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*Review TD 2020 > Rheum + Ortho > Flashcards

Rheum + Ortho Flashcards

1
Q

Hip pain
2-6 yo
4-10 yo
10-14 yo

A

2-6 yo: transient synovitis
4-10 yo: legge calves perthe dz
10-14 yo: SCFE

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2
Q

Septic arthritis

  • Cocher criteria
  • Bugs
A

– Fever > 38
– Refusal to wt bear
– WBC > 12
– ESR > 40

Staph aureus
Strept
Meningococcus
Kingella

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3
Q

HLA B27 - assoc w?

A

Spondyloarthritis

Enthesitis JIA

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4
Q

Oligoarthritis

  • how many
  • joints
A 
F>M
Max 4 joints
Asymmetric
Large joints
Knee>ankle, elbow

ANA +ve 80%
RF -ve always

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5
Q

Complications of oligoarthritis (6)

A 
Uveitis
Flexion contracture
Muscle Wasting
Leg length discrepancy
TMJ joint dz
Growth Discrepancy
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6
Q 
Uveitis - most common in what type of arthritis
\+ risk factors
Usually asymptomatic
When is it symptomatic
complications
A 
Oligo
ANA +
RF:
< 6 yo at onset of JIA symptoms
During first 4 years of diagnosis
Negative RF girls

Sx’atic in enthesitis

Synechiae
Glaucoma
Cataract
Visual Loss

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7
Q

Polyarthritis - Tx

A

DMARD (Methotrexate)
with adjuncts NSAIDS
+/- jnt injections

Biologics (TNFa)

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8
Q

Enthesitis related arthritis

A

M»F
>6yo

Assym
Lower limb

Arthritis + Enthesitis 
Tarsitis 
Daktylitis 
Sakroiliitis 
Uveitis (acute)

IBD

HLA B27

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9
Q

Psoriatic arthritis

A 
Arthritis + Psoriasis
OR
Arthritis + 2 of:
- Nail pits
- Dactylitis
- FHx of psoriasis
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10
Q

Systemic JIA

  • definition
  • assoc w?
A

1) > two weeks spiking fever (daily, predictable)
2) Arthritis
3) + at least one of:
• Rash
• Lymphadenopathy
• HSmegaly
• Serositis

MAS

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11
Q

MAS

  • causes
  • clinical
  • labs
A

Infection (EBV)
Malignancy
Meds
Rheum/autoinflamm

Persistant fevers
HSmeg
LAD
hemorrhagic skin rash
CNS dysfunction
Cytopenias
High Ferritin
High lipids
Low Fibrinogen
High D-Dimers
Low ESR 
High CRP
Transaminitis
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12
Q

Systemic JIA - tx

A

NSAID (if mild)
Prednisone (more severe or persistent mild)

If dependent: Biologic (IL1 and IL6)

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13
Q

Acute Rheumatic fever

- diagnostic criteria

A

Dx = recent GAS + 2 MAJOR
or 1 MAJOR and 2 MINOR

MAJOR
Joint - arthritis, migratory
Carditis
Nodules, subcut
Erythema marginatum
Sydenhams chorea
MINOR
Fever
Arthralgia
Incr CRP/ESR
ECG change - prol. PR
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14
Q

Acute rheumatic fever

  • treatment
  • prophylaxis
A

Penicillin x 10 days
(or IM benzathine x1)
ASA/NSAIDs for arthritis
ASA/Steroids for carditis

Prophylaxis with Penicillin (or IM benzathine)
w/o carditis: up to 21 years or 5 years post
w/ carditis: up to 21 years or 10 years post
residual heart dz: up to 40 yo

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15
Q

Arthritis definition

A 
Joint swelling/effusion
\+
2 of:
limited ROM
tenderness/pain w motion
incr heat
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16
Q

Familial Mediterranean Fever

A

Short duration < 72hr
Irregular

Hallmark = Erysipeloid erythematous rash

Serositis
Abdo pain

Complications: Amyloidosis

Tx: Colchicine

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17
Q

PFAPA

  • features
  • treatment
A

Periodic Fever, Aphtous stomatitis, Pharingitis, Adenitis

Start < 5yo
Regularly recurring fevers
3-6 days
URTI sx
– Aphthous stomatitis
– Cervical lymphadenopathy 
– Pharyngitis
WELL BETWEEN

Exclusion of cyclic neutropenia

Treatment
Supportive
Steroids - one dose at start

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18
Q

SLE

A

F»M

4/11 
(4 skin, 4 organ, 3 lab)
Malar rash
Discoid rash
Photosensitivity
Oral/nasal ulcers

Arthritis
Serositis (Pleuritis/Pericarditis)
Neurologic dz (seizures, psychosis)
Nephritis

+ ANA
Cytopenias (anemia is hemolytic)
Immunologic D/O (Abs)

Abs:
+ANA
+Anti dsDNA
+Anti Sm

False + RPR
Ro, La
Low complement

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19
Q

SLE
marker:
most sensitive
most specific

A

sensitive: ANA
Specific: DNA

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20
Q

Neonatal lupus

A

Congenital heart block

Cutaneous
Liver dz - hepatitis
Cytopenia (thrombocytopenia > anemia/neutropenia)
CNS abnormalities

Mother: anti Ro and La

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21
Q

Erythema nodosum

A 
NO cause (idiopathic)
Drugs
OCP
Sarcoidosis
UC/Crohn's or Bechets
Micro: GAS, TB

Also:
SLE

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22
Q

Dermatomyositis

  • features
  • investigations (spell it out)
A
  • Symmetric prox. muscle weakness
  • Cutaneous changes – heliotrope (eyelids) or Gottron’s papules
  • Elevated muscle enzymes (CK, AST, LDH, aldolase)

Dysphonia, Dysphagia, Dyspnea

Abnormal EMG - electromyograph
Muscle biopsy

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23
Q

Henoch Scholein Purpura
dx
bx
complications

A
  • palpable purpura
  • arthritis
  • abdominal pain
  • kidney involvement

IgA nephropathy, renal failure <5%
edema, orchitis

Dx:
clinical if above
or bx:
leukocytoclastic vasculitis w IgA deposition

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24
Q

Kawasaki Disease
Dx
Other features

A

5 days fever + 4/5:

  • rash polymorphous
  • nonsuppurative conjunctivitis
  • oral mucosal inflammation
  • cerv. LAD
  • swelling/erythema of hands/feet
Other
• Peeling in the perineal area (acute phase) 
• Aseptic meningitis
• Arthritis
• Anterior uveitis in up to 80%
• Hydrops of the gallbladder
• Sterile pyuria
• Lung involvement
• Diarrhea in approx 25% 
• Gamma-GT elevation
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25
Q

Kawasaki Disease

Labs

A 
neutrophilic leukocytosis
thrombocytosis initially
anemia
elevated transaminases
decreased albumin
sterile pyuria
elevated ESR/CRP
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26
Q

Causes of rectal prolapse

A 
Ehlers Danlos
Cystic fibrosis
Idiopathic
Chronic constipation
\+++ Coughing (Pertussis)
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27
Q

Ehlers Danlos

A

rectal prolapse, mitral valve prolapse and joint hyperextensibility

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28
Q

HSP - what to monitor after

A

U/A and BP for one year

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29
Q

Erythema nodosum

- ddx

A 
IBD
Sarcoidosis
GAS
OCP
Tuberculosis
30
Q

JIA - how often to screen w ophthalmo

A

Oligo ana+ <6: q3 months
>6: q6 months
?? need to recheck

31
Q

MAS tx

A 
high dose steroids
IVIG
Cyclosporin
Etoposide
ATG
IL-1 inhibition
32
Q

Renal complications of SLE

A 
Htn
Proteinuria
Hematuria
Edema
Nephrotic syndrome
Renal failure
33
Q

SCFE

  • location of pain
  • age
  • RF
A
  • inner medial thigh or knee
  • age > 10yo

RF

  • male
  • obese
  • African American
  • renal failure
  • endocrinopathies
  • hx radiation therapy
34
Q

SCFE

  • investigations
  • tx
A

XRAY - AP, lat, frog leg

Call Ortho STAT
Surgery - per cut. fixation

35
Q

Perthes

  • presentation
  • tx
A

AVN

males age 4-8
limp, decr. ROM, hyperactive

restrict activities
maintain ROM
antiinflamm
physio

36
Q

DDH

  • presentation
  • RF
A 
painless limp
(painful in adolescence if missed)
RF:
- 1st born
- female
- FHx
- Frank breech
- Postnatal position
- Laplanders
Native
- Syndrme
37
Q

DDH

  • best screening
  • investigations
  • Treatment
A

Serial P/E

Dynamic U/s
Xray - AP and frog leg

Early - Pavlik harness
Late - Surgical intervention

38
Q

Urgent causes of limp

A
  • Septic arthritis hip
  • SCFE
  • Osteomyelitis
  • Discitis
  • Fracture
  • Neoplasia
39
Q

Osteosarcoma

A

metaphysis
sunburst appearance
periosteal elevation
Femur>Tibia>humerus

mets: lung, bone
tx: chemo, surgery

40
Q

Ewing Sarcoma

A

diaphysis
onion skinning
periosteal elevation
Femur>Tibia>fibula, humerus

mets: lung, bone, BM

whom, surgery +/- RT

41
Q

Toddler’s fracture

A

oblique # distal tibia
minor injury
age 1-5

cast leg
repeat ray in 10-14 days

42
Q

Osgood Slatter

A

overuse syndrome
apophysitis of tibial tuberosity
(patellar tendon)

tender and prominent tub tuberosity

symptomatic treatment with NSAID, rest and activity modification, PT, protective gear!

43
Q

Sever’s Disease

A

overuse syndrome
apophysitis of achilles tendon

symptomatic treatment with NSAID, rest and activity modification, PT

44
Q

Patello Femoral Syndrome

A

overuse syndrome

dull/aching under patella/peripatellar region

45
Q

Scoliosis

  • dx
  • best clinical findings
  • who to refer
A

Angle > 10 degrees

Adams test

  • Atypical curves (left sided)
  • Skeletally immature, curve ≥ 20􏰀 at presentation
  • Skeletally immature, progressive curve
  • Rapid progression / pain
  • Skeletally mature, curve > 45􏰀
46
Q

club feet

A

Talipes Equinovarus

Complex, congenital, contractural malalignment of the bones and joints of the foot and ankle

Deformity
• Cavus
• Adductus 
• Varus
• Equinus

Treatment
• Ponsetti Method

47
Q

Intoeing by age

A

Infant – metatarsus adductus
Foot

Toddler – internal tibial torsion
Leg

Child / Adolescent – increased femoral anteversion (internal hip rotation)
Hip

48
Q

Spondylolysis

A

Gymnastics (repeated back extension)
L5

rest 4-6weeks minimum until pain free
then brace on return

49
Q

Achondroplasia - assoo w ?

A

spinal stenosis - small foramen magnum
spinal cord compression can occur at the foramen magnum and in the lumbar spine in adulthood

metaphyseal shortening

50
Q

fractures high suspicion for child abuse

A 
metaphyseal corner lesions
posterior rib fracture
scapular fracture
sternal fracture
spinous process fracture
first rib fracture
51
Q

Nursemaid’s elbow
what is it
treatment

A

Radial head subluxation

supinate extended arm and then flexion (audible/palpable click)

52
Q

Reiter syndrome

A

= reactive arthritis
→ classic triad of conjunctivitis (bilateral purulent), urethritis, and arthritis after infection
(particularly those in the urogenital or GI tract);

→ boys&raquo_space; girls;
→ symptoms worse if HLA-B27 positive;
→ present a few days to 6 weeks after initial infection

53
Q

Kawasaki Dz

tx w dose

A

IVIG 2g/kg IV now

ASA 80mg/kg daily PO until afebrile for 48 hours

54
Q

2 renal complications of SLE

A
  • nephritis (hematuria, proteinuria)

- hypertension

55
Q

Behcet disease

A

Recurrent oral and genital ulcers
arthritis
skin rash

56
Q

Time frames for diagnosing and categorizing JIA

A

Dx JIA at 6 weeks

Can’t say oligo until 6 months

57
Q

Oligo

- treatment

A

NSAIDS
+/- jnt injections

DMARD (Methotrexate)

Biologics (TNFa)

58
Q

Management of JIA

A 
Meds
PT
OT
SW
Psychology
59
Q

What are the muscle enzymes to test for in dermatomyositis?

A

CK, AST, LDH, aldolase

60
Q

scleroderma

- treatment

A

High dose steroids and MTX

Physiotherapy

61
Q

HSP

- dx

A

Purpura or petechiae w lower limp predominance

Plus one of:

1) Diffuse abdominal colicky pain with acute onset (may include intussusceptions and gastrointestinal bleeding)
2) Skin biopsy showing leukocytoclastic vasculitis with predominant IgA deposits, or kidney biopsy showing proliferative glomerulonephritis with predominant IgA deposits
3) Arthritis or arthralgias of acute onset
4) Renal involvement (proteinuria >0.3 g in 24 hrs, hematuria, or red blood cell casts, impaired renal function)

62
Q

Treatment of HSP

A
  • Largely supportive
  • NSAIDs may be used for joint pain (caution required due to potential renal involvement)
  • Prednisone in select patients
    (severe sx - GI or renal)
63
Q

How long after HSP do you need to monitor closely

A

6 months

64
Q

cANCA

A

Granulomatosis with Polyangiitis

65
Q

Sarcoidosis

A
  • skin rash - papular
  • uveitis
  • arthritis
66
Q

Ectopis lentis

  • upwards
  • downwards
A 
Upward = marfans
Down = homocystinuria
67
Q

Marfans

- features

A 
Aortic root dilation 
Ectopia lentis (upwards)
68
Q

How to treat uveitis

  • acute
  • chronic
A
  • acute: topical steroids
  • chronic: MTX
    biologics/PO steroids as a second line or if posterior uveitis
69
Q

Club foot

  • medical name
  • treatment
A

Congenital Talipes Equinovarus (clubfoot)

Tx ASAP after birth with ponseti casting followed by bracing +/-tenotomy of achilles tendon

70
Q

Rickets findings

A 
frontal bossing
craniotabes
delayed suture and fontanelle closure
defective tooth enamel
rachitic rosary (enlarged costochondral junctions)
Harrison groove (rim of rib indentation at insertion of diaphram
pectus carinatum
widened physes of wrists and ankles
bowing of the legs (femoral and tibial)

*Review TD 2020 (16 decks)

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