

A
  1. PT/OT
  2. Anti-inflammatory meds
  3. Psychosocial support
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80
Q

What is the 1st line anti-inflammatory medication for JIA?

A

NSAIDs:

  1. Indomethacin
  2. Ibuprofen
  3. Naproxen
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81
Q

In kids with JIA on NSAIDs, what are they at risk for?

A
  1. GI bleeds
  2. Elevated LFTs
    (known side effects of NSAIDs)
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82
Q

If NSAIDs don’t work in JIA, what is your next step (2nd line treatment)?

A
  1. Steroids

2. Immunosuppressive meds

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83
Q

What immunosuppresive medication may be necessary in kids with aggressive JIA?

A

Methotrexate

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84
Q

How does methotrexate work?

A

Folate antagonist

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85
Q

What are the 2 main side effects of methotrexate?

A
  1. GI distress

2. Pulmonary toxicity

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86
Q

Name 4 long term consequences of JIA

A
  1. Leg-length discrepancy
  2. Joint contractures
  3. Permanent join destruction
  4. Blindness from chronic uveitis
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87
Q

What % of kids with JIA continue to have active disease into adulthood?

A

50%

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88
Q

What do you have to remember with vaccine schedules for children with JIA taking methotrexate?

A

They are immunosuppressed- Avoid live vaccines (risk for infection)

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89
Q

What type of malignancies are children on methotrexate at risk for?

A

Lymphoproliferative

90
Q

What is the gold standard therapy for kids with JIA?

A

Methotrexate

91
Q

Name 5 causes of arthritis in children

A 
GLOVE
Gonorrhea, Genetic Syndromes
Lyme disease
Osteomyelitis
Viral (Toxic Synovitis)
Evasive infection (Septic Arthritis)
92
Q

What STD can manifest as arthritis?

A

GC

93
Q

What are 3 things than can manifest as monoartricular arthritis?

A

L’s
Lyme (and other infections)
Legg-Calve-Perthes disease
Leukemia and bone tumors

94
Q

What are 7 things that can cause polyarticular arthritis?

A

FIRE CAM
Fabry/Farber disease
Infections
Reactive arthritis (post strep, rheumatic fever, serum sickness)
slE (lupus)
Connective tissue disease: SLE, sarcoidoisis, vasculitis IBD
Malignancy (leukemia)

95
Q

What is something you need to consider in any child with fever of unknown origin?

A

Kawasaki disease

96
Q

What is the formal name of Kawasaki Disease?

A

Mucocutaneous Lymph Node Syndrome

97
Q

What age group typically gets Kawasaki disease?

A

Children younger than 4 (most commonly around 2)

98
Q

What months do you typically see more Kawasaki disease in?

A

Winter and spring

99
Q

What gender and ethnicity are more likely to get Kawasaki?

A

Males, Asian (Japanese)

100
Q

What are the diagnostic criteria for Kawasaki?

A

Acute high fever of at least 5 days plus 4 of the following:

  • Cervical lymphadenopathy
  • Dry/Fissured lips or swollen tongue
  • Conjunctivitis
  • Polymorphous exanthem concentrated on trunk
  • Changes in extremities- Erythema/induration leading to desquamation on hands and feet
101
Q

What are additional features that can be seen in Kawasaki, but aren’t part of the formal diagnostic criteria?

A
  • Sterile pyuria (WBCs in urine)
  • CNS symptoms (seizures and aseptic meningitis)
  • Polyarthritis (migratory)
  • Hydrops of the gallbladder
  • Thrombocytosis
102
Q

What is absolutely required for a diagnosis of Kawasaki?

A

Fever for at least 5 days

103
Q

What day of illness do you see thrombocytosis in KawasakI?

A

By the 5th day

104
Q

What day of illness do you see leukocytosis in Kawasaki?

A

By the 12th day

105
Q

What type of anemia is seen in Kawasaki?

A

Normocytic anemia (consistent with chronic illness)

106
Q

What acute phase reactants are elevated in Kawasaki and for how long?

A

CRP, ESR, A1AT

Remain high for 4-6 weeks

107
Q

What % of cases of Kawasaki have sterile pyuria?

A

80%

108
Q

What is seen on lipid panel for Kawasaki?

A

Decreased levels of total cholesterol and HDL

109
Q

What are 3 common tests done from a rheum perspective that are not elevated in Kawasaki?

A
  1. ANA
  2. RF
  3. Circulating anticoagulant
110
Q

What is the primary concern in Kawasaki?

A

Coronary artery disease

111
Q

When should treatment begin in Kawasaki?

A

When the diagnosis is suspected

Even if diagnosis is clear, start treatment BEFORE getting a cardiac ECHO

112
Q

What test must be done in all cases of suspected Kawasaki?

A

2-D cardiac ECHO (to look for coronary artery aneurysms)

113
Q

True or False: Even children with no coronary findings in suspected Kawasaki disease need a follow-up ECHO one year after illness?

A

True

114
Q

What are the 3 main things used to treat Kawasaki?

A
  1. IVIG, 2g/kg
  2. ASA, 80mg/kg/day for 24-48 hours… followed by
  3. ASA, 5mg/kg/day for 2 months
115
Q

What is the leading cause of acquired heart disease in developed countries?

A

Kawasaki disease

116
Q

What is the leading cause of acquired heart disease in developing countries?

A

Rheumatic heart disease

117
Q

What changes to vaccine schedules must happen in kids who have had Kawasaki and got IVIG?

A

Measles and Varicella containing vaccines must not be given for 11 months after IVIG

118
Q

Name 10 things which could be confused with Kawasaki disease

A
  1. Hypersensitivity reactions (drug reactions and SJS)
  2. JIA: Systemic type
  3. Measles
  4. Scarlet Fever
  5. EBV
  6. Enteroviruses
  7. RMSF
  8. Leptospirosis
  9. SSSS
  10. TSS
119
Q

Child on antibiotics who hasn’t responded to treatment and developed a macular papular rash?

A

Kawasaki v. Hypersensitivity reaction (Drug reaction or SJS)

120
Q

What are some features to distinguish between Kawasaki and Hypersensitivity reaction?

A

In drug reaction there shouldn’t be a high fever or other clinical criteria associated with Kawasaki

121
Q

What are some common features between Kawasaki and Systemic JIA?

A

Fever, rash, adenopathy

122
Q

How is the fever different in Kawasaki and JIA?

A

Fever is not acute in JIA

Rash is an evanescent, reticular rash that appears when fever peaks in JIA

123
Q

What are some clues that would point to systemic JIA versus Kawasaki?

A

Hepatosplenomegaly, pleural effusions, cardiomegaly

124
Q

True or False: Cardiomegaly can be seen in Kawasaki?

A

FALSE

125
Q

What two things do Kawasaki and Measles both present with?

A

Fever and conjunctivitis

126
Q

How is the conjunctivitis seen in Kawasaki different from that in Measles?

A

Measles is an exudative conjunctivitis

127
Q

Describe the rash in measles

A

Starts at hairline and progresses downward to extremities (different from Kawasaki)

128
Q

What are 2 ways to distinguish scarlet fever from Kawasaki?

A

Rash in scarlet fever is usually in flexural areas of extremtieis
Scarlet fever should have a positive strep test

129
Q

What causes Lyme disease?

A

Infection with Borrelia burgdorferi (spirochete) and the body’s immunologic response to the infection

130
Q

What carries Borrelia Burgdorferi to the the body?

A

Ixodes deer tick

131
Q

What is the formal name for the bullseye rash seen in Lyme disease?

A

Erythema chronicum migrans (ECM)

132
Q

What % of cases doesn’t have the bullseye rash in Lyme disease?

A

25%

133
Q

How are cases of Lyme disease most often presented on boards?

A

Patient with Lyme arthritis without a distinct history of ECM rash or deer tick bite

134
Q

What happens in the first 2 weeks of Lyme disease?

A
  1. ECM rash at site of tick bite

2. Vague flu-like symptoms with severe arthralgia and extreme fatigue

135
Q

What happens in the first several months of Lyme disease?

A

CNS/Cardiac/Arthritic

  • Carditis
  • Pauciarticular arthritis
  • Neurological signs (Bell’s Palsy)
136
Q

What happens years after infection with Lyme disease?

A

Progression of CNS, Cardiac, and arthritic symptoms- Especially the arthritis

137
Q

How long to deer ticks need to feed to transmit Lyme disease?

A

At least 36 hours

138
Q

What is the best way to prevent Lyme disease?

A

Frequent tick checks

139
Q

Describe Lyme arthritis

A

Pauciarticular involving large joints (especially the knee)

140
Q

What is different between Lyme arthritis affecting a knee versus a septic arthritis?

A

Lyme the knee can be tender and swollen, but the pain isn’t unbearable like in septic arthritis- The child will probably be able to walk around even with a big knee

141
Q

Why are false negatives so common in Lyme disease (especially initially)?

A

Detectable levels of serum antibodies don’t build up until 4-6 weeks (false negatives)

142
Q

How does early treatment affect lab testing for Lyme disease?

A

If treatment is given early, the immunologic response is blunted and the lab results become unreliable

143
Q

What conditions can give false positive testing for Lyme?

A
  • Autoimmune diseases: SLE, dermatomyositis

- Other rickettsial diaseases

144
Q

What tests should be done for Lyme disease and in what order?

A
  1. Lyme antibody titer (EIA)

2. Western blot to confirm

145
Q

What is treatment for Lyme disease?

A

Doxycycline (8 and older)

Amoxicillin (or cefuroxime if PCN allergic) (under 8)

146
Q

How long should treatment for Lyme disease be given?

A

14-21 days (maximum duration of therapy 4 weeks)

147
Q

Child with confirmed Lyme disease who gets treated then develops chills, fevers hypotension, sepsis-like picture…?

A

Jarisch-Herxheimer reaction- Result of lysis of the organism and release of endotoxin

148
Q

What category does reactive arthritis fall under?

A

Seronegative spondyloarthropathy

149
Q

What does seronegative spndyloarthroapthy mean?

A

ANA and RF should be normal

150
Q

What HLA marker can reactive arthritis be assocaited with?

A

B-27

151
Q

What are the 3 features of reactive arthritis?

A
  1. Urethritis
  2. Iritis
  3. Arthritis

“Can’t see, can’t pee, can’t climb a tree”

152
Q

When do you usually see reactive arthritis?

A

After infection with

  1. Enteric (Yersinia, Shigella, Campylobacter, or Salmonella)
  2. Venereal (Chlamydia, Gonorrhea)
153
Q

What is the treatment for reactive arthritis?

A

Supportive: NSAIDs and antibiotics

154
Q

What GI disease should you always consider if presented with a child with arthritis?

A

IBD

155
Q

What is the most common cause of reactive arthritis in US?

A

Chlamydia

156
Q

What was the old name for reactive arthritis?

A

Reiter’s syndrome

157
Q

How does sarcoidosis present?

A

History of weight loss and fatigue
Hilar adenopathy
Chronic cough

158
Q

What race is sarcoidosis seen more frequently in?

A

African Americans

159
Q

Otherwise healthy, afebrile child who fatigues easily during sports (sometimes to the point of quitting the sport) and has a chronic cough?

A

Sarcoidosis

160
Q

What should you thinkg of with noncaseating granulomas and bilateral peribronchial cuffing on CXR?

A

Sarcoidosis

161
Q

What effect do the noncaseating granulomas have in sarcoidosis?

A

Secrete form of vitamin D leading to hypercalcemia and hypercalciuria

162
Q

What causes renal disease and eye disease seen in sarcoidosis?

A

Hypercalcemia and hypercalciuria from excess vitamin D secreted from noncaseating granulomas

163
Q

True or False: Sarcoidosis can involve the heart?

A

True

164
Q

How can you distinguish between Sarcoidosis and TB?

A
  1. Sarcoidosis should have a negative TB test

2. Sarcoidosis may have heart involvement- EKG with a rhythm disturbance

165
Q

What is the triad of sarcoidosis?

A
  1. Arthritis
  2. Rash
  3. Uveitis
166
Q

What results in a thickening and tightening of the skin (often with induration)?

A

Scleroderma

167
Q

Which gender if more often affected by scleroderma?

A

Females

168
Q

What are the 2 main forms of scleroderma?

A
  1. Localized linear

2. Systemic

169
Q

How does the localized form of scleroderma being?

A

Linear hyperpigmented patch that becomes more and more fibrotic (only involves skin and adjacent subcutaneous tissue). Patches of skin are painful and tender.

170
Q

Shiny hypopigmented skin with a brown border?

A

Localized linear scleroderma

171
Q

Which form of scleroderma is more common and has a better outcome?

A

Localized- Requires minimal treatment and is self-limited

172
Q

What is the treatment for localized scleroderma?

A

Topical lubricants

Photochemotherapy (occasionally)

173
Q

If localized scleroderma was more widespread and progressive, what other treatment modalities (besides topical lubricants and photochemotherapy) could you use?

A
  1. Steroids
  2. Antimalarias
  3. Immunosuppressives (methotrexate, penicillamine)
174
Q

True or False: With localized scleroderma, it is important to treat to prevent the progression to the systemic form

A

FALSE

175
Q

True or False: The systemic form of scleroderma is rarely seen in children

A

True

176
Q

What can the systemic form of scleroderma present with (in addition to findings seen in localized)?

A
  1. Sclerodactyly (localized scleroderma of digits)
  2. Pulmonary fibrosis
  3. Reflux/dysphagia (from LES incompetence)
  4. Raynaud’s
177
Q

How do people with systemic scleroderma often present?

A

With Raynaud’s (almost everyone has this at some point in their course)

178
Q

True or False: ANA is almost always positive in systemic scleroderma?

A

True

179
Q

What causes SLE?

A

Formation of antigen-antibody complexes in a variety of tissues

180
Q

Which gender gets SLE more often?

A

Women (but gender ratio is more equal in younger children)

181
Q

Which race’s get SLE more often?

A

African Americans, Hispanics, Asians (versus Caucasians)

182
Q

What 3 symptoms do most patients present with?

A
  1. Rash
  2. Fever
  3. Arthritis
183
Q

Besides rash, fever, and arthritis, what are 4 other common symptoms at presentation?

A
  1. Fatigue
  2. Weight loss
  3. Lymphadenopathy
  4. Hepatosplenomegaly
184
Q

A diagnosis of SLE is suggested when 4 or more of what features present over time?

A
  1. Malar rash
  2. Discoid lesions
  3. Photosensitivity
  4. Oral ulcerations
  5. Arhtritis and serositis
  6. Hematological abnormalities
  7. Renal abnormalities
  8. Presence of anti-ds-DNA, anti-DNA, and anti-Smith antibodies
  9. Psychosis or other neurologic abnormalities
  10. Positive ANA
185
Q

Which antibodies are very specific for SLE?

A

Anti-ds-DNA (positive results are rarely seen in other patients- including those with other rheumatological disorders)

186
Q

How can the severity of disease flareups be tracked in SLE?

A
  1. Anti-ds-DNA levels (fluctuate accordingly)

2. C3/C4 levels (inversely proportional- go down in more active or acute disease states)

187
Q

Which antibody is specific to SLE, but remains elevated regardless of disease activity (useful for identifying disease, but not tracking disease)?

A

Anti-smith

188
Q

Name 3 main components to clinical disease in SLE

A
  1. Polyserositis
  2. Renal disease (nephritis)
  3. Cerebritis
189
Q

What does polyserositis affect?

A

Any organ with a pleural covering… includes primarily the heart (pericarditis) and lungs (pleurisy)

190
Q

What is cerebritis a result of in SLE?

A

Areas of microischemia and vascular disease

191
Q

What can cerebritis result in in SLE?

A

Seizures

192
Q

What type of test is ANA (sensitive or specific)?

A

Sensitive (negative rules it out)

-Positive in almost all SLE, but many other inflammatory disorders can have a positive ANA

193
Q

What type of test is dsDNA (sensitive or specific)?

A

Specific (positive rules it in)

194
Q

What test do you want to screen for a disease?

A

Sensitive

195
Q

What test to you want to secure a diagnosis?

A

Specific

196
Q

What is the course of Raynaud?

A

White: Ischemia
Blue: Cyanosis
Red: Coldness

197
Q

What do you often see Raynaud’s in?

A

Lupus

198
Q

Name 3 signs that can be seen with neonatal lupus

A
  1. Rashes on trunk
  2. 3rd degree heart block
  3. Bradycardia
199
Q

What can neonatal lupus be assocaited with?

A

Hydrops fetalis

200
Q

What can heart block lead to in neonatal lupus?

A

Heart failure (baby may need a pacemaker)

201
Q

What is the most likely explanation for death in an infant born to a mother with SLE?

A

Heart block

202
Q

True or False: Most newborns born to women with SLE don’t develop neonatal lupus?

A

True

203
Q

True or False: Many newborns with neonatal lupus, Mom didn’t know she had SLE?

A

True- If presented with neonate with bradycardia or heart block, they will likely not mention a history of lupus in Mom

204
Q

What antibody is closely associated with neonaal lupus?

A

Anti-SSA

205
Q

Most infants with congenital heart block have Mom’s who test positive for what antibodies?

A

Anti-SSA or Anti-SSB

206
Q

What is used for treatment of mild lupus?

A
  1. NSAIDs
  2. Hydroxychloroquine
  3. Dapsone (skin)
  4. Prednisone (low dose)
207
Q

What is a rare side effect of hydroxychloroquine?

A

Ototoxicity

208
Q

What is a common side effect of hydroxychloroquine?

A

Opthalmological side effects (temporary blurring to permanent retinal damage)

209
Q

What is used for treatment of severe lupus?

A
  1. Pulses of high dose steroids

2. Immunosuppressants (cyclophosphamide/azathioprine)

210
Q

What is more severe lupus characterized by?

A

Unremitting arthralgias, kidney involvement, serositis, or CNS effects (seizures and cerebritis)

211
Q

What medication is used for particular serious organ involvement in SLE?

A

Cyclophosphamide

212
Q

What are lupus patients undergoing treatment with immunosuppresive agents at risk for?

A

Serious infections (varicella)

213
Q

What are patient with lupus on steroids at risk for?

A

Complications associated with chronic steroid use: Cataracts, glaucoma, osteoporosis, high blood pressures, glucose intolerance, cushingoig features

214
Q

What is the color and viscosity of normal synovial fluid?

A

Yellow/clear

Normal or slightly increased viscosity (WBC <200)

215
Q

What is the color and viscosity of synovial fluid in arthritis secondary to trauma?

A 
Bloody/clear
Increased viscosity (WBC <2000)
216
Q

What is the color and viscosity of synovial fluid in lupus?

A 
Yellow/clear
Normal viscosity (WBC 5,000 and LE cells)
217
Q

What is the color and viscosity of synovial fluid in rheumatic fever?

A 
Yellow/cloudy
Decreased viscosity (WBC 5,000)
218
Q

What is the color and viscosity of synovial fluid in JIA?

A 
Yellow/cloudy
Decreased viscosity (WBC 15,000-20,000)
219
Q

What is the color and viscosity of synovial fluid in reactive arthritis?

A 
Yellow/Opaque
Decreased viscosity (WBC 20,000)
220
Q

What is the color and viscosity of synovial fluid in septic arthritis?

A 
Yellow
Variable viscosity (WBC 50,000-300,000 and low glucose and bacteria)

Peds (35 decks)

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