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Studying > Rheum and Ortho > Flashcards

Rheum and Ortho Flashcards

1
Q

Hip causes of limp based on age

A

2-6 yrs: transient synovitis
4-10 yrs: Legg-Calve-Perthes
10-14 yrs: Slipped capital femoral epiphyses

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2
Q

Septic joint cardinal features

A
  1. Fever
  2. Pain
  3. Edema
  4. Redness
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3
Q

Septic joint management

A

Surgical emergency:

  1. joint aspirate and culture
  2. irrigate joint
  3. antibiotics
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4
Q

Uveitis in JIA - 4 RFs

A
  • associated with positive ANA
  • most common in oligoarticular JIA (10-20%)
  • younger age of diagnosis
  • more recent diagnosis
    (highest risk = q3 month checks, lower risk = q12 months)
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5
Q

Complications of uveitis

A
  • synechiae - irregular pupil
  • glaucoma
  • cataract
  • visual loss
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6
Q

Systemic JIA definition

A
  1. > 2 weeks of fever
  2. arthitis
    and 1 of:
    - rash
    - generalized lymphadenopathy
    - hepatosplenomegaly
    - serositis
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7
Q

Macrophage activation syndrome lab findings

A

Low/dropping:
Fibrinogen low (dropping)
ESR decreasing

High/increasing: 
D-dimers 
CRP 
Ferritin
Triglycerides
Liver enzymes
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8
Q

Acute Rheumatic Fever - major criteria

A 
J - joints = arthritis (migratory and poly)
O - heart = carditis
N - subcutaneous nodules
E - erythema marginatum
S - sydenham chorea

*2 major
*1 major and 2 minor
and evidence of GAS
(or just chorea)

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9
Q

Acute Rheumatic Fever - minor criteria

A

Long PR interval
Elevated ESR + CRP
Arthralgia
Fever

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10
Q

FMF features and prophylaxis

A
  • fever (brief 1-3 days)
  • polyserositis [peritonitis, pleuritis, arthritis (70%)]
    Prophylaxis: colchicine
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11
Q

PFAPA tx

A
  • prednisone single dose with exacerbations
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12
Q

Autoantibodies found in SLE

A
  1. ANA (most sensitive)
  2. Anti DsDNA
  3. Anti-Ro (SSa)
  4. Anto-La (SSb)
  5. Anti phospholipid antibody (check annually)
  6. Anti Smith
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13
Q

HSP treatment:

A 
Supportive
Analgesia/NSAID
Steroids indicated for: 
1. severe abdominal pain
2. severe renal disease
30% recur within first 1-2 months
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14
Q

High dose ASA

Low dose ASA

A

High: 80-100mg/kg
Low: 3-5mg/kg/day

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15
Q

Salter Harris fracture types

A
  1. Separated = physis
  2. Above = through physis and metaphysis)
  3. Lower = through physis, epiphysis and into joint
  4. Through = across metaphysis, physis and epiphysis
  5. Rammed = crush injury to the physis
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16
Q

Adolescent idiopathic scoliosis
curve
and when to do surgery

A

> 10 degrees = scoliosis

> 50 degrees = surgery

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17
Q

Congenital scoliosis associations

A

Think VACTERL

vertebral, cardiac, TEF, renal

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18
Q

Scoliosis red flags

A

Hx: pain, gait change, weakness, rapid progression, bowel and bladder
Physical: foot deformity, kyphotic thoracic spine, abN reflexes, abN patterns, signs of dysraphism

19
Q

Adolescent idiopathic scoliosis

Curve < 20

A
  • x-ray q 6 months,

- observe

20
Q

Scoliosis - when to refer

A
  • atypical curves (left sided)
  • skeletally immature and curve >= 20 at presentation
  • skeletally immature, progressive curve (> 5 degrees)
  • rapid progression/pain
  • skeletally mature and curve > 45
21
Q

Genu varus age

A

Birth to 3 yrs

22
Q

Genu valgus age

A

3 to 7 yrs

23
Q

Intoeing etiologies

A 
Metatarsus adductus (infant)
Tibial torsion (toddler)
Femoral anteversion (teen)
24
Q

Warning signs for genu varus

A
  • progressive deformity
  • asymmetry
  • persistence beyond expected age
  • short stature beyond 2 SD
25
Q

Blount disease vs. physiologic bowing

A

Blount:

  • asymmetric, abrupt and sharp angulation
  • Metaphyseal -diaphyseal angle > 11 degrees,
  • medial sloping of epiphysis,
  • widening of physis and fragmentation of metaphysis with significant lateral thrust

Physiologic = gentle, symmetric with normal growth plate and no significant lateral thrust

26
Q

Most common ankle fracture in kids and most common wrist fracture in kids

A

Ankle: Salter Harris
Wrist: Buckle (torus)

27
Q

Septic arthritis of the hip - position of the hip

A

Flexion, abduction, external rotation

28
Q

Ottawa ankle rule

A

A. Bone tenderness at posterior edge or tip of lateral malleolus
B. bone tendernes at posterior edge or tip of medial malleolus
C. inability to bear weight both immediately and in ED for 4 steps

29
Q

Lab findings in acute KD

A
  • leukocytosis with neutrophilia and immature forms
  • increased ESR and CRP
  • anemia
  • abnormal lipids
  • hypoalbuminemia
  • hyponatremia
  • thrombocytosis (after week 1)
  • sterile pyruia
  • elevated transaminases
  • elevated GGT
  • pleocytosis in CSF
  • leukocytosis in synovial fluid
30
Q

Osteosarcoma features

A
  • metaphyses of long bones

- “sunburst” pattern

31
Q

Ewing sarcoma

A
  • diaphyses of long bones and flat bones

- periosteal reaction, “onion skinning”

32
Q

Myositis-specific autoantibodies in JDM

A
  • Anti-Jo-1,
  • anti-Mi-2,
  • anti p155/140,
  • antiNXP2
  • ANA is present in > 80%
    help define clinical subsets in JDM and predict complications
33
Q

DDH physical exam findings

A

Ortolani and Barlow - 0-3mo
>2-3mo: limited hip ABduction, Galeazzi, asymmetry of creases, Klisic test
Walking: limp, waddling, Trendelenburg, limited hip abduction, Galeazzi, excessive lordosis

34
Q

FMF flare

A

1-3 days self limited with:

  • fever
  • serositis (e.g. chest or abdo pain)
  • arthritis (often large joints)
  • erysipeloid rash (dorsum of foot)
35
Q

Serious complication of FMF

A

Amyloidosis

renal failure within 3-5 yrs

36
Q

Hallmark triad for granulomatosis with polyangiitis

A
  1. upper airway inflammation
  2. lower airway inflammation
  3. renal disease
37
Q

2 methods for reducing a pulled elbow

A
  1. flexion and supination

2. hyperpronation (better)

38
Q

Spondylolysis vs. spondylolisthesis

A

Spondylolysis = defect in pars interarticularis
Spondylolysthesis = forward slippage of one vetebrae on another
- thesis more likely to have neuro sx

39
Q

Medication classes that can cause drug induced lupus

A
  • anticonvulsants
  • anti TNF e.g. infliximab
  • antiTB e.g. isoniazid
40
Q

Erythema nodosum most common causes

A
  1. Group A strep
  2. Yersinia
  3. Medications: cephalosporins, penicillin, macrolides
  4. Inflammatory disorders e.g. IBD
  5. Sarcoidosis (young adults)
41
Q

PFAPA features

A
  • Episodes of high fever that occur with regular periodicity every 4-6 weeks
  • Fever episodes last up to 5 days
  • aphthous ulcers,
  • non-exudative pharyngitis
  • cervical adenitis
42
Q

Most severe complication of missed DDH in first year of life

A

Avascular necrosis of femoral epiphysis

43
Q

Neonatal lupus manifestations

A
  • macular rash
  • cytopenia
  • hepatitis
  • congenital heart block
    (usually Anti-Ro (aka SSA) and anti-La (aka SSB)
44
Q

Kawasaki predictors of poor outcomes

A
  • age (< 5 months or > 5 yrs)
  • male
  • persistent fever
  • poor response to IVIG
  • elevated BNP, CRP, neutrophils, liver enzymes
  • low plts, Na, albumin
  • Asian, pacific islander and Hispanic

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