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Pediatrics 101 > Rheumatology > Flashcards

Rheumatology Flashcards

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1
Q

Antibodies specific for SLE

A

anti-ds DNA (assoc with renal disease activity) and anti-Sm

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2
Q

SLE criteris for Dx (4/11)

A

Malar rash 60%, Discoid rash, Photosensitivity 90%, Oral Ulcers 20%, Nonerosive arthritis, Pleuritis or pericarditis, Renal disorder, Seizures or psychosis, Hematologic disorder, +ve Ab (anti-dsDNA, anti-Sm or antiphospholipid/lupus anticoagulant), +ve ANA

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3
Q

Antibodies NOT specific for SLE

A

ANA, antiphospholipid/lupus anticoagulant

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4
Q

Oral ulcers on the hard palate associated with

A

SLE active disease

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5
Q

Ab assoc with psychiatric disorders

A

Anti-ribosomal P

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6
Q

Lab eval for SLE

A

CBC, ESR, CRP, C3,C4, LFTs, UA, VDRL

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7
Q

Assoc with hemolytic anemia

A

Coomb’s

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8
Q

Ab assoc with Neonatal lupus or cutaneous lupus

A

Anti-Ro (SS-A) and Anti-LA (SS-P)

Ab directed at RoRNP, HLADR3

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9
Q

Ab assoc with Thrombosis, Thrombocytopenia, Hemolytic anemia

A

Antiphospholipid, Anti cardiolipin

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10
Q

Childhood SLE more severe because

A

Renal disease 50-90%

CNS disease 40%

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11
Q

SLE Mortality most frequently due to

A
  1. Infections

2. MI sec to vasculitis and steroids

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12
Q

Ab assoc with MCTD

A

Anti-RNP AB

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13
Q

Baby born starts developing rash on exposure to Sun or UV light, Heratblock (15-30%), Hepatitis (8%), Cytopenias 6%, Hemolytic Anemia

A

Only 10% of women who cary the Ab have symptoms, so it may be their first child with Neonatal lupus

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14
Q

Large vessel vasculitis

A

Giant cell - older people

Takayassu’s - teenage girls

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15
Q

Medium vessel vasculitis

A

Polyarteritis Nodosa - children

Kawasaki’s

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16
Q

Small vessel vasculitis

A

Wegner’s granulomatosis (Granulomatosis Polyarteritis)
Churg Straus (assoc with asthma)
HSP
Cryoglobulinemic vasculitis

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17
Q

MC vasculitis in children

A

HSP, Purpura without thrombocytopenia & normal coats.
IgA deposits skin, joint, GI
Renal imvolvement may occur 3 months after disease onset

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18
Q

Complications of HSP

A

Intusucception, Bowel infarction/perforation, hydrops of the gallbladder, pancreatitis, Massive GI bleeding, Proteinuria, hematuria, Renal failure

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19
Q

Evaluation of HSP

A

CBC, PT/PTT, CMP. ESR/CRP (ususally normal)

UA (protein) Stool (FOCB)

20
Q

HSP treatment

A

Supportive, Tylenol/NSAIDs for joint pain, steroids for severe GI/Renal complications

21
Q

Mucocutaneous lymph node syndrome

A

Kawasaki Disease - Medium sized arteries

22
Q

Kawasaki’s disease 5 days of fever + 4/5 criteria?

A
  1. Bilat. Conjuctival Injection,
  2. Erythema of oropharynx, lip fissure, strawberry tongue
  3. Erythema nad swelling of hands and feet
  4. Erythematous rash
  5. Cervical lymph node > 1.5 cm
23
Q

Kawasaki syndrome associated clinical findings

A 
Aseptic Meningitis (Irritability),
Arthritis,
Hydrops of Gallbladder
Tachycardia
Myocarditis
Pericarditis
Coronary artery aneurysm
24
Q

Kawasaki disease lab findings

A

STERILE PYURIA, hi ESR/CRP, hi WBC, left shift, hi Plts, Normocytic normochromic anemia, hi transaminases, hi TG & LDL, low HDL, hyponitremia

25
Q

Kawasaki disease management

A

IVIG 2 gm/kg over 8-12 hrs, ASA 100 mg/day div QID, Decrease ASA o 3-5mg/kg/day 48hrs after resolution of fever, Continue ASA until all acute phase reactants return to normal unless coronary aneurysms detected. If no adequate response Repeat IVIG, consider steroids, TNF inhibitors

26
Q

Three phases of Kawasaki disease

A
  1. Acute, febrile 10-14 days
  2. Subacute 2- 4 weeks until Plt + ESR return to normal
  3. convalescent/recovery period months-years, vessels undergo healing, remodeling, scarring
27
Q

c - ANCA

A

Wegeners (GPA) 30 -90%

Churg-Strauss 25-50%

28
Q

p - ANCA

A 
Microscopic polyarteritis 25-75%
Churg-Strauss 50-75%
Ulcerative Collitis 40-80 %
Sclerosing Collangitis 65-85%
Crohn's Disease 10-40%
29
Q

poly arteritis nodosa

A

small and medium vessel vasculitis

30
Q

wegners/ granulomatosis + polyarteritis

A

small vessel vasculitis, c- ANCA, kidney, lung,

31
Q

Bechet-Occlusive small/medium vessel vasculitis

A

Uveitis, Pathergy

32
Q

Takayasu arteritis (TA), pulseless disease,

A

large-sized vessel vasculitis, aorta and its branches - nonspecific, such as fever, fatigue, and weight loss,

33
Q

Laboratory findings of Takayasu arteritis

A

elevated ESR and CRP, leukocytosis, and moderate anemia. Diagnosis is made by angiography or MRA demonstrating segmental involvement

34
Q

Heat, swelling of joint; Pain, limitation of motion

A

Juvenile Idiopathic Arthritis

6 weeks

35
Q

Oligo/Pauci articular JIA

A

<=4 joints (hips rare), 2-3 yrs, F:M 5:1, lack of systemic involvement, UVEITIS, RF-ve, ANA +ve, excelent prognosis except eyesight, 50-60% of all JIA

36
Q

Oligo/Pauci articular JIA Eye findings

A

Anterior Uveitis, Band Keratopathy, Catracts, Glaucoma, Needs optho consultq3months

37
Q

Oligo/Pauci articular JIA - Xray indiacted to —

A

r/o infection / malignancy. affected limb grows longer due to increased blood supply

38
Q

Poly articular JIA

A

> 5 joints, symmetric, throughout childhood, F:M 3:1, systemic involvement mild but there, ARTHRITIS, rare (5%) chronic uveitis, RF+ve (10%) increases with age, prognosis gaurded to moderately good.

39
Q

Poly articular JIA complications

A

short stature/FTT,

micrognathia, osteopenia, flexion contractures

40
Q

Systemic JIA

Very high fever, Rash (salmon colored) that comes and goes

A

Variable# joints, throughout childhood, F:M 1:1, 50% systemic involvement, rare uveitis, RF, ANA+ 10 %, moderate to poor prognosis

41
Q

Systemic JIA clinical symptoms

A

HSM, lymphadenopathy, Peri/myo/endocarditis, pleuropulmonary disease, CNS disease, growth failure, Osteoporosis, CERVICAL spine (intubation?)

42
Q

initial meds to treat JIA

A

NSAIDs, MTX, DMARDs, Hydroxychloquine, Sulfasalazine, Steroids, Cytoxic/immunosuppresive therapy, PT, OT, splinting

43
Q

Juvenile Ankylosing Spondylitis

A

axial and peripheral skeleton, enthesitis, -ANA, -RF, (HLA-B27+) bilateral inflammation of sacroiliac joints.

44
Q

enthesitis related artheritis

A

males more common, LE hips, knees, ankles. Enthesitis/Tendenitis (achilles) HLA B27

45
Q

Puffy eyelids. heliotropic rash, proximal muscle weakness, fatigue

A

Juvenile dermatomyositis, small vessel vasculitis (skin+muscles), MC pediatric myopathy 5-14 yrs F:M 1.7:1,
Treated with steroids to prevent calcinosis

Pediatrics 101 (18 decks)

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