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RHEUMATOLOGY Flashcards

1
Q

Variations of normal posture

A

Flatfoot, bow legs, knocked knees, in-toeing, out-toeing, toe walking

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2
Q

Bow legs will be considered normal until the age range of?

A

1-3 years

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3
Q

Normal age range of knocked-knees

A

2-7 years

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4
Q

Flat feet?

A

Foot arch is lost

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5
Q

Normal age range of flat-feet

A

1-2 years.

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6
Q

In-toeing normal age range

A

1-2 years

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7
Q

Out-toeing normal age range

A

6-12 months

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8
Q

Toe walking normal age range

A

1-3 years.

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9
Q

Hypermobility should be a suspicion in what abnormal postures?

A

Flat feet, out-toeing.

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10
Q

What abnormal posture can be seen in autism?

A

Toe-walking

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11
Q

Knocked knees can be seen in?

A

Juvenile idiopathic arthritis

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12
Q

DDs to consider in toe-walking

A

Spastic diplegia, muscular dystrophy, JIA, cerebral palsy, autism

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13
Q

Which abnormal postures can be seen in Marfan syndrome

A

Out-toeing.

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14
Q

Congenital talipes equino varus also known as

A

Club foot

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15
Q

Ideally when should club foot be diagnosed

A

Before discharging after birth head to the examination

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16
Q

T/f
1. Club foot is mostly seen in males
2. Club foot affects both feet in all cases
3. Oligohydramnios can cause club foot
4. Club foot is also associated with calf atrophy and hip problems.
5. Club foot should be radiologically diagnosed & confirmed
6. Club foot should be surgically corrected always.

A
  1. T
    2.f
  2. T
  3. T
  4. F
  5. F
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17
Q

Causes of club foot

A

Twin births
Uterine fibroids
Oligohydramnios
Bone and muscle abnormalities of the child

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18
Q

Other problems in club foot

A

Calf atrophy
DDH - (development dysplasia of hip)

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19
Q

IX of club foot

A

X-ray AP & lateral

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20
Q

Mx of club foot

A

Most children will physiotherapy
Some will need surgical correction - ponseti method (serial casting)

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21
Q

Clinical dx of club foot

A

Foot cannot be flexed enough to touch the shin and extended back to it’s normal anatomical position

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22
Q

Perthe’s disease is?

A

Avascular necrosis of the head of femur

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23
Q

Perthe’s disease is associated with

A

DDH
Mucopolysaccharoidosis
Achondroplasia
Rickets
Protein C & S deficiency- blood clots

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24
Q

T/f
1. Perthe’s is seen mostly in males
2. Perthe’s involves both femurs.
3. Perthe’s should be surgically corrected.
4. There is a painless limp in Perthe’s
5. There is a delayed bone growth in Perthe’s

A
  1. T( 5:1)
  2. F (20% bilateral)
  3. F (not always)
  4. T (can become painful )
    5 T
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25
Q

Classic age of presentation of Perthe’s disease

A

Around 7 years

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26
Q

What movements of the hip joint is limited in Perthe’s disease

A

Internal rotation
Abduction

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27
Q

Mx of avascular necrosis of the hip

A

Mainly non surgical
Physiotherapy & decreased activity
Devices
Surgery

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28
Q

Pre-pubertal obese boy presents with painful gait. Dx?

A

Slipped upper femoral epiphysis ( SUFE)

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29
Q

Classic age of presentation of SUFE

A

12-15 years. (During growth spurt )

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30
Q

SUFE can be associated with?

A

Hypothyroidism
Increased growth hormones
Reduced sex hormones
Renal osteodystrophy

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31
Q

SUFE children presents with

A

Painful gait
Externally rotated leg

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32
Q

What happens in SUFE

A

Head & neck of the femur is separated

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33
Q

Mx of SUFE

A

Pin fixation in-situ (surgery)

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34
Q

T/f about transient synovitis
1. There is an antibody reaction in the hip joint in transient synovitis.
2. Fluid accumulated in the hip joint can be seen in X-ray
3. Child will present with a mild fever and limping

A
  1. T
    2.F
  2. T
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35
Q

What tests will be normal in transient synovitis

A

FBC
CRP

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36
Q

Mx of transient synovitis

A

PCM
Bed rest

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37
Q

How long will it take for transient synovitis to resolve

A

Within 1 week but some may lead to perthe’s

38
Q

Septic arthritis age of presentation

39
Q

T/f about septic arthritis.
I. Usually 2 joints are affected.
2. Staphylococcus aureus spreads hematogenously
3. They present with high fever.
4. The affected joint will be erythematous and non-tender
5. WCC is high
6, antibiotics should be given for 4-6 months
7. Ultrasound can be used for DX joint effusions.
8. Septic arthritis can be fatal.

A
  1. F (one joint)
  2. T
  3. T
  4. F (tender)
  5. T
  6. F (4-6 weeks)
  7. T
  8. T
40
Q

Presentation of septic arthritis

A

Erythematous, tender, warm joint with reduced range of movement in an acutely unwell, febrile child. Infant may hold the limb still (pseudoparalysis) and cry if it is moved

41
Q

Ix and findings of septic arthritis

A

WCC high
ESR high
Ultrasound → to identify effusions
Blood culture

42
Q

Treatment of septic arthritis

A

Joint aspiration and 4-6 weeks antibiotics.

43
Q

Can you send the child home with oral antibiotics once joint aspiration was done for septic arthritis

A

Nope. Intravenous antibiotics needed initially

44
Q

Difference between Transient synovitis and septic arthritis

A

Transient synovitis first septic arthritis second
Onset- Acute limp, non- weight bearing
Acute onset, non- weight bearing

Fever- Mild/ Absent
Moderate/high

Child’s appearance- looks well
looks ill

Hip movement- comfortable at rest, limited internal rotation, pain on movement
Hip held flexed, severe pain at rest and worse on any attempt to move joint

WCC - normal
high

ESR- normal
high

USS- fluid in joint in both

Radiograph- normal
normal/ wide joint space

Mx- rest, analgesics
Joint aspiration w USS guidance

Prognosis- resloves <1 week, some may go into perthe’s
Progressive and severe joint damage if not treated

45
Q

MOs that cause osteomyelitis

A

Staph aureus
Group A beta hemolytic streptococcus

46
Q

MO method of spread in osteomyelitis

A

hematogenous

47
Q

C/F of osteomyelitis

A

Pseudoparalysis
erythema and swelling in hip

48
Q

Part of the bone affected in osteomyelitis

A

Metaphysis

49
Q

Ix of osteomyelitis

A

Increased CRP, ESR, WCC
Xray will take around 1-2 weeks to show
USS/bone scan/MRI

50
Q

Rx of osteomyelitis

A

IV Abx for 4-6 weeks
Cloxacillin, Flucloxacillin, Vancomycin, Fusidic acid

51
Q

Rx of osteomyelitis of the hip

A

Emergency surgery

52
Q

JIA is seen in

A

<16 year olds

53
Q

JIA is arthritis persisting for more than….

54
Q

Subtypes of JIA

A

Monoarticular
Oligo/ Pauci articular (<4)
Polyarticular(>5)
Systemic

55
Q

JIA is seen more in Females than males in….. subtypes

56
Q

JIA is seen equally in males and females in…. subtypes

57
Q

Poor prgnosis of JIA is associated with

A

Polyarticular and RF+

58
Q

Pauciarticular can be associated with

A

chronic iridocyclitis

59
Q

Characteristic rash seen in JIA

A

Salmon pink evanescent rash which only appears when the fever is present

60
Q

JIA extra- articular manifestations

A

Hepatosplenomegaly
LN enlargement
Pluritis/ Pericardial effusion

61
Q

Ix done for JIA

A

ANA
RF
CBC- High Plt, WCC, Low Hb
High ESR
High Sr. Ferritin
High CRP

62
Q

Mx of JIA

A

NSAIDs
Steroids
DMARDs

63
Q

SLE typical Sx

A

Arthritis
Malaise
Malar rash- photosensitive

64
Q

Ix done for SLE

A

ANA+
ds DNA +
ESR High
Pancytopenia
CRP normal

65
Q

Juvenile dermatomyositis Sx

A

malaise
progressive weakness
heliotropic rash
myalgia
skin hypertrophy in MCP, PIP joints
arthritis

66
Q

Ix for juvenile dermatomyositis

A

High ESR
High CPK ( creatine phosphokinase)

67
Q

The rashes seen in juvenile dermatomyositis

A

Malar
Heliotropic ( around eyelids)
Heliotropic more common than malar

68
Q

Mx of juvenile dermatomyositis

69
Q

Recurrent fractures and blue sclera. Dx

A

Brittle bone disease

70
Q

Osteogenesis imperfecta is also known as

A

Brittle bone disease

71
Q

The issue in Brittle bone disease

A

Disorder of collagen metabolism causing fragile bones

72
Q

Most common form on brittle bone disease

A

Type 1 (AD)

73
Q

Mx of brittle bone disease

A

Bisphosphonates

74
Q

Marfan syndrome is

75
Q

Sx of marfans

A

Tall stature
Long thin digits ( arachnodactyly)
Hyperextensible joints
High arched palate
upward dislocation of the lens
severe myopia
Arm span> height

76
Q

Deformities that might be seen in marfan

A

Chest- pectus excavatum, carinatum
Scoliosis

77
Q

Major CVS complication in marfan

A

Mitral valve prolapse, regurgitation
Aneurysm of the aorta

78
Q

Ix for marfans

A

Echo
eye referral

79
Q

highest chance of JIA to have ANA positive tests

A

Oligoarticular

80
Q

Most likely to be both ANA and RF negative

A

Systemic JIA

81
Q

Intra- articular steroids are most likey used in

A

Oligoarticular JIA

82
Q

serial casting for club foot is known as

A

Ponsetti method

83
Q

MCC of acute hip pain in children is

A

Transient synovitis

84
Q

salmonella osteomyelitis is associated with…. anemia

A

Sickle cell

85
Q

Most common bone involved in acute osteomyelitis

A

Distal femur or proximal tibia

86
Q

MCC of acute arthritis in children is

A

reactive arthritis

87
Q

MCC of chronic arthritis in children is

88
Q

Most serious complication in neonatal lupus is

A

Heart blocks

89
Q

Gottron’s Papules

A

Skin hypertrophy over the MCP, PIP joints

90
Q

CKPA is elevated in dermatomyositis

A

due to myositis

91
Q

life threatening complications in dermatomyositis

A

Respiratory failure
Cardiac failure
Aspiration pneumonia

PAEDIATRICS (15 decks)

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