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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
Classic age of presentation of Perthe's disease
Around 7 years
26
What movements of the hip joint is limited in Perthe’s disease
Internal rotation Abduction
27
Mx of avascular necrosis of the hip
Mainly non surgical Physiotherapy & decreased activity Devices Surgery
28
Pre-pubertal obese boy presents with painful gait. Dx?
Slipped upper femoral epiphysis ( SUFE)
29
Classic age of presentation of SUFE
12-15 years. (During growth spurt )
30
SUFE can be associated with?
Hypothyroidism Increased growth hormones Reduced sex hormones Renal osteodystrophy
31
SUFE children presents with
Painful gait Externally rotated leg
32
What happens in SUFE
Head & neck of the femur is separated
33
Mx of SUFE
Pin fixation in-situ (surgery)
34
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
1. T 2.F 3. T
35
What tests will be normal in transient synovitis
FBC CRP
36
Mx of transient synovitis
PCM Bed rest
37
How long will it take for transient synovitis to resolve
Within 1 week but some may lead to perthe’s
38
Septic arthritis age of presentation
<2 years
39
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.
1. F (one joint) 2. T 3. T 4. F (tender) 5. T 6. F (4-6 weeks) 7. T 8. T
40
Presentation of septic arthritis
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
Ix and findings of septic arthritis
WCC high ESR high Ultrasound → to identify effusions Blood culture
42
Treatment of septic arthritis
Joint aspiration and 4-6 weeks antibiotics.
43
Can you send the child home with oral antibiotics once joint aspiration was done for septic arthritis
Nope. Intravenous antibiotics needed initially
44
Difference between Transient synovitis and septic arthritis
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
MOs that cause osteomyelitis
Staph aureus Group A beta hemolytic streptococcus
46
MO method of spread in osteomyelitis
hematogenous
47
C/F of osteomyelitis
Pseudoparalysis erythema and swelling in hip
48
Part of the bone affected in osteomyelitis
Metaphysis
49
Ix of osteomyelitis
Increased CRP, ESR, WCC Xray will take around 1-2 weeks to show USS/bone scan/MRI
50
Rx of osteomyelitis
IV Abx for 4-6 weeks Cloxacillin, Flucloxacillin, Vancomycin, Fusidic acid
51
Rx of osteomyelitis of the hip
Emergency surgery
52
JIA is seen in
<16 year olds
53
JIA is arthritis persisting for more than....
6 weeks
54
Subtypes of JIA
Monoarticular Oligo/ Pauci articular (<4) Polyarticular(>5) Systemic
55
JIA is seen more in Females than males in..... subtypes
Oligo Poly
56
JIA is seen equally in males and females in.... subtypes
Systemic
57
Poor prgnosis of JIA is associated with
Polyarticular and RF+
58
Pauciarticular can be associated with
chronic iridocyclitis
59
Characteristic rash seen in JIA
Salmon pink evanescent rash which only appears when the fever is present
60
JIA extra- articular manifestations
Hepatosplenomegaly LN enlargement Pluritis/ Pericardial effusion
61
Ix done for JIA
ANA RF CBC- High Plt, WCC, Low Hb High ESR High Sr. Ferritin High CRP
62
Mx of JIA
NSAIDs Steroids DMARDs
63
SLE typical Sx
Arthritis Malaise Malar rash- photosensitive
64
Ix done for SLE
ANA+ ds DNA + ESR High Pancytopenia CRP normal
65
Juvenile dermatomyositis Sx
malaise progressive weakness heliotropic rash myalgia skin hypertrophy in MCP, PIP joints arthritis
66
Ix for juvenile dermatomyositis
High ESR High CPK ( creatine phosphokinase)
67
The rashes seen in juvenile dermatomyositis
Malar Heliotropic ( around eyelids) Heliotropic more common than malar
68
Mx of juvenile dermatomyositis
Steroids
69
Recurrent fractures and blue sclera. Dx
Brittle bone disease
70
Osteogenesis imperfecta is also known as
Brittle bone disease
71
The issue in Brittle bone disease
Disorder of collagen metabolism causing fragile bones
72
Most common form on brittle bone disease
Type 1 (AD)
73
Mx of brittle bone disease
Bisphosphonates
74
Marfan syndrome is
AD
75
Sx of marfans
Tall stature Long thin digits ( arachnodactyly) Hyperextensible joints High arched palate upward dislocation of the lens severe myopia Arm span> height
76
Deformities that might be seen in marfan
Chest- pectus excavatum, carinatum Scoliosis
77
Major CVS complication in marfan
Mitral valve prolapse, regurgitation Aneurysm of the aorta
78
Ix for marfans
Echo eye referral
79
highest chance of JIA to have ANA positive tests
Oligoarticular
80
Most likely to be both ANA and RF negative
Systemic JIA
81
Intra- articular steroids are most likey used in
Oligoarticular JIA
82
serial casting for club foot is known as
Ponsetti method
83
MCC of acute hip pain in children is
Transient synovitis
84
salmonella osteomyelitis is associated with.... anemia
Sickle cell
85
Most common bone involved in acute osteomyelitis
Distal femur or proximal tibia
86
MCC of acute arthritis in children is
reactive arthritis
87
MCC of chronic arthritis in children is
JIA
88
Most serious complication in neonatal lupus is
Heart blocks
89
Gottron's Papules
Skin hypertrophy over the MCP, PIP joints
90
CKPA is elevated in dermatomyositis
due to myositis
91
life threatening complications in dermatomyositis
Respiratory failure Cardiac failure Aspiration pneumonia

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