Rheum and Ortho Flashcards
Hip causes of limp based on age
2-6 yrs: transient synovitis
4-10 yrs: Legg-Calve-Perthes
10-14 yrs: Slipped capital femoral epiphyses
Septic joint cardinal features
- Fever
- Pain
- Edema
- Redness
Septic joint management
Surgical emergency:
- joint aspirate and culture
- irrigate joint
- antibiotics
Uveitis in JIA - 4 RFs
- 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)
Complications of uveitis
- synechiae - irregular pupil
- glaucoma
- cataract
- visual loss
Systemic JIA definition
- > 2 weeks of fever
- arthitis
and 1 of:
- rash
- generalized lymphadenopathy
- hepatosplenomegaly
- serositis
Macrophage activation syndrome lab findings
Low/dropping:
Fibrinogen low (dropping)
ESR decreasing
High/increasing: D-dimers CRP Ferritin Triglycerides Liver enzymes
Acute Rheumatic Fever - major criteria
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)
Acute Rheumatic Fever - minor criteria
Long PR interval
Elevated ESR + CRP
Arthralgia
Fever
FMF features and prophylaxis
- fever (brief 1-3 days)
- polyserositis [peritonitis, pleuritis, arthritis (70%)]
Prophylaxis: colchicine
PFAPA tx
- prednisone single dose with exacerbations
Autoantibodies found in SLE
- ANA (most sensitive)
- Anti DsDNA
- Anti-Ro (SSa)
- Anto-La (SSb)
- Anti phospholipid antibody (check annually)
- Anti Smith
HSP treatment:
Supportive Analgesia/NSAID Steroids indicated for: 1. severe abdominal pain 2. severe renal disease 30% recur within first 1-2 months
High dose ASA
Low dose ASA
High: 80-100mg/kg
Low: 3-5mg/kg/day
Salter Harris fracture types
- Separated = physis
- Above = through physis and metaphysis)
- Lower = through physis, epiphysis and into joint
- Through = across metaphysis, physis and epiphysis
- Rammed = crush injury to the physis
Adolescent idiopathic scoliosis
curve
and when to do surgery
> 10 degrees = scoliosis
> 50 degrees = surgery
Congenital scoliosis associations
Think VACTERL
vertebral, cardiac, TEF, renal
Scoliosis red flags
Hx: pain, gait change, weakness, rapid progression, bowel and bladder
Physical: foot deformity, kyphotic thoracic spine, abN reflexes, abN patterns, signs of dysraphism
Adolescent idiopathic scoliosis
Curve < 20
- x-ray q 6 months,
- observe
Scoliosis - when to refer
- 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
Genu varus age
Birth to 3 yrs
Genu valgus age
3 to 7 yrs
Intoeing etiologies
Metatarsus adductus (infant) Tibial torsion (toddler) Femoral anteversion (teen)
Warning signs for genu varus
- progressive deformity
- asymmetry
- persistence beyond expected age
- short stature beyond 2 SD
Blount disease vs. physiologic bowing
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
Most common ankle fracture in kids and most common wrist fracture in kids
Ankle: Salter Harris
Wrist: Buckle (torus)
Septic arthritis of the hip - position of the hip
Flexion, abduction, external rotation
Ottawa ankle rule
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
Lab findings in acute KD
- 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
Osteosarcoma features
- metaphyses of long bones
- “sunburst” pattern
Ewing sarcoma
- diaphyses of long bones and flat bones
- periosteal reaction, “onion skinning”
Myositis-specific autoantibodies in JDM
- Anti-Jo-1,
- anti-Mi-2,
- anti p155/140,
- antiNXP2
- ANA is present in > 80%
help define clinical subsets in JDM and predict complications
DDH physical exam findings
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
FMF flare
1-3 days self limited with:
- fever
- serositis (e.g. chest or abdo pain)
- arthritis (often large joints)
- erysipeloid rash (dorsum of foot)
Serious complication of FMF
Amyloidosis
renal failure within 3-5 yrs
Hallmark triad for granulomatosis with polyangiitis
- upper airway inflammation
- lower airway inflammation
- renal disease
2 methods for reducing a pulled elbow
- flexion and supination
2. hyperpronation (better)
Spondylolysis vs. spondylolisthesis
Spondylolysis = defect in pars interarticularis
Spondylolysthesis = forward slippage of one vetebrae on another
- thesis more likely to have neuro sx
Medication classes that can cause drug induced lupus
- anticonvulsants
- anti TNF e.g. infliximab
- antiTB e.g. isoniazid
Erythema nodosum most common causes
- Group A strep
- Yersinia
- Medications: cephalosporins, penicillin, macrolides
- Inflammatory disorders e.g. IBD
- Sarcoidosis (young adults)
PFAPA features
- 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
Most severe complication of missed DDH in first year of life
Avascular necrosis of femoral epiphysis
Neonatal lupus manifestations
- macular rash
- cytopenia
- hepatitis
- congenital heart block
(usually Anti-Ro (aka SSA) and anti-La (aka SSB)
Kawasaki predictors of poor outcomes
- 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
