Rheum and Ortho

Question 1

Hip causes of limp based on age

Answer 1

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

Question 2

Septic joint cardinal features

Answer 2

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

Question 3

Septic joint management

Answer 3

Surgical emergency:

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

Question 4

Uveitis in JIA - 4 RFs

Answer 4

• 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)

Question 5

Complications of uveitis

Answer 5

• synechiae - irregular pupil
• glaucoma
• cataract
• visual loss

Question 6

Systemic JIA definition

Answer 6

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

Question 7

Macrophage activation syndrome lab findings

Answer 7

Low/dropping:
Fibrinogen low (dropping)
ESR decreasing

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

Question 8

Acute Rheumatic Fever - major criteria

Answer 8

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)

Question 9

Acute Rheumatic Fever - minor criteria

Answer 9

Long PR interval
Elevated ESR + CRP
Arthralgia
Fever

Question 10

FMF features and prophylaxis

Answer 10

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

Question 11

PFAPA tx

Answer 11

• prednisone single dose with exacerbations

Question 12

Autoantibodies found in SLE

Answer 12

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

Question 13

HSP treatment:

Answer 13

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

Question 14

High dose ASA

Low dose ASA

Answer 14

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

Question 15

Salter Harris fracture types

Answer 15

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

Question 16

Adolescent idiopathic scoliosis
curve
and when to do surgery

Answer 16

> 10 degrees = scoliosis

> 50 degrees = surgery

Question 17

Congenital scoliosis associations

Answer 17

Think VACTERL

vertebral, cardiac, TEF, renal

Question 18

Scoliosis red flags

Answer 18

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

Question 19

Adolescent idiopathic scoliosis

Curve < 20

Answer 19

• x-ray q 6 months,

- observe

Question 20

Scoliosis - when to refer

Answer 20

• 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

Question 21

Genu varus age

Answer 21

Birth to 3 yrs

Question 22

Genu valgus age

Answer 22

3 to 7 yrs

Question 23

Intoeing etiologies

Answer 23

Metatarsus adductus (infant)
Tibial torsion (toddler)
Femoral anteversion (teen)

Question 24

Warning signs for genu varus

Answer 24

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

Question 25

Blount disease vs. physiologic bowing

Answer 25

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

Question 26

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

Answer 26

Ankle: Salter Harris Wrist: Buckle (torus)

Question 27

Septic arthritis of the hip - position of the hip

Answer 27

Flexion, abduction, external rotation

Question 28

Ottawa ankle rule

Answer 28

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

Question 29

Lab findings in acute KD

Answer 29

- 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

Question 30

Osteosarcoma features

Answer 30

- metaphyses of long bones | - "sunburst" pattern

Question 31

Ewing sarcoma

Answer 31

- diaphyses of long bones and flat bones | - periosteal reaction, "onion skinning"

Question 32

Myositis-specific autoantibodies in JDM

Answer 32

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

Question 33

DDH physical exam findings

Answer 33

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

Question 34

FMF flare

Answer 34

1-3 days self limited with: - fever - serositis (e.g. chest or abdo pain) - arthritis (often large joints) - erysipeloid rash (dorsum of foot)

Question 35

Serious complication of FMF

Answer 35

Amyloidosis | renal failure within 3-5 yrs

Question 36

Hallmark triad for granulomatosis with polyangiitis

Answer 36

1. upper airway inflammation 2. lower airway inflammation 3. renal disease

Question 37

2 methods for reducing a pulled elbow

Answer 37

1. flexion and supination | 2. hyperpronation (better)

Question 38

Spondylolysis vs. spondylolisthesis

Answer 38

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

Question 39

Medication classes that can cause drug induced lupus

Answer 39

- anticonvulsants - anti TNF e.g. infliximab - antiTB e.g. isoniazid

Question 40

Erythema nodosum most common causes

Answer 40

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

Question 41

PFAPA features

Answer 41

- 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

Question 42

Most severe complication of missed DDH in first year of life

Answer 42

Avascular necrosis of femoral epiphysis

Question 43

Neonatal lupus manifestations

Answer 43

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

Question 44

Kawasaki predictors of poor outcomes

Answer 44

- 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